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I'm stealing this from Twitter

Here's the link

I am a high-definition gateway drug body double!

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Gentlemen, This is No Humbug

Heh. Heheh. Here I thought I was on a DEA list with the Truth Serum post…

[Due to the possibly dangerous/sensitive nature of this post, I’m going to remind everyone that everything on my blog, including this post, is meant as a writing reference and should NEVER be used in real life.]

So you’re in a pickle. You’ve got a character who really needs surgery and, well… lets just say the circumstances are not ideal. Maybe they’re in a remote village in a developing country/war zone with extremely limited access to medicine. Maybe they’re in a long-post-apocalyptic world where hospitals and pharmacies have been entirely looted. Maybe its even the late 1800s. I don’t know your characters lives.

But what’s an author to do? You’ve got the basics of low-resource surgery down from this post, but you’re scrambling on one extremely important point- the anesthesia.

Where the frickity-frak are you going to find a quality anesthetic in the 1800s, during an apocalypse, at this time of night?

I’m going out on a limb here and say you’ve probably heard of something called ether. And maybe you just recoiled reading that. Ether? Isn’t that stuff really ineffective and dangerous and laughably out of date?

Actually… no. Not really. Ether has been used effectively for over a century. Its relatively cheap, reliable and besides a couple of unpleasant (but not particularly dangerous) side effects, surprisingly safe- even in the hands of those with minimal training. Not only that, but it is CURRENTLY the most widely used inhalation anesthetic in the world. Bet you weren’t expecting to read that today.

I mean, a clean operating room, anesthesia machine, choice of medication and trained anesthetist will beat it hands down, but you gotta work with what you’ve got.

But, wait. Do my characters even have access to it? They’re chilling in the apocalypse, remember? The answer is still a surprising probably.

OBTAINING ETHER

In the early 1800s, it was used as a recreational drug. In the late 1800s, it was used as an anesthetic and a recreational drug. It might not have been overly abundant just everywhere, but it existed.

Today, its a lot more abundant. Medical-grade Diethyl Ether comes in special brown bottles (light causes it to significantly lose potency) and is relatively expensive. Industrial-grade Diethyl Ether is exactly the same stuff with significantly less insurance attached to it, meaning its a heck of a lot cheaper. It just comes in 55-gallon drums and must be carefully transferred to smaller bottles before use. There are many other varieties of industrial ether available as well. All of them work, but some may have more severe side effects or less anesthetic power. In industry, it is used as a solvent.

“Those looters may have torn that hospital apart, but damn if they forgot all about the local paint factory.”

Also, if they’re really desperate but have some time and knowledge of chemistry, Ether can be made with ethanol (strong drinking alcohol) and sulfuric (plumber’s) acid (can also be obtained from a lead-acid battery). Here’s a video. You’re writers- get creative.

EDIT #1: Ether is really flammable and if not stored correctly (in sealed cans or dark bottles, away from heat, oxygen and flames) it has a tendency to explode. Your characters should be really careful.

USING ETHER

Once acquired, Ether can be administered most easily and safely through an “open-drop” technique by someone with little medical training. The open-drop method involves a wire mesh mask covered by disposable cloth. the ether is dripped from a bottle onto the cloth, and the patient breathes it in through the mesh. This can be improvised using a small kitchen strainer or molded piece of screen as the wire mesh mask and a rubber band to hold the cloth in place. It can also be made by cutting the other end off an empty aluminum can and draping the cloth over the hole, but that’s getting real desperate.

The person handling the ether should drip roughly 12 drops/minute for the first minute, 24 the second, 48 the third, 96 the 4-15th minute, 50 the 15-30th, and 20-30 every minute after that. The bottle doing the dripping must be glass- plastic can react with the Ether and melt.

Typically, general anesthetic is a mix of a hypnotic (unconsciousness-inducing agent like propofol), an analgesic (painkiller like fentanyl) and a paralytic. Ether, conveniently, works as all of these things at once (to a usable extent), and so is the only drug needed. It also has the advantage of being difficult to overdose on- unconsciousness can be achieved way, way, way before overdose becomes a problem. No intubation is necessary (at optimal dose Ether does not depress respiration), and while helpful, supplemental oxygen is not even completely necessary. Ether does not impact heart function.

So, you might be thinking- why doesn’t everyone just use Ether? Wouldn’t it be a lot easier, safer and cheaper? Well, yes, probably. But Ether isn’t pleasant. First of all, it smells like gasoline. You like the smell of gasoline? Me neither. Your poor character probably won’t either. If that wasn’t bad enough- it takes forever to knock someone out with Ether. Like a solid 20 minutes. It’s also somewhat irritating to the lining of the mouth, nose and throat- not to mention that during this intervening time between starting to breath the anesthetic and actually passing out, the patient may be very anxious, panic, or vomit. All in all, its a pretty sucky 20 minutes (note- pre-op medication with a benzodiazepine (anti-anxiety drug) can shorten this period of time and make it a lot more pleasant).  Side effects upon waking up from Ether include profound nausea, vomiting and drowsiness.

Also, everyone involved is going to smell like Ether for a while.

EDIT #2: If IV equipment is available (I was earlier assuming it was not, given the circumstances I randomly came up with at the beginning, but you may be using this info for other reasons), Ether IV solution can be prepared by injecting 50mL of Diethyl Ether into a 1L bag of an IV solution called D5W (5% dextrose in water). That needs to then be cooled to 4C, then shook for about a minute. Characters should give about half of it as quickly as possible (after which the patient should be anesthetized), then allow it to flow just enough to keep the patient in the ideal level of anesthesia for the duration of the operation. This method reduces side effects both at the beginning and end considerably, but sacrifice’s Ether’s natural paralytic function (not really important unless patient needs bowel surgery).

There are reasons other drugs were invented to take Ether’s place, but if its what you’ve got, its what you’ve got.

And it works pretty well compared to the alternatives.

R E F E R E N C E S

Iserson, K. V. (2012). Improvised medicine: Providing care in extreme environments. New York: McGraw-Hill Medical.

Follow @macgyvermedical for more like this!

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The Road Not Taken...

Introducing the 13th and final chapter in Paul Kidby's Designing Terry Pratchett's Discworld, where Paul envisions covers for some of the books that Terry spoke of but, sadly, never got to write.

You can pre-order your copy here: https://linktr.ee/terrypratchettestate

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Can you imagine how absolutely wild it must have been for Eliot's students in The French Connection Job? Like, you come to this overpriced class that you don't really care about and your teacher is a 5'5" angry wall of muscle who can spin a knife faster than you can see and tosses your phone in the water when you text during his class. But he only looks physically pained and moves on from the geek grinning over the laser so he's probably not gonna kill you? Probably?

He's a hardass, though, like the ultimate of hardasses and he has definitely killed before, so, you know, be careful.

But then you glue a unicorn horn ice cream cone to a plate and he physically crumbles like he cannot believe you are this stupid.

Oh and he and the geek definitely know each other. Only someone you care about could physically embarrass you that bad at your work. And the geek clearly knows something you don't because he will propose the stupidest ideas just to get Chef Scary Guy to growl in his face with a knife and stay grinning the entire time like he knows he's safe.

Okay, so maybe this chef's actually a marshmallow? Like a crusty one, but sometimes you'll do something right and his face will just light up with pride and you get this wave of relief. So maybe he's gruff for show and wouldn't actually hurt anyone.

Then opening night comes, and it's chaos, and at one point a guy walks in and without looking up Chef Scary Guy tells him to leave if he isn't gonna help. And almost faster than you can watch the guy is out cold on the ground and Chef is stepping over him shouting that he needs a medium steak and you don't have the time to process this cause it's the dinner rush. This happens two more times. There are three guys unconscious in the corner of the kitchen and the man who put them there is patting you on the shoulder and beaming with pride at how you roasted those veggies and just ...

Wild. Absolutely wild.

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got a major pest problem this year actually

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I cannot stand the parodies of modern major general, they're overdone and simply not as good as the original. They've done them about everything, whatever topic, big or small.

And when i notice one of them my eyes will always start to roll.

The diction's always slurry when they rush the complicated words, and adding many fricatives will turn it so cacophonous. The slanted rhymes are silly and they keep just making more and more, please someone stop the parodies of modern major general.

The scanning of the lyrics in the meter is unbearable, they emphazise the syllables in ways that are untenable, in short in matters musical, prosodic and ephemeral, i cannot stand the parodies of modern major general!

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So I had a thought about this in the shower and I agree, it’s incredibly frustrating for buck not to have a goal to work for, and is very much the reason he ends up kicking off the lawsuit, but (and I may be reading too much in to this) I’ve always thought of it as Bobby not being ready. We know their relationship is intended to be more father/son (look at their exchange about Tommy, tying his tie for dates, and also Bobby teaching Buck to cook, including all his recipes) and Bobby at that point had seen a ladder truck land on Buck’s leg, the treatment, the PT, buck’s moods, and then just when he seemed better he vomited blood and nearly died right in front of him. Then there was the tsunami where buck shows up bleeding, distressed, and practically collapses in front of them again from exhaustion.

“You’re not ready” has no basis in Buck’s fitness, that’s why there can’t be a goal to work towards. It’s not about buck. It’s about Bobby. (I wish buck had been able to see that, or that Bobby had used his words. I hate the lawsuit arc 😢 )

One of the things that really bothers me about the lawsuit era is that Bobby says "You're not ready" but never once gives any idea of what "ready" might be. Buck was never given anything to work toward, which I know can feel hopeless. Never being enough, but not really knowing what enough is.

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Can't believe I almost forgot!!

HAPPY INTERNATIONAL WHUMP DAY EVERYONE!!

We chose this day in honor of the air date of Daniel Jackson's first death on Stargate SG-1 and since the term Whump originated in that fandom for him.

In honor of the day, send an ask to that special whumper in your life, share your Whump origin story, or a favorite gifset or memory from the community. How ever you want to celebrate :)

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Oh god, I want this as a long fic asap. 🙏

oh WAIT A MINUTE we've all been getting it wrong. in a magical AU, Eliot Spencer isn't the one with healing powers or immense strength—he's the psychic.

"it's a distinctive____" no the fuck it isn't. he just KNOWS. but people get uneasy when a guy just KNOWS stuff, so eliot learned a line that keeps everybody calm, gives everybody just enough plausible deniability to keep the unease at bay.

he's always got that extra bit of knowledge to help him out. not more than he can handle, not like some kind of savant in more ways than it's possible for one human to be. nothing flashy. it's not that eliot's never lost his keys before. it's just that he always, always knows where to find them.

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currently maybe possibly single-handedly crashing whatever servers eton hosts its archived student newspapers on because me and a friend are getting obsessed with a single outspoken prefect from 1883

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Harvey’s favourite smile on Mike is when he ducks his head a little and Harvey can see his cheeks bunch up gently, the laugh lines showing. It’s a quiet sort of happiness that he wouldn’t trade for anything.

Not the biggest case to win, another promotion. Not for all the money in the world.

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There's a flavor of whump I'm always craving that I don't see very often, I think because the possibilities are so context-specific. You can do some things in some universes that you can't in others! You can do certain things with non-human characters that you can't with others!

But hear me out:

Whumper making physiological changes to Whumpee's body.

Could be through programming for robot characters, dedicated brainwashing for humans, magic for fantasy settings, weird biology for aliens...

A few examples off the top of my head:

Alien species that instinctively responds to neck squeezing by going limp like a scruffed kitten, because this helped them survive encounters with predators. Delicious all on its own -- now throw in a quick surgery to permanently clamp the nerve responsible. Whumpee wakes up in a permanent state of relaxed submission and can't even show how terrified they are.

Obedience programming/training that's wired directly into a character's brain. When the system detects unwanted thoughts, it applies pain. Even after rescue, Whumpee can't think of themselves as an autonomous being because their mind is desperately protecting itself.

Characters with magic having their magic corrupted or bound so it either hurts them to use, or it can only be used to serve Whumper's purposes. Bonus points if Whumper has full control over their magic AND the use of it hurts them.

Characters given a brain implant or parasite that stimulates the reward center of the brain, which would be great, except they can't turn it off. They're kept in a constant state of bleary euphoria... with just enough sense of self left to know they want it to stop.

Characters being spelled or programmed so they physically cannot function independently. Characters who very literally NEED to be given permission to do things like relax or take a walk or even use the bathroom. Not being given this permission leaves them in a state of locked stasis -- fully aware of the time passing. Bonus: Caretaker can't reverse it, so they just HAVE to navigate All Of This.

Alien species that will a develop chronic physical illness if deprived of touch for too long. Said illness can only be treated through regular physical touch. Defiant Whumpees will often be locked in solitary confinement and fed through a slot in the bars until symptoms start to manifest. Sometimes they'll be left even longer, to make sure they end up a severe case. And now, oopsie, the only way to ease this horrible pain is by letting your captors put their hands on you!

Just. Physiological whump. The horror of someone else controlling your body or your mind. Betrayal of body. Etc. Do you understand.

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Is there like a fic category for hardcore (possibly forced) caretaking because I think I’m super in to that.

Like, char b patching up wounds on char a, even though a doesn’t feel worthy or want to bother.

Or char a feeding/making sleep char b when they haven’t eaten or slept for ages. (Remember that episode of mash where Hawkeye gets forcefully sedated because he just won’t sleep? That. )

Or b realising a is ill/injured and taking them home or hospital or treating them. Mmmmmmmm.

Recs of fanfic or original fic are welcome.