Do No Harm (64 page)

PBd: Is Clyde's end inevitable?

Hurwitz: Tough question. No character's fate is inevitable when you begin writing a book, because then all you'll do is railroad that character to said fate. But if you draw realistic characters, and if you allow them free reign within your prescribed plot, the choices at their disposal narrow until one ending can be said to be more or less organic than another.

PBd: Clyde escapes, Clyde comes back -- happens all the time in our all-too-real world. We've grown used to it. Further to the verisimilitude theme we've got going here (and this relates to Do No Harm as well as ER) at what point as a novelist does reality leave you feeling defeated -- or does it? It's become cliche to say that anything a writer can think up, wait for just a little while and reality will trump him.

Hurwitz: This is not the sort of thing that leaves me feeling defeated as a novelist. In fact, I find it sort of invigorating. There's a relationship between art and life -- and a complex one. I don't believe one merely imitates the other. I think they affect each other, while maintaining distinct rules of their own. There is something magical in the fact that legal proceedings from Oscar Wilde to Joseph McCarthy offer suspense, structure, and pacing that is superior to most courtroom thrillers. And then something like September 11 comes along, and everyone's first thought is "How can we write after that?" But that event offered us examples of heroism and patriotism, not to mention cowardice and maliciousness, on a scale that we haven't seen in years. And that, too, will find expression in art.

PBd: Ever toy with the idea of becoming a doctor yourself?

Hurwitz: Not recently, much to the chagrin of my Jewish parents. When I was younger it was something I contemplated, in part because severe injuries and blood don't faze me tremendously. I suppose that quirk of mine aids in my career as a novelist as well -- flipping through crime scene photos or standing in on a gory procedure aren't pleasant tasks, but I can handle them. If I were going to be a doc, the ER appeals to me the most -- the fast pace, the constant surprises, the quick fixes. But I think the primary obstacle to a career in medicine is that I like writing novels too damn much.

STAT, SALINE, CBC: 

Why do the characters on ER say "stat" all the time? Why the constant demand for saline? "Pulseox" -- huh? And just what is a CBC? Melissa Hurwitz, M.D. (the author's sister), offers some quick definitions of terms you've heard dozens of times on TV, and also terms that are specific to the medical scenes in Do No Harm. You can easily navigate between this glossary and the text of the novel with a click of a hyperlink.

"blood pressure had just hit sixty": a healthy blood pressure. In this scene, it indicates that the patient has been helped by fluid and blood resuscitation, along with draining of the blood from around the heart.

CBC: The complete blood count (CBC) measures the number of red and white blood cells, the total amount of hemoglobin in the blood, and other vital aspects of blood.

crepitance: gas/air that has escaped from the lungs and has become lodged in the subcutaneous tissues, just beneath the skin. A faint crackling sound or sensation is appreciated when fingers are run over the skin.

cyanotic: displaying bluish or purple skin or mucosal color; caused by poor oxygen supply to tissues.

EKG: electrocardiogram, also referred to as ECG. A method of demonstrating the electrical activity of the heart. Circular adhesive patches attached to electrical leads are placed externally on the chest wall and other locations on the patient's body. The results, seen on a monitor or strip of paper from the EKG machine, show the heart's rate and rhythm.

erythematous: redness of the skin caused by congestion and dilatation of the capillaries.

etomidate and rocuronium: standard medications used to sedate and paralyze a patient prior to intubation.

"heart rate = 140": the heart rate is a key vital sign. It is usually assessed along with blood pressure, respiratory rate, and oxygenation saturation. A normal resting heart rate in adults is between 50-70 beats per minute. An elevated heart rate indicates pain, anxiety, fear, fever, or decreased intravascular (within the veins) volume.

Decreased intravascular volume: indicates that there is not enough volume (i.e., blood) in the patient's blood vessels to get enough oxygen to the patient's tissues and organs. The body compensates by having the heart beat faster.

o-two saturation: refers to how well one is breathing and getting oxygen to tissues and organs. Normal saturation is 100%.

patency: openness, extent of being unblocked.

pericardial tamponade: occurs when blood fills the sac around the heart, impeding the heart's ability to beat properly and pump blood to the body.

pH strips: placed on the skin to determine whether a contaminant is basic or acidic. The nature of the contaminant affects assessment and treatment of injuries.

"pulseox", or pulse oximeter: is a device used to measure oxygenation saturation (see "o-two saturation"; a small sensor is typically attached to the patient's finger.

rapid infuser: a machine that quickly transfuses blood.

retractions: the skin of the chest pulls in upon inspiration, indicating difficulty breathing.

saline: the standard fluid used for volume resuscitation. If someone has had significant bleeding, lost volume must be replaced. While waiting for blood products to arrive, intravascular volume can be quickly expanded with saline.

stat: from the Latin, statim, meaning: "Immediately!"

stridorous: a loud, harsh respiration, usually upon inspiration (inhalation); caused by swelling of the upper airway.

substernal: beneath the sternum.

supraclavicular: above the collar bone.

tension pneumothorax: A collapse of the lung caused by a puncture of the lung. Air escapes and fills the space around the lung, compressing it. The lung cannot expand during inspiration because it is being pressed on by the air that now surrounds it. This was accurately depicted in David O. Russell's film of the Gulf War, Three Kings (1999). When Mark Wahlberg's character, Sergeant First Class Troy Barlow, had a tension pneumothorax and had a needle inserted into his chest with a valve to relieve pressure by releasing the air.

Melissa Hurwitz, M.D., is a Fellow in Pediatric Gastroenterology at Packard Children's Hospital at Stanford University.

Melissa Hurwitz, M.D.: My staunchest (and longest) supporter and one hell of a reader

The memory of my grandfather, David Hurwitz, M.D.

My mother: For everything

Matthew Guma: My indefatigable advocate and not-so-indefatigable bourbon cohort

Marc H. Glick and Stephen F. Breimer: Dedication personified

Jess Taylor: King of Commentary, Queen of Vitriol

Adriana Alberghetti, Brian Lipson, Dawn Saltzman, Tom Strickler: Simply the best

David Vigliano, Dean Williamson: For getting it done

Michael Morrison: My esteemed publisher

Lisa Gallagher and Libby Jordan: Marketing gurus

Dr. Jordan B. Peterson, Professor of Psychology, University of Toronto: Who continues to be a major influence on my life. Blame him.

G___M___: For his expertise on everything from digital transmitters to shoe profiling

Matthew Lissak, M.D., Neuropsychiatric Institute: For his insight

Marshall Morgan, M.D., Director, UCLA Medical Center Emergency Room: For allowing me to shadow his attendings and residents

Don Mebust, M.D.: For showing me the UCLA ER from abscess to zoster

Keith Lewis, Embalmer/Autopsy Tech, UCLA Med Center: Brilliant raconteur of the grisly

Peter Catalino: For the med student tour

Officer Marlin Hill: For helping me get down the attitude and the argot

The two John Does: For stuff

Professor Michael S. Berlin, M.D., Director, Glaucoma Institute/Beverly Hills: For his generous counsel on matters ocular

Mohammed M. Elahi, M.D., FRCSC-Plastic Surgery: For his guidance about burn treatment

Robert Andonian, M.D.: For input regarding Peter

Charlotte Brinsont-Brown, L.C.S.W.: For enlightening me on aspects of Children's Services

Bret Nelson, M.D.: The next generation

Kristin Herold: For her support

The booksellers: Thank you

My readers: Who make it all especially worthwhile

Gregg Andrew Hurwitz is the author of The Tower and Minutes to Burn. He is currently at work on his fourth novel. He lives in Los Angeles.

THE TOWER 

MINUTES TO BURN

Jacket design by Richard Aqaun Jacket photograph by Jan Cobb

Designed by Renato Stanisic