Throwback Thursday #10: Top Five Favorite Medical Scenes

It’s Medical May! This week, we’re throwing it back to my top five favorite medical scenes. I’ve always been fascinated by medical stuff – even as a small child, my favorite book was Curious George Goes to the Hospital, and I grew up watching shows like Rescue 911 and ER and reading Lurlene McDaniel books about teenagers with terminal illnesses. So, naturally, when I began to write as a hobby, I gravitated toward medical-based storylines. Hospital scenes have become a staple of my stories, and I’ve certainly gotten better at writing them over the years. Here are the five I’m most proud of!

5. Cary Treats Nick Right

In Chapter 15 of Curtain Call, nurse-practitioner-turned-performer-turned-home-health-nurse Cary administers newly-diagnosed cancer patient Nick’s chemotherapy for the first time. I love the interaction between Cary and Nick in this scene. Written from Cary’s perspective, it shows the awkwardness she feels as she straddles the blurred line between starstruck fangirl and skilled professional, a feeling that will linger through at least the first half of the novel. But I’m also proud of the level of detail I put into the medical aspect of not only this scene but this story as a whole. Since Curtain Call was my second Nick cancer story, it was a goal of mine to improve upon the first one, Broken. Writing Broken taught me how to research in order to write what I don’t know as realistically as I can. I took that and ran with it while working on Curtain Call. I kept a fourteen-page outline full of information I’d found about Nick’s condition and its treatment, including a detailed timeline that interweaved his chemo schedule (which was a real regimen called Hyper-CVAD) with the Backstreet Boys’ tour dates. In the course of my research, I read medical journal articles and watched videos of procedures on YouTube in order to get the details right. I’m sure it’s not perfect – at the end of the day, I am just an amateur who does research online, not a trained medical professional – but I take pride in the effort I put into making stories like this one seem plausible.

4. Nick Shows Dr. Elizabeth the Shape of His Heart

In Chapter 9 of A Heart That Isn’t Mine, Nick undergoes a stress echocardiogram to evaluate his worsening cardiomyopathy – or, at least, that is what he’s told. The chapter starts with Nick having a nightmare about Freddy Krueger stabbing him in the back while he’s in bed. On the surface, it seems like a simple dream inspired by a conversation about horror movies in the previous chapter. But, on a deeper level, it symbolizes Nick’s vulnerability, the danger he’s in every time he loses consciousness while under the care of his cardiologist, Dr. Elizabeth, and nurse, Dani. There’s a light-hearted conversation between these three characters in the first half of the chapter about how many BSB song titles include the word “heart.” I had a lot of fun writing that little exchange, although “Quit Playing Games (With My Heart)” hasn’t been quite the same for me since. 😬 Then things get serious again, as the echocardiogram triggers a memory of the sonogram that detected the fetal death of Nick and Lauren’s (fictional) second baby – an important bit of backstory that influences Nick’s state of mind and decision-making throughout the story. Since Nick’s heart condition has seemingly been exacerbated by physical activity, Dani puts him on a drip of dobutamine, a drug designed to speed up his heart rate in order to simulate the effects of exercise. During the procedure, Nick experiences an irregular and potentially dangerous heart rhythm called ventricular tachycardia, which his medical team reverses with more drugs. But what Nick and first-time readers don’t realize is that the drugs Dr. Elizabeth orders are not always the same drugs Dani actually administers.

If you go back and reread this story, you’ll probably pick up on details you didn’t notice or think twice about the first time around. In this chapter, for instance, Nick doesn’t experience any concerning symptoms until they increase the infusion rate of his IV drip – which, unbeknownst to him, also contains a drug called digoxin. Digoxin is used to treat heart failure, but it can also cause symptoms that mimic those of heart failure when given in toxic doses or mixed with other medications. When she disconnects the drip, Dani pretends to flush Nick’s central line with saline, but really, she injects more digoxin directly into his bloodstream, causing a dramatic increase in his symptoms. He has difficulty breathing, so Dani puts an oxygen mask on his face. Later in the story, it’s revealed that at least some of the “oxygen” tanks are actually filled with a hypoxic breathing gas used by deep-sea divers, which lowers Nick’s oxygen levels and worsens his shortness of breath, making him look and feel sicker than he would otherwise. While he’s on the verge of blacking out, Nick’s vision blurs, and the room takes on a yellowish-green hue, which is a hallmark sign of digoxin toxicity. I mentioned this yellow-green tint several times throughout the story, and every time, I wondered if there was a medical professional reading who would pick up on that clue and recognize what was really going on. But, at this point in the story, poor Nick doesn’t know any better and takes his medical team at their word when they tell him what’s happening. Under the pretext of giving him lidocaine to stabilize his heart rhythm, Dani administers digoxin immune fab, the antidote to digoxin, which resolves his symptoms. In hindsight, you realize this was all just a dress rehearsal for the next chapter, in which she takes her act a step further and actually causes Nick to go into cardiac arrest for the first time. It also validates Dr. Elizabeth’s recommendation that Nick have an ICD – implantable cardioverter-defibrillator – inserted in his chest, which she and Dani will use to continue torturing him.

The chapter ends with a Wizard of Oz reference, which is also symbolic of the deception happening in the story. Much like the wizard, the members of Nick’s medical team are not what they seem, as he will discover further down the yellow brick road. Researching for and writing this part of the story was a fun challenge for me. I had to try to keep Nick and my readers in the dark while planting clues that would come to light once the big twist was revealed later on. The many layers of this chapter make it one that I’m really proud of.

3. Brian’s Heart Beats Again

🎵 Brian, Nick can’t help it… He left you drowning in the van.🎵

In Chapter 5 of Heroic Measures, my BSB/ER crossover, Brian is rushed into the emergency room at County General Hospital in cardiac arrest after drowning when the group’s van crashed into the Chicago River. While the chapter starts with Kevin and ends with Nick, it’s the heroic measures taken by the ER staff as they desperately try to save Brian’s life that make up the heart of this absolute beast of a chapter and the story as a whole. When I first started writing Heroic Measures back in 2012, this was the scene I was most excited about. It was inspired by my favorite episode of ER, Season 2’s “Hell and High Water,” which made George Clooney a star. Clooney’s character, Dr. Doug Ross, spends most of the episode trying to save a kid who gets caught in a storm drain during torrential rain. As the water rises, Dr. Ross pulls off a dramatic rescue, only for the hypothermic boy to crash on the way to the hospital. The last part of the episode is particularly riveting, as Ross leads the effort to resuscitate the boy in one trauma room while a little girl who was hit by a car earlier in the episode codes in the room next door. I looked forward to the challenge of writing a really dramatic, drawn-out, detailed, ER-style resuscitation scene. But that was before I wrote A Heart That Isn’t Mine.

Since Heroic Measures was always more of a side project that I played around with in between my main projects, it took me until 2020 to finish the first four chapters and make it to this point in the story. By then, I was burnt out on writing resuscitation scenes, so this chapter wasn’t nearly as much fun to write as I’d thought it would be. I did have fun researching for it, though. A lot of my “research” for this story involved watching old episodes of ER, which is honestly part of the reason it took me so long to write – I would watch part of one episode for a specific purpose and promptly get sucked into an ER marathon that took up all my writing time. This happened multiple times over the course of writing this story. But, of course, I did real medical research, too. One of the biggest challenges I faced with this chapter was figuring out the most realistic course of treatment for the time it takes place in. After AHTIM, I was pretty familiar with modern ACLS (Advanced Cardiac Life Support) guidelines, but they were different thirty years ago. I did end up striking gold and finding a medical journal from September 1995, the exact month and year my story takes place, that laid out the guidelines, and it was interesting to see the similarities and differences from the information I’d read while researching for AHTIM. It gave me an even greater appreciation for the ER writers because, while they weren’t always perfect, they got a lot of stuff right, according to the best practices of that time period. And not only did they nail most of the medical info, but the way they wove it so seamlessly into the action of each scene was masterful. I tried my best to emulate them, but it was definitely not as easy as they always made it look.

I’m really happy with how this chapter turned out, though. I love the interaction between Kevin and Susan Lewis, who was always one of my favorite characters (so much so that I’ve been using her last name for my pen name since I was 14). I love the tension between her and Kerry Weaver, who was fun to write despite not being one of my favorite characters. I love the angst of Kevin and Nick watching the team work on Brian, begging them to keep going and not give up on him. I love the miraculous moment when Brian’s heart finally starts beating again. And, just when it looks like the Boys might be out of the woods at last, I love the dramatic twist of Nick suddenly collapsing, ending the chapter on a cliffhanger. It’s hard to beat that… but there are still two more scenes ahead of this one on my list!

2. Quit Playing Games With Nick’s Heart

The climax of A Heart That Isn’t Mine takes place in the cardiac cath lab, where Dr. Elizabeth Gravel tries to cover her tracks by removing the device she implanted in Nick’s chest earlier in the story, which has caused a life-threatening infection. Of course, the latter doesn’t matter to Elizabeth, since she intends to kill him anyway. Most of Chapter 40 is written from her perspective, which gave me the opportunity to really go in-depth and write about the ICD removal procedure in gory detail. That was a challenge for me because I had to research in order to know what I was talking about so that I could write it convincingly. Fortunately, I was able to find medical journal articles that provided a fairly detailed, step-by-step outline of the procedure. I think I even watched a video while I was writing it.

I remember this being a really fun chapter to write because it is full-on horror, which is one of my favorite genres. By this point in the story, the readers know that Elizabeth is a villain and that she has no reason to save Nick’s life. If he survives, he can identify her and ruin not only her career, but the rest of her life. She can’t let that happen. But she can’t just blatantly kill him either. To avoid suspicion, she has to make it look like his death was caused by a complication of the procedure she’s doing on him. This gives each scene a sense of growing dread and makes the whole chapter really suspenseful. The readers are a step ahead of all the other characters, so they see Elizabeth deliberately tear Nick’s vena cava before anyone else notices the blood pouring into the sac surrounding his heart. They realize how much danger he’s in before the detective or the other Boys do. But there’s absolutely nothing they can do about it.

In the last scene of the chapter, Nick codes on the table, prompting Elizabeth to crack open his chest so she can pretend to try to relieve the pressure on his heart, repair the damage she caused, and prevent him from bleeding out. This is where it gets really gory, progressing to the point where Elizabeth is literally elbows deep in Nick’s open chest cavity, squeezing his heart in her hands. And I’m not gonna lie: I absolutely loved writing this scene. It’s intense, dramatic, and horrific. In a comment, one of my readers compared it to a scene from one of the Saw movies, which I took as a huge compliment. The original Saw is one of my favorite horror films, and that type of body horror was exactly what I was going for in this chapter. But you can also see the influence my decades of watching ER had on me in the dialogue. “Come on, people, let’s get those lines placed! We’re losing him!” sounds just like something Benton would say.

And speaking of Benton…

1. Carter Than Life

In Chapter 7 of Heroic Measures, Carter meets Carter as fourth-year medical student John Carter and his mentor, third-year surgical resident Dr. Peter Benton, operate on their fifteen-year-old patient, Nick Carter. When I first outlined Heroic Measures and started matching ER characters to the Backstreet Boys they would treat, I couldn’t miss my opportunity to make the Carter connection and have Carter be involved in Nick’s case. It worked out perfectly because Carter was in his surgical sub-internship in Season 2 of ER, the time period in which my story is set, and I already knew that Nick would need surgery, as I wanted him to initially seem uninjured, only to crash later due to undetected internal bleeding. That was another idea I borrowed from “Hell and High Water,” the episode I mentioned earlier.

To be honest, this chapter was not the first one that came to mind when I was making this top five list. I knew I would include at least one chapter from Heroic Measures, of course, but I naturally gravitated toward the Brian-centered Chapter 5 at first. It’s more dramatic and, thus, more memorable to me. But when I reread both chapters, I realized I actually like Chapter 7 a little better. Maybe it’s because I have better memories of writing it; this chapter was a lot more fun to write than the Brian chapter, which felt too similar to the seven or so resuscitation scenes I’d written for AHTIM a year earlier. Like I said, I was tapped out on those by the time I wrote the majority of Heroic Measures. But Chapter 7 had a different vibe. It doesn’t have the BSB bromance that Chapter 5 does, but it does feature my favorite ER bromance: Benton and Carter!

As a kid watching ER, I loved power couple Doug and Carol best, but as an adult rewatching ER, I’ve come to appreciate Benton as the complex character he is. I love the growth he makes over his eight seasons on the show, and of course, I adore the way his relationship with Carter develops during that time, too. I really enjoyed writing the mentor-student dynamic between the two of them in this chapter. Their personalities are very different, which shows in the way they each interact with Nick. Benton is all business, cold and clinical as he examines the kid, whereas Carter’s warm bedside banner shines as he makes conversation with Nick and tries to comfort him before surgery. Throughout the chapter, we see how eager Carter is to earn Benton’s approval – and how much the rare bit of praise he gets from Benton at the end means to him.

As I wrote in my author’s note at the end of Chapter 7, I made this chapter much more dramatic than it was originally intended to be. Nick collapsing at the end of Chapter 5 was supposed to be his most dramatic moment; I wasn’t planning to have him code on the table, too. But as I wrote the surgery scene, I saw an opportunity to use my favorite line of ER trauma room dialogue – “We got a pumper!” – and I took it. Nick blows a clot in his mesenteric artery and starts bleeding out. Despite Benton’s desperate efforts to control the bleeding, Nick’s blood pressure plummets, and they lose his pulse. I love how the dialogue in this scene turned out; to me, it sounds just like what they would say on the show. I think that’s why this chapter reigns supreme.

Considering most of my stories contain at least one chapter set in a hospital, it may seem odd that out of all the medical scenes I’ve written over the last twenty-five years, my top five come from just three stories: Curtain Call, A Heart That Isn’t Mine, and Heroic Measures. But what these three stories have in common is that they’re all told partly from the perspective of characters who are medical professionals, which gave me the opportunity to go more in-depth with the medical details than I would have otherwise. Of course, this also made them more difficult to write because they required more in-depth research – but I love a challenge! That’s why I’m so proud of these five chapters in particular.

What are your favorite medical scenes or storylines? Leave a comment below and let me know!