Monday, November 26, 2012

Heroin Addiction in an Undercover Police Officer

I have an undercover narcotics officer. In the course of investigating a gang, he’s become addicted to heroin. After the bust, he goes through withdrawal. How can I write this realistically?

Your undercover police officer is in for a rough ride. Here’s some information about heroin:
Heroin is derivative of morphine. Opium poppies yield morphine, which undergoes acetylation (adding two acetyl groups) to the molecule of morphine.
Heroin’s chemical name is diacetylmorphine hydrochloride or morphine diacetate or diamorphine—street name “smack.” It is a narcotic analgesic, meaning it decreases pain and produces euphoria. Heroin is illegal; it’s been around for over a century, but has been illegal for over eighty years in the USA.
Diamorphine is a legal restricted drug requiring prescription, is tightly controlled, and typically used only for severe pain.
In the body, heroin is a “prodrug,” metabolized to the active form, which is morphine. The drug works by binding to opioid receptors in the brain, inhibiting release of the brain chemical GABA, increasing the action of dopamine, a natural substance occurring in the brain. This leads to pleasure and addiction to the pleasure produced by the drug.
Morphine itself is a weaker activator of this reward pathway.
Heroin is much stronger than morphine, and as an illegal drug is often “cut”—other inactive substances are added to the heroin to amplify the amount of drug. This makes the strength of the drug on the street extremely unreliable and leaves users vulnerable to overdose.
Regular use of heroin results in tolerance and addiction, or physical dependence. Abstinence results in withdrawal within twenty-four hours, which is accompanied by physical symptoms:
Anxiety, sweating, tearing and runny nose, chills, body aches, GI irritation such as diarrhea, nausea, and vomiting; inability to relax and sleep. This is what your character will experience as he comes off the drug. As withdrawal can be fatal, close medical care will be necessary.
In the United States, the legal (but controlled) drug Methadone is used to wean heroin addicts. Many addicts, however, then become addicted to Methadone and never become drug-free. The advantage of Methadone is consistent dosing and quality, which is associated with a decreased incidence of overdose.
Hope this helps!
Cheers, Kelly
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.


Wednesday, November 14, 2012

Writing a Code Blue--Cardiac Arrest and Resuscitation

Here's the set-up:
The character is a doctor-in-training (He has graduated from medical school, and is now doing a residency--training in Emergency Medicine).
A young man in his early thirties has coded. No sign of drugs or alcohol. Good health history. It's the third man who has come in with massive cardiac arrest with no known health problems. My doctor doesn't want the patient to die so I have him ordering them to keep doing the chest compressions (like I've seen done on TV shows). Since I am starting this mid scene, the patient has already been intubated. Eventually the doctor's supervisor talks sense into him and he calls it. I really need to know how long should the doctor do this before calling time of death.


Hello.
It's fine to start mid-code with the patient intubated and during chest compressions.
To introduce a little reality, consider having your doctor administer some IV medications. Epi (epinephrine) is an easy one and most people will have heard that used in a TV cardiac arrest scene. Atropine is another. They are usually ordered in doses of ampules, as in "Give him an amp of epi!"
At some point, you may want to have the doctor defibrillate the patient, something like this:
"Charge to 300 Joules. Clear!" (this is when everyone jumps back from the bed) and have him slap the paddles on, press the button on the side of the paddle, and deliver the shock.
Consider a comment about the patient's heart rhythm. "Damn. Still V fib." (Ventricular fibrillation, a fatal rhythm.) Alternatively, it can be a "Flatline" with no rhythm at all.
Your doctor can insist they keep doing chest compressions through all this.
A respiratory therapist to “bag” the patient (use an ambu-bag) to deliver breaths through the ET tube in the throat is appropriate.
The supervising doctor may want to suggest that "The patient's heart is gone," or "It's too late," or "You've done everything possible and it's time to stop."
The duration of a true code can be minutes to nearly an hour, depending on the situation and the determination of the doctor doing the resuscitation.
Cardiac arrest occurring outside a hospital is likely to have a shorter resuscitation period after the patient arrives in the ER. If the paramedics can't resuscitate the patient in the field, it's unlikely the ER will have much better luck.
You may want to consider a time interval of twenty to thirty minutes since the patient is young and apparently healthy, and the doctor is determined.
I hope this helps. If you have questions about the above, or have other ones that crop up, let me know.
Cheers, Kelly
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.


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Friday, November 2, 2012

What Happens to the Knife After the Doctor Removes It?

I was wondering...if a patient comes into the ER with, say, a switchblade stuck in him, what happens to the switchblade after the doctors/nurses remove it and patch him up?

Here's my take--
In the Great Midwest, the switchblade removal/chain of custody depends on where in the hospital the knife is taken out.
In surgery, the knife goes to pathology to be claimed.
In ER, if the cops are there and weapon is removed, it can go to them. I'd check with your local hospital-- many have media departments (yes, you are media!)
Unless the stabee wants to press charges against the stabber, the police may not be involved if there’s no felony assault or death. We see this sometimes in domestic abuse/ fights.
Genuine switchblades (not a pocketknife) may be illegal.


Is there a central location in the hospital where the belongings of unconscious patients are stored? Or do the belongings follow the patient to whatever room he ends up in?
Depends on the belonging(s). In the ER, guns go in a safe until the cops arrive. It’s illegal to bring a weapon into the ER.
The hospital has a safe for stuff like jewelry.
The pharmacy takes custody of meds patients bring in with them.
If a patient goes to surgery, belongings go in a big plastic bag that goes with the patient. Sometimes things get lost—glasses and dentures are on that list. The biggest thing I’ve seen lost was a patient’s prosthetic leg!

~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.