Authorpreneur Dashboard – Richard Van Anderson
The Final Push
Mystery, Thriller & Suspense
While on call for the trauma service, third-year medical student Michael Higgins finds himself in an extraordinary situation. He is summoned to the ER to participate in the evaluation and management of a critically-injured patient and soon discovers that the unconscious man lying before him is the same man who, two months earlier, committed a heinous act of violence that shattered Michael’s personal life. Following a lengthy emergency operation, the patient—known only as John Doe—is now under the care of the trauma team, of which student doctor Mike Higgins is a member. As John Doe’s condition gradually improves, Higgins’ personal life deteriorates further, but there might be a way to reverse the downward spiral: if he sees to it that John Doe never leaves the hospital, Michael Higgins’ world may right itself.
Book Bubbles from The Final Push
John Doe is Dead
Third-year medical student Mike Higgins has taken the life of John Doe, a patient to whom he was assigned while on the trauma service. But Doe was not just another patient. In a meth-fueled, random act of violence that preceded his hospitalization, John Doe shattered Michael Higgins' life. Now that Doe is dead, two questions remain: will Higgins get away with murder, and if he does, will the act of taking John Doe's life allow Higgins to piece his back together? To find out, you will have to read the story, as this is the final book bubble for THE FINAL PUSH. If you have been following along, I thank you.
John Doe is Dying
The efforts to resuscitate John Doe are failing, and medical student Mike Higgins is coming to the realization that he just committed murder. In addition, his plan to remain undetected relies on the coroner declining John Doe for a post-mortem examination, but the pushy Leadership nurse has other plans. One of the hospitals in which I trained actually had an entity known as The Leadership. This was a group of nurses who had somehow wrestled power away from all but the most senior physicians, and they were nosy and pushy.
Resuscitating John Doe
Medical student Mike Higgins has followed through with his plan to kill a patient for whom he is caring. John Doe is now in full cardiac arrest and the code team is trying to resuscitate him. As I've said in blog and social media posts, the ER thoracotomy is the most dramatic procedure in medicine and surgery. However, participating in the resuscitation of a full cardiac arrest is right up there. And when you command the body of knowledge needed to run a code, and you save a life, it imparts a powerful sense of accomplishment and satisfaction.
John Doe Codes
Third year medical student Mike Higgins has just injected a syringe full of potassium chloride into John Doe. Even though potassium and chloride are two of the most abundant electrolytes in the human body, when the heart is "flooded" with a massive concentration of potassium, it fibrillates and stops pumping. One of the first things we were taught as interns: never give a patient a bolus (a syringe full) of potassium chloride. The correct way to treat low potassium is to dilute the potassium chloride solution in a bag of IV fluid and give it over several hours.
Higgins Pulls the Trigger
The success of Higgins' plan depends on John Doe's violent reaction to the placement of a nasogastric tube, thus creating movement artifact on the heart tracing, and hiding the real cardiac rhythm from the nurses in the monitoring station. As a medical student and resident I was always struck by the strong reactions of semiconscious, and even comatose, patients to the placement of an NG tube. A testament to the strength of the gag reflex.
The Living Autopsy
Higgins' act of murder stands a better chance of going undetected if an autopsy is not performed. The "living autopsy" was a real entity back when I was training. Surgery patients who had undergone a number of operations for well-defined injuries, but succumbed to those injuries nonetheless, were usually turned down for autopsy by the coroner.
A Perfect Murder
Third-year medical student Mike Higgins is going to kill a man, a patient for whom he is caring, but before he does, he goes over his plan one last time.
The Quiet Before the Violent Storm
Medical student Mike Higgins is about to commit a violent act that will forever define him, but he is willing to do it to save his wife.
John Doe Won't Die ...
... so third-year medical student Mike Higgins convinces himself that the only way to save his wife is to take matters into his own hands. But time is running out.
John Doe has been admitted to the trauma service.
Michael tells Lisa that their attacker, John Doe, is in the hospital with life-threatening injuries sustained during a car accident. She is unsure of the best way to proceed.
Higgins laments his wife's condition
During a home-invasion robbery and brutal assault, Lisa suffers a depressed skull fracture, which has left her with severe migraine headaches. Despite the risk of addiction, Higgins willingly administers intramuscular injections of Demerol in order to relieve his wife's suffering.
Higgins returns home to find darkness and pain
Following a home-invasion robbery in which medical student Mike Higgins and his wife were violently assaulted, their lives have become dominated by fear, darkness, and Lisa's increasing dependence on Demerol injections to treat her crippling migraines.
John Doe is bleeding internally
While third-year medical student Mike Higgins is evaluating John Doe, Doe's vital signs crash and his stomach becomes distended--all consistent with massive internal bleeding. Doe is rushed to the operating room for emergency laparotomy (exploration of the abdomen), and chief trauma resident Conrad Porter has Higgins scrub in and assist on the case.
Higgins successfully intubates John Doe
To intubate a patient means slipping a breathing tube into the trachea. This can be challenging under ideal conditions, but with a combative trauma patient, intubation can be exceptionally difficult. With the help of a paralytic agent and favorable anatomy, Higgins pulls it off, thus scoring points with his chief resident.
Student doctor Higgins evaluates John Doe
Third-year medical student Mike Higgins finds himself in an unusual situation. The junior residents on call for the trauma team are tied up in the OR, so Dr. Conrad Porter, the chief resident on the trauma service, is giving Higgins the opportunity to evaluate and treat severely-injured trauma patient, John Doe. Higgins will soon be applying for a surgical residency position and, therefore, wants to impress his chief resident.
Mike Higgins meets John Doe
In this excerpt from early in the story, third-year medical student Mike Higgins is called to the ER to participate in the evaluation and management of a severely-injured trauma patient known only as John Doe. As he examines Doe, Higgins soon discovers something that will knock his world off its axis.
Author Insight
WOULD YOU TAKE A LIFE TO SAVE A LIFE? A cop would. A soldier would. How about a medical student? What if you were that student, and you had unrestricted access to the comatose trauma patient who shattered your personal life two months earlier, and by taking his life you could piece yours back together? THE FINAL PUSH is the (fictional) story of Michael Higgins, a third-year medical student who finds himself in that very situation.
The Organ Takers
Mystery, Thriller & Suspense
Failed surgeon David McBride is in exile from the surgical community after making a costly error in judgment. Down but not out, he perseveres and is given a second chance to establish a career in surgery. But, as McBride stands on the threshold of a new life, the malignant underside of his fellow man intervenes. Under the threat of violence, David is forced to perform illegal organ harvests in a makeshift operating room hidden in a dilapidated meatpacking warehouse in lower Manhattan. Unable to resolve the excruciating moral dilemma faced each time he invades the body of an unwilling victim, David McBride fights to free himself from the situation and in the process, loses everything. When he finally loses the last shred of his humanity, he seeks revenge with surgical precision ... and instrumentation.
Book Bubbles from The Organ Takers
An Offer He Can't Refuse
Yes, an offer that one can't refuse is a cliché, but it happens all the time in fiction and in real life. If you want someone to do your dirty work for you, you have to offer that person something they really want or need (bribery), or you have to threaten them, or someone close to them, with bodily harm, great financial loss, public scandal, etc. (blackmail). In this scene bribery didn't work, so Mr. White has resorted to blackmail. What or who is in that stack of photos? You'll have to read the book to find out.
The Sinister Silhouette
Dr. David McBride was fired from his surgery residency two years ago. He now works as a lab tech and lives in a sketchy area of the city, and on his way home one night, he encounters a stranger in the park, a stranger who is about to make him an offer he can't refuse. When I wrote this, I immediately visualized the scene from the Exorcist where the priest arrives at the Georgetown home of the possessed girl. The priest climbs from a cab and pauses under a streetlight as he contemplates the task that lies before him. This famous shot became an iconic image, and it was this image that popped into my head as I wrote the scene.
Rapid Cooling is the Enemy
Rapid cooling is not only the small animal's biggest enemy, but it can also be fatal for human infants. As a cardiothoracic resident, we took great care in keeping our newborn and infant patients warm while preparing them for open heart surgery. There is a lot to do to prepare a patient for heart surgery--monitoring lines, IV access, etc.--and if the baby should cool significantly while lying naked on the operating table, the heart will fibrillate. To prevent this, powerful warming lamps were placed over the baby, and the core temperature was carefully monitored.
Doctors, Nurses, and Drugs
When Cassandra McBride says that hardly a year goes by without someone on staff getting fired for drug related problems, she's right. During my surgery residency, I recall at least two anesthesia residents and a handful of nurses who were either fired or asked to go into rehab for drug related incidents. And as a surgical attending, one of our residents was found dead in his apartment after overdosing on IV narcotics he had stolen from the hospital. So when David McBride jokes about dipping into the lab's drug supply, his wife has every right to admonish him.
No Glory in Rat Surgery
I disagree with David McBride when he says there is no glory in operating on rats. When I was doing a two-year research fellowship at the National Institutes of Health, I learned how to transplant the heart from the thorax of one rat into the abdomen of another. The rat aorta and vena cava (the vessels that need to be sewn together) are about half the diameter of a cocktail straw with the consistency of wet tissue paper. They are extraordinarily difficult to sew together, and to keep together once the transplanted heart starts beating. I would say to Dr. McBride, if you can sew rat aortas together, you can sew anything together.
The Good Son
The protagonist of the story, Dr. David McBride, has had a spectacular fall from grace. He was fired from his surgical residency, lost his license to practice medicine, and is now living in an unsavory area of the city. In addition, he is caring for his father, who suffers from Alzheimer's disease. I, too, had to care for a parent with Alzheimer's, and I can tell you, the tension between the compassionate son and the frustrated caregiver is very strong. (Ironically, I wrote the father character and gave him Alzheimer's well before my mother was diagnosed.)
The Convoluted Path
Dr. Andrew Turnbull, the antagonist of the Organ Takers, has resorted to nefarious means to fund his startup biomedical research company, and it seems he is driven more by ego than capital gains. The money is, in fact, secondary, needed only to propel him to the level of glory and adoration he deserves. If this outsized ego seems over the top, I can assure you it isn't. As a student and resident, I spent years standing across the operating table from egomaniacal attending surgeons, and ultimately became one myself.
Bloody Hands
One of the prominent themes of The Organ Takers is the notion that men of intelligence, drive, and compassion will often choose to venture down a dark path in order to achieve something of great importance. At other times, they are forced into the darkness to protect themselves or someone close to them. This story is full of both, such as Associate Professor of Psychiatry, Dr. Brian Steinberg, who has been blackmailed into "recruiting" the donors for the organ-stealing conspiracy.
The Emergency Room Thoracotomy
In The Final Push, I refer to the ER thoracotomy as “the most coveted surgical procedure for a medical student to witness.” In The Organ Takers, I call it “the greatest spectacle in all of medicine.” This is not an exaggeration. ER thoracotomy literally means opening the chest in the emergency room to expose the heart. “Cracking a chest” is medical jargon for the procedure. I cracked my first chest when I was a third-year resident, and the outcome was right out of a horror movie. If you want details, go to my website and read part 3 of the Me, Myself, and I Interview. For videos of the procedure (graphic and disturbing), go to my blog and look for "Let's Crack Him" under Surgery Related Topics.
Call 911 - your kidney's been stolen!
Back in the ’90s, if you were a man drinking in a hotel bar or at the tables of Vegas, and you allowed yourself to be led upstairs by a seductive woman, this is the message you might have found scrawled in lipstick across the mirror as you awakened in a bathtub full of ice. A telephone would have been conveniently left near the tub, you would’ve called 911, and a well-informed EMS operator would have instructed you to check your back in the mirror. If you saw two 9-inch slits on your sides, the operator would tell you that your kidneys have been stolen, and to climb back in the ice and wait for paramedics to arrive. Far fetched? Now it is, but at the time it garnered the attention of various law-enforcement agencies, the National Kidney Foundation, and The United Network for Organ Sharing. The rumors have since been debunked and relegated to the realm of urban legend, but there is in fact a black market for human organs, and there are documented cases of kidneys, half-livers, eyes, and skin being bought, sold, and stolen. Is this not the stuff of good fiction? I thought so, and that’s why I’ve brought the organ-snatcher legend to life in my first novel, The Organ Takers.
