Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

10 December 2017

Good Drug, Bad Drug

by Mary Fernando

I would like to introduce my colleague: an Emergency Room doctor with a passion for crime novels. He is a father and an all around good guy who saves lives regularly. He is also a passionate fan of crime novels and has some interesting ideas about murder. I will call him Emergency doctor Extraordinaire or EE for short.

My interview with EE was wide-ranging, but one of the issues he discussed at length was fentanyl - a drug that we hear about daily as a killer of addicts. In EE’s hands, fentanyl is transformed into a character, a noble one that has fallen into disrepute, and finally becomes a murderer of one person at a time, or many in one fell swoop.

Let me tell you EE’s story of fentanyl: the good guy gone horribly wrong.

Although fentanyl has been in the news as a deadly street drug, it has far nobler origins. Since the 1960s, fentanyl has been used as a pain reliever when other opioids aren't strong enough. About 50 - 100 times more potent than morphine, fentanyl is used for cancer pain and thank goodness we have it. In the hands of a doctor who prescribes the right dosage, it is a safe and decent drug. I stress the word decent, because if you haven't seen a person screaming in pain, then you have no idea how relieving this pain is the height of decency and good medicine.

However, if the dose of fentanyl is too high it can cause death. Fentanyl binds with opioid receptors in the brain that give a sense of well being. The problem is that these same opioid receptors are found in the area of the brainstem that controls breathing. So, breathing - essential to living - can be shut down by this same sense of well being - everything is fine it says - no oxygen needed. A high dose of fentanyl gives people such a sense of well being that they forget to breathe.

That last sentence should give us all pause: smothering while surrounded by air. For those of us who write about murder, the focus is always justice - righting a wrong. The murderer is that vile, unsavoury creature to be chased down and brought to justice. However, not all methods of murder are equal and, I would argue, the method of murder is a character in itself. And you will find few viler methods of murder than fentanyl and smothering a victim in air.

So, back to my EE and his thoughts: ‘In a fentanyl naive patient, it can kill at much smaller doses, so a patch that is therapeutic for cancer patients, can kill someone who has never received fentanyl.’
As with all drugs, a tolerance develops. So, patches, clear and small, can be put on the skin of a victim who is fentalyn naive. EE thinks a nicotine patch or other patch could easily hide it and be removed after. Another intriguing method of delivery is a nasal spray - so perhaps a method of substituting that for Aunt Gertrude’s sinus irrigation? Would this come up on an autopsy? EE responds by saying, “At first glance it would look like someone had a heart attack and died.”

This also brings up the issue of getting fentanyl. Healthcare workers can pretend to give it and store it up. Even a couple of patches could kill an opioid naive victim. Or there is always the street market.
EE pointed out a very frightening and immensely writeable option: weaponizing of carfentanyl. This drug is 100X more potent than fentanyl, and as much as 10,000 times stronger than morphine. There is the frightening scenario of mass murder. Carfentanyl’s deadly potential comes as no surprise to the various countries that have experimented for decades with weaponizing this synthetic opioid.
Although never officially confirmed, it was reported that the Russian military pumped aerosolized carfentanyl into a theatre to incapacitate the armed Chechens who took more than 850 people hostage in 2002. In this event, more than 120 hostages died.

This has thriller written all over it. An aerosolized form can kill many - how about a chase to find the carfentanyl and those who plan to use it?

If a character can be a focus- so can the weapon of choice. There is something poignant about a noble drug, developed to ease the extreme suffering of patients, being turned into a killer. Worse, this killer can then massacre thousands. It is a noble character gone wrong. And the making of a crime novel. Or a thriller.

08 October 2017

Hospitals and Murder in One Step or Two

by Mary Fernando
“Hospitals are a great place to kill people” said MC, during our interview, “You can kill people in one-step or two.”
I would like to reintroduce MC – Mystery Cardiologist. He is a doctor who opens up blocked heart vessels with stents, puts in new heart valves and uses defibrillators to bring people back from the brink of death. He is also a voracious reader of mystery novels. What can be more delicious than a man who saves lives and ponders how to kill people? After he read my last blog, he felt it made him sound a bit ghoulish. So I would say, unequivocally, that he is a great guy. A wonderful husband, father, puppy owner who has never murdered anyone. He is safe to have over for dinner and introduce to your children.

Although his one-step and two-step murders are worth hearing about, what is equally as interesting is the character of a hospital murderer.
“There is nothing more creepy than someone like a nurse, doctor or paramedic who kills.” said MC. “That is the person with the most access to the patient, the knowledge to kill and the person everyone trusts.”
MC is right. The best person to know what drugs could kill and at what dosages, is a person who is medically trained. Further, they would know, for example, that in death, all cells break down, release sugar, and make an insulin overdose difficult to detect. However, a sample of the vitreous humour (fluid in the eye) could be a perfect way to catch this murderer.

Setting a murder in a hospital opens up avenues of murder but also allows for the creation of a complex character. What makes someone who has devoted a great deal of time educating themselves on how to save lives, who has a career of service to patients, turn themselves into a killer?  It could be a latent aggression finally coming to the fore, or it could be a character up against hard times who changes and becomes embittered. Or it could be a character who becomes a doctor or nurse to compensate for a sense of helplessness but gradually develops a sense of arrogance and invincibility, coupled with the a distain for those who are helpless like they once were.

One-step murders in hospitals can involve numerous methods. If someone is admitted to hospital for routine surgery such as an appendectomy or even for a heart attack that they survived, then finishing them off in hospital is an interesting option.

In hospital, people have IVs that provide a portal to inject them with something deadly. An overdose, of insulin, epinephrine, or potassium are some of MC’s suggestions.

A two-step murder is another intriguing option. Perhaps a murder attempt - a car accident, or bludgeoning on the head - has failed to completely kill off the victim. Bringing them to hospital provides an opportunity to try to kill them again.

Here a principle of reversing medical treatment is key. For example, if the victim has brain swelling after a thump on the head, in hospital they will give drugs to reduce swelling. They will also raise the head, using gravity to get rid of excess fluid in the brain. A visit during which the hospital bed is positioned to lower their head will send enough fluid into their brain to kill them. It is a gruesome way to die as the brain swells and pushes into your skull and again, it takes a certain twist of character to make a person trained to save lives, now take them.

Killing via an IV line is of course an option when a murder is botched and someone wants to complete the kill. Insulin injected could bottom out their glucose and put them into a deadly coma. Adrenaline could cause a fatal heart attack. And someone who has survived a murder attempt would be frailer and more susceptible to most drugs. Air injected into an IV is a perfect way to kill someone.

Once you have decided to set up a hospital murder, either in one or two steps, there is a wealth of internet info to look at. For example, if you are set on killing someone with air injected into an IV, I would like to recommend the blog by James J Murray, Prescription for Murder, as a great starting point. Another intriguing find is a book about murder by insulin.

For me, the intriguing part of my interview with MC was the hospital setting as an opportunity for murder with a necessity of developing the kind of complex character who would murder in a hospital. I truly think this hospital killer allows a writer to develop a character that embodies the saying: ‘As we get older, we just get more so.'

All our vulnerabilities, our fears and frailties, can be hidden under work and purpose. However, in the end we all become ourselves and more so. What haunts us eventually will consume us and that, in essence, is the making of a murderer.