The Outlandish Companion - Diana Gabaldon [181]
Many thanks—your comments are _very_ helpful!—Diana
Fm: Alan Smithee 110165,3374
To: Diana Gabaldon 76530,523
Dear Diana,
Yes, I understood that Rosamund presented with high fever. I just wanted to explain that, to me, this sign made it seem less likely that her death was due primarily to anaphylaxis, particularly because death ensued some time later after the second injection. This sequence would make me suspicious that the drug had been ineffective, rather than that it had elicited a fatal reaction in the patient. Normally, to set up anaphylactic reaction with a drug, the patient would have to be exposed to it a week or more before the dose which precipitates the reaction. I’ve been assuming that the patient has been sensitized to something besides the penicillin which is present in her environment _and_ in the drug (as an impurity). I believe this to be the most likely scenario for anaphylaxis, given the circumstances. What I’m trying to get at is that, if you wish to appear (medically) certain that the death is from anaphylactic shock, there has to be a sudden change in the patient’s condition as soon as the penicillin is introduced. As stated before, the best time to administer the drug would be before invasive treatment of the wound. Given the nature of severe anaphylactic shock, I doubt that Claire would have the opportunity to do anything but life support following onset of the reaction.
With a longer time span, the idea that the penicillin engendered a fatal reaction in Rosamund becomes less supportable, I think, though not out of the question. That’s what I was getting at. If you want there to be a question of cause, the scene’s timing is good as is—with the exception that the first penicillin injection should have come before the wound care. I do think it’s important for her to explain her reasoning in her notes, to justify her unorthodox choices. I don’t know if it’s necessary to be explicit. There might be an artful way to allude to it without shoveling medical concepts by the bucketload at the reader.
I think that the scene stands well as is, as long as you intend for there to be a question about cause of death. And the way you use the words really fixes the scene in my mind. I feel like I’m looking out through Claire’s eyes part of the time, and I can feel the warmth of the communion with her daughter on my skin.
I’m having to fight my wife for OUT-LANDER. Shouldn’t have said anything about it until I had finished it. Ha!
Have a good one! Alan
Fm: Ellen Mandell 76764,2512
To: Diana Gabaldon 76530,523
Dear Diana,
Made me cry. More later. Ellen
Fm: Jo C. Harmon 103151,655
To: Diana Gabaldon 76530,523
Dear Diana,
I’ve read your excerpt from THE FIERY CROSS. I’m an RN who worked in the area of internal medicine for a few years. For me, what interrupted the flow of the narrative were the following questions:
Just how is Claire purifying and/or extracting the penicillin from rotted casaba rind?
Where is she getting needles to administer the medication IV?
(My guess is that you’ve addressed these issues earlier in the book.)
With the patient’s manifestations of symptoms which could be indicative of hypersensitivity, why did Claire choose to administer the second dose of the drug… given that the state of the patient’s illness was, for that time, most assuredly fatal?
Was she gambling that she could knock out the infection before hypersensitivity became life-threatening?
I know she’s feeling guilty, but there are other possibilities as to why the patient developed these symptoms, aren’t there? Do these other