Infusing Medical Details into Your Fiction
For a number of weeks, we’re running a series featuring professionals sharing tips and expertise in order to help novelists convey accuracy in their fiction. Last week we took a fun, hard look at forensics and dead bodies. If you are writing any scenes that include doctor, lawyers, investigators, or law enforcement officials, be sure to study these posts (and print them out for reference).
Today’s guest post is from physician and best-selling medical thriller novelist Richard Mabry:
Are you interested in writing medical thrillers? Or perhaps you are planning some scenes in your novel that show medical procedures. Writers often make mistakes in accuracy when it comes to medical details.
We’ve all seen these in novels, but few of us know if they’re accurate. Here are just a couple of examples from books by best-selling authors. I’ve chosen not to show the names of the authors or the titles of the novels, but they’re real. See if you can spot the errors.
- “Merci knelt down and placed two of her right fingers on the man’s jugular vein . . .”
- “She drained the Vicodin into his IV bag and watched the clear liquids for a moment.”
Did you notice that the character palpated the jugular vein looking for pulsations? Of course, the carotid artery would be the correct structure in the neck to feel for a pulse. And most of us have heard of the pain-reliever Vicodin, but did you know there’s no IV (or IM) form of it? These authors didn’t bother to do the research necessary to avoid these mistakes.
The knee-jerk response of writers reading this post might be to avoid such mistakes by never including a medical scenario in their book. But how difficult would it be to get things right? And would adding a medical aspect make a difference? I don’t think it’s that difficult, and in my opinion it does make a difference.
I suspect everyone reading this post has experienced or had a friend or relative who’s been part of a medical situation. It’s something with which your readers can identify. Why not add such a scenario to your novel? It will not only enhance the story arc but will draw in readers who can identify with the experience, as well as contribute to the suspense that keeps people turning the pages of your novel.
What Type of Medical Scenario Do You Want?
The first thing to decide is what you want to accomplish.
- A medical situation may provide a chronic undercurrent to your story. For example, throughout the entire book there might be the implied question of whether a character that has had a previous heart attack might suddenly clutch at his chest, sending someone running to get help.
- Or medical details can inject acute tension into the plot. For instance, a child could run into the street and be struck by an oncoming vehicle. What happens next, from a number of points of view, can be the basis for acute tension at the time as well as figuring into the plot later.
- Finally, a medical event or condition can be used to change a character. Suppose a self-centered and hedonistic character emerges from a life-threatening illness or accident as a person who thinks less about himself and more about others. You can decide how all this works because you, the writer, are in charge.
What if you need a medical problem to plug into your novel, but can’t think of one that might fit? Here’s where you may need a bit of help, which I’ll describe in a moment. But lest you think there aren’t many choices, consider these:
- Surgery (elective or emergency),
- Heart problems of various types (from a full-blown “heart attack” to chest pain as a warning)
- Pregnancy (uncomplicated or complicated)
- Trauma (motor vehicle accident, beatings, etc.)
- Infection (either a real one or one you make up).
And that’s just a partial listing of common problems a writer might choose to use in a novel.
For those of you who write historical fiction and are always needing to know if such-and-such would have been available in a particular year, you’d do well to compile a list of important dates associated with milestone medical advances so you can write realistically about an accident or illness in a given time period. Here are a few dates to get you started:
- From the 1600s to late 1800s, patients were often prepared for surgery by the administration of opium (laudanum) mixed with rum and whiskey. Ether anesthesia was first used in 1842, and injectable local anesthetics like procaine (trade name Novocaine) was developed in 1905.
- The use of Plaster of Paris for casts dates to the 1850s, whereas X-rays were first employed clinically about 1895.
- And the first antibiotics, penicillin and sulfa, were developed in the 1940s.
Perhaps you have a plot twist or scenario in mind, and need to know the details of “which of these diseases or circumstances might produce thus-and-such.” That’s where a network of resources comes in. You may wish to start with your own physician, but if that’s not an option, there are numerous others you can consult for information:
- Nurses (physician’s office, school)
- EMTs and emergency room personnel, hospitals and medical schools (many have a public information officer, librarians, or can put you in touch with an appropriate person to answer your questions).
Additionally, you can submit a question to one of the medical professionals whose blogs supply great answers:
- Jordyn Redwood, an ER nurse, has a very helpful blog in which she poses and answers medical questions.
- Dr. D. P. Lyle, a practicing cardiologist with extensive writing experience, frequently deals on his blog with forensic problems. Or you may find yourself consulting a site from this extensive list of medical blogs.
It’s interesting how many helpful resources are available via the Internet.
Because of computers, research on various disease states and procedures has become much easier than it was in past decades. Use your favorite search engine (my favorite is Google). But I’d caution you to watch out for sites that have something to sell, whether a procedure, a hospital or physician’s particular expertise, or even a surgical approach. Check out authoritative sources like WebMD and emedicine. Look for information from the National Institutes for Health. Depend on sites from medical institutions (these end in “.edu”) or professional organizations (these end in “.org.”). And, if possible, confirm your data from two different sources. Journalists do this, and authors should strive to do the same.
Misinformation and Misunderstandings Have Their Place
Finally, remember that, unless you’re writing from the viewpoint of a medical professional, you needn’t be too technically correct. Patients can misunderstand what they’re told, and I have seen on more than one occasion a novel in which such a misunderstanding and the subsequent action that follows is part of the plot. If the point of view character is a physician, realize that generalists and specialists may approach a problem in a different manner, even vary in their knowledge of the problem.
My suggestion is to write mainly from the point of view of a layperson, while avoiding the excessive technical information that one of my colleagues calls the “look how much research I did” syndrome.
Maybe you’ll decide that adding a medical scenario to your novel isn’t for you. But if you choose to include one, I hope you’ll do it accurately and well. It’s not an impossible task, and it may be the addition your novel needs. The resources are out there.
Richard Mabry is a retired physician, now writing novels of “medical suspense with heart.” His novels have merited semifinalist for International Thriller Writers’ debut novel; finalists for the Carol Award, Inspirational Reader’s Choice Award, and Romantic Times’ Reader’s Choice Award; and winner of the Selah Award. His upcoming release on May 19 is Fatal Trauma. You can follow Richard on his blog, on Twitter, and his Facebook fan page.
Susanne, I’m honored to be asked to participate in this endeavor.
Appreciated this post. Not being medically informed myself, I probably wouldn’t pick up on a lot of medical mistakes in other fiction, but I don’t want any in mine.
I’ve been working on a story that involves a chronic medical condition and have wondered if I’m being realistic, given the time period. So I’d have one question for the doctor:
Setting: Holland circa 1600; no aspirins or fancy antiseptics. A bricklayer falls from a scaffold and is taken up paralyzed from the neck down. His wife is caring for him at home and must turn him to dress bedsores. In my story he has excruciating pain whenever she and her friend have to turn him; sometimes he passes out. Could this be true?
Hi Dr. Mabry,
I began my nursing career in 1973 in Boise Idaho. During my last semester of classes at BSU, I was assigned to the Delivery Room for my OB rotation. My own OB doctor had recently confirmed my pregnancy at ten weeks of gestation. I am assigned to assist in a delivery in room one. When the case is over, I proceed to take the instruments into the utility room for processing. There on the counter is a stainless steel basin with a green surgical towel draped over it. I proceeded to fill the sink with wash water for the instruments and take the towel off the basin so it can be washed too. I looked inside the basin to my horror. There inside the stainless steel basin is a well developed fetus at what appears to be about seven months gestation. A perfectly formed baby laying beside a umbilical cord and placenta. I couldn’t believe my eyes.
The historic passage of Row V Wade changed the face of medicine forever. I just happened to be standing in the crowd of mistified onlookers with my mouth agape. What do you remember about this historic day Dr Mabry?
Christine, I’m working under two handicaps here–quadriplegia isn’t something with which I’m familiar, and I don’t have any knowledge of medicine in the 1600’s. Although quadriplegia doesn’t normally cause unusual pain (I checked WebMD for this info), I suppose it could, but I’m not sure it would be related to turning. Your best bet for that would be to consult a nurse who works on a neurology ward, if you can find one.
Carol, that would be a tough thing for a nursing student to encounter. There’s undoubtedly a story behind it, and without details I can’t really comment further. I hope your own pregnancy came to term without problems. As for Roe v. Wade, I don’t recall what I was doing on that day, but I was pretty well occupied with getting my own practice (otolaryngology) started and caring for those patients.
Between my mother-in-law and my husband, we owned a wing of our local hospital and I learned a lot of medical jargon and saw how things worked. I often use a medical scenario in my books and have a couple of doctors on call for questions. 🙂 Nurses, too.,
Thanks, Patricia. Glad you were finally able to leave your comment (I had a bit of trouble earlier as well). It’s good that you have medical consultants available–saves a lot of red faces later on.
i didn’t realise how much of a corner I was painting myself into when I set my POV character as a female paramedic. However, I was very lucky to be given a great deal of assistance by a team of paramedics, plus ongoing Q&A help from one of the team. As is sugested above, set your POV character as a layperson, unless you already know a professional, or you are one yourself.
Andrew, great advice. And EMTs are excellent resources for medical details. When it comes to emergencies, they can be a great deal of help to a writer…even one who has painted himself or herself into a corner. Thanks for your comment.
Thank you for such an informative article. My question is more of a psychological one, so I’m not sure to what extent you’ll be able to help me, but I am interested in elective mutism. I have looked this up to research it, and I still have questions. According to my online research, elective mutism is where a child could have had a traumatic event and they cannot or refuse to speak. In my WIP, my protagonist, a 37 year old woman, witnessed her parents’ murders when she was 7 years old. From the night of the murders until she was about 12 years old, she was mute. Then, just as suddenly, she started speaking again, but she had no memory of the night of the murders. My question: What would cause her to start talking again and what could cause her to regain her memory? I understand there are triggers than can cause the memory to return, but must there be a trigger to regain the speech as well or could she actually just start talking again without this trigger? Thanks for your help. 🙂
Rebecca, your question sent me to the source I often recommend an author consult–Google. The term, by the way, is selective mutism. One very complete discussion is found here:
http://www.selectivemutismcenter.org/aboutus/whatisselectivemutism
If you go to emedicine.com, you’ll find more about selective mutism.
I read a bit about it from several sources, and although opinions differ, most legitimate authorities seem to feel that a shocking experience isn’t necessarily the cause of this disorder. They feel there’s a genetic predisposition, upon which a traumatic event is overlaid.
the other hand, cases can occur where trauma is linked to the inability to speak, and–after all–you’re the author, so you can make this one of those cases. If you choose to go that route, I’d think that a single event should alleviate both the amnesia and the mutism. However, I’d suggest that you have the child psychiatrist (which would be the appropriate specialist to examine the child) say that every situation is different, and this isn’t as easily diagnosed or treated as, say, a broken leg or inflamed appendix.
Hope that helps.
This post is a reminder to me to set aside what I think I know and double check the facts, which could be used in relation to anything. Thanks!
Catherine, thanks for your comment. People assume that, since I’m a retired physician, I know everything about medical details in fiction. Unfortunately, I don’t. That’s why I double check my facts just like every other author. John Grisham says he hates research (and one of the mistakes I quote in the blog post is his)–but until I have a following as large as his, I guess research will be part of what I do as an author.
I was reading the comments and replies and I have to say I love the research side. There is always going to be a reader who is an expert on a subject or incident you have written about so you have to do your research and you may as well enjoy learning new things, even if they are going to reside in the trivia folder of your brain.
I have a fair amount of medical drama in my books, which are military fiction, but I keep the details of the treatment that is meted out to within the bounds of what I know about, First Aid level care. The casualties die, limp away, are whisked off by helicopter, or field ambulance whereupon the story continues.
In real life, I did have a doctor, a larger than life gentleman who was a frustrated ‘Rumpole of The Bailey’, giving evidence for me in an attempted murder trial in London. He kept lapsing into Latin with accompanying flourishes of the arms and hands, which were entertaining but nearly lost us the case. I must find some place in a future yarn for him.
Thank you very much for imparting your wisdom, sir.
Andy, thanks so much for your comment (and for calling me “sir”–the check will be in the mail tomorrow). You’re exactly right about writing medical scenarios at the level you’ve chosen. Anyone can put medical details in their fiction if they write from an appropriate point of view. And I think you should put that doctor in one of your novels…but not on the stand in the future. Glad you dropped by.
Dr. Mabrey,
I am working on a story and have a question. One of my characters has dissolved Vicodin in distilled water and injected the mix into his victim’s IV bag. Diluting the Vicodin in such a manner, will it still be effective? Murder, obviously, is the intent of my character. Also, do you think six Vicodin HP would be sufficient?
Thank you, sir, for your time.
Respectfully,
Veronica Marie Lewis-Shaw
Veronica, interesting question, and one that isn’t answered in most medical texts. As you have probably found out, there’s no injectable form of Vicodin (although John Grisham mentions IV Vicodin in one of his books–he hates research, but that’s another subject). Anyway, most of the information I could find about dissolving Vicodin was in sites frequented by IV drug users. Apparently, Vicodin is soluble in boiling water, and giving it IV triggers a massive histamine release that can be fatal (anaphylactic reaction), aside from the effect of the hydrocodone. I’d think six tabs injected directly IV would be enough, but not added to an IV bag (which would dilute the material and might cause it to precipitate again).
I’m writing a story that is going to involve a character who’s been beaten and stabbed repeatedly. My surgeon character is trying to save his life but he will flatline a few times before finally stabilizing. I’ve been trying to search for the types of things that would be said by the surgeon and nurses, orders to do this or that, use this instrument, etc. Can you, if nothing else, point me in a direction to research? I’m coming up empty on my internet searching 🙁
I’m writing a story set in the late 70s. My protagonist isn’t part of the medical community, but one of my important characters is a neuroscience professor. I’m stuck because I need to know his daily routines. I’m having more trouble than usual finding this infomation since the setting is in a very different time. I don’t even know what medical technology would have been used in a research lab at that time. Please help! What can I do to get unstuck?
Hi,
A quick question about eyes and flames. A propane oven on a boat explodes shooting flames into a man’s face. His sight quickly dims. I want him to regain his sight in a day or two. Could this happen? What actually would happen to his eyes?
Thanks for any info.
Cheers,
David Burton