Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

13 May 2018

Death comes in...

by Mary Fernando

She is the first person I have spoken with who has actually killed. 


“Unlike a lot of people, I do kill,” says Dr. V. As a veterinarian, she does indeed kill as part of her job. “There is how I end a life and what it is like.”

She starts with the latter.

“As one of my duties it is a bit of a double edged sword - it is so sad. Euthanasia literally means good death in Latin- I have to concentrate on that. it is my job to stay professional and not show grief. It can build up over time.”

Veterinarians have a very high suicide rate. One of the contributing factors is the result of facing grief over killing animals they are attached to while not being allowed to express their grief. It is their job to stay calm and comforting when they need comfort themselves.

She then moves onto the how she kills. She is describes both how to kill and what you see when death arrives. Not just for the animals in her practice, but for all living beings. 

“I front load sedatives and anti-anxiety meds, so the animal is still with it enough to know their owners are there, but not as aware of the insertion of the IV catheter. We use pentobarbital at 300 times the dose used for anaesthesia. In 30 secs to a minute the syringe is fully injected and in 15 sec to 30 secs they pass.”

“I believe that is when the soul leaves the body. Breathing is slower and slower and then it stops - and I get a feeling - it is a deep stillness and you can almost see an emptiness.”

“I know what to expect and I warn my clients. The eyes will stay open. Even if you try to close them, they open up again. The  animals will urinate and defecate. When calcium is released from the cells, sometimes you will see muscles contraction and the most scary thing is when the diaphragm contracts it looks like breathing. But it isn’t.”

“If this was an overdose of sleeping pills, it would be just like this.” 

Listening to her, I think of the many dogs I have had over the years. How their pain and suffering was relieved by vets just like her. And how it must have worn each of them down. 

I also wonder if any of us can kill - and watch this stillness - the emptiness - followed by the open eyed release of bowels and bladder and the breath that is merely the release of calcium and not life. Can we watch this and not be gutted to our core?

As a doctor I have seen death marching in - sometimes slowly and sometimes on a rampage - and I have seen death arrive. I have heard people say that it was a mercy, for the best. I have said that myself. But here’s the thing, the arrival of death is always frightening. There is no way that you can wipe out a life lived without that. Even if it is for the best.

30 March 2017

Bleeding, Sweating, Purging

by Eve Fisher

Or, as some people call it, the good old days of holistic medicine.

Seriously, these were all the standard medical treatment from ca 200 AD until the first use of antibiotics in the 1940s.  Nostalgia isn't what it's cracked up to be.  The truth is, standard medical practice between those dates probably killed more people than all the wars in history.  And it certainly makes for some interesting possibilities as far as historical murder, because how would you tell a homicide from a treatment?

The reason bleeding, sweating, and purging caught on was because of Galen, the most famous Greek physician of the Roman empire.  A legend in his own time, his writings survived the wholesale wreckage of ancient books and learning of the Dark Ages:  they were the major source of medical information for Byzantium and the Arabic Abassid Dynasty, and got reintroduced to the West in the 11th century as part of the treasures that the Crusaders brought / sent back to Western Europe.  His influence was so great that, when 13th century anatomists found differences between, er, actual anatomy and Galen's theories, they explained that the human body had obviously changed since the ancient world...

Anyway, Galen practiced medicine by humors, which has nothing to do with jokes.  According to this theory (which probably started back in ancient Egypt), humans are divided into four types:


18th c. woodcut - Wikipedia
  • Sanguine (enthusiastic, active, and social) - ruled by their blood, which Galen believed was manufactured in the liver.  Element, air; season, spring, infancy - warm and moist
  • Choleric (short-tempered, fast, or irritable) - ruled by yellow bile, which came from the spleen.  Element, fire; season, summer, youth - warm and dry
  • Melancholic (analytical, wise, and quiet) - ruled by black bile from the gallbladder.  Element, earth; season, autumn, adulthood - cold and dry
  • Phlegmatic (relaxed and peaceful) - ruled by phlegm, made in the brain/lungs.  Element, water; season, winter, old age - cold and wet  

(There were also astrological aspects to all of this).  

Anyway, all your ills, moods, "humors", etc., were based on an imbalance of the blood, bile, phlegm. So the obvious thing to do was the cleanse you so that your body could rebalance.  (A lot like the eternal craze for juice fasts, fad diets, and high colonics...)  Thus, bleeding, sweating, and purging.

Folks, all I can say is that we are living in the best time to be ill in history.  Back during the plague years, one physician infamously said, bleeding patient after patient, "Plague, I will cure you by bleeding!"  All the patients died, but he soldiered on, knowing that eventually it would work.  And doctors continued on the same path until very modern times.  Louis XIV's oldest son, the Grand Dauphin, grandson (the Duke of Burgundy), and his wife, the Duchess, and their oldest son, the Duke of Brittany, all died within a year and a half because their doctor tried to cure smallpox and measles with bleeding.  The result was that two entire generations of the royal family were wiped out and the future Louis XV became the Dauphin at the ripe age of five.  (This was, in case, you don't know it, a disaster:  "Apres moi, le deluge".)

Throughout the 17th, 18th, and 19th century, heart attack patients were bled; young girls suffering from "green sickness" were either bled or advised to have sex; Marianne Dashwood of Sense and Sensibility was bled when she obviously had pneumonia.  And, aside from illness, it was largely believed that everyone should be bled regularly, to help balance their humors:  monks and nuns were bled about four times a year. The only real change over the centuries was that, instead of using leeches, doctors actually performed a phlebotmy using special lancets or knives.

Photo of Bloodletting in 1860 -
Wikipedia
By the 19th century, "One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed." (Wikipedia, Bloodletting)  

There are fewer references to sweating than to bleeding.  The main one I can think of is in Little House in the Big Woods by Laura Ingalls Wilder, where a naughty little boy gets stung by a whole nest of wasps, and is slathered with mud, and bound up in sheets and left to sweat the poison out.  It apparently worked, because he survived.  When I was a child, if I had a fever, I had blankets piled up on top of me to make the fever break by sweating it out.  And, of course, sweat lodges, hammams, and saunas all operate on the theory of making you sweat, thereby cleansing you, both inside and out.

And purging is everywhere in the literature, from diaries to novels.  My mother, born in 1917, believed that in spring you need to eat purging foods and/or take a thorough laxative to cleanse the body.  In Jack Larkin's invaluable The Reshaping of Everyday Life 1790-1840, he describes a world of hard work, much fun, and horrifying medicine.  "Bleeding and blistering, purging and puking" were the standard remedies for EVERYTHING.  And they were the kind of thing that your average frontier citizen in America could do at home, for themselves, using plants, herbs and (sometimes) kerosene.  (No, I am not kidding.)  Thus when Zadoc Long's wife suffered what was probably a nasty gallbladder attack, he gave her a strong emetic made of thoroughwort to "puke her".  (88-92)

What about medicine?  Well, there wasn't much.  Quinine did work on malaria, but it was also given for almost any "ague", or recurring fever.  One of the most widely used drugs was calomel, mercurous chloride, which was used for such things as syphilis and yellow fever.  It didn't cure either of them, but it gave wonderful proof that it was strong medicine:  mercury [poisoning] made people salivate like a mad dog, then lose their teeth, and perhaps their hair.  A thorough purging indeed.  And let us not forget alcohol. Whenever you read in the literature about someone being given "cordials" that is some form of alcohol.  A lot of people died in a prescribed drunk.  Supposedly Oscar Wilde, being prescribed champagne on his deathbed, said, "I am dying as I have lived, above my means".

There were a few things that worked:   As I mentioned in a previous blog ("Arsenic and Old Lace") there was opium in its various forms, especially laudanum (alcohol and opium combined - the pause that refreshes and the mother's friend).  Cocaine was used as a numbing agent, a stimulate, and even, apparently as a cure for dandruff.  There was an effective smallpox inoculation, using live disease material.  This was risky, because many patients got smallpox from the inoculation, and some died.  Even more effective was Dr. Jenner's vaccination using cowpox, which ran far less risk of infection and death.  While smallpox was never eradicated (not enough people were either able to get the vaccination or were willing to run the risks), at least it became rarer.

Basically, before 1945, the best thing to do for your health was to choose your parents wisely.  And not get in accidents, wars, or be pregnant.  If you could survive birth, infancy, early childhood (all of which wiped out about 50% of the population), and then could manage to not die in accidents (a simple scratch could give you blood poisoning or tetanus), childbirth, epidemics or war, you could become very, very old.  And be remarkably healthy the whole time.  Eleanor of Aquitaine had 10 children, a complex and busy life, and still managed to live active and healthy until she was 82.  The philosopher Fontenelle (1657-1757) was known for his intellect and his womanizing.  (He said to Madame Helvetius, when he met her in his late 90s, "Ah Madame, if only I were eighty again!")  A medieval letter from a visiting priest to an abbey offered birthday wishes to Brother Narcissus, on the occasion of his 116th birthday.

Good genes?  Undoubtedly.  And darned little bleeding, sweating, or purging.









09 March 2015

Me and the Derringers. (Maybe.)


by Melissa Yi.

At the end of my emergency room shift, I got a Twitter message that looked like this:

Quoi? Dr_sassy and the Derringers? That's never happened before. Sounds like a good band title, though.

My first thought was, Did someone tag me by accident? As in, they want me to know about the Derringer Award, which honours the best short mystery fiction published in the English language?

But another tag-ee, Britni Patterson, was already celebrating, so my heart kicked into high gear, just wondering if I was a chosen one.

And if so, which story was it? I had two eligible tales. “Because,” a biting tale of 490 words published in Fiction River: Crime, and “Gone Fishing,” a 12,000-word serialized Hope Sze novella commissioned by Kobo and kindly mentioned by Sleuthsayers last year.

I clicked on the link and found this Derringer short list:

For Best Flash (Up to 1,000 words)
  • Joseph D’Agnese, “How Lil Jimmy Beat the Big C” (Shotgun Honey, May 12, 2014)
  • Rob Hart, “Foodies” (Shotgun Honey, May 2, 2014)
  • Jed Power, “Sweet Smells” (Shotgun Honey, July 28, 2014)
  • Eryk Pruitt, “Knockout” (Out of the Gutter Online, August 31, 2014)
  • Travis Richardson, “Because” (Out of the Gutter Online, May 15, 2014)*
  • Melissa Yuan-Innes, “Because” (Fiction River: Crime, March 2014)*
Ah. Because.

I do love that story.

Warning: it’s extremely noir. I don’t find it scary, but then I face blood, guts, vomit and potentially Ebola every day in the emergency room. I’ve already alerted the SleuthSayers powers that be that I’m not especially cozy. I’ve written what I consider cozies, and I love Precious Ramotswe and Agatha Raisin, but I also regularly stare into the darkness and take notes. When I attended the Writers of the Future winners’ workshop in 2000 and turned in a pitiless story about werewolves, the Grand Prize winner, Gary Murphy, stared at me and said, “I can’t believe that such a sweet-looking woman wrote this!"

I laughed. I adore werewolves. And good stories of any stripe.

But Cozy Monday may need a new name. Any suggestions? Cozy or Not; Cozy and Noir; Alternatively Cozy Mondays (because I’ll bet Jan Grape can stick to one genre better than literary sluts like Fran Rizer and Melodie Campbell and me); Cozy and Crazy…hmm.

Back to the Derringer. Until now, I never really understood why awards have a short list. Well, I understood whittling down the list so that celebrity judges don’t need to plow through a mountain of stories.

But now I get the glory of the finalist. I’ve won other prizes in a binary announcement. Either I win the award or I don’t. But right now, the uncertainty makes it all the more treacherous and exciting!

If you're curious, I’ve published “Because” for free on my website for the next week only. You can download it to your friendly neighbourhood KindleKoboiBooks deviceSmashwordsor any format for a whopping 99 cents. That price will triple in a week. Please admire the cover photo by 28-year-old French photographer Olivier Potet. The non-cropped version is even better.

If Because tickled your fancy, you can also download Code Blues, the first Hope Sze novel, for free, as part of a bundle on Vuze, until March 16th.

And please tune in on March 23rd, when I plan to write about how medicine trains your mind for detective work. Watson, anyone?