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The science of “Space Medicine” was founded in 1948 and developed rapidly. Key medical issues related to space travel include decompression sickness, maintaining muscle mass and density, fatigue, radiation, spatial disorientation, insomnia, low blood pressure, blindness, performance and balance, immune system health, psychological stress and isolation, and more.

Sometimes the writer has to ignore the medical facts in order to favor the fiction, especially in TV and Film. The director of “Gravity” refused to show Sandra Bullock in a diaper when she removed her space suit, even though it is required attire for astronauts. That would have been too much realism, distracting, and not a pretty picture. It’s great that you are looking to current space medicine facts to craft your fiction. Here are a few resources to get you started:

Pick a mission and the crew answers medical questions:

University Space Research Association (USRA)
Videos on Space Medicine Topics:

Interview with NASA flight surgeon Richard Scheuring:

NIH Medline Plus articles on NASA space medicine origins and spinoffs:

H.S. Clark, MD

Posted on July 11, 2016 at 3:14 AM


Great question, and I’m a huge fan of Hawaii 5-0! I watched that show, Season 6, Episode 25: O Ke Ali’l Wale No Ka’u Makemake. It pains me to see so many medical inaccuracies that could have been avoided by a quick consultation with a physician. I guess most people never notice the medical mistakes, or just excuse the bad science in the name of good drama.

Danny tells the transplant surgeon that he can stop looking for a compatible liver donor, because he and Steve are the same “blood type.” This is a partial truth, at best, because HLA antigen typing of organ donors goes way beyond matching the blood type. The chance of Danny being a good donor match for Steve is actually quite low, even if they are both the same blood type.

In the operating room, Steve and Danny are shown wearing simple oxygen facemasks, possibly awake, as they are prepped and draped for surgery. In reality, they would both be under general anesthesia, unconscious, with airway tubes coming out of their mouths and connected to a mechanical ventilator. This would be done long before the surgical area was prepared. Their eyes would be taped shut. I admit the scene wouldn’t be pretty for primetime TV.

I’m not aware of any medical facility where two patients are operated on in the same room, even for organ donation. Normally, the two procedures take place in separate rooms, and the donor organ is transported to the recipient. Putting the two stars in the same room for surgery reinforces the “loving partner” theme, eliminates the need to shoot two scenes, and saves airtime, too.

Hawaii 5-0 isn’t a medical show, but the writers could have easily checked their medical facts. I forgive the director for simplifying the shoot, fitting the time allotment, and optimizing the drama at the expense of medical accuracy.

H.S. Clark, MD

Posted on May 17, 2016 at 1:15 AM


Excellent question Clive, and the answer is a rapidly moving target. In my recent Medical Thriller, IMMORTAL FEAR, I predicted genetic advancements that could lead to an apocalypse for mankind. Many of my predictions have already begun to come true. Check out the article I posted on the front page of the forum: “Gene-Editing Scientist Ready to Play God.” The technology of genetic engineering is currently complex and tightly regulated, which should (in theory) slow down potential abuse and accidents. However, along with advancements in genetic engineering will come simplification of technique. Conceivably, future armchair scientists and terrorists will be able to manipulate DNA in their garages with supplies from the kitchen and hardware store. Genetic engineering technology has almost unlimited potential to remake human beings into super humans, aliens, or to kill. As a sci-fi writer, you are experiencing a merging of science fiction and science fact in the field of genetic manipulation. Anything is possible, and major advancements in designer genetics are inevitable. Think of the controversy over the dangers of GMO food, and then imagine GMO humans!

H.S. Clark, MD

Posted on February 07, 2016 at 2:18 PM


The medical TV series CODE BLACK began in September 2015, starring Marcia Gay Harden as ER Residency Director Dr. Leanne Rorish, known as “Daddy” by the staff. Although Harden’s acting has been stellar, the series has not received great reviews.

H.S. Clark, MD

Posted on February 07, 2016 at 1:28 PM

Re: MIRACLE CURE (Faith or Science?)

Thank you for the excellent question. This is quite timely, as recent breakthroughs in chemotherapy leave the door wide open for potential miracle cures. The late stages of cancer, with wide spread of metastatic disease all over the body (as to lung, liver, bone, brain) used to guaranty a rapid and certain death, baring a miracle of faith. This is still most often the case today, but not always. New classes of drugs have recently been developed that can, in some cases, cause dramatic remission of late stage cancers. Most often these remissions only last from a few months to up to two years.

However, in truth, no one really knows how long these remissions might last in some patients. This is especially true as these new chemotherapy drugs are now being used early on, in innovative ways, and in combination with more traditional drugs. It takes many years to get definitive studies, so the full potential of these new drugs is actually not currently known. Dying patients cannot wait for extensive studies; so many oncologists are relying on a combination of science, intuition, and experience in attempts to bring about miracle cures. This is what I call the ART OF MEDICINE, and it requires a leap of faith from both doctor and patient to even begin the treatment.

In today’s modern medical environment, the terminal patient in your story could realistically be treated with a new class of drugs, the full potential and effects of which are unknown. She would be a pioneer for that treatment, a study of one. All outcomes would be possible, including permanent remission. Your readers could debate whether it was the drugs or faith that cured your cancer patient.

H.S. Clark, MD

Posted on September 14, 2015 at 11:13 AM

Re: Zach Braff

Kristen, this show is one of my favorites. The medical sit-com Scrubs spanned 9 seasons from 2001-2010 on 2 networks NBC and ABC. Zach Braff played the lovable Dr. "J.D", who started out as a lowly intern. The live action show mixed fantasy, dreams, animation, song and dance into a fast paced, stream of consciousness type of humor.

H.S. Clark, MD

Posted on September 14, 2015 at 10:05 AM


Body of Evidence ran for three seasons from 2011-2013. Dana Delany played Dr. Megan Hunt, neurosurgeon turned medical examiner after several traumatic life events. Dana Delany’s life ran somewhat parallel to her role, as she is a health enthusiast and suffered personally some of the same traumas as her character.

Posted on July 28, 2015 at 9:22 AM


This is an interesting fiction story set-up with many little parts and lots of directions in which you can go. As for the medical aspects, there is nothing in the set-up here that is impossible or unrealistic. Pregnancy rarely happens over age 50, but it’s not unheard of. Today, it’s often the result of using fertility drugs. The beginning stages of menopause can be intermittent, and mimic complete menopause. Eggs can still be released, and hormones can still support the early stages of fetal development. The odds of such a pregnancy are very low, but this is the type of unlikely transforming life event that good fiction is often about.

The ER would not suspect or look for a pregnancy in this woman. However, it is likely they’d do an abdominal CT scan (and maybe an ultrasound) as part of a workup for a major infection of unknown origin. Either of the previously mentioned tests would visualize the growing fetus, and discover the pregnancy.

Your patient might be treated with IV fluids for rehydration, and antibiotics for a bacterial infection and/or pneumonia. She’d be kept in the hospital for a few days for observation and IV medications. Keeping her in the hospital is justified, because she’s at risk for a massive infection (septic shock) or severe pneumonia leading to respiratory failure. And now, she’s an elderly pregnant woman, and at high risk for pregnancy related complications. This story will make an interesting graphic novel, and be a challenge to illustrate!

H.S. Clark, MD

Posted on April 19, 2015 at 10:57 AM


The X-files ran for nine seasons on TV and spawned two feature films. Dana Scully came from a military family. She had an undergraduate degree in physics and then earned her MD at Stanford. During the course of the franchise, Scully worked as an FBI agent, surgeon, medical doctor, and a forensic pathologist.

H.S. Clark, MD

Posted on April 19, 2015 at 9:47 AM


Dear Jean,
I’m glad you enjoyed my new medical thriller IMMORTAL FEAR. I’ll be signing at the meeting and I’ll have plenty of time for a chat. You can text/call my conference number 206-673-3251 anytime during the meeting to find me.

Poisons are a traditional murder method in mystery fiction. The history of poisons in fiction reads like a who’s who of great writers. You have to consider many questions: how to get it, how to safely handle it, how to hide it, how to transport it to the victim, by what route is it administered, how fast it works, is there an antidote, how easy is it detected after the fact by forensics, how to dispose of any extra, and can it be traced to the original source? Lets look at ten of the most historically significant poisons that have also often been used in fiction:
1. Arsenic: Easy to obtain, administered orally, discrete, high potency. Basically, it causes cellular metabolic failure and cell death. Historically, it’s been hard to detect, but modern forensics (the Marsh test) can now detect microscopic amounts. It absorbs into and contaminates everything, and it’s hard wash off. So it leaves a trail right back to the murderer.
2. Botulinum Toxin (Botox): The now popular cosmetic drug is made from deadly bacteria. It can be administered orally or by injection. Basically, this poison inactivates the contraction mechanism of muscles, causing paralysis, and death from inability to breathe. Used to be hard to get, but now it’s everywhere. It’s a prescription drug, and should be traceable back to the source. Yeah, right, like all those wayward narcotics floating around!
3. Cyanide: Easy to get, but easy to back trace, a small dose kills quickly, easy to conceal, given orally or can be inhaled (poison gas). It kills by preventing the body from using oxygen, causing internal, cellular suffocation. I used Cyanide as a poison in my medical thriller SECRET THOUGHTS. Cyanide is found in many common consumer and industrial products, so your death could be an “accident.” Forensically, it’s easy to find if you are looking for it. There’s an antidote, but it’s not readily available and has to be injected immediately in order to work. Cyanide is good when you need your poison tiny, fast, and deadly, or when the death needs to be an option, or a suicide, like the so overdone spy poison-in-a-tooth.
4. Mercury: Easy to get, takes repeated doses over a long time to kill, easy to detect, but only if you are looking for it. Mercury causes progressive brain and nerve damage. The nerve damage is irreversible, but treatment can stop progression. Mercury is a nice poison when you’re after the inheritance, and need to get rid of your spouse or boss, or just make them demented and legally incompetent.
5. Polonium: This is a radioactive isotope, and a tiny amount ingested or inhaled causes death in weeks to months from internal radiation exposure. It’s easy to trace back to the source, but impossible to cure. Polonium is a favorite spy poison, because you usually need to be a government to get it. This poison is classically used in D.O.A. type stories, where the walking dead murder victim helps find his own killer. Check out the classic noir film D.O.A in 1950 and the remake in 1988.
6. Tetrodotoxin: It’s a deadly nerve poison found in puffer fish, and the blue-ringed octopus, which has a painless, deadly bite. Puffer fish with toxin removed are a culinary delicacy. So the toxin is easy to come by, and hard to trace back. A small amount injected or inhaled causes death in minutes by muscle paralysis that stops your breathing. Put all chefs on your suspect list.
7. Dimethylmercury: It’s a man-made form of mercury that kills slowly over months, but only takes a single exposure of as little as one-tenth of a milliliter, just a drop. It’s highly absorbent, and will easily penetrate skin, and most protective gloves and clothing. This poison is hard to get, but you don’t need much, and by the time death occurs, you’re dealing with a cold case.
8. Belladonna or “Deadly Nightshade”: This is a plant used now to make Atropine, a common, life-saving drug in the right situation. But eating one Belladonna leaf or a dozen berries can cause a rapid overdose, leading to rapid heartbeat, seizures, loss of coordination, extreme anxiety, confusion, delirium, hallucinations, irregular breathing, and death. This is not an easy plant to find or grow.
9. Aconite (Monkshood or Wolfbane): Aconite kills by causing an irregular heart beat in which blood does not effectively circulate. Death is in a few minutes or a few hours, depending on the dose. It’s absorbed rapidly by mouth or via the skin, so touching it can kill. Magnesium can sometimes correct the deadly heart rhythm. It’s hard to detect, and hard to trace back to the source. It’s found in mountain meadows in Northern climates, and is not too difficult to grow from seeds. Historically, this was a favorite for poison tipped arrows, so it’s good if you need to dart your victim.
10. Hemlock: This plant is easy to find and highly deadly to humans and animals. It can be brewed into and masked by a flavorful drink, and given orally without being detected. It kills by muscle paralysis over minutes to hours. Onset is often slow, with a long period of immobility before unconsciousness, perfect for putting the horror in your murder.
I hope this overview helps you to plan the perfect crime!

H.S. Clark, MD

Posted on February 27, 2015 at 12:56 AM


Dr. Derek Shepherd, Neurosurgeon, is played by Patric Dempsey on Grey's Anatomy. This up close and personal medical series takes place at a fictional Seattle Hospital. I like that it's set close to my home, even though its mostly filmed in Los Angeles, California. Grey's Anatomy has been on the air since 2005 and is now in its eleventh season.

H.S. Clark, MD

Posted on February 24, 2015 at 8:36 AM


Great question! And you are correct; I deal with surgical risks on a daily basis. Most of the details of the demise of Joan Rivers during “simple” outpatient surgery are currently hidden due to pending legal action. Much of what information did get out is sketchy at best. This is partly what forced the press to speculate. So lets deal with the basics, and stick to known facts. No surgery is without risk, no matter how simple. We do surgery only when the potential benefits outweigh the risks. There are three problems that happen during surgery: human error, equipment failure, and medical complications.

Human error includes poor training or preparation, failure to recognize or correct common problems, and violation of established protocols. The high reliability of critical medical equipment can lull providers into a false sense of security, because no one is expecting equipment failure. Advanced medical technology creates miracles, but is also a crutch. Bad physical reactions to the manipulations and stresses of surgery can lead to catastrophic outcomes.

Rumor has it that both human error and adverse physical reaction to surgery may have contributed to the death of Joan Rivers. A vocal cord biopsy, a procedure not normally done at that institution, done by a visiting doctor, not authorized to practice at that institution, may have caused irritation and spasm of the airway. This spasm may have progressed to complete airway closure and suffocation, in spite of attempts to reopen her airway. My explanation is based on innuendo and hearsay. The truth will eventually come out.

To keep it real, weight the fictional risks vs. the benefits of surgery in your stories, and do what would make sense in the real world. Make sure that any surgical complication is due to some combination of human error, equipment failure, or bad medical condition. If all else fails, obscure the surgical details in the name of legal action and patient privacy. After all, that’s what the real media does.

H.S. Clark, MD

Posted on November 04, 2014 at 9:05 AM


Dr. John Zoidberg was a fictional, animated, alien physician on the Futurama TV show, which ran for seven seasons between 2003-2013. Zoidberg was a lobster-like Decapodian voiced by Billy West. As an alien doctor that treated humans, Zoidberg was, to some extent, a parody of Dr. Leonard McCoy of Star Trek, (see previous post above) who often treated non-human patients.

H.S. Clark, MD

Posted on October 10, 2014 at 8:10 AM


Molly Glynn died tragically in a freak bicycle accident in Evanston, IL on September 6,, 2014, when a falling tree struck her in a sudden storm. Her husband, Joe Foust, was riding with her at the time. She was born in 1968 and her credits include several movies starting back in 2002, and her recent role as an ER doctor on the TV series Chicago Fire. She will be missed.

Molly Glynn movie credits:
In America – 2002
No Sleep ‘till Madison – 2002
Ctrl + Life + Delete - 2013

H.S. Clark, MD

Posted on September 08, 2014 at 4:53 PM


Pat, your question plunges us into the controversial, emotional, logistical, and religious quagmire of blood transfusion therapy. In your story, you’ll need to first understand and forensically eliminate transfusion related causes of death. To paraphrase Sherlock Holmes, whatever remains after you eliminate known transfusion complications, however unlikely, must be the cause of death. So lets review some potentially deadly transfusion complications:
1. Transfusion reactions: A type of system wide allergic reaction, possibly caused by mismatched blood, leading to circulatory shock. Your character might experience chest and back pain, anxiety, fever or low temperature, low blood pressure, and nausea. This would come on rapidly during or immediately after the transfusion. Blood tests are used to confirm this problem.
2. Hemolytic reactions: In which the body’s defenses attack the transfused blood cells and destroy them. This can be immediate like a wildfire, or slow over days. Toxic byproducts from the broken blood cells poison the body, leading to multiple organ failures, especially of the kidney and liver. Blood tests can help to determine if this is happening.
3. Graft vs. Host reaction: The transfused blood attacks the patient. This is the reverse of number two above, but similar in presentation and can be just as deadly. Again, blood tests help to diagnose this complication.
4. Infections: Although blood is carefully tested before transfusion, some infections still occur rarely. This includes bacteria, viruses (such as hepatitis B and C, HIV, West Nile), parasites, and Creutzfeld-Jakob disease (the human version of Mad Cow.) Cultures of the blood and antibody tests can determine which organism has infected your character.
5. Fluid overload and congestive heart failure. This usually occurs immediately or within a few hours of the transfusion. Bloody, foam-like froth may leak from the patient’s mouth, and they complain of difficulty breathing. Oxygen levels in the blood will be low (measured via a finger pulse oximetry monitor or blood tests). Using a stethoscope, wet, crackly sounds are heard in the chest. Chest X-rays will show a streaky, white, ground-glass pattern. This is often correctable, but can be rapid and deadly.
6. Heart attack or stroke due to thickening of the blood from the added blood cells. Thickened blood is dense, sticky and harder to circulate Think of your heart trying to pump syrup instead of water. Diagnosed with blood tests.
7. Iron overload with liver and heart damage. This can be mild or severe enough to kill. Diagnosed with blood tests and liver biopsy.
8. Rapid spread of cancer. Probably due to immune system impairment caused by the transfusion. This is a delayed cause of death from blood transfusion, over weeks to months. There is no specific diagnostic test and therefore no way to prove that the transfusion was responsible for the spread of the cancer.
9. Massive system wide inflammatory response that can lead to many problems, including DIC, an inability to form blood clots. Ironically, DIC causes the patient who got a blood transfusion to bleed to death. Blood coagulation tests are used to diagnose this. Patients may bleed continuously from puncture sites, the mouth, rectum, and eyes.
10. Metaphysical death: Eternal damnation due to the intake of another person’s blood. This is a religious or spiritual belief that is held by fair number of people and groups. To the devout believer, this is a fate worse than bleeding to death.

Many of the above causes presuppose that all the proper procedures for blood transfusion have been followed. You’ll also have to rule out a distracted, incompetent, or malicious healthcare worker who used the wrong blood, stored, handled, or transfused the blood incorrectly, or introduced a large amount of air during the transfusion. If you are looking for a “non-transfusion” related way to kill your character, tampering with the computer codes, ID bands, or blood labels could work. Foul play could eventually be discovered by retesting all the blood, but by then it might be too late, and the killer long gone.

If none of the above complications explains the death of your character, then you have a coincidental death from another totally unrelated cause, or a very clever assassin.

H.S. Clark, MD

Posted on August 15, 2014 at 8:55 PM


Rob Morrow played Dr. Joel Fleischman in Northern Exposure from 1990-1995. He won two Emmy Awards and three Golden Globes for his roll as a doctor from New York City who was forced to work off his government loan obligation in the fictional remote town of Cicely, Alaska. The show was actually filmed about an hour and a half east of Seattle, in the tiny town of Roslyn, in my home state Washington. This location was chosen to avoid the high cost and isolation of filming in Alaska. Morrow is also well known for playing the role of Don Eppes in Numb3rs.

H.S. Clark, MD

Posted on July 31, 2014 at 4:15 AM


Thanks Jamie,
I watched the episode and you are correct, the Propofol use by Jack to sedate Kate is wrong in so many ways! I'm an anesthesiologist, and quite familiar with Propofol, as I use it daily in my practice. First of all, it's a white, milky liquid, and the syringe Jack used had a clear liquid inside. Amazing that they didn't even get the color right. It would be potentially deadly to inject the Propofol directly into Kate's neck, as it has to enter a vein or artery in order to work and not cause damage. Jack used 5 cc's, and that would be 50 mg, barely a "stun" dose for a young agent like Kate. It might make her sleepy for a few minutes, but she would not be immobile. There is no way it would last as long as it did in the episode, or have the desired effect. And the Arm's Dealer's "antidote" does not exist, as there is no antidote for Propofol. It has to wear off naturally. Even if there were an antidote, why would the Arm’s Dealer have it, especially when he’s still using car batteries for interrogation? You’re RN assessment is correct. They blew it. A ten-minute consult with an anesthesiologist could have avoided this bizarre fictional medical fiasco.

H.S. Clark, MD

Posted on June 08, 2014 at 6:29 AM


That's a timely question, as botched executions have been in the news lately. Death penalty states started death by lethal injection as a humane alternative to hanging, firing squad, electric chair, or a gas chamber. In theory, lethal injection might be more humane, but in practice, not so much. Some state laws initially required a physician to oversee the process, and tried to recruit physicians, and specifically anesthesiologists (like me) for the task. But physicians swear an oath to “first do no harm”, and state laws were changed when no doctors signed up for the job.

The technical aspects of lethal injection can be hard to overcome. First, secure access to a vein must be established. In a hardened prison population of IV drug users, finding an unspoiled vein can be next to impossible. And to be absolutely sure of a humane execution, you really need to access two veins, in case one fails, a frequent occurrence. Next, you have to choose your drugs carefully. Again, the high use of sedative and narcotic drugs in the prison population makes many inmates highly resistant to depressants. So at the least, we’re talking massive drug doses for a sure-fire execution.

The order and rate of drug administration is also a variable to contend with. The usual three drug cocktail approach uses a sedative to render the person unaware, a muscle relaxant to immobilize, and a potassium infusion to stop the heart. Here you run into a moral dilemma, and a PR nightmare if you have witnesses. If you give the muscle relaxant first, you can have an awake, terrified, but paralyzed inmate. So you have an execution that’s pretty for the press, but cruel and inhumane. If you give the sedative first, (as was done using midazolam in the recent botched execution that’s been in the news) you can have a sedated, unaware inmate that reacts violently until the relaxant kicks in. So you can have a humane execution that’s very ugly for the press, and appears to be very inhumane. If you give the potassium infusion before adequate sedation, it burns like fire.

Now if all these issues were not enough, drug companies often refuse to provide drugs for use in executions. This may be for reasons of religious or political objections to the death penalty, or because of the fear of negative PR that will impact drug sales. Another factor in drug shortages may be drug company fear of lawsuits from civil liberties groups and family members for pain and suffering.

Here’s a summary of what can go wrong:
No venous access, poor venous access, lost venous access.
Too low a drug dose/too slow drug administration/drug resistance.
Drugs not available/inadequate supply.
Paralysis before sedation/inmate terrorized/press happy.
Sedation before paralysis/inmate happy/press terrified.
Potassium infusion before effective sedation/burns like fire.

And lets not forget that DNA analysis of old evidence has uncovered many an innocent person on death row. The ultimate botched execution is the wrongful execution of an innocent person.

H.S. Clark, MD

Posted on May 24, 2014 at 5:38 PM


DeForest Kelly played Leonard McCoy, a compassionate and dedicated physician with a failed marriage who joined Starfleet because he was divorced, broke and wanted to get as far away from Earth as possible. He hated advanced technology but mastered it for his practice. The original Star Trek series ran from 1966-1969 and spun off an endless number of movies, comics, books, video games, and related series. DeForest Kelly died in 1999. Karl Urban assumed the role of Leonard McCoy in movies beginning in 2009.

H.S. Clark, MD

Posted on May 24, 2014 at 5:14 PM


Your astute question reinforces the critical importance of getting it right when a writer creates fictional children. If your story spans months (for infants) or years (for older children), then the writer must deal with changes in physical and mental attributes. It’s very hard to be a virtual parent! Pediatric attributes are constantly changing. Attributes such as height, weight, mental capacity, eye-hand coordination, developmental milestones, nutrition, health issues, disabilities, injuries, educational achievements, congenital defects, and more, must be accurate in order to keep your fiction real.

Here are three quick resources that will help to get you started:

1. For info on general height and weight through the early ages go to:

This is divided into two sections. The WHO charts are for children ages 0-2 years, and the CDC charts are for children 2 years and up.

2. For a quick check of normal pediatric growth and developmental behavioral milestones go to:

This is divided by ages, so you can reference each section as a check on the behavior of each of your child characters, and keep their behavior appropriate.

3. For more detailed info on every stage of child development, the following website is nicely indexed by age groups and specific areas of child development. It contains a good mix of basic info on healthy children of all ages, and articles on childhood health issues.

H.S. Clark, MD

Posted on April 06, 2014 at 7:23 AM
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