The Outlandish Companion - Diana Gabaldon [180]
I would also note that a _single_ (massive) PE causes death by sudden occlusion of major pulmonary arterial supply, resulting in the dramatic onset of anoxia. A strong victim fights violently for a few moments, flailing and gasping desperately for air, before succumbing, a weak patient merely ceases to live. (The problem with pulmonary embolic phenomena is that, however well the patient can move air, it just doesn’t do any good. The blood won’t be oxygenated because pulmonary circulation has ceased due to the blockage. No heroic measures of any kind can save the victim from massive PE.) A less sudden death from pulmonary embolic phenomena results when there is a more gradual showering of many micro-emboli into the lung-bed capillaries, causing a more gradual reduction in pulmonary circulation. So you might want to refer to pulmonary emboli instead of pulmonary embolus if this is to be the possible cause of a death that doesn’t occur suddenly.
Is any of this helpful? I hope I’m expressing my ideas clearly here, and that they may be constructive for you. Ellen and others may have more useful suggestions.
I’m sorry to hear about the migraine. One of my problems in recent months, too. Matter of fact, I had one yesterday—all day. It’s a terrible thing when a man feels so bad he can’t even whine!!! Sincerely, and with best regards, Alan Smithee To: Alan Smithee 110165,3374 (X) Dear Alan— Thank you! Re your comments, let’s see if I can disentangle enough to answer coherently. Okay. Rosamund is suffering from fever _before_ administration of penicillin (I’d figure anybody who’d had a major wound infection for three days would have some degree of fever, don’t you?). So we can probably assume that the septicemia is systemic, thus providing a stronger motive for trying the experimental penicillin. Likewise, we can safely assume that the fever is not caused by the injection. (Claire does write, “Patient presented with high fever…” right? Doesn’t this mean the patient had a high fever when first seen?) Rosamund does expire very quickly following the second injection—maybe ten to fifteen minutes? (given that Claire is trying various resuscitory [goodness, is that a word?] techniques, like cricothyrotomy). You (the reader) might not have much idea of the time frame from the original description—which is the result of Claire’s caution in writing down a detailed description. If that seems a necessary piece of information, it would be easy to add a line regarding the timing. If she’s writing this purely as her own case notes, it wouldn’t be necessary to record a lot of stuff—like the time between injection and expiration, or the failure of resuscitation—because she (Claire) would be unlikely either to forget those details, or to need them later. On the other hand, if she’s writing at least in part for the information of an unknown person who may have nothing to go on _save_ the case notes, she’d better put down every single thing she can, including things like a very detailed description of the anaphylaxis and the steps taken to combat it (ineffective though they might be); an illustrated account of how to perform a cricothyrotomy (with notes on the circumstances in which to employ this procedure); possible causes of complication (including pulmonary emboli, abscess-spilling, etc.), and so on. However, she hasn’t gotten to the point of deciding how much to put down; when the scene opens, she’s still in the process of writing. (One thing to consider from a purely novelistic point of view is how much detail will lend hat sense of reality to a reader, and how much is overkill Yes, OK; she should administer the first injection before doing the mechanical intervention—a good point. Re the pigeon
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