Communion Of Dreams


An excerpt from Chapter 14

I mentioned the other day that many of the early reviews of St Cybi’s Well talk about how eerily prescient the book seems now.

Well, judge for yourself. This is an excerpt from the book (Chapter 14: Llangelynnin) when news of the pandemic is just really getting started. The main characters are discussing it, and their plans to collect medical supplies since the St Melangell Centre is a designated rural care center. I first wrote this portion of the book about two years ago, did major revisions last fall.

“The government here is asking people to just stay home if they have any indications of illness. They’ve implemented a week-long ‘bank holiday’, so people don’t go in to work or school, and declared that only essential government employees and emergency workers are to report in. All the bus and train lines have been shut down. They’re even talking about closing all the restaurants and pubs. We’ll probably hear more about that later today. And there have been more anti-immigrant riots in London and some other places. And not just the so-called ‘Tommys’.”

“People are frightened.”

“Yeah, no surprise.” Darnell nodded at the stereo again. “There was also some science reporting about VCS itself. Looks like it is caused by a flu strain which is similar to the 1918 virus, the Spanish Flu, but one which is even more virulent.”

Megan paused, her hands lowered. The towel hung limply by her side. “Didn’t that kill millions, world-wide?”

“Yeah, something like fifty million.”

“And this looks to be worse?”

“Yeah,” Darnell repeated. “This seems to spread just as easily, but kills faster. Well, kills healthy adults faster – that cytokine storm thing, which is basically the immune system going crazy, creating high fever and complete exhaustion, leading to the inability to get enough oxygen and general system collapse. Victims often develop cyanosis – a blueish tint to the skin, particularly on the face and hands. Anyone who is very young, or old, or otherwise has a compromised immune system, can still get the flu, but don’t generally have the VCS reaction. But there’s a good chance that they’ll develop pneumonia which can kill them in a week or so without proper treatment.”

“But there are treatments for pneumonia.”

“There are. And even some things that can be done for someone with Cytokine Syndrome, if you get to them soon enough. Or anti-virals, like Theraflu.” He sighed. “But there’s not nearly enough of those stockpiled. And how well do you think the health system here or anywhere will be able to handle such a fast-moving epidemic, particularly if health workers are among the most vulnerable group because of massive exposure? Do you remember how devastating hemorrhagic fevers like Ebola have been in isolated areas, because health workers are often among the first victims of the disease? And those require direct contact with bodily fluids . . . this flu is airborne.”

There was a wild look in her eyes, and for a moment Darnell thought he even saw fear. Then Megan closed her eyes, clasped the small crucifix necklace she wore, and muttered what he assumed to be a prayer. When she opened her eyes again, the wildness was gone, replaced with a cold determination. “We already have basic personal protection gear – surgical masks, gloves, even disposable gowns – and it sounds like we should wear them when we go to Llandudno. I’ll get them and meet you downstairs when you’re done with your shower.”

 

Jim Downey



The end of things.

This morning, NPR repeated the story of Voyager 1 having apparently left the solar system.

I wonder why?

 

* * *

Philip James Bailey, Festus:

We live in deeds, not years; in thoughts, not breaths;
In feelings, not in figures on a dial.
We should count time by heart-throbs. He most lives
Who thinks most, feels the noblest, acts the best.
Life’s but a means unto an end; that end
Beginning, mean, and end to all things,—God.

 

* * *

We went shopping yesterday.

Big deal, right? Actually, it kinda was. It was the first time my wife had been in good enough shape to do so since her emergency appendectomy. Things are slowly returning to whatever passes for normal.

 

* * *

Dr. David Casarett is the director of hospice care at the Perelman School of Medicine at the University of Pennsylvania. He works with families as they try to navigate end-of-life decisions.

At least once a week, Casarett says, one of his patients expresses a desire to end his or her own life. “It’s a reminder to me that I have to stop whatever I was doing … and sit back down to try to find out what is motivating that request,” he says. “Is it really a carefully thought out desire to die, or is it, as it is unfortunately many times, a cry for help?”

It’s a good story.

 

* * *

Tomorrow’s the last day this month to get the free Kindle edition of Communion of Dreams. And this week is the last one to get entered into the drawing for a hand-bound leather copy of the special edition. Remember, you have to have posted a review on Amazon of the book, and then post a comment with a link to that review in this blog entry. There are currently 65 reviews on Amazon, but only 8 entrants for the drawing — don’t delay, as the end will come sooner than you expect.

As it usually does, for good or ill.

 

Jim Downey



Have a shot of oxygen.

There are a lot of ways we die. Massive trauma. Heart failure. Diseases of the organs which cause other body systems to shut down. But one of the more common mechanisms of death is lack of oxygen in the blood, what is called hypoxemia in the medical community. Without adequate oxygen in your blood, your brain and other organs start to die at the cellular level within minutes (in most conditions).

Hypoxemia can be caused by many different things, including a wide range of diseases and a variety of trauma. But if you can keep the blood oxygenated, you can buy time to treat the underlying cause. In the case of someone who has drowned, for example, this can be as simple as CPR. In other cases a heart-lung machine can keep someone alive while awaiting a transplant.

The problem is that sometimes it is impossible to buy that time. Maybe CPR isn’t viable. Maybe you’re too far from a hospital for other immediate treatments. Maybe it’d just take too long to get someone stable. In which case, this might work:

n a new study, published online today in ScienceTranslational Medicine, he and colleagues report the development of microparticles filled with oxygen gas that can be injected directly into the bloodstream. The particles quickly dissolve, releasing the gas and keeping organs, such as the brain, from suffocating.

* * *

The microparticles are tiny bubbles whose surfaces are membranes already used clinically to administer chemotherapy drugs and ultrasound dyes. But while those microparticles release their contents slowly, Kheir and his collaborators designed oxygen-containing particles that would dissolve as soon as they hit the bloodstream. They then tested the microparticles in rabbits breathing air low in oxygen. Within seconds of receiving the microbubbles, the levels of oxygen in the rabbits’ blood rose from a dangerously low 70% to nearly 100% saturation, the ideal level.

Promising. Very promising. From the abstract of the paper:

We have developed an injectable foam suspension containing self-assembling, lipid-based microparticles encapsulating a core of pure oxygen gas for intravenous injection. Prototype suspensions were manufactured to contain between 50 and 90 ml of oxygen gas per deciliter of suspension. Particle size was polydisperse, with a mean particle diameter between 2 and 4 μm. When mixed with human blood ex vivo, oxygen transfer from 70 volume % microparticles was complete within 4 s.

As noted, this is based on very proven technology: liposomes. These lipid-bilayer artificial “cells” are commonly used to deliver drugs in the bloodstream, and they are very well understood. This new application changes the liposome construction so that it dissolves much more quickly, allowing the oxygen to infuse the bloodstream almost instantly.

It is currently in animal trials. But based on how well the technology is understood, and the potential benefit it offers for a wide variety of life-saving applications, we could easily see this approved for human trials in the near term, and available for deployment within a few years.

And I just may need to find a way to work it into the next book

Jim Downey



Looking back: Being prepared.

While I’m on a bit of vacation, I have decided to re-post some items from the first year of this blog (2007).  This item first ran on December 29, 2007.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

As I have mentioned previously, I enjoy shooting. And I carry a concealed weapon (legally – by permit and where allowed by law) pretty much all the time. This isn’t paranoia, just a simple recognition that we live in an unpredictable and sometimes dangerous world. That same mindset applies to preparations for any kind of small-scale disaster, whether natural or man-made. If you live in the Midwest, you understand that power outages occur due to weather (tornadoes in Spring, Summer, and Fall, ice-storms in Winter), and that you may need to be self-reliant for days or even a couple of weeks. I’ve long abided by the Scout motto of “Be Prepared”, and while you wouldn’t find a years worth of supplies and a generator cached here, we could manage pretty easily for a period of a couple of months. That’s not too far off what is recommended by both the government and independent health agencies. As I’ve discussed, the onset of a pandemic flu may well cause a disruption of normal economic activity for a prolonged period, and I cite such a disaster as the background for Communion of Dreams.

Anyway, in an accident during one shooting trip this fall I managed to slice open my right thumb pretty well. I had ridden out to the family farm where I usually shoot with one of my buddies, so didn’t have my car, which contains a fairly complete first-aid kit. And, as it turned out, my buddy didn’t have any kind of first aid supplies in his car. We improvised a bandage from stuff in my gun cleaning kit, and things were OK. When I got home, I added a real first aid kit to my ‘range bag’, and didn’t think much more about it.

Then, a couple of weeks later I was back out at the farm with my BIL. We were walking the border of the property adjacent to a state park and marking it as private, since a lot of people don’t bother to keep track of where they are and we’ve had a lot of tresspassing. At one point down in a secluded valley my BIL and I paused for a breather, and just out of curiosity I checked to see if I had a signal for my cell phone. Nope. Hmm.

Now, it was nice weather, just a tad cool and damp when we set out. But it was November, and the leaves were slick in places where a fall could easily result in a twisted knee or a broken bone. I got to thinking – if I were on my own, what did I have with me that I could use in the event of an emergency? Oh, I had plenty of stuff in my car – but that was the better part of a mile away. What did I have on my person?

In truth, I was in better shape than most people would likely be in such a situation. I always have a Leatherman multi-tool on my belt, a small LED flashlight on my keychain, and a pistol and ammo. But still, since I don’t smoke I’m not in the habit of carrying matches or a lighter, I once again didn’t have any first-aid items, et cetera. I had stuck a small bottle of water in my jacket pocket, but that would hardly last long. I could probably cobble together some kind of splint or impromptu crutch, but it would be a challenge to get out of such a situation on my own.

When I got home I got to doing a bit of research about emergency survival kits. Google that, and you’ll come up with about 30,000 hits to sites offering everything from bomb shelters to equipment for first responders. Not particularly helpful. I decided to take a different tack, and started to think about what I wanted to have in a kit small enough that I would *always* have it with me. I set my goal for constructing a kit which would fit into an Altoids tin, since that is small enough to easily slip into any pocket.

This problem has been tackled by others, and there are actually some such small kits for sale that’ll run you upwards of $50. I looked over the commercially available kits, saw what others have done to solve the problems inherent in such a project, and came up with the following:

kit02a.jpg

What you see there is:

  • Surgical Mask (can also be used as a bandage)
  • Fresnell lens for magnification or starting fires
  • 20mm bubble compass
  • Single-edged razor blade
  • Suture pack (curved needle mounted with suture thread)
  • Band-aids & steri-strips
  • Antibiotic packet
  • Emergency whistle
  • Superglue (repairs, fabrication, wound sealant)
  • Mini-lighter
  • Cotton tinder tabs
  • Water purification tablets (can also be used as antiseptic)
  • 30′ of Spiderwire (15 lbs test)
  • Safety pins
  • Small ziplock bag for water
  • Cash
  • Painkillers
  • Benadryl (anti-histamine, sedative)
  • Anti-diarrheal tablets

Yes, it all fits in the Altoids tin. Just. It is not entirely satisfactory, as I would have liked to have a large piece (say 18″x24″) of heavy-duty aluminum foil, a couple of garbage bags, some lightweight steel wire, maybe some duct tape or heavier cord. But it is a pretty good start – any small kit like this is by necessity an exercise in trade-offs. (Edited to add 06/01/08: I wrapped about 15′ of 24ga steel wire around the mini-lighter in a single layer, tightly wrapped.  Takes up almost no additional room, and will be easy to unwrap for use.)

In searching out the items I wanted (difficult to find items linked to my sources), it became clear that in some cases I would spend more on shipping for some of the components than I would for the actual items. So I made one such kit for myself, and another half dozen to give to friends. That got the cost down to under $10 each (not including the cash, obviously).

Your best survival tool in any situation is your brain. But it doesn’t hurt to have a few advantages in the form of useful items close at hand. With this small kit, and what I usually have with me anyway, I am reasonably well prepared to deal with most situations that I can envision. And I thought that since I went to the trouble to construct it, I would put the information about it here for anyone else who might have some use for it.

Jim Downey