In writing the Angels of Mercy series it has been my intent to stay as close to the medical realities as possible while still remaining entertaining. In WARNING SIGNS, I skirted a few medical truths and I would like to take this opportunity to delineate the truth from the fiction.
The locked box syndrome does exist, although it is rare. It’s often a consequence of a stroke or traumatic brain injury. If you’re interested in learning more, try reading Jean-Dominique Bauby’s memoir, “The Diving Bell and the Butterfly.”
Hyperbaric therapy is not as dangerous as I had Lucas portray it to Amanda. Yes, there are remote risks of the complications he listed (brain injury, blindness, etc) but these are exceedingly rare. Also, hyperbaric chambers are designed to be as safe as possible, although fire remains the leading cause of death due to hyperbaric treatments.
Certain hyperbaric chambers can indeed pose a risk of explosion as Amanda worried about–in fact I toyed with using that for her climactic showdown, but if I did, all my characters would be dead and half of Angels gone, and I didn’t think anyone would want to read that story.
Modern hyperbaric chambers minimize this risk as much as possible. Finally, hyperbaric treatment has not been proven useful in diseases involving abnormal protein depositions such as MS, Parkinson’s, or Huntington’s, but it has been tried.
Medically induced hypothermia is currently a therapy that is being widely researched. Studies have indeed indicated that it might help cases of traumatic asphyxia but it is not yet the standard of care and no defined protocols for situations such as the patient Lydia faced exist as of this writing. It is a therapy that has shown promise and some spectacular success in certain cases such as that of Kevin Everett, the Buffalo Bills football player whose doctors credit early induced hypothermia as preserving his spinal function.
The drugs Amanda mentioned, ceftriaxone and calcium, do exist and recently have been found to cause lethal protein deposition in rare patients, causing the FDA to add a new warning recommending that they not be given within 48 hours of each other. Both drugs are safe and effective–during my 17 years of practicing pediatrics I have seen countless patients saved by ceftriaxone–but like all drugs, they should be used with forethought and planning.
Narcan, the drug Trey used on the narcotic overdose, does indeed act that fast to reverse the effects of a heroin overdose. Most patients do not wake up violent, but some do. In my experience, they mainly wake up complaining about us well-meaning medical providers who just saved their lives by “stealing their high.”
The disease Amanda suffers is totally fictitious. But her symptoms, particularly the dreaded muscle fasciculations, are real. I myself suffered from fasciculations when I had an inflammation of the lumbar plexus, the nerve bundle that travels from the spinal cord to the leg. My entire leg was numb, it was like hauling around a block of deadwood, but without warning I would experience pain that was random and could range in severity from an itch that couldn’t be scratched to electrical shocks. The muscle fasciculations were the worse: imagine a horde of mutant zombies coming to life below your skin and rampaging through your body.
Thankfully, my neurologist, while never able to explain the source of the inflammation that came on suddenly during a weekend on call (“idiopathic lumbar plexopathy” he called it. Translation from medical speak: we don’t know why, we don’t know how, but your leg nerves are all messed up), he was able to treat it and it resolved, hopefully never to return.
And finally, for those of you curious about Lydia’s Rules of Emergency Medicine, they are actually my own rules. For a complete list, check out CJ’s Rules of Emergency Medicine.
As always, thanks for reading!
CJ
January, 2009
