You no doubt have accepted the fact that my membership in Romance Writers of America has been totally wonderful for me and that I encourage everyone, no matter what they write, to join up and start networking. Having D.P. Lyle come to speak to us is merely one of the amazing benefits of belonging to this group.
Doug Lyle is an amazing cardiovascular surgeon with an amazing hospital and a pretty good writer. I love that he writes books for writers on medical issues we might need to know about. But he also writes stories, mysteries, and thrillers that make good use of his knowledge. So here’s a brief overview of his talk to us on that day. Warning: This is not as bad as the Forensic Pathologist who visited last year, but it can still be challenging.
1. Heart attack or myocardial infarction.
Your vascular system is a closed system. When trauma happens, the crazy elements get crazier. They can’t tell the difference between a heart attack and a gunshot to the leg. Luckily, the police usually can. You can’t fake a heart attack and no drug can induce one. But there are ways in which your villain can fool everyone.
If you have any heart issues, fix it now instead of just waiting for it to fail. Time is muscle. The older you get, the less muscle tone and condition you will probably have. There is a way to make it look like a person had a heart attack. Electrical system does go on and on, but, basically, everyone dies of a heart attack. You can be kept on life support with your heart going on, without any brain activity. Death is not declared until the plug is pulled and your heart stops.
You might die from overdoses of Adrenalin, meth, cocaine, speed, digitalis, beta blockers. Those are different because there’s no arterial blockage, there’s just crazy electrical misfiring. Coroners can’t detect that in an autopsy. They have to wait for a toxicology report. Poisons, like cyanide, also don’t leave any signs that can be found in an autopsy. (We learned before that those toxicology reports don’t come back the next day. Weeks at least, maybe months.)
Rheumatic fever doesn’t cause valve damage in this country any longer. That’s because it’s a complication of untreated strep throat. Your body recognizes those germs that don’t belong there. The immune system gets busy and produces white cells that eat the germ. Some heart muscle cells become inflamed, and if not reversed soon enough, that can leave scars. Eventually, you will produce antibodies. However, everyone who gets strep is given penicillin and that kills the Rheumatic fever progression.
You will always have a heart murmur. It just means the heart is working. It’s not like the liver that just lies there, making no sounds as it filters out old cells and produces proteins to aid in clotting, the heart works for a living. As technology let us listen to hearts more clearly, we learned the difference between murmurs and a defective valve. Isn’t that amazing?
Before 1920, medicine and medical practices stayed the same as they were in the early 1800s. There were not many changes, even though nitrous oxide was being experimented with and the syringe was invented. So scarlet fever and rheumatic fever were used interchangeably. Both were the results of untreated strep throat, but one produced a rash.
Learn the vocabulary of your business. Myocardiopathy is the disease of the myocardium or heart muscles. We usually get over an inflamed heart, but if scaring happens, we will have ongoing issues. The scars don’t contract. In the past, Doctors couldn’t do much for these patients but watch them die. Now, we have a lot more options including a heart transplant.
There is a close partnership between these two organs. Your brain is intimately involved with your heart. But your brain is divided into parts. Each area contributes to controlling something the body does. That’s why frontal lobotomies were thought to be a good thing since that lobe controls behaviors. Scramble that up and you change behavior.
Seizures are common. Simply, they are an electrical misfire in the brain. There are several types, including local seizure and Jacksonian progression when it moves through the body.
Amnesia is a real condition, not just a plot twist. A woman lost 4.5 hours when she left for lunch. She entered a fugue state and when she returned to work, her coworkers were understandably concerned. She had no memory of doing anything out of the ordinary. But she didn’t lose her memories from before that short time.
Temporal lobe epilepsy may be present in childhood or may be caused by head trauma. Michael Crichton’s Terminal Man was about a patient who experienced this. He was given a brain pacemaker, but he started to like the sensation and (Spoiler Alert!) jacked the program. That made him crazier. Brain pacemakers are used now for Parkinson’s, epilepsy, even Obsessive-Compulsive Disorder in severe cases.
We have made advances, but there’s still have a 20% fatality rate for Delirium Tremens. If your character needs to kick the drinking habit, expect severe consequences at Day 3 or so.
Trauma often is found by subdural or epidermal hematoma. Usually, people will show different behavior but not always. If head trauma is not found and relieved, the brain will be pushed out the big hole at the back of your skull like toothpaste. That will press on your respiratory control and then you die.
When Doug was working as an intern in July, in Texas, a man came in wearing a raincoat. Not only was there no rain, but the temperature was also hot. On questioning, the man opened the coat and revealed an ice pick put there by his wife. He was smart not to pull it out because the tip was in his heart. The surgeon used a purse string suture around the entry wound in the heart at the tip of the ice pick and when it came out of the aorta, he pulled on the stings and closed it up with almost no bleeding.
So there you have it, things that might be useful in your writing about death and sickness and the facts of life. Thanks for reading, I’ll be back on Thursday with the Word of the Month.