Monday, February 28, 2011

Women of Authority: Midwife Series Part 2/4

            
              This Monday, we're continuing with Laurie Alice Eakes four part mid-wife series.

Childbirth was more than a duty to God and husband.  Childbirth was a time when the woman was guaranteed attention in an atmosphere of “supreme drama”. Because, except in extreme cases, men were excluded from the birthing chamber, the laboring woman held the leading role with her friends, relatives, and neighbors as supporting actresses and, directing them all, was the midwife.


Well into the early modern era in Europe and throughout the American colonial period, women in religious orders and mistresses of the local manor performed the office of midwife as charitable work, but in the towns and villages, other women made a living presiding over childbirth.  More than likely many of these women were unskilled practitioners, relying mainly on personal experience with childbirth or observation of other women’s labor; however, from the beginning of the sixteenth century to the end of the eighteenth century, when “man midwives”-physicians in obstetrical practice-became the reigning practitioners in the birthing chamber or hospital, midwives could and did consider themselves professionals.

            Unlike other members of their gender, midwives received wages and, through necessity, more often than not, worked outside the home.  Yet, unlike actresses, prostitutes, and domestic servants, midwives were respected, revered, and sometimes even feared members of society, giving them a power few of their peers realized.


            In comparison with obituaries of good women at the same period, the death notices of midwives laud them as not merely exemplary human beings, but extol the virtues of their work and their benefit to their communities.  Mary Bradway of Pennsylvania and Lydia Robinson of Virginia were, according to their obituaries, exceptional women and midwives:
“Yesterday was interred here the Body of Mary Bradway, formerly a noted Midwife.  She was born on New-Years Day, 1629-30, and died on the second of January 1729-30; aged just One Hundred years and a day.  Her Constitution wore well to the last, and she could see to read without Spectacles a few Months since.”

“Last Sunday died here Mrs. Lydia Robinson, aged 70 years, who during her practice as midwife for 35 years past, delivered a number of women, in this and the neighboring towns, of Twelve Hundred children; and it is very remarkable that in the whole of her practice she never left one woman in the operation.  The death of a person so eminently useful is a very great loss to the public in general, and to this town in particular.”

            Martha Ballard, made famous through Laurel Thatcher Ulrich’s work with her diary, received only a one-line obituary.  Ulrich, however, quotes the eulogy of Jared Eliot, a Connecticut minister, delivered in 1739 on behalf of another midwife, Mrs. Elizabeth Smithson:

“The deceased was a true light upon a hill. She was a person of Humility, Affability, Compassion, and on whose Tongue was the Law of Kindness; Her Ear was open to the Complaints of the Afflicted, and her Hand was open for the Supply of the Needy.
As a Midwife, she was a person of Superior Skill and Capacity; as was found by Experience in the most difficult Cases ….

She regarded the Poor as well as the Rich ….

She denied herself both Sleep and rest, and spared neither Skill nor Pains for the Belief of those that were Afflicted and Distressed.

************************************************************************
Midwives historic role in society began to fascinate Laurie Alice Eakes in graduate
school. Before she was serious about writing fiction, she knew she wanted to write novels
with midwife heroines. Ten years, several published novels, four relocations, and a
National Readers Choice Award for Best Regency later, the midwives idea returned, and
Lady in the Mist was born. Now she writes full time from her home in Texas, where she
lives with her husband and sundry dogs and cats.

          Laurie Alice Eakes--Lady in the Mist from Revell Books, February, 2011. Read an Excerpt
at: http://www.lauriealiceeakes.com/

Saturday, February 26, 2011

"I Love this Blog Award!"

WOW! I'm honored that Ava Pennington (http://avawrites.com/2011/i-love-this-blog-award/) chose Redwood's Medical Edge to give the "I Love This Blog Award!" to. Hence, my special Saturday post. Now, Ava, stop lurking! Remember, if you follow (where I can see your picture on the sidebar) or subscribe via Feedblitz, this is where I pull names from for my special surprise drawings. So, all you lurkers out there, subscribe!



Here's how the award works:

1. Thank and link back to the person who gave you the award.
2. Share seven things about yourself.
3. Award up to 15 blogs that are deserving. (I’m awarding seven.)
4. Contact those bloggers and let them know about the award.

Here's seven things about myself:

1. I love Sandra Bullock Movies. I could watch While You Were Sleeping over and over and over...
2. Dean Koontz is one of my favorite authors.
3. I've been thrown into the river four times whitewater rafting (not all in one trip).
4. My novel, Lilly's Ashes, is currently making the rounds at a few publishing houses.
5. I dream of  having a log cabin in the mountains.
6. I'm blessed with two wonderful daughters and one loving husband.
7. I love to ride horses and wish I owned one.

Here's who I'm giving the "I Love This Blog!" award to.

1. Dale Eldon

2. Peg Brantley

3. Mike Dellosso

4. STET!

5. Hook 'em and Book 'em

6. One Woman's Dream

7. Novel Journey

Thanks again, Ava.

Jordyn

Friday, February 25, 2011

How to Determine Blood Type

In the age of DNA testing, blood typing seems to have fallen by the wayside in use in novels but I think it can still be very valuable and add an element of suspense and surprise. A child's blood type may be the first clue to a parent that they may not be biologically related.

Blood type is determined from two allele's. An allele is a "form of genetic information that is present in our DNA at a specific location on a specific chromosome".

There are four blood types: A, B, AB, and O. Blood type A can be designated either by AA or AO. Blood type B can be designated by BB or BO. This will be clearer below.

This is the easiest way I've been shown to determine a child's potential blood type. In the square below, the top horizontal portion is one parent, the vertical side is the other parent. Each box with a single letter is the one allele that parent will give their child. A child receives one allele from each parent so you need to "cross multiply" each square to determine blood type.



A
O
O
AO
OO
O
AO
OO


In the above instance you have one parent that is blood type A (designated AO) and one that is blood type O (designated OO). As you can see, their child would have a 50% chance of having blood type A and a 50% chance of having blood type O.

Let's look at another example. Take a look at what happens when both parents are blood type AB.



A
B
A
AA
AB
B
AB
BB


In this case, their biological child would have a 25% chance of being blood type A, a 50% chance of being blood type AB, and a 25% chance of being blood type B.

How can this work for your fiction? Let's look at this example. You're writing a novel that centers around a child diagnosed with leukemia. The child needs a bone marrow transplant. The presumed parents are blood type A (AO) and blood type AB. You have a child with blood type O. Can this child be the biological offspring of these two parents?



A
O
A
AA
AO
B
AB
BO


Give your answer in the comments section.

_______________________________________________________________________

Resources: http://www.biology.arizona.edu/human_bio/problem_sets/blood_types/inherited.html. This resource includes a blood type calculator!

Wednesday, February 23, 2011

Cost of Medical Care on the Frontier

I've been reading through David Dary's book Frontier Medicine as research for this blog and came across an interesting list of what it might cost for certain medical treatments. I found these to be fairly expensive in light of what a family might earn. Take a look. What do you think of the costs?



For $0.50
            Traveling more than 18 miles
            Cathartic
            Emetic
            Tincture per oz
            Blisters to ankles and wrists
            Bleeding
$1
            A visit
            Tooth Extraction
$2
            Administration fee for therapy
$5-20
            Infant Delivery
            Curing gonorrhea/venereal disease
            Reducing Fracture
            Reducing Kneecap Dislocation
$50
            Amputation
            Trepanning (skull-boring)
Resource: Frontier Medicine by David Dary
_______________________________________________________________________

Monday, February 21, 2011

Qualities of a Good Midwife: Part 1/4

Laurie Alice Eakes is starting a four part Monday series on midwifery and I'm really looking forward to it. Today, she'll be focusing on the character of a good midwife. Comment contest is still in force. Whoever leaves the most comments this month wins a prize. Winner announced March 1.

The following section is redacted from the presentation I made at the 1999 New Perspectives in History Conference.  For facility of reading, I have changed the arcaic spelling into modern spelling.
“As concerning their persons, they must be neither too young nor too old, but of an indifferent age, between both; well composed, not being subject to diseases, nor deformed in any part of their body; comely and neat in their apparel; their hands small and fingers long, not thick, but clean, their nails pared very close; they ought to be very cheerful, pleasant, and of a good discourse; strong, not idle, but accustomed to exercise, that they may be the more able if need require.
Touching their deportment, they must be mild, gentle, courteous, sober chaste, and patient; not quarrelsome nor chollerick; neither must they be covetous, nor report anything whatsoever they hear or see in secret, in the person or house of whom they deliver…
As concerning their minds, they must be wise and discreet; able to flatter and speak many fair words, to no other end but only to deceive the apprehensive women, which is a commendable deceipte, and allowed, when it is done, for the good of the person in distress.”
Thus did William Sermon, a seventeenth century physician and clergyman, describe the attributes of a good midwife.  Compared with the attributes of a good woman, described in the numerous pamphlets, obituaries, and epitaphs of the same time period, a midwife in Early Modern England and the North American colonies was expected to embody the traits of a good woman as well as the characteristics of a good professional.  Though one cannot expect that midwives met the standards Sermon, his peers, and other midwives set down for childbirth practitioners, through the nature of their work, and the standards set down through the ecclesiastical and municipal laws, and the expectations of other women, midwives achieved goals superior to the ideals of mere virtuous women.  In an age when women possessed little to no authority outside the home, the midwife achieved a position of power over other women and  within society itself.
Would you make the cut?
***********************************************************************
Midwives historic role in society began to fascinate Laurie Alice Eakes in graduate
school. Before she was serious about writing fiction, she knew she wanted to write novels
with midwife heroines. Ten years, several published novels, four relocations, and a
National Readers Choice Award for Best Regency later, the midwives idea returned, and
Lady in the Mist was born. Now she writes full time from her home in Texas, where she
lives with her husband and sundry dogs and cats.

Laurie Alice Eakes--Lady in the Mist from Revell Books, February, 2011. Read an Excerpt
at:
http://www.lauriealiceeakes.com/

Friday, February 18, 2011

Pharmacy in World War II—The Military

Sarah Sundin concludes her series today on WWII and the role of the pharmacist. Wasn't the information amazing? Don't forget the comment contest: whoever leaves the most comments this month wins a prize. I'll tally and announce a winner March 1st.

While researching the military medical system for my World War II novels, I read about physicians and nurses, dentists and veterinarians. But where were the pharmacists? In the civilian world, the physician prescribes medication, the pharmacist purchases, compounds, and dispenses, and the patient or nurse administers. I discovered the wartime military system differed. As a pharmacist I was baffled and intrigued.

On February 14th, I discussed the role of the pharmacist in the 1940s. On February 16th, I described the local drug store and how its role changed during the war, and today I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Drug Distribution in the Military

In the US Army and Navy, outpatient prescriptions were filled at base or unit dispensaries, while inpatient orders were filled at hospital pharmacies. Both dispensaries and pharmacies were staffed by enlisted personnel—pharmacy technicians in the Army and pharmacist’s mates in the Navy—under the control of physicians. In 1936, the pre-war Army had forty graduate pharmacists serving as enlisted technicians.

Pharmacy technicians did not need any previous health care background or education. They went through a three-month program based on practical training rather than scientific understanding.

Medical Administrative Corps

For decades, pharmacy organizations had lobbied for a Pharmacy Corps with commissioned pharmacists. Indeed, most nations had similar corps. However, the US Army Medical Department was run by physicians. They thought of pharmacists in a condescending manner as businessmen rather than professionals, and they saw the drug distribution system as adequate.

The Medical Administrative Corps was formed in 1920 as a compromise. The MAC was responsible for administrative duties within the Medical Department, including medication procurement and distribution. In 1936, the MAC was permitted to commission sixteen pharmacists, with future appointments in the MAC restricted to graduate pharmacists.

The number of officers in the MAC increased during the war. In 1943 six hundred graduate pharmacists served as MAC officers—but none of them served as pharmacists.

Options for Pharmacists

Since most draft-age pharmacists had four-year bachelor’s degrees, they were eligible to serve as officers. While physicians, nurses, dentists, and veterinarians were commissioned as officers and placed in appropriate positions, no such guarantee was available for pharmacists.

Upon enlistment, pharmacists could apply for the Army Officer Candidate School, but upon graduation, they could be assigned anywhere. Pharmacists served as infantry officers, artillery officers, and in many other divisions. Even if they happened to be assigned to the MAC, as noted above, they did not practice their profession.

If a pharmacist wanted to compound and dispense medication, his only option was to serve as an enlisted technician, with pay and privileges far below that of an officer.

Fight for a Pharmacy Corps

The American Pharmaceutical Association (APhA) renewed the legislative battle for a commissioned Pharmacy Corps. While the Surgeon General’s office argued that “Army pharmacy was simpler than civilian practice. The department's three-month pharmacy technician course was sufficient preparation. There was little compounding. Since medications were furnished in tablet form, ‘any intelligent boy can read the label’” (1).

These arguments did not sit well with pharmacists—or with the general public. Dr. Evert Kendig of the APhA argued that “Army pharmacy technicians were given responsibility beyond that legally permissible in civilian life even as the Army misused its professional pharmacists” (1). Several incidents were reported of prescriptions improperly filled by technicians and of blatant physician prescribing errors that would have been caught by a pharmacist. Public opinion tipped the scale, and on July 12, 1943, President Roosevelt signed legislation authorizing the formation of the Pharmacy Corps.

Pharmacy Corps

The Pharmacy Corps was authorized to commission seventy-two pharmacists. However, the military moved slowly. In January 1944, after receiving 900 applications and conducting two-day written examinations, physical examinations, and interviews, twelve officers were commissioned. By January 1945, the Pharmacy Corps had only commissioned eighteen pharmacists. The other officers’ slots were filled by former MAC officers.

The drug distribution system did not change by the end of the war, but the formation of the Pharmacy Corps laid the groundwork for post-war reforms.

Resources:
1.      Ginn, Richard VN. The History of the US Army Medical Service Corps. Washington DC: Center for Military History, 1997. (Accessed February 6, 2011 at http://history.amedd.army.mil/booksdocs/HistoryofUSArmyMSC/msc.html).
2.      Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.
*******************************************************************

Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist

Wednesday, February 16, 2011

Pharmacy in World War II—The Drug Store

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—a personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. On February 14th, I discussed the role of the pharmacist in the 1940s, today I’ll describe the local drug store and how its role changed during the war, and on February 18th,  I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Welcome to the Corner Drug Store—1939

Perkins’ Drugs stands on the corner of Main Street and Elm, where it’s stood all your life. Large glass windows boast ads for proprietary medications and candy, and a neon mortar-and-pestle blinks at you. When you open the door, bells jangle. The drug store is open seven days a week, sixteen hours a day, so you know it’ll always be there for you. To your right, old-timers and teenagers sit at the soda fountain on green vinyl stools, discussing politics and the high school football game. The soda jerk waves at you.

You pass clean shelves stocked full of proprietary medications, toiletries, cosmetics, hot water bottles, hair pins and curlers, stockings, cigarettes, candy, and bandages. You know where everything is—and if you can’t find it, Mr. Perkins or his staff will be sure to help you.

The owner, Mr. Perkins, is hard at work behind the prescription counter with good old Mr. Smith and Mr. Abernathy, that new young druggist Mr. Perkins hired last year. Mr. Perkins greets you by name, asks about your family, and takes your prescription. He has to mix an elixir for you. If you don’t want to wait, he’ll be happy to have his delivery boy bring it to your house. But you don’t mind waiting. You have a few items to purchase, and you’d love to sit down with a cherry Coke.

Welcome to the Corner Drug Store—1943

Perkins’ Drugs still stands at the corner of Main Street and Elm. Large glass windows boast Army and Navy recruitment posters and remind you that “Loose Lips Sink Ships.” The neon sign has been removed to meet blackout regulations. The store is open for fewer hours since Mr. Smith retired and Mr. Abernathy got drafted. Mr. Perkins hired Miss Freeman. Not many people are thrilled to have a “girl pharmacist,” but if Mr. Perkins trusts her, that’s good enough for you. Perkins’ Drugs and Quality Drugs on the other side of town alternate evening hours so the town’s needs are met.

A placard on the door reminds you that Perkins’ Drugs is authorized by the Office of Civilian Defense as a pharmaceutical unit, meaning the store will provide a kit of medications and supplies for the casualty station in case of enemy attack. You pray the town will never need it.

Bells jangle when you open the door. The soda fountain is closed. Mr. Perkins can’t buy metal replacement parts for the machine, the soda jerk is flying fighter planes over Germany, and sugar is too scarce a commodity.

A barrel stands by the door. You toss in five tin cans, washed, labels removed, tops and bottoms cut off, and flattened. Mrs. Perkins at the cash register thanks you.

You pass clean shelves with depleted stocks. Proprietary medications, cosmetics, toiletries, and medical supplies remain, but rubber hot water bottles, silk and nylon stockings, hair pins and curlers, candy, and cigarettes are in short stock—or unavailable. Most of the packaging has changed. Metal tins have been replaced by glass jars and cardboard boxes. You pick up a bottle of aspirin and a tube of toothpaste, double-checking that you brought your empty tube. Without that crumpled piece of tin, you couldn’t purchase a replacement. Tin is too dear.

At the prescription counter, Mr. Perkins greets you by name and asks about your family. Miss Freeman gives you a shy smile and you smile back. There’s a war on and women have a patriotic duty to do men’s work so men are free to fight. Mr. Perkins frowns at your prescription for an elixir. He’s used up his weekly quota of sugar, and his stock of alcohol and glycerin are running low. Would you mind capsules instead? Of course not. Mr. Perkins phones Dr. Weber and convinces him to change the prescription. Mr. Perkins can’t have the prescription delivered—he doesn’t qualify for extra gasoline and he couldn’t find a delivery boy to hire anyway.

You and Mr. Perkins discuss war news as he sets up a wooden block with little holes punched in it, then lines the pockets with empty capsule halves. He weighs powders on a scale, mixes them in a mortar, then fills the capsule shells. After he sets the capsule tops in place, he puts the capsules in an amber glass bottle with the familiar Perkins’ Drugs label.

You buy a few War Bonds. Your wages are higher than ever with the war on, and with all the shortages there’s nothing to buy. Besides, War Bonds are a solid financial investment and your patriotic duty. On a poster by the counter, a smiling pilot leans out of his plane and reminds you: “You buy ‘em. We’ll fly ‘em. Defense Bonds and Stamps.”

Mr. Perkins thanks you for your purchase, and you thank him for his service. War or no war, you know Perkins’ Drugs will always be there for you.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

***********************************************************************

Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist



Monday, February 14, 2011

Pharmacy in World War II—The Pharmacist

Happy Valentine's Day! As a treat, I'm so pleased to have Sarah Sundin back. This week, she'll be discussing the role of the pharmacist on several different fronts during WWII. I've found this information absolutely fascinating!

Don't forget the comment contest: whoever leaves the most comments this month wins a prize. I'll tally March 1.


In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—the personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. Today I’ll discuss the role of the pharmacist in the 1940s.  On February 16th,  I’ll describe the local drug store and how its role changed during the war, and on February 18th, I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

The Profession of Pharmacy in the 1940s

Although the term of druggist has been abandoned by the profession—please do not use it in your contemporary novels—in the 1940s, the terms of pharmacist and druggist were interchangeable. The 1940 US census counted over 80,000 pharmacists. The majority worked in retail pharmacy, with only 3000 working in hospitals. In fact, less than half of hospitals had a pharmacist on staff.

A cornerstone of pharmacy had always been compounding, the practice of mixing a prescription from raw ingredients. Pharmacists made creams, ointments, elixirs, suspensions, capsules, tablets, suppositories, and powder papers. Only pharmaceutical grade ingredients could be used, approved by the USP (United States Pharmacopoeia) or the NF (National Formulary). Every pharmacist owned a copy of the USP guide—the 11th Edition (1937) or 12th Edition (1942). The USP guide provides chemical data on each substance. By the 1940s, pharmacists compounded less—about 70 percent of prescriptions were filled with manufactured dosage forms.

In the 1940s, the pharmacist was a vital member of the community. Often viewed as more accessible than physicians, pharmacists were relied upon for health information and the treatment of minor ailments.

Education and Licensing

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955, and did not become mandatory until 2000. Therefore, in World War II, pharmacists were addressed as “Mr.” or “Mrs.” or “Miss.”

In 1942, sixty-eight colleges of pharmacy operated in the United States. In addition to general education requirements, pharmacy students also studied pharmacy, pharmaceutical chemistry, pharmacognosy (deriving pharmaceuticals from raw substances, such as plants), pharmacology (the effect of a drug on the body), and business. To increase the chance that a student would finish his degree before being drafted, most colleges of pharmacy adopted a year-round, three-year program during the war.

Each state had its own licensing requirements and examinations, and there was no reciprocity between states. For example, a pharmacist licensed in California had to take a new set of examinations if he moved to Michigan.

Manpower Shortage

In a nation of 130 million, over 11 million would serve in the armed forces during the course of the war. This produced a manpower shortage on the home front, and pharmacy was not immune. As a class, pharmacists were not exempt from the draft, but local draft boards could declare individuals as “necessary men” if their enlistment would negatively affect the health of the community. During World War II between 10,000-14,000 pharmacists served in the military. Due to this loss, approximately 15 percent of drug stores closed during the war. The west coast was hard hit when all Japanese-American pharmacists were forcibly interned.

However, more opportunities opened for women as colleges and employers actively recruited them. While less than 5 percent of pharmacists in 1940 were female, the percentage of female pharmacy students rose above 15 percent during the war.

Effects of the War

Due to store closures, the average store filled 13 percent more prescriptions than before the war. This increase in workload was balanced by depletion of other goods due to rationing and shortages. In addition, citizens were encouraged to take better care of their health so they could contribute to the war effort, which led to an increase in physician visits. Overworked physicians dispensed fewer drugs from their offices and sent more patients to pharmacies. As a result, the average drug store enjoyed an 80 percent increase in sales during the war.

Pharmacists dealt with shortages of ingredients and medications. A serious shortage of quinine, used to treat malaria, led the military to collect the majority of the nation’s quinine stock. Also, shortages of alcohol, sugar, and glycerin taxed the ability of pharmacists to compound. Each pharmacy received a ration of ten pounds of sugar a week for compounding purposes.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

United States Pharmacopoeial Convention. The Pharmacopoeia of the United States of America, Twelfth Edition. Easton PA: Mack Printing Company, 1 November 1942.

***********************************************************************


Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist





Friday, February 11, 2011

The Face Behind The Mask: Part 5/5

This is our final Friday post with certified nurse anesthetist Kimberly Zweygardt. It's been a pleasure have her blog. I know I've learned several ways to increase the conflict in my OR scenes. What are some ways you'll add conflict? Comment contest is still in force. Leave the most comments this month and win a prize!

Finally, the complication that movie nightmares are made of: recall under anesthesia.
Recall under anesthesia is defined as remembering something while surgically anesthetized. The most common scenario involves the patient receiving muscle relaxants without enough amnesia and/or pain control provided. Some patients recall being in pain but unable to move while others have no pain but can remember things being said during the operation.
How can this happen?


Thirty years ago we had patients being told their heart wasn’t strong enough for anesthesia. With the advent of Open Heart surgery, anesthesia techniques changed that were safer for the heart, so we now operate on people who are on drugs that mask the normal response to pain. It becomes harder to asses if the patient is truly asleep if the heart rate and blood pressure don’t change related to pain.
And we also have what I call the “drive through” surgery phenomena. Surgery used to mean recovering in the hospital for several days. Now, you are dismissed within hours of the operation. Anesthetics must be shorter acting or patients not as deeply anesthetised during the operation so they will be safe to go home. I believe that is why recall is on the rise.
But we also must account for how we are fearfully and wonderfully made.
I read an interesting study that monitored depth of anesthesia and recall. Volunteers were anesthetized using an EEG to measure depth of anesthesia. They were not having surgery, but when they reached surgical depth of anesthesia, the anesthetist stood up and said, “There’s something wrong! They are blue! There’s something wrong.”
There was nothing at all wrong. They waited a period of time then woke the volunteer up. A small percentage spontaneously remembered that event and their fear. The rest were hypnotized to see if they recalled the event. A percentage became agitated, bringing themselves out of the trance at that point. The rest were able to recall under hypnosis what had been said during their anesthetic. What the study showed was that we are not just a physical body and though our physical body is anesthetised, our spirit may be aware of what is happening much like the near death experiences where the spirit hovers over the body.
I personally know of several incidences where a patient could not recall events in surgery but acted upon something said while they were asleep. Some were positive changes and others were tragic.
The BIS monitor was designed to prevent recall but it isn’t standard of care and only offers that most patients at a certain number are truly “asleep.” Even so, I am careful what is said in the patient’s presence.
But when it comes to fiction, I can think of several scenario’s to rachet up the drama and suspense related to anesthesia. How about you? 



*********************************************************************************

Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

Wednesday, February 9, 2011

Take Me First: Triage in the EMS Setting

Dianna Benson is back posting about triage in the EMS setting. Last Wednesday, I covered triage in the hospital setting.

Today, will be a great opportunity to test your EMS triage skills in the comments section. I'm taking the test. How about you? Dianna will be checking in to give her expertise. Also, don't forget, whoever leaves the most comments this months wins a prize!

                    Mass/Multiple Casualty Incident Triage



I’m FEMA certified in ICS – the Incident Command System, which is the US National emergency system. I serve in times of crisis in my local community as well as anywhere I’m needed or sent. MCI (Mass or Multiple Casualty Incident) falls under that command system. By definition, a MCI is any event that places excessive demands on personnel and equipment, and involves three or more patients. Like in a Haz-Mat situation, a small town can rapidly become overwhelmed by a MCI. Then again, even in a large metropolitan city, chaos can and does occur if there’s enough conflict – extreme weather, rush-hour traffic, an earthquake that affected most of the city, etc. 
Some examples of a MCI: Structure fire and/or explosion, MVC (motor vehicle collision), gang-related violence, bus rollover, tornado, flood, public shooting, etc.
ICS is also used in preparatory and scene control for large crowd events like: Sporting events, concerts, a visit from the US President, etc. ICS is in place during as well as pre and post these events to handle normal activity and to deal with any emergency crisis if one or more occurs.
Numerous emergency agencies are involved in handling a MCI. Together, the ICS allows us all to efficiently and effectively work together. The first EMS personnel to arrive on scene of a MCI becomes the EMS incident commander. That person sets up the following sectors:
A)     Mobile Command
B)     Extrication
C)     Staging
D)     Supply
E)      Treatment
F)      Transportation
G)     Triage

For this post, I’ll discuss triage only. Typically, there are two phases of triage – primary and secondary. For this general explanation, assume I wasn’t the first to arrive on the scene, and when I did arrive, the EMS incident commander assigned me in triage.
1) Primary Triage: In the staging area, I suit-up in my necessary protective gear and grab equipment. I enter the hot zone of the MCI. I quickly assess each patient, one-by-one. Based on my assessment findings, I then categorize each patient by placing them in their appropriate priority status.
Priority 1 – Referred to as Red, these patients need immediate care and transport to a hospital.
Priority 2 – Referred to as Yellow, these patients’ conditions will tolerate a delay in emergency care and transport.
Priority 3 – Referred to as Green or the walking wounded, these patients only have minor injuries and are ambulatory (able to walk under their own power).
Priority 4 – Referred to as Black, these victims are either dead or they’ve suffered fatal injuries and there’s nothing anyone can do for them. Yes, it sounds cruel to leave them and move on to the next person, but these patients are unconsciousness, dead, or will soon die, and in a mass causality incident most likely we cannot save everyone, so we must save those who can be saved.
After I assess a patient, I place a colored (example – Red) and named (example – Priority 1) tag on that patient, and move on to the next. I may give some medical care before I move on, but it’s quick. 
2) Secondary Triage: Once the patient is extricated to the triage sector, a reassessment is performed. If there are any changes in the patient’s condition that alters their priority status, they’ll either be upgraded to a higher priority or downgraded to a lower one.
Jordyn here: Let’s practice our triage skills. You arrive at a five-car pileup and are assigned by the incident commander to triage. These are your three patients.

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1.      Patient #1: A 32 y/o woman with an obvious deformity to her left forearm. She was able to get out of her car and is standing by the road side.

2.      Patient #2: A 10y/o male ejected from his vehicle. He is found on the road side. He is awake but having severe difficulty breathing. There are no breath sounds heard on his left chest.

3.      Patient #3: A 65y/o male with open head injury. His pupils are fixed and dilated and he is taking agonal respirations.

What triage level would you give each of these patients?

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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. An EMT and Haz-Mat Operative in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com/