Help!
Her training is typical for a modern doctor--I haven't decided on a specialty but nothing that would prepare her for this situation. Pediatrian maybe but that seems so cliche for a female doctor. There are other human survivors who she will hope to help but not nearby so she needs to take supplies with her. At the start of the story the only survivors around are her and her daughter.
You have to think about this situation--there won't be the manufacture of drugs. So what would she do in this situation? And yes, she will want what texts she can take. But what would help in a primitive situation? And is there anything she could or would take that would help with the provision of drugs? She could take morphine and antibiotics with her--but she will want to plan for when that supply runs out.
What WOULD a modern physician do if society totally fell apart?
Edit: And with no refrigeration, what drugs could she take with her? Another complication.
My point about text books, is that most wouldn't help in a primitive situation, would they? Which would a doctor choose assuming the need to be selective? Most, I assume, presuppose modern conditions.
I may or may not go into detail about what she chooses to take, but I always feel that if I don't know the reader will know that I'm faking it.
[This message has been edited by JeanneT (edited June 10, 2008).]
Would anything be available on say surgery under primitive conditions, perhaps intended for doctors who do philanthropic work in undeveloped areas? Surely for surgery she will need items not normally in a physicians bag. (DO physicians normally HAVE a bag these days? LOL)
I had no idea what I was getting myself into with this story. <g>
Same thing anyone else would do: stack the sandbags, load the shotgun, and stock up on Spam.
In most situations, surgery would be right out. Complications, side effects, and post-operative infection would kill most people. Without modern pharmacology, chronic disease is mostly untreatable.
The idea about natural remedies seems to make the most sense, but then again, if it is the end of the world... whether you need fresh aloe or insulin, where will you find either?
But would a doctor simply refuse to try to do an appendectomy just because conditions were primitive? That doesn't seem likely. Sure it would be high risk, but a ruptured appendix would be even more so.
I don't hink a doctor would stop being a doctor just because things got rough. Or my doctor won't anyway. Sure she'll stock up the spam. But she'll still heal if she can.
No, there won't be insulin. Any diabetics are going to die--actually already have. And she will know that genetically they're probably a lost cause--too small a gene pool. But she'll still try. I know any proper dystopian would have them give up. But then I think that's what's wrong with Sci/Fi today. <g>
[This message has been edited by JeanneT (edited June 10, 2008).]
If she is fleeing to the wilderness, and the world has gone primal. You might check on old west doctors for inspiration. Dr Quinn. Off hand A saw, a drill comes to mind. Drill through the skull to relieve pressure on a swelling brain, type situation.
If the city, or cities is only partially destroyed, she could get books from Barnes&Nobles and such, and raid drug stores, not all drugs have to be kept cold, and find basic rudementary stuff in the hardware stores.
I hope this helps.
Edited: reading more of your posts, I feel you should research the old west, civil war doctors and such, they did surgery with nothing, basic tools. Not always succesful but they tried. Amputations were common, but you're right they tried to survive.
[This message has been edited by Tiergan (edited June 10, 2008).]
A good supply of things like alcohol (which you can produce pretty easily with a still later), surgical instruments like scissors, forceps, scalpels, clamps, even retractors... You'd probably want some sort of sharpener. Even today you could probably find a hand bone saw. That would give enough to do a basic emergency surgery--and I do think you're not going to do much except emergency.
Sure aloe is good but there are drugs that can be made from certain pine pitches as well.
Edit: What I was thinking was that someone who is educated will have an instinct to grab books to take and she would, I suspect. What I don't know is if there is anything that would cover the situation. So maybe she just shakes her head and grabs her Gray's Anatomy.
[This message has been edited by JeanneT (edited June 10, 2008).]
And what I would take...an ambulance. To hell with an SUV!
[This message has been edited by InarticulateBabbler (edited June 10, 2008).]
I was sure one of the Hatrackers was a Dr. but couldn't remember who. I did find a fieldguide to wilderness medicine that might be helpful to someone in that situation.
[This message has been edited by JeanneT (edited June 10, 2008).]
Although there is a lot of destruction there are still some buildings with supplies she can loot. It's a good point though that there should be something she wants and can't find because of the destruction. I'll think about what.
[This message has been edited by JeanneT (edited June 10, 2008).]
Organic chemistry textbooks from before WWII might contain methods for preparing and purifying basic medical preparations like penicillin. My 1860 Porter details several alkaloid extraction processes, not to mention some pyrotechnic stuff. All kinds of "primitive" chemistry methods in that book.
Willow tree bark is the natural source for aspirin. Digitalis, a medicine for heart conditions, comes from foxwood. They're easily extracted, purified, and concentrated using solvents.
A still would be absolutely essential not just for making alcohol, but for making other solvents necessary for extracting alkaloids, and for purifying other liquids. An alembic can be made from clay, but it's not as efficient as a good ole copper still. Any doctor who doesn't have access to modern anaesthesia drugs will need ether. Ether is relatively easy to make. The Civil War era method for making it is in my Porter.
Chemistry texts of some kind are a good idea. She would have the skills from classes but probably not the "off-the-top of the head" knowledge for doing that. I rather doubt that pre-Civil War texts would be readily available but even a basic textbook might be useful.
[This message has been edited by JeanneT (edited June 10, 2008).]
I've seen Porter and other collectible chemistry books spanning a wide selection and range of years listed on eBay. Branch repositories of the Library of Congress have quite a collection of rare books. Porter is not rare. Many university libraries are branch repositories.
If it were up to me, my basic field kit of medicines would include;
Alcohol for sterilization and "medicinal" consumption.
Ether for general anaesthesia. Pharmaceutical grade or reagent grade until it ran out, then automotive grade if the huffers didn't get to it first, then homemade.
Lidocaine/prilocaine injections for local anaesthesia, until it ran out, then all ether as needed. Nitrous oxide is in Porter and easier to make than ether.
Penicillin for infections, made from carefully molded bread when the pharmaceutical grade ran out. I made some in my first year chemistry class in high school.
Iodine and sulfa for wound treatment. I'd grab a jar of reagent grade iodine crystals and mix it with alcohol to make tincture of iodine. Porter details how to make iodine from seaweed. Sulfa compounds date from the 1930s and aren't in my Porter, but they're readily made under primitive conditions from sulfurous acid and ammonia.
Asprin until it ran out then extract the natural compound from willows, weeping willows, or the Hercules club tree for topical and ingested analgaesics. The raw sap of the Hercules Club is a topical analgaesic.
I'd also want sodium hydroxide/lye and ammonia for cleaning and making compounds for other basic needs. Lye is easy to make, ammonia too. Lye means soap. Under primitive conditions, boiling cloth in lye is ideal for sterilizing it.
On the type I diabetes issue, the first successful insulin treatment used crudely purified insulin extracted from oxen pancreases with no noticeable side effects on the patients.
Recovery of patients in diabetic comas were swift. Pig and human cadaver pancreases have also been harvested to extract usable insulin.
The Foxfire series has a host of plant and natural remedies from American sources, plus wild food gathering, and all the basics of backwoods living. Euel Gibbons' books are another source for wild harversting. The doctor must eat.
[This message has been edited by extrinsic (edited June 10, 2008).]
I would ensure that my doctor was one whose hobby/research was on bush medicine/tribal medicine, had collated lots of info on how medical emergencies were dealt with in extreme circumstances. That way she could just go, "Emergency trachiostomy--yup. I need a bic biro, a pair of scissors, and you--get some sheets."
As to what to take--ANTIBIOTICS, Antiseptics--small infections would kill loads of people--Suturing (needles and thread, forceps) equipment. She won't be able to do a coronary bypasses and her ability to heal will be restricted to what she can do. ADVANCED FIRST AID BOOK.
Also PARACETEMOL and/or IBUPROFEN and/or ASPIRIN--for fevers, from infections--also they are painkillers.
Also thermometer, stethoscope, torch. Scalpel and saw.
I am no doctor--so Sara can correct me--but I would take loads of the above, maybe some sterile dressings, bandages. You will save more peoples lives over the years with the above, than if try to cater for every eventuality.
[This message has been edited by skadder (edited June 10, 2008).]
There is no way she can take enough supplies to last very long though. So I'm not really sure what she would grab. Obviously she can't order something off ebay.
Oh, the "she's already an expert in survival medicine" makes it too easy. Never make life easy for your characters. 
Actually, so far, I'm reminded of Heinlein's Farnham's Freehold and the medical aspects of Richard Matheson's I Am Legend of which there were two film adaptations before the 2007 one starring Will Smith. I've not seen the first one, but I have seen Charleston Heston in Omega Man.
[This message has been edited by JeanneT (edited June 10, 2008).]
However, he carries his around in a pdf file (or whatever it's called) in his Blackberry. Just a thought. That might make it a little more futuristic. Of course, batteries die, books don't.
Tea tree oil, for instance, has antiseptic qualities. Lavendar and Camomila/camomille are calming. Dandelions are useful for all kinds of things, but in the midwest where I life, they're most abundant only for about a month from late April til late May. Like most perennials (plants that come back year after year) they have a 3-4 week blooming period and then are pretty much done for the season.
The leaves of a certain plant are good to pack wounds to prevent infection...I just read this in my local paper's home and garden section. I think it's Yarrow leaves...someone more up on herbals can confirm or you can look that up - but that would be something someone could do out in the wilderness. Yarrows are in bloom right now in the midwest, most are clumps of tiny yellow flowers on 12" stems with clusters of almost silvery foliage. Tons of wildflower/herbal sites out there - do you need some recommendations? Oh, and a fun one to stick in if she's really out in the prairie is compass plant. The plant orients itself straight north/south, so that it gets the morning sun on its east face, the afternoon sun on its west face, and at the heat of the day the sun is not beating down directly on the face of the plant. It is a reasonable way to navigate to find a compass plant (common in prairie restorations around where I live) and that will help establish north/south (you still ahve to figure out which one is north, which one is south - but that's not too hard unless it's high noon on June 21.)
One thought for consideration (I've recently written a post-apocalyptic story...) is that if the majority of the population is gone, there might be somewhat large storehouses of things like medications and bandages that are going unused because there's so few people left. She just needs to find them.
Good luck - sounds like fun!
Most of the medical stuff in this story is on a pretty primitive level--dealing with wounds that involve stitching someone up. But I don't want some dr. reading it and saying well any idiot should know that a doctor would pick up something or other I didn't think about. LOL
quote:
I haven't decided on a specialty but nothing that would prepare her for this situation.
May I suggest that you "up the ante" by having this be a psychiatrist who hasn't done general medicine in ages, and who chose psychiatry because the sight of blood makes her queasy?
That's the kind of thing I'd like to see her take, because she's thinking about sustaining herself and others beyond what will fit in the SUV.
Cram it with books. How to make whisky--not alcohol dammit, whisky--dual purpose!
How to purify water. How to make fire to boil water to purify it. (Pack a kettle.) How to find water (maps showing rivers, streams.) How to stop water-borne disease. How to get rid of human waste hygenically when the sewers don't work.
How to sharpen steel. Something to heat and causterise wounds with? Some weapons. (Your female characters don't need books on self defense, right?)
How to make bandages and string from stuff you find in the forest. Herbal remedies. And for those who will die anyhow, how to make death more comfortable.
If she's a modern specialist, no matter what her specialty is, it will be almost useless if the world is falling apart. She'll have to change her game to one of life and death. So, general medical books covering the specialties she knows little of. How to run a triage system. How to recognise who will live with the treatment available, who must die. How to train nursing help quickly--the ten things you need to know to help someone live.
A book on midwifery and child rearing--assuming she makes the world a better place, they'll want kids. And some books for the kids, so they can learn how to avoid dystopia the next time around.
Sounds like an interesting story.
Pat
[This message has been edited by TaleSpinner (edited June 11, 2008).]
Birch bark contains a basic form of aspirin and can be used as a painkiller and to reduce fevers. Cannabis has medical uses--perhaps she could find some seeds in a dead person's stash bag. Then she could grow it. They used to give it to pregnant women when they gave birth--yeah, baby.
[This message has been edited by Kathleen Dalton Woodbury (edited June 12, 2008).]
If one were carrying around a book, how about the Physician's Desk Reference? I think that's what it's called---I don't have a copy myself. I don't know how useful that would be in anybody's hands but a trained doctor...
;-)
Pat
quote:
I don't know how useful that would be in anybody's hands but a trained doctor...
Perhaps you missed the part where I discussed that she is a physician.
My doubt is that it would be useful in a situation where you don't have access to medical supplies. But it might be something she would want.
Pat, I'm sure she will never want to be an author. She isn't that insane.
[This message has been edited by JeanneT (edited June 11, 2008).]
Firstly, many modern drugs are derived from natural sources, plants etc. She would go to a library / medical library / something and get books both on: the local plantlife of her region/her destination ; books on what plants have what medicinal uses -- herbal medicine books etc ; books on HOW to extract the useful medicinal parts of these various plants, do you chew a leaf? boil it? extract sap? etc.
Now, there is bound to be many things that can be reproduced naturally. She wouldn't bother to stockpile things like tylenol / asprin / advil / etc, because headaches, sores, rashes, common things like that won't be life threatening, usually, and will probably have some kind of medicinal treatment that could be found in the wild.
So far as drugs that she WOULD stockpile and take with her, she would take as much as possible of every different class of wide-spetrum antibiotic. Because once you have an open wound, say, and it has become infected, you have prescious little time to get yourself and antibiotic, and many modern antibiotics work against a WIDE range of bacterial infections.
Now, this is heavily from the pharmacalogical side. Obviously a surgeon would want to bring a scalpel, etc. But so far as drugs go, this is the natural instinct / response of a soon to be doctor of pharmacy.
Hope this helps. =)
Besides, there's the issue of training---when and where, and what kind. I'm reminded of Granny on "The Beverly Hillbillies." She said she was an "M. D.---Mountain Doctor."
Given time and opportunity, perhaps your character would have similar thoughts about medicine in some of her book selections. Not to take with her, but to store, protected from theft (especially as fuel for fires) and moisture.
[This message has been edited by MrsBrown (edited June 12, 2008).]
Astro, thanks. That makes sense although I'm not sure I follow the thinking on aspirin which can act as a fever reducer (and there was a time when people died of high fevers) as well as a pain reducer. It's not like it would take much room for a couple of thousand-table bottles and it would take some time before she could make some replacement.
The same with alcohol. She can distill it but that won't happen right away so I think she would take some as it's an easy way to sterilize and it can even be used directly on wounds.
Wide spectrum antibiotics are a good idea as long as they don't need refrigeration but many don't.
The books on making herbal medicines are a very good idea.
quote:
Wide spectrum antibiotics are a good idea as long as they don't need refrigeration but many don't.
Most come as tablets, IV (which would need refrigeration), or oral suspensions (which would need refrigeration). Some supensions come as a powder in the bottom of a bottle and you mix it with water when you start the course. If your doctor could get a couple of bags of amoxycillin powder (very common broad spectrum antibiotic and she could mix her own supplies), and clarithromyicin tablets(again quite common) or flucloxicillin she would be primitively covered for a wide range of infections--but obviously not all. Newer antibiotics cost a fair bit more and so fewer would be kept in hospitals pharmacies etc, as the low-cost options are usually tried first.
Again I am only a psychiatric nurse and my knowledge is very limited, I am sure a doctor will show up here and say how wrong I am!
[This message has been edited by skadder (edited June 12, 2008).]
[This message has been edited by skadder (edited June 12, 2008).]
I've actually discussed this with a couple of doctors who have a really hard time wrapping their minds around the idea that someone won't start manufacturing medicines. Post-apocalyptic novels apparently aren't on their reading list.
[This message has been edited by JeanneT (edited June 12, 2008).]
I would probably also look into how to isolate phage. While that won't be good for internal stuff, I have heard of some success at preventing and treating external wounds. Anything to try and save the good stuff.
I also have read that appendicitis is more of a first world disease, so I would not worry too much about that one (and probably wouldn't include it in a story about a post-apocalyptic world).
I'm not sure why people in 3rd world countries wouldn't suffer from it though. My point, however, was that this is the kind of emergency surgery a doctor would have to do whatever the conditions as it is life-threatening in its advanced stages. I would assume that she would put off surgery as long as possible if it came up. Whether something like that will come up or not is--open to question. I'm still in the "what if" stages of plotting. The story will more be people coping with a horrible situation than concentrating on the medical aspect.
My thought on the antibiotics is that she won't have a large enough supply to make any long term effect on bacteria. Certainly what she has will only be used when it has to be. And of course she won't have access to equipment such as centrifuges.
[This message has been edited by JeanneT (edited June 12, 2008).]
Steve
[This message has been edited by SimonSays (edited June 12, 2008).]
[This message has been edited by SimonSays (edited June 12, 2008).]
[This message has been edited by SimonSays (edited June 12, 2008).]
We, on the other hand, are so used to our technology and our market society that when there is a collapse, it is a real collapse. A vast majority of the people cannot even start a camp fire from sticks and stones, let alone survive easily.
Where the doctor is, makes a very big difference in what is planned and expected. A doctor in the middle of the city might be able to get loads of supplies, but one would need a special reason why the doctor survived when everybody else did not.
A doctor out in the boonies, living near a town with a small hospital, might not have to escape very far. The hospital itself could be the only place for supplies since they are trucked directly in. There might not be any supply houses around.
A doctor in a small town might not even have a hospital nearby. The family doctor would, of course, be pretty good at dealing with most problems with a limited amount of equipment or supplies. One might have to drive an hour to get to a hospital so they might not have to even leave their town. Another place just might not be any better. Small towns tend to be self sufficient anyway so they would likely stay put unless it is like those floods in the mid west right now.
I will not use the phrase
"I am not a doctor, but I played one with my girl friend one time.....
I am thinking that books describing pills and their effects would be quite useful. She finds a stash of pills, she can verify which they are and how they are used. A book listing diseases and their
symptoms. basically books outside what the doctor handled all the time. It could be the books used for when they worked emergency.
quote:
A doctor in the middle of the city might be able to get loads of supplies, but one would need a special reason why the doctor survived when everybody else did not.
I think that is true in a post-apocalyptic story no matter what the career or the location of the character.
[This message has been edited by JeanneT (edited June 12, 2008).]
quote:
Sorry, my computer was misbehaving yesterday, and the site won't let me delete the superfluous copies of my post.
I fixed it. But I have to say, RobertB, that I am impressed. I've never seen a triple post before. Way to go!
quote:
One might have to drive an hour to get to a hospital so they might not have to even leave their town.
Of course, she is leaving. The size of the town has nothing to do with it. *looks confused*
I must have explained something really wrong.
Anyway, thanks for the help everyone. You've given me a lot to think about.
I have been contemplating my earlier bacteria question and I think that with the amount of bacteria used in our food processing today, the elimination of that would allow for less resistant bacteria to thrive, so I think the antibiotics are going to be more effective. Right now, things like penicillin are pretty useless (except for syphilis but syphilis is special).
I always wondered what if was for...... <g>
Good luck with this. Sounds like fun!
There are many natural remedies for things that aspirin cure. Herbal teas, etc. Things in the wild that, after a learning curve, could be used as a decent proxy. It's the drugs that cannot be easily reproduced with herbal medicine from indigenous plants that should be stockpiled to no end, cases and cases, thousands of pills not hundreds.
And more common antibiotics (penicillin is a prime example) have been used and overused the the point that its potencty in the current world has gone down by a lot. This was the comment she/I made about taking as much as possible of EVERY current "class" of wide-spectrum antibiotic. That way you can use the "penicillin derivative" drugs like amoxicillin, etc. but if the bacteria become too immune to that class you can switch over to the next class.
But certainly there will be a learning curve period where your doctor will have to read and study the herbal medicine books she's snatched, and will want a steady supply (enough for a few months? a year?) of more common drugs. A year's supply of aspirin, etc. isn't going to take that much space (a year's supply for one person anyway). The other reason to stock up on antibiotics to such an extent also goes beyond one person's need for them. (How often do you require antibiotics? Once a year at most, on average?) But if there are any other survivors that this doctor finds, or expects to find, if she ends up in a small community of survivors, you have to think about everyone. The point of raiding a pharmacy / a few pharmacies / a hospital is to serve as "post-apocolyptic" doctor for an entire community, I would think.
HOwever, if you think the hospitals after Katrina except somewhat worse you will see the problems she will have. It won't be easy to find what she needs and most supplies will have been destroyed. But I do need to know what she would look for and your help is greatly appreciated.
She will have a steep learning curve. She isn't trained for this kind of medicine but she can learn. And of course she has to plan for the possibility/probability that she will have to train any future doctors for her community.
This story has grown from what I originally envisioned. It's nice when one takes on a life of its own.
Thanks again for all the help everyone.
I'm late to the party, but:
Why didn't the crusty old country doctor "uncle" who inspired your protagonist to become a doctor when she was a young girl have a copy of this stuff in his library? Why didn't she read these materials when she was a kid? And why doesn't she break into his widow's abandoned house to get them? It might make some good backstory, too.
Joe