Thursday, October 18, 2012

Chest and Head Wounds: First Aid for Your Sleuth

Ellis Vidler has a new book coming out next month. TIME OF DEATH tells the story of artist Alex Jenrette, who has a psychic streak—or is it a curse? While visiting on an island near Charleston, she draws scenes of murder that turn out to be real. The police think she’s involved, the prosecutor fears a psychic witness will destroy his case, and the killer believes she was there. But she wasn’t, and she doesn’t know who’s behind it.

Ellis sent in this week's medical question.

A man has been shot in the chest and is lying face-down. The bloody exit wound is visible on his back. Should the witness turn him over and try to stop the bleeding in front? She can place a wad of cloth over the hole in his back, but would that help? Paramedics are maybe ten minutes away. What should she do? I want him seriously hurt, but he should live to recover.

A second man has been hit over the head with a china lamp as he stuck his head inside a doorway. He’s unconscious, but I don’t want him dead either. Would a head wound bleed a lot? Is he likely to be unconscious for a while or could he recover enough to get to his feet and possibly fire a gun?

Here's my answer.


The important thing in your case, Ellis, is to keep your victim breathing, so yes, the witness should turn him face up, and she can use a wad of cloth to help put pressure on the exit wound when he's on his back. Gravity will then cause most of the blood to flow downward towards the exit wound. There will still be some blood flow from the entrance point, so yes, the witness can cover that wound also. The victim's biggest problem will be a traumatic pneumothorax and/or hemothorax on the affected side of the chest. (Thorax means chest, pneumo refers to air, hemo refers to blood.)

I'm assuming the bullet missed the heart and only hit the lung. A traumatic pneumothorax is a collapsed lung due to trauma, in this case the bullet passing through the lung. A collapsed lung occurs when air escapes from the lung and fills up the space outside of the lung, inside the chest. The lung more or less folds in on itself, making it difficult for the victim to breath. 

A hemothorax occurs when the bullet tears the inner lining of the chest wall or the lining covering the lung. Blood flows out into the space between the chest wall and the lung, and again we have pressure on the lung causing collapse and extreme difficulty breathing. 

Blood loss is generally massive in gunshot wounds to the chest because each side of the thorax (chest) can hold 30-40% of a person's blood volume. The blood will leak out from the wounds, but it will also build up inside the chest cavity around the lungs and the heart and put so much pressure on the heart that it can't pump blood to the brain or the rest of the body and will eventually stop beating. Your witness will see frothy blood flow from the chest wound which indicates air bubbles mixed with the blood. She may also see blood coming from the victim's mouth. 

The witness will mainly want to keep the victim breathing, and may have to assist breathing with mouth-to-mouth resuscitation. Your victim may be conscious when first shot, but shock due to rapid blood loss will render him unconscious within a minute or two. Even if conscious, he'll be too busy trying to breathe to be able to speak.

Ten minutes is a long time to have to wait for your paramedics. If you want this guy to survive for that long, I'd shoot him in the lower right chest so that the affected area is the lower lobe of the right lung. The right lung has three lobes, or sections, so if you shoot him in the third lobe -- the lowest and smallest lobe -- the upper part of the lung has a better chance of staying inflated and helping him breathe. Also, the blood will drain down and away from the heart causing less chance of pressure on the heart from accumulated blood in the chest. I'd have the witness turn him over and apply a wad of cloth to the back, then cover the chest wound with a cloth, then turn the victim on his affected side so the wound opening is down and the good lung is up (helps with breathing and keeping blood from putting pressure on the heart). Then have the witness apply pressure to both the chest and the back wounds using one hand for each wound. Take pressure off the wounds every 4-5 minutes to let air escape from the chest, then apply pressure again. 

http://www.primary-surgery.org/ps/vol2/html/sect0247.html  You can check this site for pictures that may help you understand what happens to the lung.

As for the guy hit over the head with a china lamp, unless the lamp is really heavy, it's unlikely he'd be more than stunned by the blow. So yes, he could easily get up and fire a gun. If the lamp broke and cut his head, yes, he'd have a lot of bleeding. Head wounds bleed like mad. Even a one inch long cut will bleed enough to mat the hair, cause blood to run down the face and neck and reach the shoulders. I saw plenty of patients in the ER who looked like somebody threw a bucket of blood on them, and it turned out they had cuts that only required a few stitches. Of course, the deeper the cut, the more it bleeds, so if you want the guy to fire the gun and miss, a good whack on the head should stun him enough to throw off his aim while also messing with his vision by having blood pour down over his forehead into his eyes.

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

Do you have a question concerning medical procedures in the ER, medical care given by paramedics, or first aid hints for use by your sleuth? Send your questions to me at maryvwelk@gmail.com and I'll do my best to answer them.


Wednesday, October 10, 2012

Disposing of Bodies

Mystery writers know how to dispose of bodies -- you either bury them deep in a forest, or you dump them in a place where your sleuth can conveniently stumble over them.

But what happens when your victim dies in the ER? How does the ER staff move the body without sending other patients into hysterics or causing visitors to faint dead away? 

Years ago I worked in a very crowded ER -- one that desperately needed enlarging -- where patients often ended up on carts in the hallways or on chairs under a large hanging clock in the central room. Occasionally someone would die in the ER, generally someone already close to death on arrival or someone the paramedics had been trying to revive as they raced to the hospital. On a slow day, curtains would be drawn around our other patients and the dead person would be whisked away to the morgue unseen by patients or visitors. But when we were overcrowded, and patients and visitors were stacked everywhere in the room, we  were forced to resort to more creative methods of body removal.

When I wrote TO KILL A KING, I included a scene where a dead body needed to be removed from an overcrowded ER in a quiet but creative way. I based the scene on something that had actually occurred in the ER I mentioned above, the one where I worked many years ago. I added a character to the scene who hadn't existed at the actual event, but whose fictional presence added a humorous twist to the story. I'm posting that scene here, and I leave it to you to decide which part is based on fact and which part I included just for the fun of it. Enjoy! :)

From TO KILL A KING, the third 'Rhodes to Murder' mystery:


The charge nurse slid a chart into its slot on the desk. "Now tell me, Cari. What we gonna do with that old gentleman on cart five? I need that cubicle for a live one, but Mr. Gone-To-His-Just-Reward is smack dab in the middle of the room, and I hate to move dead folks past sick ones. Tends to shake their confidence in the ability of the doctors, if you know what I mean."
Caroline laughed. "Leave it to me. I'll move him to the morgue without anyone noticing." She waved to Michelle and Wendy. "Can I tear one of you away from that computer for a minute?"
Michelle looked reluctant, but Wendy was more than ready to abandon her job. After listening carefully to Caroline's instructions, the girl broke into a broad grin.                      
"I took some acting classes back in England," she said in a confident voice. "I'm sure I can pull this off."
"Then follow me." Caroline headed towards the back of the east wing. Passing Susan Kane midway through the room, Caroline called out, "Hey, Sue! We're taking your patient on cart five upstairs."
Susan was starting an IV on a woman on cart two. She looked up in alarm and stuttered, "But…but…he's…"
"I know," sang out Caroline. "No need to worry. We'll take good care of Mr. Gone."
Three minutes later Wendy pulled back the curtain encircling cart five.
"There now, sir. Are you warm enough under that blanket?"
The elderly dead man sat semi-upright on the cart, staring blindly at the ceiling. Propped up by pillows, an oxygen mask hid most of his lower face; a towel draped over the top of his head shielded his forehead and ears. A thick blue blanket covered the rest of his body.
"Let me pull it up a bit. Can't have your chin getting cold now, can we." Wendy tugged on the blanket, tucking it under the edge of the oxygen mask. Ten toes suddenly appeared at the end of the cart.
"Forget the feet, Wendy. Let's go," whispered Caroline as she nudged the gurney out of the cubicle and into the walkway between the other patients' carts.
Caught up in the act, Wendy wasn't listening.
"Oh, dear," the girl exclaimed. She yanked on the blanket, forcing Caroline to pull up. "Mustn't have our piggies sticking out."
"Let's go!" hissed Caroline as several patients sat up to stare in their direction. She smiled at them reassuringly while motioning to Wendy to back off. The girl never moved.
"You'll like your room," Wendy went on in a booming voice, reaching over to pat the dead man's arm. It promptly slid from beneath the covers and fell to his side.
"Enough!" Caroline muttered through clenched teeth as Wendy grabbed for the offending extremity. Ignoring the unit receptionist, she leaned against the cart, gave a mighty shove, and ran right over Wendy's foot.
"Oowww!"
A male medical student raced up, eager to assist the pretty young woman staggering about the room on one foot. Stumbling in his haste, he slammed into Wendy, ricocheted sideways into the cart, and fell headlong across the dead man's legs.
"Son of a…!"
Caroline threw her weight against the cart as it rocked backwards, slamming into her knees. Her action had an opposite effect from the one she'd desired. The pillow propping the dead man's chin toppled to the left and slid to the floor. Unsupported, the heavy skull pitched forward.
"He's not alive!" The medical student gazed up in horror. The oxygen mask had fallen away exposing the waxy features of the corpse. Hovering only inches above the boy's head, the dead man stared down through sightless eyes, his wrinkled face frozen in a toothless grin.
"Oh my gawd!"
His legs spinning uselessly off the end of the cart, the medical student tore at the blanket, struggling to right himself. The thick blue material slithered through his fingers and wadded up against his face, throwing him even further off balance and causing the corpse to bounce up and down in a silent jig.
The hairless head bobbed ever closer to the boy. He scrambled blindly to find purchase on something solid, and after what seemed like an eternity but was only a second, his hand brushed against a knobby object. In desperation, he closed his fingers over it and pulled. As he did so, the last bit of blanket fell away.
Caroline leaped to the side of the cart, but she was too late to avert disaster. The body tumbled over, bent at the waist, the torso flattening the medical student.
Fortunately, the young man never felt the blow. He'd fainted dead away after seeing his fist wrapped around the most private part of Mr. Gone's anatomy.
As for the corpse, he seemed no worse for the wear. His face turned to the side, the old man's head rested squarely on the medical student's soft buttocks.
********************************************** 

TO KILL A KING is available as a Kindle e-book at http://amazon.com/author/marywelk 
 TO KILL A KING will be available in trade paperback at Amazon and B&N later this month.
***********************************************

Friday, October 5, 2012

Book Reviews

Ellen Hart, Carl Brookins, and William Kent Krueger tour together as The Minnesota Crime Wave. These three have championed the cause of short stories by Minnesota authors via two previous anthologies: Silence of the Loons: Thirteen Tales of Mystery by Minnesota Premier Writers and Resort to Murder: Thirteen More Tales of Mystery by Minnesota Premier Writers.

Now they present us with a new anthology, Fifteen Tales of Murder, Mayhem, and Malice from the Land of Minnesota Nice.

Peter Hautman's excellent introduction sets the stage for short mysteries of every manner, and Marilyn Victor's This Old House kicks off the collection in a startling way. Her tale of two aging sisters feuding over a hidden inheritance has a twist ending that will surprise and delight readers. The Dark Under the Bed, by Richard A. Thompson, is both spooky and disturbing in its portrayal of "the shadow men" who "always come for you at night". This one will give you the chills. 

And then there's Michael Allan Mallory's Desperados, a story of two bank robbers who, when their getaway car breaks down, make the mistake of hiding out in the home of a very resourceful older couple. Brains over brawn wins the day in this fine tale.

Death by Potato Salad features Mrs. Berns from Jess Lourey's Murder-by-Mouth series set in Battle Lake, Minnesota. The town's All Church weekend retreat has never been so lively as this year when Mrs. Berns attend the "Day One Icebreaker Class" called "Miracles with Mayonnaise". Lourey proves once again that even murder can be humorous at times.

Mary Logue, author of the Claire Watkins mysteries, offers two thought-provoking poems to the collection. Her work is followed by Lori L. Lake's An Age-Old Solution, in which two women handle a blackmailer's demands in a most unusual and cunning way.

Next in line is a fine piece by William Kent Krueger. Set in an earlier time, Woman In Ice tells the story of a girl found encased in a block of lake ice and the many townsfolk who visit the local priest believing they are to blame for the young woman's death. This one ends with a twist that I should have seen coming, but didn't.

David Housewright's A Turn of the Card follows a high profile crook's decision making dependence on the reading of Tarot cards by a beautiful young woman. The twists and turns in this story carry through to the end in a most clever and satisfying manner.

Ellen Hart brings a touch of the supernatural to Overstuffed, the story of a woman determined to take revenge on the ex-husband of her dead sister. The author of twenty-eight novels, Hart knows how to weave a tale and does so in a convincing manner in this well written story.

Elizabeth Gunn gives us a solid police procedural story in The Butler Didn't. Was it murder by improvisation, or death by neglect?  One thing is for sure: the butler didn't do it.

Howard T. Crandell is the best actuary in the Twin Cities. On the bad side, his habit of thinking only in term of statistics costs him his job in Lois Greiman's Iced. On the good side, it helps him catch a murderer. This is a character you'll come to love, flaws and all.

Pat Dennis is known for her humorous take on life. That humor shows up in Minnesota Iced where a long-suffering wife decides to terminate her mother-in-law's unwelcome visit by terminating her life. Who said ice fishing wasn't fun? Not Pat! :)

Carl Brookins is known for the three mystery series he writes, all of them set in Minnesota. The Horse He Rode In On features the star of one of those series, private investigator Sean Sean. Terminally short--or height challenged, as he puts it--Sean doesn't enjoy investigating a death while riding a horse that's taller than he. But horses played a part in the death of a city councilman. Sean must figure out exactly what that part was.

Judith Yates Borger writes of friendship gone wrong in Stone Arch Bridge. Kate and Anna had been sidekicks since kindergarten. But then along came Josh, and there went Anna. Can Kate save her friend from a fate worse than death? Only in an unexpected way.

Joel Arnold's Blue-Eyed Mary ends this fine anthology. This well-crafted tale speaks of the love of a son for his mother and the lengths to which he'll go to protect her. This is a sad little story in which the reader's empathy will stretch to include both the living and the dead. Perhaps that is why it was chosen as the concluding story in the collection; the emotions it plays to are so true to real life. 

If you enjoy short stories, I highly recommend you read this latest anthology presented by The Minnesota Crime Wave. You won't regret it.

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