Yesterday, I received the following email from a reader:
I am currently reading “The Surgeon”, and I wanted to question a few technical points.While I am only a nurse practitioner, I worked in the ICU for almost 15yrs. While it seems silly and ridiculous to email over such small details that the average reader would have no clue as to their accuracy, I wanted to clarify a few points (again, as silly and ridiculous as they may be).
O positive is the “universal donor”, not O neg. The rH factor difference would cause a transfusion reaction.
While DIC a common possibility in the post-op patient who is bleeding out, I have never seen it in a trauma patient in less than 6 hours post injury. Physiologically, it takes hours for the coags to become so out of whack that DIC begins.
In addition, the use of Heparin in a DIC patient is very risky and is not done (at least in my clinical experience), unless there is a confirmation via the lab results that all other differential diagnoses are ruled out.
Finally, LR is not normally referred as Ringer’s lactate. In an ER/ICU it is referred to as Lactated Ringer’s – an isotonic fluid (NS is the same, but in TNCC certification, LR is preferred)
While I am not a physician, these details are important ro a reader who knows trauma and medicine. If I am incorrect, please feel free to let me know. No one kn\ows everything,
Oh, by the way, in future books, if you are talking about a nurse, instead of saying “nurse- do this or that” give him or her a name and refer to them by that at tag the nurse title after the name. Again, a silly minute detail.
These comments relate to an early scene in THE SURGEON, in which a trauma patient comes into the E.R. In the frantic moments that follow, my heroine, Dr. Catherine Cordell, makes a number of life-and-death decisions, and manages to save the man’s life. Although that scene is only eight pages long, this reader found a number of details that troubled her, and she took the time to write me about mistakes that she felt I had made. Did that email trouble me or irritate me?
Not at all.
Although it turned out she was mistaken about several points (O-negative is, in fact, the universal donor blood type, and “Ringer’s lactate” is what many doctors actually say when they want what’s formally known as “lactated Ringer’s”. Also, the patient had cancer, which would explain the rapid onset of DIC, aside from the trauma) I did not mind responding to her email, because her criticisms were polite and friendly — even if they were not correct.
Other readers have not been so kind. One reader sent me an email lambasting me because I’d referred to Aphrodite as the goddess of love. “Don’t you know that Venus is the goddess of love?” she wrote, amazed that I could be so misinformed. “Everyone knows that!” She included links to Botticelli’s painting of Venus rising from the sea on a clamshell, to support her stance that I was an ignoramus. I took a few deep breaths, then responded with a link to Wikipedia about the parallel pantheons of Roman and Greek gods, explaining that Venus and Aphrodite were names for the same goddess of love. (I love Wikipedia.)
I never heard back from her. Which is par for the course. The readers who build up the biggest heads of steam about my being an idiot are often not amenable to being corrected.
Still, I welcome such emails because I’ve learned so much from my readers. I’ve learned that you are never a “former” Marine. (I will never make that mistake again!) I’ve learned that Ford did not manufacture automobiles during WWII. I’ve learned that the “scleral hemorrhages” I described in Gravity should have been called “conjunctival hemorrhages” instead. I’ve learned that my understanding of the term “immaculate conception” is incorrect, and is more accurately called “virgin birth”. I’ve learned so much from my readers, and I always welcome enlightenment, if it’s offered in a friendly and non-threatening way. And when my readers are incorrect, I hope that they’re happy to be enlightened in return.
Here’s how I answered that email from the nurse:
I’m always glad to hear from someone in the field! And I deeply respect anyone who’s been an ICU nurse. Wanted to go through some of the points you bring up.
Re: universal donor blood type. According to this website, O neg is considered the “universal donor type.”
“Type O-negative blood does not have any antigens. It is called the “universal donor” type because it is compatible with any blood type. Type AB-positive blood is called the “universal recipient” type because a person who has it can receive blood of any type. Although “universal donor” and “universal recipient” types may be used to classify blood in an emergency, blood type tests are always done to prevent transfusion reactions.”
Re: LR versus Ringer’s Lactate. Back in the dark ages, when I was still in practice, in the ER we’d say “Ringer’s Lactate” because it was quicker and easier to say than the five-syllable “Lactated ringer’s”. (Say it quick a few times– it’s a mouthful!) Not technically correct, perhaps, but common shorthand in a tense situation.
As for using the actual names of nurses in the stories, it’s really a matter of what works in a novel. In a quick-paced ER scene, it really slows the action down to have to introduce everyone in the room by name “Tiffany! Jennifer! Amy!”. The more names I add to a scene, the more confused a reader is likely to get by all these people. So unless the character becomes important to the plot, I tend not to name walk-on characters, but call them by their positions (Ward clerk, X-ray tech, patrolman) rather than give them each a name. I think you’ll notice that in crime scenes, I seldom name the individual crime-scene techs, either. Unless they have more than a walk-on role.
And yes, giving heparin in a situation of unconfirmed DIC is a dangerous thing to do. But novelists do get dramatic license to make a scene more exciting!
I don’t know if she welcomed the response. But I always appreciate having my mistakes corrected, so I hope she did too.