This article is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert. Please join the mailing list to be notified every time new content is posted.
The Expert: Karyne Norton
Karyne has worked as a labor and delivery nurse for nine years and been an avid reader for twenty-five years. She’s also a wife, mother, photographer, missionary, and writer of fantasy and science fiction. You should follow her on Twitter and check out her blog, Because of Books.
Medical Misconceptions in Fiction
I haven’t been able to watch shows with hospital scenes for the last decade, and I cringe or skim when I run into medical misconceptions in books. I wish I could ignore them, but they stand out to me like bad grammar to an English teacher. My hope is to help writers get through some of the common pitfalls of writing about medical situations when they don’t have any medical training.
Misconception #1: CPR is for living patients
I can’t tell you how many times I’ve seen writers mess up CPR. One of the first things they teach us in Basic Life Support is that you can’t screw up CPR because the person is already dead. Your goal is to bring them back life. BUT if the patient is talking, moving, breathing, or has a heartbeat, you should NOT be doing CPR.
Real CPR Training
If your character comes across an unconscious person, and they have any medical training, here’s what they’ll do.
- They’ll gently shake them and call their name (or shout something) to see if they wake up.
- They’ll ask for people around to call for help/911. If the patient is old or young, they might ask for an AED (automated external defibrillator).
- Sometimes (especially on children) they’ll check for breathing. It used to be taught ABC (airway, breathing, circulation), but for strangers they don’t recommend mouth to mouth, and recent studies have shown that circulation should be prioritized because our blood has plenty of oxygen to circulate without rescue breaths. Children tend to have healthy hearts, so if they’re unconscious it’s usually because they choked or drowned.
- Most often they’ll immediately check for a pulse on the neck or wrist. If there’s no pulse, they start chest compressions. Chest compressions look awful. If they don’t look awful, you’re not pushing hard enough. Bones break.
- When an Automated External Defibrillator (AED) is available, they use it. (DK note: follow that link and read it. You might save someone’s life).
- They continue this until an ambulance arrives.
When this happens to a patient in a hospital setting, the same general steps are followed, except when someone calls for help, they push a code button on the wall that alerts an entire team of medical professionals to come to the room with a code cart. This is often depicted as a chaotic moment, but honestly it’s more like a highly intricate dance. The first person to find the patient is generally the one to do chest compressions.
The next to come will start giving oxygen through an ambu bag. If there isn’t already an IV someone starts it. Another person sets up the code cart and hooks the patient up to the EKG monitor. Another simply records everything that’s being done at what time so they can chart it all later. Usually there are 5-10 people that walk in within a minute (if not sooner).
When the anesthesiologist arrives, the person in charge of airway assists him while he gets the patient intubated and compressions are paused during intubation. The patient’s primary doctor usually stands and watches everything that’s being done and gives out orders. Others in the room are encouraged to voice any other ideas or steps that might have been missed.
There’s a lot happening at one time, but don’t think for one second that it’s disorganized. The code teams in hospitals are trained to respond to every code in the hospital, and depending on the size of the hospital, there can be a handful each day.
Misconception #2: Babies fly out in one push
This is the absolute hardest one to please me on because it’s MY area. If I love a book and a delivery scene shows up, I tend to skim out of fear that I will forever close the pages. Your personal labor experience is yours and probably shouldn’t be your character’s. If you barely made it to the hospital and your babies practically slid out, please realize it’s not common. I’m about to make up some statistics on the fly, but these are based off what I’ve seen while working on a labor and delivery unit. I would guess that 30-40% of our patients have inductions. Many of those inductions last DAYS. Another 30-40% (there’s definitely crossover) end up with C-sections. Yes, your character can have a C-section. It could even be planned. Only 5-10% of people labor without getting an epidural. I’m sure your character is a very strong woman with a high pain tolerance, but that doesn’t have anything to do with whether or not she would get an epidural. And the women that don’t get epidurals? They don’t all scream bloody murder. Some don’t make a sound.
Misconception #3: IVs are needles
This is a pretty quick fix, but I see it often enough that it’s worth mentioning. When an IV catheter is inserted a needle is used, BUT the needle is immediately removed and a plastic catheter is all that remains. This is a common misconception among patients too (especially ones that like to complain). Don’t have your characters notice the needle in their arm or complain about it being sharp. Or if they do, have your nurse character set them straight so you get a smile out of this reader.
Misconception #5: Meds are used to shut people up
This is incredibly illegal, and for some reason writers like to have their characters being given meds that knock them out left and right. “You have a scrape on your elbow? Here, let me start an IV for no reason other than to give you an incredibly potent narcotic that I happen to have in my pocket and I can’t possibly already have an order for. That way you’ll fall asleep super confused and the reader will want to turn the page.”
That’s seriously how I read those scenes. In the hospital setting, we need a physician’s order to give any kind of medication. Even oxygen requires an order. In emergency situations, there’s almost always a doctor present to give us that order, but we can’t just pull it out of our hat. Narcotics (and most every medication) are kept locked up in medication dispenser that require pass codes and fingerprints to access.
We also have to get permission from the patient to give any medication. If a patient is in hysterics and needs to be restrained in some way, most hospitals have policies requiring TWO physicians agreeing that the physical restraints or medication (never both) be used. And these are very rare occurrences.
Now, I’m not gonna lie. Medications get used to shut people up, but it’s usually done by the nurse strongly encouraging the patient to ask for the medication. Nursing licenses are too hard to earn just to lose over a stupid narcotic and an annoying patient.
Misconception #6: Teens get treatment without parental sign-off
Be careful what you have your YA characters getting done without parental figures present. In emergency situations, minors are treated in order to save their lives. But pain medications won’t be given out to every crying kid. You may not always need parent permission to get an abortion, but if that same girl shows up at the hospital 6 months later wanting an epidural, mommy or daddy better sign for her. Some of these issues are state specific, so do your research.
How to Get the Medical Stuff Right
I’m only scraping the surface of medical misconceptions. Someone who works in an oncology unit or cardiac unit might have very different things to point out. So what’s a writer to do? Make a nursing friend. Or two. Or twelve. Honestly, we’re very friendly people and we LOVE talking about our jobs. Just be aware that you might hear more than you want, and you might not want to eat while we talk.
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|Click to Tweet 6 medical misconceptions by nurse @becauseofbooks: http://bit.ly/1plsfYL Myth #2: Babies fly out in one push. #ScienceInSF by @DanKoboldt|
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