By Cheryl and Mel Hodde (Hannah Alexander)

Cheryl: Are you working on a medical scene, or a full medical novel?

Are you writing a contemporary novel or historical? That will make a huge difference in the research you need to do. We once worked very hard on an historical novel set in 1864, in which whiskey was often used for medicine. Not to drink socially, but to kill infection or kill pain. The editor took out all mention of alcohol—whiskey could not even be mentioned for medicinal purposes, and so I had to do research into alternative medications used today, because those are age-old practices that have been around for a long time.

For instance, willow bark was the precursor to aspirin and would lower fevers and help with pain. We had to know about the plants and trees indigenous to the setting, and since most of our settings were in Missouri where we lived for 50 years, we had an abundance of natural resources to utilize.

If you’re working on a historical novel, research your setting for healing plants available in that area. And if you don’t live where your novel is set, maybe you know someone who lives there whom you could ask.

Do you have a day job in the medical field, or have friends or family working in the medical field who would be willing to work with you on a writing project?

You might have a head start with your story if you have a good understanding of medicine, though it’s something you might need to practice simplifying for your reader.

There are good reasons to write medical fiction:

*You know something about medicine and can educate others. In our first ER novel, one of our medical emergencies was a child with a bee sting who developed an anaphylactic reaction and nearly died. Before the book was ever published, we received a call from one of our editors. He was in tears as he told us he had just finished editing that scene when his own daughter developed an anaphylactic reaction. He recognized it and got her to the ER. The doctor told him that if he hadn’t gotten her there when he did, she would have died. This was a good reason for us to keep writing these books. That, plus we had a contract.

*Another reason is that you might have personal experience with a particular medical subject. Also a good reason, because this way you already have half your research done. Writers have to do research for every book we write, so why not make use of what we already know. This is another take on “write what you know.”

*Another reason could be that a particular medical scene is necessary for the storyline. If you have a character who is injured in an accident, knowing the medical of the case can enhance your story—not too much, but enough to make it realistic.

*Another reason could be that you’re a medical professional with fun stories to tell, or you personally know one.. Your interests tend toward medicine anyway, and that’s where your heart lies. You have the passion to write good medical scenes or novels that others will enjoy reading because they pick up on that passion.

For thirty years, Mel always practiced in small towns, where everyone knew everyone else. Often, friends would come up to me and start talking about their health, fully expecting me to know about it. Mel took his oath of patient confidentiality seriously. He never betrayed a trust. No medical person should.

Bad reasons to write medical fiction:

*You think it will sell well. Medical fiction is just as difficult to market as any other genre—and in some ways, harder. Bethany House had a lot of trouble figuring out how to market our six ER novels, even though the television show, ER, was popular at the time. By the end of our sixth release, they were wringing their hands in frustration, and we started looking for alternate plotlines for our next novel.

*You have an axe to grind. These days in medicine, that is a likely scenario as patients become hot potatoes being tossed from family doctor to specialist to another specialist, with no one there to look at the big picture. I hate going to the doctor. But if you’re only writing to point out how awful medical care has become in the past few years, don’t bother. Everyone knows. However, you can still acknowledge the problems while writing a realistic story. Just don’t let your bitterness show. Or be sure to invest it into your antagonist like we do.

*Another bad reason to write a medical story is because you’ve enjoyed reading medical novels and have been itching to try it yourself because you think you’ve learned enough from them. Reading medical novels is not good research. If the writers of those novels make any mistakes, you’re likely to multiply those mistakes. Start with your own research.

*Another bad reason to write medical fiction: You think it’s easy. Without particular medical knowledge, you’ll find out very quickly that ease has nothing to do with it.

Mel: Which would you prefer to do—write an intense medical scene set in the ER, or go to the dentist? Cheryl would rather have a root canal.

A good medical scene or novel will be three things:

1. Realistic. If the reader doesn’t believe your world, she won’t stay there. Later I’ll share some medical scenes I’ve seen on television that were so unrealistic I couldn’t continue watching—or that Cheryl got so tired of hearing me complain she turned the channel.
2. Understandable. If the reader is confused, she will close the book. I’ll provide some examples later of medical scenes that are incomprehensible, but Cheryl has warned me to keep them short.
3. Entertaining. If the reader isn’t emotionally invested in the scene and doesn’t care about the characters, she will exit.

CHERYL: Mel and I discovered decades ago that we had both studied our respective career fields—his in medicine and mine in writing—for an equal number of years, though obviously Mel did a lot more intense studying.

After we got married, Mel came home from work and downloaded his experiences of the day in the emergency department. I found his stories fascinating and decided his experiences would be great in novel form, such as the time he treated a man who called in about being bitten by his cat. It turned out that this cat was a full-grown African male lion.

We decided to work together with a pen name. I chose Hannah, as I had never had children, and so I identified with pre-Samuel Hannah from the Bible. Mel chose Alexander because it means “Servant of mankind.” He took that to heart, and he still serves others.

When Mel talked about his cases, I was convinced the stories would tell themselves. Mel was sure of it, too. We were both wrong. They absolutely did NOT write themselves. It was more work than I’d ever expended on any book as I tried to weave the medical, romantic, suspense, and spiritual threads together into a three-book series—Writing a series was also a first for me.

The additional work was worth it, because readers and editors do enjoy a well-written medical scene. We took our first ER manuscript, Sacred Trust, with us to the Mount Hermon conference decades ago, where Steve Laube read the proposal and first chapters. He was working at Bethany House at the time and was looking for new writers. During the event, we attended a meet-and-greet with editors and agents and other writers one evening.

I had an attack of shyness during which I dragged a chair behind a ficus tree and retreated the whole night. I discovered later that quite a few other writers have the same issue, so we have an unofficial sisterhood of the ficus tree. On the night we won our Christy, our friend Carol Cox brought a ficus tree branch and gave it to me at the dinner.

Anyway, while I hid, Mel had a conversation with Steve.

Steve read our Sacred Trust proposal and said it didn’t grab him and drag him in at the beginning, but to give it another try and send it to him at Bethany House when the conference ended.

This was Mel’s first experience with what he perceived to be rejection. He was devastated. I was encouraged. I rewrote it and moved a dramatic medical scene from the middle of the book to the beginning, using that to jumpstart the whole story.

Mel didn’t want to change any of the words on “our baby.” He has since learned more about the writing world. With that rewrite we were offered a contract for a three-book series.

When Mel and I began working together, we agreed that I was always the writer who would make the final editorial decisions, and Mel was always the doctor, and no medical mistakes could slip by his edits.

Despite Mel’s efforts, I’ve maimed or killed a character or two, and while he was distracted treating real patients, he missed those scenes. It wasn’t my intention and I’ve apologized and Mel brought them back to life in follow-up edits. I won’t blame Mel for it, but I will blame his language which, combined with my cluelessness, became quite an issue for us early in our writing efforts. This is a hint for you to see if you can get a friend or loved one who is a medical professional to read your finished work to make sure you haven’t killed a patient.

Another reason for this is because editors don’t know medicine. We depend on editors to catch any of our mistakes, and an editor cannot catch mistakes in medicine.

Mel: When Cheryl complained about my language, she isn’t talking about the kind of language that would shock our pastor, but a whole new vocabulary that I had to learn in med school, where the student has to memorize an additional 50,000 terms, mostly Latin, practically doubling the typical vocabulary. But the Latin is vital, because doctors all over the world can communicate in this language. Communication is key to treatment of patients, and often doctors need that extra help.

Doctors also love to use abbreviations. Before I went to med school, I was a respiratory technician. One of my first orders on the job was to give a breathing treatment for an SOB. I admit, the patient wasn’t very nice, but I complained about the derogatory term. A seasoned coworker explained that SOB was an abbreviation for “shortness of breath.”

The medical world is always in a hurry, so we fall back to abbreviations for those Latin or English words used to describe pretty much everything. HA is headache, EKG is electrocardiogram, etc. There are approximately 20,000 official medical abbreviations. They are used universally, so anyone speaking English can communicate with anyone else about a patient using those abbreviations. It saves a lot of time, which is in short supply. And if you include acronyms, which are abbreviations where each letter stands for an individual word, the number approaches 90,000. For example, ABG stands for “arterial blood gas.”

To further complicate communication issues for patients and writers of medical scenes or novels, doctors love to name things after themselves, such as illnesses and treatment plans, surgeries and procedures. The National Library of Medicine estimates that these medical eponyms number over 8,000.

For example, five basic symptoms of appendicitis—vague, diffuse abdominal pain, nausea/vomiting, pain localizing to the right lower quadrant, fever, elevated white blood cell count on blood work; in that specific order—are called Murphy’s Sequence and are highly predictive of appendicitis. Of course, don’t make the mistake of confusing this with Murphy’s Sign, which is used to diagnose an inflamed gallbladder. That is just one of thousands of confusing examples of using doctor names in the medical field, which further alienates the doctor from the patient—or, in this case—the writer.

And of course, we doctors have to have drugs to treat patients. At latest count, there are 4,763 approved drugs in the United States. And they all have generic as well as trade names.

Please remember not to use trade names, such as Tylenol, in your book. Especially if it’s derogatory. Use the generic name acetaminophen instead. But as writers, you already know that.

Lastly, to add to the confusion: Medicine is as much an art as it is a science.

For example, something as simple as treating a sore

throat. Do you go ahead and put them on antibiotics based on how miserable the patient is, or do you need to do testing first? Fortunately, we can use the Centor Criteria to…

Cheryl told me not to get so technical. As our good friend Ron Benrey liked to say, “Fear, panic, chaos—my work here is done.”

So If you’ve ever read your doctor’s notes about an appointment, you might be confused, but also a little frightened when you try to figure out what all those technical phrases and abbreviations might mean.

For patients, the doctors need to simplify, or, as Cheryl calls it, dumb down. This has become one of her favorite phrases when working with me on medical scenes.

Cheryl: I’m constantly warning Mel not to talk over my head, especially when speaking medicalese. I almost always beat Mel on the Reader’s Digest Word Power test—though never by much. That’s because those tests are written in English for the common reader, and not for doctors. They’re also multiple choice, which I like.

I have a decent vocabulary, but when I started working with Mel I was stunned to discover how much I didn’t know. I had to swallow my pride very quickly and admit that I had no idea what he was saying when he was describing a medical scene—sometimes not a single word of it. And that actually surprised him. First, I asked him to dumb it down as if I were a fifth grader. After he did that, I had to say give it to me as you would a kindergartner. Simplify. Over and over again. This became frustrating for both of us.

If you’re an experienced doctor, nurse, med tech, physician assistant, nurse practitioner or any other medical professional, writing fiction, for you, could be like a wild, untamed horse wearing a bridle and saddle for the first time. I had a horse like that once, and he was never tamed. Mel was more tamable.

Fiction is a whole new world of communication for someone steeped in math and science. And you have to communicate with words your readers will be able to not just understand, but enjoy.

Simplifying the medicalese isn’t enough. Reading medical terms can be overwhelming for the reader in the first place, but additional complicated words might scare the reader away completely, especially when one is writing a lot of medical scenes.

Even if you’re great with English and vocabulary, you have to be cautious. Too many readers have told me they had to use a dictionary for some of the words I’ve written, and some of these readers were medical professionals. There are a lot of nurses who read medical novels. But the words they had to look up weren’t medical, they were a part of my own vocabulary. I was doing these readers no favors.

These days I will use my computer’s thesaurus to find a simpler word for the one I’ve used.

Ever since I started writing decades ago, the term KIS was something I had to practice often. Keep it simple. A medical thread through the plot can be as much of the story as the spiritual thread, the romance thread, and the suspense/mystery thread. Weaving three or four plotlines through the whole manuscript can be overwhelming, so keep the medical talk as streamlined as possible, doing yourself and your reader a favor.

MEL: Shortly after the TV series ER became a hit, the creators were asked what was the secret to their smash success. They replied that they knew they couldn’t make the show realistic, but they could give the ‘allusion of reality.’

You can put a glossary in the front of the book, and maybe one or two readers will refer to that if you don’t overwhelm them. But as we know, readers typically read for entertainment, and they won’t be entertained if they’re scrambling back and forth in the book trying to understand it better. They aren’t reading for a medical degree, but for pleasure.

Another reality you need to skip is that the amount of time a doctor will allow the patient to talk before interrupting is 11 seconds. I’ve looked this up and several online sources agree on this. It’s a shame, too, because if that patient would be allowed to talk for a minute, or even thirty seconds, the doctor would often learn what he needs to know from the history. Unless you want readers to see this doctor as a jerk, you will want to allow more time for the patient to talk in your scene.

CHERYL: The ER novels we worked on together contained a lot of hot medical action. When I had Mel outline each scene for me, he kept them strictly medical. It wasn’t until I took the outline and developed it into a story with a spiritual message, a romance, a suspense, along with the medical, that he grasped what I was trying to do. I had to delete a great deal of the medical-speak, which he didn’t understand at first. You know these egg-head geniuses don’t realize that not everybody computes difficult equations as easily as they do.

Each scene needs to draw the reader in. We can’t lose the reader with technical terms. On the other hand, since many readers are medical professionals, we need to get the foundation of the medical scene correct.

When Mel and I were working on our second series of ER novels, we were at a medical accreditation conference, and one woman who sat with us at dinner said she wanted to read about the personal lives of doctors, not their work lives. She didn’t want to delve back into work on her off hours.

That was kind of a discouragement at the time because, even though we did write about the personal lives of our characters, there was a lot of medicine involved. And it was a lot of work.

After we wrote six heavily medical novels, I was able to see what this woman meant. It was overwhelming. As I’ve said, our publisher was also having trouble figuring out how to market these novels, because despite the television series ER, ours was a fairly new genre, as Emergency Medicine was a new specialty.

About that time, we received word from Harlequin that they were starting a new women’s Christian fiction line and wanted a Hannah Alexander novel.

I pulled out a proposal for a manuscript I had written years before I met Mel, and together he and I worked on medical scenes for the book, but with far less medical than we’d been doing. This began our Hideaway series. We typically used medical people as our main characters, but wrote more about the lives of the doctors and nurses and veterinarians than about the medicine itself. In these books, medicine wasn’t the main theme of the story, but a decent part of it. We wrote ten Hideaway novels before switching to another series.

As an example for how we wrote about medicine without writing a lot of medical scenes, our main character in Hideaway loses a patient in the ER who was mortally wounded in an accident. The husband sues. That patient was her sister. The death of her sister—seeing her that way, and dealing with the upheaval of the legal battle, sends her escaping to the small town of Hideaway to deal with the pain. It was much easier to write her after-story of hiding out in a small town than it was to write any one of our six ER novels, and it sold better.

A well-known medical speaker once said that some meds are the main course, and others are used as the spices. To use the analogy, the medical aspect became the ‘spice’ to provide a unique perspective, but a good story line and strong characters will always be the main course.

I still love our Sacred Trust Series and our Healing Touch Series. I have enjoyed rewriting them extensively for a newer readership, but even though Mel is retired now, I don’t think I can handle all the extra work it involves to get all the medical correct—especially since it seems to change every few minutes.

MEL: Keep in mind that every medical scene needs to tie in with the whole story. Don’t do a medical scene just to write a medical scene.

If you are an experienced medical professional, you can decide for yourself what to do.

If you need help from a medical professional, then you decide beforehand what kind of injury or illness you want your character to have—or to deal with—and then give those parameters to the medical person. What do you want to be the outcome of the scene? If they’ve never experienced fiction writing before, it might take some explanation from you about what you need from them. Every patient’s outcome is one of the following.

Treated and released

Admitted

Transferred: either to another part of the hospital, such as Labor and Delivery or Surgery, before actually being admitted.

Or to another hospital if your hospital lacks the specialty care or the capability to treat the patient’s needs.

Died

Eloped (which means left against medical advice AMA)

I recommend writing the medical scene technically at first. Just as in choir or chorus you try to hit the top of the high note instead of straining to reach it, I think it’s best to wait until later to simplify the technical aspect of the scene for the enjoyment of the reader. If you’re a medical professional or are working with one, this will ensure you get the medical right. Then you can simplify from there.

If you’re explaining something medical in the book that you need your reader to understand in the scene, either have the doctor character put it in layman’s terms to the patient, or to the patient’s family.

CHERYL: This is why it helps to write from the patient’s vp if possible. It isn’t always possible, but KIS.

Also, medicine is gross. Many times Mel has come home and I’ve waited to have dinner with him, and while he’s downloading about his day during dinner, I’ve lost my appetite. We’ve joked about writing a book entitled: Dinner Date with a Doc; a Dieter’s Guide to Success.

Karen Ball once said, “You want your readers to lose themselves in the story, not lose their lunch.”

One of our editors told us to get into the gory details of one of our characters losing a pinky finger, because readers would expect it. I did it for him, but I didn’t enjoy it. I don’t have the strongest of stomachs. A huge majority of our readers are women, and though there are quite a few who can stomach the gore, there are others who can’t. We’re writing for all of them.

MEL: For research for the layperson, I recommend checking out Mayo Clinic, Johns Hopkins, or Cleveland Clinic. Ideally, you want to find at least two respected resources that agree on the topic you’re researching. I’ve been frustrated with marketing when one respected expert tells me one thing and another tells me the opposite.

We recommend the following sites to help you with your research on medical terms, and to jumpstart your imagination.

For a VERY detailed listing of about any drug you could imagine, go to PDR.net. FYI, this is very good information but also very technical.

For a LARGE listing of medical terms (mostly in the Latin form) and medical abbreviations, check out Merriam-webster.com/medical

A free site that claims to have 856,000 medical abbreviations and acronyms is allacronyms.com/_medical

For a good listing of eponyms, go to wikidoc.org. but be advised it ONLY includes diseases and syndromes. Does not include any eponyms for diagnostic tests or signs.

Litfl.com/eponymictionary claims to have 3,504 medical eponyms and 7,921 related terms.

To summarize the medical world,

There are more patients

There are fewer health care providers

There is more paperwork

This means less face time with patients

How can doctors do this increasingly impossible task?

Templates. These are preformed outlines individually tailored for everything from a bug bite to cardiac arrest. They have gone from checklists to forward slash means positive and backward slash means negative. All of these changes are both time-savers and better legal protection for physicians. For example, if the doctor didn’t check the chest pain box, does it mean the patient didn’t have chest pain or that the doctor didn’t ask? By marking the words with a forward or backward slash, that question becomes moot. Never use the term R/O (rule out), as you can almost never completely rule out anything. Rather, use ‘evaluate for’. Use WNL (within normal limits) at your own risk. Also, don’t use the term normal, as to lawyers that means ‘the doctor didn’t check.’

Red flags. Physicians, and especially ER physicians, ask a lot of what we call red flag questions. What is a red flag question? The term red flag is a slang term used to indicate a warning sign or a reason to exercise caution. It originated from the use of actual red-colored flags to signal danger.

For example, if a patient presents with a HA, red flag questions would be “Is it the worst headache of your life? Did it come on all at once? Have you ever had a headache like this before? The idea of red flag questions is to quickly identify potential life-threatening conditions.

‘Shotgun’ medicine. This is essentially following guidelines and often actual protocols to start diagnosing a patient before the doctor even sees them. One such example is ordering CT scans for complicated complaints. I.e. bad HA; CT head. Bad abdominal pain without obvious cause; CT abdomen/pelvis. Severe flank pain with dysuria (difficulty urinating); CT stone study. Unfortunately it also means ordering a lot of potentially unnecessary tests based on the general complaint because the doctor doesn’t have the luxury of doing a comprehensive history and physical and no one wants to risk missing a serious diagnosis.

Focused vs. comprehensive. The physician shifts from comprehensive to focused in their history and physical exam. Although it is still good advice, especially in ER medicine to “do the fast things fast and the slow things slow,” in reality the focus is in making the diagnosis faster and faster without ever missing anything serious.

What do I mean by focused rather than comprehensive? Basically, focusing on the patient’s chief complaint as opposed to doing a yearly history and physical exam. For example, if someone comes to the ER in severe respiratory distress, should I make sure I do a head-to-toe skin exam looking for a cancerous mole?

An ER doctor can generally tell in the first 30 seconds of actual patient contact if a patient is:

Level 1: Resuscitation (Critical): IMMEDIATE life or limb threat; i.e. cardiac arrest

Level 2: Emergent: POTENTIAL life or limb threat; i.e. heart attack

Level 3: Urgent: Condition could potentially progress to a serious problem; i.e. bad asthma attack

Level 4: Semi-Urgent or Less Urgent: Condition that would benefit from acute treatment; i.e. strep throat, bad ankle sprain

Level 5: Non-Urgent: Condition that required care can be safely delayed; i.e. bug bite

Medicare classifies all hospital/physician visits as:

Levels 1-5 (lowest to highest) plus a special one for Critical Care

All patients, especially in the ER, are evaluated based on the A,B,Cs:

A. airway; patient talking normally; airway is fine; young child with severe croup-in trouble and needs emergency treatment.

B. breathing; can patient talk without pausing for breath, breathe normally lying down, etc. Can’t breathe except seated and leaning forward, baby with respiratory rate of 60 that shouldn’t be higher than 40s-needs emergency care

C. circulation: is skin pink, warm, & dry (P/W/D)? Pink means good oxygenation, if very pale think blood loss; Warm (normal), cool (shock), hot (fever/sepsis); Dry (normal), too dry (dehydration; types of poisoning), moist (shock; types of poisoning; low sugar). Pulse; strong and steady—good; weak and thready—bad. Capillary refill is brisk meaning less than 2 seconds (normal)—good; >4 seconds (severe dehydration)—bad.

D. disability; specifically neurological disability; usually use Alert & Oriented x 3 (A & O x 3)–to person, place, and date; sometimes 4^th (purpose); A & O x 3; good. Unconscious–bad

E. exposure: in trauma look for injuries; in any serious patient should do this looking at skin for i.e. infections, any injuries/deformities

No bones sticking out; good.

Bones sticking out or active bleeding—bad. (Sorry, but Cheryl did tell you medicine can be gross)

All doctors use this charting format:

Subjective (History) How much history? ‘My 3^rd cousin on my mother’s side had…”—too much. However, “It feels like an elephant sitting on my chest…”—start immediate treatment for a heart attack. One popular acronym we use is:

SAMPLE:

S: Symptoms (vs. Signs). Symptoms cannot be objectively measured, such as “I have a bad headache. Signs are objectively measured, such as any of the vital signs-heart rate, respiratory rate, temperature, blood pressure, and pulse oximetry (oxygen saturation).

1. Allergies; i.e. don’t give penicillin to a patient who is allergic to penicillin

M. Medications

PMH. Past Medical History; also Past Surgical History—it’s really embarrassing to be talking to the surgeon about an acute appendicitis case when the nurse points out the patient had an appendectomy 5 years ago. They don’t grow back.

L. Last meal; It’s very important to a surgeon and anesthesiologist when the patient last ate as they don’t like to operate on a patient with a full stomach.

E. Events; specifically concerning the chief complaint. This is a good place to ask the red flag questions.

Objective (Physical) plus all lab, xray, etc., results

Assessment: Diagnosis. Until all the results are back you have a differential diagnosis.

Plan: Treatment based on all the above.

A new term for SOAP, since—as Cheryl has already mentioned, they are always chhanging terms—is SBAR, (Situation, Background, Assessment, Response

I promised examples of NOT getting the medical details right:

Don’t get me started on a half-way realistic CPR scene. Granted, to do CPR correctly you can seriously injure a healthy patient, but there are lots of realistic looking mannequins now.

To say nothing about what is anatomically impossible to do. For instance, you can’t cross clamp an aorta from the right side—Nevermind. Cheryl tells me I’m getting technical again.

Some of my ER associates once encouraged me to watch a certain TV show (which shall remain nameless) because they thought it was so realistic:

First episode: paramedic in back of ambulance screams “Stop.” Driver screeches ambulance to a stop. Paramedic goes “It’s v. fib,” then shocks patient. Portable cardiac monitor/defib units are much more sophisticated than AEDs. You certainly don’t have to stop the ambulance to check the rhythm.

Second episode: Monitoring a small child for respiratory collapse who is stuck between two buildings. Ambulance is on standby with full resuscitation capability. When firemen free him and bring the unconscious, nonbreathing child to the paramedic, she pulls out a pocket mask and does rescue breathing. No oxygen, no bag valve mask ventilation, no IV, no cardiac monitoring. Of course this child wakes up and starts breathing on his own after just a few rescue breaths.

I could never bring myself to watch the show again. Don’t do that kind of thing to a reader who knows medicine. This is why you need to get your details right.

I promised you earlier that I would give you an example of a medical situation that was realistic, and then make it understandable. Cheryl told me to keep it short. This used to be a full page and she made me pare it down because she was afraid we’d lose attendees.

Realistic: Pt. c/o malaise, myalgias, asthenia, anosmia, and dysgeusia. Also c/o HA and mild SOB. Denies CP, N/V.

I can see what Cheryl means. This makes it understandable:

Patient complains of body aches, weakness, loss of smell, and altered taste. Also complains of headache and mild shortness of breath. Denies chest pain or nausea or vomiting.

That explains what the realistic notes are saying, but there’s no way even Cheryl can make that entertaining, even though it’s understandable.

Hopefully, here is a scene Cheryl wrote that is Realistic, Understandable, and Entertaining. It doesn’t pertain to the above example, because the patient in this scene is receiving CPR. I just wanted to read a scene Cheryl wrote to finish up. It also qualifies as the meet/cute (or is that cute/meet?) for our 2 protagonists in The Sacred Trust series.

Lukas Bower, DO, has started CPR on a Do Not Resuscitate patient because the power of attorney has legally overridden the written DNR form. The patient’s grand-daughter, Mercy Richmond, MD, has just arrived in the ER.

Mercy Richmond raced down the block from her medical office to the hospital without bothering to remove her lab coat.

Shoving open the glass doors into the emergency reception area, she barely slowed her stride. “Carol, where’s Grandma?”

“She was in exam room eight, but they called a code and moved her to Trauma Room One.”

Mercy stopped and whirled back with a gasp. “There’s not supposed to be a code.”

Carol shook her head in sympathy. “Dr. Bower called it. He had to.”

Mercy swung back on course. This was unconscionable. First, administration had arbitrarily decided to bring in a full-time ER doc from Kansas City, and now this hotshot doc had decided to ignore a perfectly legal DNR request.

She pushed through the swinging double doors where several staff had gathered in the trauma room, six people altogether including Grandma’s frail still body on the bed. Others worked with quick efficiency, responding without question to the soft-spoken commands of a broad-shouldered, brown-haired man in green scrubs. He knew the drill well.

“Get me a blood gas…. Push the epi now, Lauren…. Continue CPR.”

Mercy stopped inside the doorway as a nurse from upstairs pushed methodically against Grandma’s chest and another bagged her.

“What’s going on here?” Mercy demanded. “Doctor, what are you doing to my grandmother?”

He looked up, his blue eyes behind gray-framed spectacles holding her with surprisingly gentle concern. “You must be Dr. Richmond. I’m sorry, but as per your mother’s request, we are attempting resuscitation.” He turned back to the table. “Stand clear,” he called as he pushed the button to defibrillate Grandma’s chest.

Mercy stood in stunned horror as the frail body jerked, arms flying out, legs up. Mercy had done the same procedure herself many times during her shifts in ER, but not on someone she loved like Grandma.

“Continue CPR. Prepare more epi, and give amiodarone 300 mg IV push now. What’s that blood gas?”

“Not back yet, Doctor.”

Mercy stepped toward him. “Dr. Bower, I’m this patient’s granddaughter. Stop this code now.”

He was a few inches taller than her five feet eight. His expression held calm authority. “As I said, Dr. Richmond, your mother—”

“I heard what you said, but my grandmother signed a DNR form weeks ago. Surely that has bearing on this case.”

“You should know as well as I do that it doesn’t.” Dr. Bower’s voice betrayed frustration. He leaned closer to her. “Your mother’s direct order is to resuscitate.”

Mercy wanted to scream. “Don’t abuse this patient any more than she has already been abused!” The words shot through the trauma room and across the ER with far too much energy. Mercy clamped her mouth shut.

Dr. Bower leaned close to her. “Then please talk to your mother. I tried.”

“Where is she?”

“She was in the private waiting room when I left.” Dr. Bower told the staff, “Stop CPR.” He shook his head at the monitor. “No change. We have to shock again.”

He charged the defibrillator to 360 joules. “Clear.” It was obvious he did so with extreme reluctance.

Again they shocked, and Mercy could not bring herself to leave. CPR resumed. She knew the routine well. The longer they worked the more obvious it became that Grandma was far past their so-called help. And that meant she was also past any more pain.

Dr. Bower called a halt a seeming eternity later. Mercy did not move until he pronounced the time of death. The words of finality shot through her with a hideous sense of loss. She was suddenly numb. Part of her mind acknowledged that Dr. Bower stepped to her side and whispered kind words of commiseration, but she couldn’t respond. He backed away but didn’t leave the room.

She stepped from the doorway as the code team cleaned up the mess of scattered monitor strips and plastic wrapping that had been tossed on the floor during the code. One by one, they filed out past her, some avoiding her eyes as if ashamed of the work they had done.

If you have general questions about writing medical—and we’ve left so much out due to time—email us at askhannah@hannahalexander.com