Medical Writing

The last few months I have talked about the medications and injuries of the Old West but in order to bring this full circle for writers/authors I’ve got to go a bit more current or modern. First disclosure, I am not a doctor. Doctors and nurses think differently but are focused on the same goals. After 28 years in an acute care facility, it is easy to see the change in the relationship between physicians and highly skilled nurses. The docs rely on us a lot to help put together the picture that is going on with the patients. Still what is presented here will let you know that these kinds of injuries today can often result in death and even more so in your historical novels.

Nurses are no longer thought of as bedside hand maidens as they were back in the 1800’s and before. If your heart stops in the hospital, it isn’t the doctor doing what is needed. He is probably there shouting the orders, but it is the Registered Nurse who is pushing the medications. It is the Registered Nurse who is starting the IV and inserting an enterotrachial tube so you can breathe. It is the Registered Nurse who is monitoring your vital signs and it is a Registered Nurse who is monitoring the screens and equipment that tell how you are doing. But it is also the RN who is outside the room, holding your husband’s hand. It’s the RN who is the first one to hold your child once the physician passes off the bundle. It is the RN who sits with you when you are afraid and who offers you a smile when the diagnosis seems grim. You don’t know it but she had prayed for you, cried about your pain and researched hard to find the answers. She is the one who says you can do this during your recovery. She is the one who cheers you when you reach even the small goals and she might ever be the only one there when you take your last breath. She cried then too, but there is reward in being a nurse and many of us have found that. That’s the pretty picture. Here is the reality. I have been hit, bitten, scratched, spit on, cursed, pee’d on, pooped on, shoved, degraded, badgered, threatened and that is just before lunch, but the good always seems to out weight the bad, like just one patient who really appreciates what you do.

But onto the writing medical things…

What I find when I am reading stories where characters are injured is that often times the medical information isn’t correct or isn’t what a nurse would say. I’ve also read a few where the medical position isn’t described as it really is. So first let me discuss the roles in a hospital beginning with nurses and techs. So I have several things I can cover.

Nurses Defined

Licensed practical nurses (LPNs)---licensed vocational nurses (LVNs)-Work under the direction of an RN and train most often in Technical Colleges, though a lot of these programs are being phased out. 

Registered Nurses-Usually a 4 year Bachelor’s of Science Degree from a college or university. Practice under physician orders, but most often independently.

Advanced Practice Nurses:

Nurse Anesthetists-(CRNA)-Nurses who train further to administer anesthesia. They often work under the orders of an Anesthesiologist but do practice independently.

Clinical Nurse Specialists-Often in Educator Roles, but this seems to be phasing out in most programs where Nurse practitioner programs are growing.

Nurse Practitioners-Work in a variety of specialties from offices to hospital setting and even public health. A degree higher and specialized such as geriatrics, family practice or emergency medicine. NP’s have prescriptive rights in most states and are highly paid in rural areas where doctors are not available.

Certified Nurse Midwives-Highly Trained to deliver babies under a physician’s guidance. Prescriptive rights also. 

Ancillary Nursing Staff:

Certified nursing assistant- Assists RNs and LPNs with vital signs and basic patient care from baths to potty help. This is obtained in six or eight month certificate programs, but they are not nurses.

Nurse Tech-Patient Care Tech-Often trained to do a little more than a CAN. For the most part candy stripers and orderlies are non-existence. There are also a large number of male nurses these days.

Orderlies and Candy stripers rarely exist any longer. There are transport teams to move patient from one place to another but most of those employed in the role have some medical training. The emergence of HIPAA laws on confidentiality had made it where you can no longer have as much access to medical facilities or patient information so be careful in writing what is happening to your characters on what may be told over the phone or what may be seen or done while in a medical facility.

Other Roles in the Hospital:

Physician Assistants-Trained to work alongside a physician, making rounds and even assisting with orders and the plans for patient care. Highly skilled.

Hospitalists/Internists-Hospitalists are hired physicians that work on staff to monitor patients within the hospital. Internists specialize in the care of ICU patients.

Anesthesiologist-Administer Anesthesia for surgery cases and or pain blocks such as epidurals.  

Pharmacists-Specialize in measuring and mixing medications that are ordered for patients.

A note to writers: Not all docs are rich, some have a years of student loans to pay back and others pay dearly for the required malpractice insurance. For example the insurance for an OB/GYN physician can be in excess of 150,000 a year. Today’s physicians often work in large group offices and time is money. Physicians do not typically work for the hospital but have privileges to admit and treat their patients. A lot of people think the doctor works for the hospital.

Emergency Medical Technicians (EMTs) and Paramedics-Most often are firemen with advanced training for responding to accidents and injuries outside medical facilities. EMT do first aid type care and emergency care, but paramedics are trained to push medications in the field and are highly skilled.

Medical Assistants (MA). Trained to run the front and back offices or clinics. Can draw blood and also run the billing of an office for example.

Occupational Therapists—Work to assist for instance stroke patient to regain functional use of limbs at least to be able to perform the activities of daily living.

Physical Therapists—Assist with regaining full use of injuries, to help relieve pain, to assist patients who have been bedridden to get up and about again after surgery, plus much much more.

Speech-Language Pathologists-Assist with feeding issues and regaining speech after stroke or other injuring.

Most people in these positions are happy to allow an interview of what they do on a day to day basis. HIPAA laws sometimes limit shadowing experiences, but most will answer phone interview questions or meet away from actual patients. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires employers to protect employee medical records as confidential. HIPAA includes regulations that cover how employers must protect employees’ medical privacy rights and the privacy of their health information. Tis law also means that staff do not discuss patient information over the phone except to give a basic condition: Stable, critical etc.

Even if you are not writing medical romance, your hero or heroine may be injured and often times the care or the scenes are not described correctly. Do your research! Interview your doctor or a nurse friend.

Writer Tips: Remember a couple of things. Your hero is not going to bounce back from some of these injuries very quickly. Don’t give him a concussion and fractured ribs and then have him making love the next day or in the next chapter.  Broken bones can take 8 or more weeks to heal and it isn’t likely he’ll feel up to it for a while even if he is a Scottish Highlander or Hot Cowboy.

Vital signs are the first thing often checked on a injured patient, so let’s talk about the normals. Most searches for medical information will offer you similar parameters. There are all kind of medical websites offering free information. I have not listed any here because there are so many. My favorite book for research is the Merck Manual-. I lived with that in my hands as a nursing student and new nurse. It sits on my desk at work still. It runs from $50 to $75.00 but is well worth it.

And to understand the life of a nurse, Echo Herron wrote Intensive Care and Condition Critical. The first is the best example of how it was to survive nursing school and the later is how it is in the real world of nursing. Both are great reads.

So on to vital signs. I think a lot of writers have trouble describing vital signs in rescue scenes for instance.

Temperature: Normal is 98.6--Children can run a high fever up to 104, but at 104 the adult is really ill. Ice packs, not heavy blankets, but cooling blankets.

Pulse: Normal 60-90.  Describing Pulses: (Never check a pulse with your thumb-because you will count your own pulse and not the patients!)

Strong-normal rhythm

Bounding-unusually strong rhythm-running or the heart working hard

Thready-pulse beats are weak-losing blood or in shock

Irregular-does not have a regular beat, skipping beats-heart issues

Regular-regular rhythm- “The pulse is regular, 80”

Respirations: 12-20. Someone having an asthma attack might breath as rapidly as 60 breath a minute, but they are having symptoms. Audible wheezing etc. After a time of not getting in enough oxygen, the rate might begin to fall as you lose the person.

Blood Pressure:  Systolic (top number) 100-130    Diastolic (bottom number) 60-90. If someone is injured or in pain the blood pressure will initially rise, but if they continue in crisis or are losing blood and the loss isn’t stopped, the blood pressure will then fall. This is when you are losing the patient. The newest guidelines on blood pressures is systolic under 120 and diastolic under 80 or the patient is labeled pre-hypertensive.

Nursing Duties beyond Vital Signs: Coordinating and prioritizing multiple patients doses of daily medication which must be given within thirty minutes of the time due. This might involve by mouth pills and tablets, injections and Intravenous fluids. Follow the plan of care: Nursing Diagnosis and Assessment of each patient multiple times a shift, implementing nursing diagnosis, interventions and assessing outcomes. Record and document all necessary information, communicate with peers, subordinates, supervisors and other members of the healthcare team, research, follow legal and facility standards, teach patients, resolve issues, inspect and work equipment, maintain patient confidentiality.

Don’t forget that in history while many survived the injury, they often died of bleeding and infection some days later. Gunshot wounds-might have died right away, but many died days or even week later of infection/gangrene. Stabbings-some died right away but others might have developed infections that took them weeks to die from. Disease and illness-no antibiotics, but often herbal remedies and many died from the things we easily cure today. Writer Tips: Hand washing was a huge issue along with sanitation and cleanliness, often leading to infection if someone did survive the injury.

Stay Tuned next month for Emergencies then and now!

Medicines of the Old West

Medicines in the Old West

It’s easy enough to establish while watching a movie or television series about the “Old West” there was limited access to any kind of Healthcare. Just watch a few episodes of Dr. Quinn Medicine Woman or something of Doc Cochran from Deadwood and you will see their hands were often tied due to lack of resources. Medical care in the 1800’s was growing fast in the civilized eastern cities such as Boston and New York, but even there some of the care would be viewed today as widely lacking even in the best facilities at that time. But take it out west, and if a doctor could be found, it was more likely he’d given better care to animals and had little access to anything that might be considered modern at the time.

As I write my historical novels and because I am a Registered Nurse, I get into a bit of trouble with my editor because I can get a little too graphic at times when someone in my stories is injured. But I have found as I write, I constantly have to think about the year a medication or treatment was discovered and even if it was available in the Eastern cities didn’t mean it was something that could be found with physicians out west. So I had to come up with a cheat sheet on a few things and thought I would share.

Whiskey-used as a mood depressant for pain-sometimes it was the only thing that could be given to dull pain for an injury.

Cognac-was often used to pack the sockets of tooth extractions to dull the pain.

Opiates/Opium-was used prior to 4000 b.c. and was extracted from the Poppy Plant as it is now. Many medications were derived from this medication including: Laudanum, Tincture of Opium, and eventually Morphine (1803-oral and injected). The concern with any of the pain relieving medications and given how the medications were made was dosaging. Many a cowboy lost his life or suffered ill effects of overdosing of opiate medications. Laudanum was a more stable product and commonly used in the Old West for pain relief, colds, insomnia, childbirth, nausea, vomiting, cough suppression, hysteria in women and heart ailments. Demerol and Codeine came along in 1930, so be careful of your history and the hypodermic needed was invented in 1803. Heroine was a boiled Morphine in the 1870s. This medication had a brief used as an accepted pain medicine in the 1900’s but only for a short time. It was discovered to cross the blood-brain barrier making it highly addictive with adverse effects.

In the 19^th Century and with the commonality of Opiates available and shipped in from the Orient or brought in with Chinese immigrants after 1850, Opium Dens grew in some western towns. The active ingredient was smoked or sipped in “medication” form and abuse was common. Lawson against Opium Dens came along about 1870 but were highly enforced by the 1900s.

Cocaine/Coca plant-(1885)-the leaves of the plant were chewed for energy and strength. The leaves were also wrapped around injured or broken limbs for pain relief and was thought to reduce festering of wound. It was sold in various forms in stores and was also prescribed for depression or melancholy. It wasn’t until years later that it was discovered that it held addictive properties.

Cannabis/Hemp/Marijuana: Has been used for centuries and is often a common news debates as the drug has become legal in some states. In the 1830’s it was used for medical spasms, seizures and for relaxation of a patient. It wasn’t until 1937 that the drug became controversial and still remains so.

Aspirin/Willow Bark Extract- First used by the Indians, this tree bark tea was known widely for it’s pain relieving properties. The active ingredient was Acetylsalicylic Acid or what is known today as Aspirin. Indians commonly chewed the stalks or boiled the bark for a pain relieving tea. Interestingly enough Hippocrates studied this medicine in 1850.

Peyote (Cactus)-Was used by many tribes of American Indians for religious ceremonies. The highly potent extracted drug was known to cause hallucinations.

This list is by far not complete as to what might have been used in the “Old West” when relief was needed, but it’s a good start if you are a writer. My best advice would be to look up the medications before writing about them and to make sure of the years they were actually in use and then verify they would have made their way to the area where your story takes place. As any writers know, do you research and keep a notebook or typed file of your findings.


And stay tuned as next month I bring you a bit of modern medicine info for authors and writers. Stay tuned.

Wyatt's Bounty: A Maggie Award of Excellence Finalist!



It's official, Wyatt's Bounty is a Maggie Finalist! The winners will be announced at Ga. Romance Writer's annual Moonlight & Magnolia's event in October of this year.

So excited about this as Sawyer's Rose was a Golden Heart and Maggie finalist as an unpublished work and an IDA finalist as a published work. I was beginning to wonder if Wyatt's Bounty would final in anything, so this comes as a great surprise. Two for two I guess and I'll take it!

 



Medicine in the Old West...

By day and for twenty-eight years I have been a Registered Nurse. In that role I've done patient care, Education and now I work as a Quality Analyst, and all these jobs have been in hospitals. When I started writing, I would talk to authors who were writing "Medical Romance" and who would often ask me why I wasn't doing the same. I thought about it, but when you do something everyday, it's hard to find the passion in it after that many years.


But what has always fascinated me was how Medicine was done in the 1700's and 1800's, some of which things make me cringe as what was no known as it is today. For this post I am going to focus on a bit of old remedies, short and sweet in hopes you will enjoy it if interested and if an author something you might use in your own stories.


From those arriving out West in the pursuit of their own land and new start, those hearing of GOLD for the taking, or those outrunning a past that had caught up to them, the journey there could be hard physically and mentally. What many didn't think about ahead of time were all the illness and danger along the way: Smallpox, Syphilis, Typhoid, Scarlet Fever, Cholera, Diphtheria, Scurvy, Pneumonia, Malaria and even Rabies. (Will talk about more of these in depth on my April Post coming up next month.)


It never fails as we read or watch a western, the loaded wagon of a "snake Oil" salesman ride up in town stirring all kinds of commotion about a remedy that will cure any ailment. In the end, no one is cured but got a good dose of alcohol, menthol, liniments, oils and vegetable compounds for the most part. Now days we all shake out heads that the townsfolk should have known better and not wasted the last penny they had in hopes of a cure. But hold on, let's think about that...the salesmen were likely crooked in one way or another but a lot of the remedies they produced did have healing effects sometimes.

Alcohol-long used as an anesthetic, to sooth a fussy baby's teething, mixed with honey and lemon to sooth the throat, given in large amounts to knock someone out for surgery or to set a limb--at times it was all a doctor out west could hope to do. Render the patient as drunk as possible and until passed out so the care could be rendered. Whiskey was used as a depressant, mood modifier, for pain and even as a packet to place on an abscess tooth prior to removal.


Menthol/minty herbs-often used to create a strong medicinal smell and to offer a bit of relief to ailments. Let's think about this. When I was a child and had a chest cold, my mother would pull out the small glass jar of Vicks Salve and smear it across my chest and on my upper lips so I could breathe as I slept. Yuck huh, but the idea was the menthol kept the breathing passages open letting me rest. Well it worked back in history just the same.


Liniments and oils-do we not still use these today? The biggest thing out there right now is essential oils and each one treating a certain issues for those trying them. Sports medicine today uses heat lotions, creams and oils to sooth muscles and take away pain. Well in it's "snake-oil" form back then it did much the same.


Vegetable compounds-good for digestion and stomach pain. But today's health food stores are full of all kind of plant compounds and emulsions that offer some kind of health or illness benefit. Back in the day, it was much the same though there was little way preserving many of the concoctions without the benefit of alcohols as a preservative.


There probably isn't a one of you that hasn't had Grandma tell you about or use on you some kind of old remedy. I've heard the horror tales from people a good bit older than me that talk about the once a month caster oil (Fletchers Castoria) dose that mothers gave to their children. While the taste was their biggest dislike, the end results, a good clean out did everyone some good and some mother's swore by it.


On the same note, many osteopathic/holistic doctors will tell you that using probiotics and helpful digestive enzymes will keep things more regular and thus your health. Maybe those mothers were onto something back then. My mother remembers as a child cutting her foot badly on something rusty and her open cut was rinsed in Kerosene. Yikes, this one seems scary but I imagine it would have in sorts killed any germs in the wound so that nothing would grow.


I grew up where when my sister or me coughed through the night, it wasn't unusual to be jolted awake by my father who stuck a spoonful of whiskey, honey and lemon right down your throat. You know what? It worked in that it cut the congestion which lessened the cough and the little bit of alcohol helped with sleep. Child abuse? Nope, but it was done that way back then. Another on the same note...my mother remembers getting Turpentine mixed with a spoonful of sugar And might I also mention again a mom dipping her finger into whiskey and rubbing it on her fussy baby's gums. Hey, they didn't have a drug store and oral just down the street back then.


But some of Grandma's other remedies are some that came from generations back and still it used today would work.

• Onion or other Poultices-draws out toxins/kills germs and kills germs
• Cold Compresses-decreases swelling and lessens pain
• Clay or mud Poultices-Draw out toxins/kill germs and purify
• Boiled herb Poultices-Draw out toxins/kill germs
• Herb/Plant Teas-helpful to a number of body and mind ailments

Many of the items above might simply mimic what we call RICE in emergency situations today. REST, ICE, COMPRESS, ELEVATE.


And there is more for some quick fun and thought.


Anemia could be treated in the 1800's by boiling rusty nails and drinking the water to gain the iron remnants. There were no vitamins in that time and this worked, or continuing to cook in a rusty iron skillet.


Consumption or Tuberculosis had no cure but patients were sent to places with drier air which we all know promotes better exchange of air and breathing. Some are sure, besides a bit of criminal past, that this is the reason Doc Holliday made his way further West, though he still succumbed to the disease.


Chills and fever were often treated by boiling Horehound to drink.


Colds and Pneumonia's and pain were often treated with mixture of Willow Bark Tea. It was said to have the benefits of pain relief and lessen the cough. It turns out the Willow Bark Plant is extracted of Acetylsalicylic Acid or into today's terminology--Aspirin. As it turns out Hippocrates studied the plant in 400 B.C.


Quinine Powder was also used mixed with liquids to lower the fever. It is derived from the cinchona tree and even today is used for the treatment of the symptoms of Malaria.


As I have done some reading and research over the years for my own historical writing, I had added to my notes and been brief here to share a bit of it. There is so much more to this and again I will post more on the illnesses Cowboys and Frontiersman faced as well as the treatment for pain and injury, so stay tuned.

What's going on with the Writing???

I try to keep everyone up on the latest with my writing. It seems lately I have had a lot of interest in Sawyer's Rose and Wyatt's Bounty due to the narrated books being available. And I have been getting a lot of questions on when the next story will be released and will there be a story for various characters. And the answer is yes and yes and yes! There will be plenty more on the McCades with some spin offs of extra characters....one day.

 

You guys gotta remember I work a full time job as an RN Quality Analyst, Monday thru Friday, 8 to 5, and I have daughters aged 10 and 13 , ad husband (who does way more than I do around this house) and we also have my husband’s mother with dementia—so no rest for the weary.  While my main goal of each day is to make it to that part if each evening where I can write, somewhere in the middle are the things that must come first:

 

Up at 6:00 am

Out the door by 7:15am

Drop one daughter at elementary school

Drop the other at middle school

Race to work avoiding cop who always sits a little store on the corner-listen to books on the way there and back.

8:15 to 5:00...The Day Job  

5:20 Pick up one kid (the other buses home)

Home at last.....oh but wait....there's more

Cook supper

Dishes

Laundry

Feed the pets-2 dogs and 4 guinea pigs

Yard work

House pick up

HOMEWORK HELP

Mail and bills

Baths

Somewhere in the middle of all this being a mom and wife

9:00pm Off to bed for the girls

Yipee....WRITING TIME....and I am exhausted!!! But the weekend is on the way, isn't it hump day or is it Friday yet?

 

No whining but you guys can see I get 1 to 2 hours a night to write if I am not exhausted. Some weekends I get a lot of writing time, others not so much. But here is what is in the works:

 

Dawson's Haven, the third in The McCades of Cheyenne Series is more than half done. I am pushing hard on this story each night making progress. But I have to take the time to make this story right so that the character and the readers get the story they deserve. The gist of this story without giving too much away is: Dawson will be wrongly accused of a crime and it is the woman who he recently rescued that will return the favor.

 

The delay on Dawson’s Haven is due to me working hard to submit a fully written contemporary story that I completed in 2013. The Wild Rose Press had a call for contemporary cowboys and I pulled out a story I had written back then and dusted it off for several months last year. I have learned a lot since I first started writing in 2011 and so there were some craft issues I had to fix up. Anyway, this story was contracted by Wild Rose in January 2018 (Yipee!) And edits will begin soon which means this story All But the Fall will be out sometime this year if all goes as planned. It is about a horse stunt jumper on the set of an old west television series who falls for the nurse consultant on the set. She is running from the past and he is running to her and he is very yummy! And of course he has 2 brothers so more to come on this series too.

 

In the meantime, as some authors know characters sometimes demand to be heard. This time the voice in my head was Leaning Bear, Dawson's BFF Cheyenne Medicine Man buddy. And so in less than a week, and I am not by nature a plotter, I mapped out an entire story for this guy. Not only did I make an outline but I know all the characters and what happens in every chapter thru the whole story. For a pancer this is amazing. And then because this darn Medicine Man wouldn’t leave me alone, I have already written the first two chapters with a goal of this story following closely after Dawson's story if I can get my act together. In this book it seems Leaning Bear falls for the school teacher sent to the reservation, but I can’t tell much more without telling too much. Maybe this story, Paint the Sky, will be a good read in between Dawson and Evan's stories.

 

And I do have a full outline for the 4th McCade brother Evan!  Evan's Ransom will follow as soon as I can get these others out there. The youngest McCade will be loaded with a number of surprises that will bring something from all the previous stories full circle. Let's just say this youngest McCade brother has a lot of surprises!

 

And then the big question! WILL THERE BE A STORY FOR DODGE AND BRETT? When I first started writing this series, I never expected Dodge to be such a loved character and the response to her has been huge. I like to say I write romance and I write the west but truly I think my stories would fall into a family saga genre easily. With that being said and given the time, I would love to write a story for Dodge. The requests have been mostly for a current story for them and some for a story from their past. I am thinking I can accomplish both with a current story where she and Brett both reflect on the past while they tackle their romance and all the happenings around them.

 

And the saga will continue...everyone loves Zane, Sawyer's son and so do I. But I have not mapped any story for him yet though I think there is a good possibility he will find his girl back home on a visit to where he grew up!

 

Oh and there is still Hudson Collier, the deputy BFF of Wyatt who has a comically fun way of putting his words

out there. He ends up the sheriff in Denver at the end of Wyatt's story. I do believe I have a bit of story mapped out in my head for this guy but it will be a while.

 

And while we are at it, except for a few of my beta reader friends, I will bet you didn’t know unless you paid good attention in my current stories that I have stories for The Hagen Brothers. Remember the mention of the horse guys in Sawyer and Wyatt’s stories? Well, if I can one day get my act together these are full stories I have written for Adam, Samuel and Will Hagen. I wrote these three stories all in 2011 and 2012  and they need a good deal of work and story changes, but I would love the chance to rewrite these and get them out there to readers.  

 

Whew…no wonder I am tired. But for now, back to the story which must get written!

 

Kim