Monday, March 30, 2020
Spenser(protagonist)-Spenser, A Former Boxer, Is A Private Detective F
Spenser(protagonist)-Spenser, a former boxer, is a private detective from Boston. He is a very down to earth man, who likes to have fun in his work. He is very humorous and takes life as a fun ride. There is a point in the story where a larger man who attempts to intimidate Spenser, who responds by taking the large man down with one kick, all the while laughing at the man. Susan-Spenser's girlfriend who has a Ph.D. in psychology from Harvard. She is a clinical psychologist, who has been romantically involved with Spenser for many years. She often helps him on his cases when he is dealing with a disturbed or possibly dangerous person. She helps Jill Joyce overcome her problems in this novel. Jill Joyce-typical overzealous television star. She is extremely pampered and feels that it is her right to be waited upon. She has lead an extremely rough life, from abandoning her parents to having an illegitimate child. She has tried to keep this from ruining her reputation, so she is very quiet when it comes to her past. Hawk-is a large, intimidating black man who was born in a ghetto, served with the French Foreign Legion, and was a boxer during the same period as Spenser. His occupation is 'enforcer', collector for loan sharks; he will murder for money, which he makes a lot of. Plot Synopsis- Spenser is hired by Zenith Meridien Television to guard Jill Joyce. She has experienced harassment in the recent past, and the company wishes for her to feel safe on the set. Spenser finds that Jill is a troubled, alcoholic, drug addicted, egocentric annoyance that is lost in life. The morning after they meet, a Mr. Rojack and his thug, Randall try to get Jill to go with them. Jill declines their offer, at which point, Randall attempts to attack the smaller Spenser, only to find himself on the ground within moments. Later that week, Spenser tracks down Rojack, who turns out to be quite wealthy and discovers that Rojack and Jill had more or less gone steady for a couple years. He also learns of Winfred Pomroy, a man who had been "bothering" Ms. Joyce. He makes plans to visit this man, as it may provide an idea to the identity of the assailant. The following morning, Spenser and Jill discover Babe Loftus, who was Jill's stunt double, murdered in her dressing room. This provokes spenser to take quicker action, and he sets out for Pomroy's home. While he is gone, he has a friend of his, Hawk, look after the starlet. When Spenser visits Pomroy, he finds a recovered alcoholic, living with three dogs. He had been married to Jill 25 years ago and seems to be slightly obsessed with Ms. Joyce at the present. Spenser journeys to the San Diego area in search of more of Jill's past, where he finds her mother. Through her, he learns Jill conceived a daughter with a man Del Rio. Del Rio has since adopted Jill's daughter, who is now 20 years old. Spenser also tracks down Jill's father, who hasn't seen her since she was four. He briefly questions the poor, troubled man and returns home. Spenser returns to Boston only to find that Jill has run away, Then Del Rio calls and informs Spenser that Jill has escaped to see him. Spenser travels to retrieve Jill. She talks about the man harassing her. Spenser suggests they bring the father in to see Jill. Spenser then accuses him of killing Babe Loftus, the stunt-woman, to which he confesses, then tries to pull a gun on Spenser. Spenser kills him before he can do anything. Spenser and Jill return to the peaceful setting of Susan's cabin in Maine and she seems to be in hopeless condition. Susan comes, bringing the 3 dogs that Wilder Pomory had. and when they come to Jill, she responds to them, and as the story ends, she and Spenser have walked around the lake with the dogs, Jill is showing signs of emerging from her condition, where Susan may be able to help her, in fact Jill expresses interest in being treated by Susan. Opinion-This book was wonderfully written. The characters were all realistic, and they reacted as you
Saturday, March 7, 2020
Compartment syndrome Essays
Compartment syndrome Essays Compartment syndrome Essay Compartment syndrome Essay     COMPARTMENT SYNDROME    Page 1     Compartment syndrome is a condition that occurs when the pressure in an anatomical compartment increases due to swelling which can cause damage to the muscles and the nerves. As the pressure increases, it cuts off circulation and starves the muscle and nerve cells. This can cause temporary or even permanent damage and as a result, the affected area can develop paralysis. In severe cases, amputation of the limb may be required or the end result could be death.     Compartment syndrome is classified in two different forms. It can be chronic compartment syndrome which is a common ailment among athletes due to exercise and physical activity. The other form is acute compartment syndrome that is a medical emergency, generally trauma induced, where time is of the essence.     Compartment syndrome most commonly affects the lower leg and forearm, although it can occur in the foot, thigh, hand and upper arm.     The first case of chronic compartment syndrome of the leg was diagnosed by Mavor in 1956. Over the next twenty years, only nine other cases were of chronic compartment syndrome were reported. But as physical fitness became more of a trend and grew in popularity, chronic compartment syndrome became a more significant problem.     Chronic compartment syndrome generally occurs in the legs as a result of steady exercise or running. This can generate a constant pressure to the areas in the anterior or lateral compartments. Exertion can cause the muscles to swell and expand forcing pressure within the compartment. Most often this occurs in the lower leg and can usually be relieved with plenty of rest, applying ice and elevation of the affected area. Compression is not to be applied.                                                                          COMPARTMENT SYNDROME    Page 2     Pain and swelling are the primary symptoms in chronic compartment syndrome and it can last for weeks and even months. Diagnosing chronic compartment syndrome can be done by testing the pressure in the compartment with a handheld pressure catheter provided the condition exists within the anterior compartment. If the problem is deeper into the posterior compartment, it is more difficult to test because the area is harder to reach. Doctors measure the pressure before a person exercises, then one minute after exercise and finally five minutes after the exercise. If the pressure has not decreased, compartment syndrome is the likely diagnosis.     Thallium stress testing is another test used to detect chronic compartment syndrome. In this test, thallium is injected intravenously into the body as the patient undergoes various forms of exercise. By use of this form of testing, multiple compartments can be found to be affected as was proven in some cases. This test, however, does not indicate the extent of the condition.     In chronic compartment syndrome, the patient often feels a numbness or tingling when moving the affected area. This usually subsides once the movement ceases but the pressure inside the compartment has the potential to still remain high afterwards.     Treatment for chronic compartment syndrome rarely requires surgery. Doctors suggest rest and avoiding activity, especially anything strenuous or physical involving the affected limb. Ice and elevation are recommended and the patient is to take aspirin or ibuprofen to reduce the inflammation.     Should this type of treatment fail, a fasciotomy is recommended. Fasciotomy is a surgical procedure involving the fascia, or fibrous tissue that surrounds the muscle. The fascia is cut to relieve the pressure in the compartment. The procedure has a high rate of success but many patients require skin grafts to heal the surgery site.     Chronic compartment syndrome can result from running, a change in physical activity, exercise without proper stretching, the use of braces and wrapping or taping a limb too tight.     Acute compartment syndrome is the more severe form of this injury. It is generally caused due to some sort of trauma to the compartment. Bone fractures, tearing the muscle itself, blood clots and blockages, extreme workouts, anabolic steroid use and crush injuries are typical causes of this condition.     While chronic compartment syndrome is not a life-threatening medical emergency, acute compartment syndrome is extremely dangerous. It allows a four to eight hour window in which the pressure of the severe swelling can kill off all of the capillaries and muscle and nerve cells in the compartment.     Once this happens, the limb would have to be amputated or eventually death would occur from a lack of oxygen. When acute compartment syndrome occurs from a bone fracture in the leg or arm, the limb should not be casted until the pressure stabilizes. A splint should be applied until the swelling recedes.      If acute compartment syndrome is not diagnosed in time and the cells in the compartment die off, infection and gangrene will set in. This would be the reason that amputation would be needed. Renal failure is another likely result. The tissue and nerve cells can survive for up to four hours before the damage becomes irreversible.     Compartment syndrome is a condition that needs to be monitored closely for several days following the initial injury. A patient is still at high risk for three to six days after the initial cause of swelling in the compartment. In severe cases, a hospital stay is required to record the frequent examinations and pressure measurements. Some studies show that maximum swelling due to an injury may take 21 to 36 hours to peak. This is one of the reasons that rest is particularly important because any slight increase in pressure can trigger the need for emergency surgery.     Since pain is common with any injury but also a major symptom in acute compartment syndrome, it can be interpreted wrong, tolerated and remain undiagnosed. The pain level with acute compartment syndrome is severe. As pressure builds in the compartment, the feeling is very tight. Movement can be excruciating as the pressure compresses against the muscle. Skin will feel stretched and the affected area can experience a tingling or burning sensation. Patients will also feel a palpitation in the area.     Once the pressure is tested in the compartment and diagnosis is confirmed, treatment begins with complete rest, ice and elevation. During this time the muscle will feel tight and the pain will be severe. Compartment pressures must be monitored and when the readings maintain a high number, emergency surgery is required.     During the fasciotomy, a long incision is made in the fascia to release the pressure. The wound is covered with a dressing and left open for 48 to 72 hours before closure. Due to this nature, skin grafts are often required to close the wound.    Acute compartment syndrome is a typical injury of motorcycle riders as a result of being run over by the bikes, thus crushing an arm or a leg. COMPARTMENT SYNDROME    Page 5     Football players also tend to be prone to acute compartment syndrome from injuries received by hard hits when helmets come in contact with the thigh during a tackle. If these injuries are not treated properly with acute compartment syndrome taken into consideration, the result can be permanent paralysis of the limb.     Compartment syndrome does not just affect running athletes and trauma victims. Bodybuilders and bowlers often suffer from a tightening of the muscle in the wrist. This is more commonly known as carpal tunnel syndrome. It is also a medical condition that is common among writers and typists or anyone who performs repetitive motions with their fingers and wrists. Carpal tunnel syndrome affects the muscles in the wrist creating a compartment syndrome.     There needs to be more of an awareness made on the symptoms, treatment and severity of compartment syndrome. People sometimes shake the signs off as a complication from the injury, expecting pain and swelling. Medical personnel involved in treating motorcycle riders and athletes should understand the depth of the injury because in the case of compartment syndrome, time is critical. REFERENCES Medline Plus (04/05/07) Medical Encyclopedia: Compartment Syndrome. Retrieved 4/12/07 fom nlm.nih.gov/medlineplus/ency/article/001224.htm Pediatric Orthopaedic Society of North America (02/05). Compartment Syndrome. Retrieved 4/13/07 from http://orthoinfo.aaos.org Swain, R. MD and Ross, D. MD 03/99. Lower Extremity Compartment Syndrome. Retrieved 04/13/07 from postgradmed.com/issues/1999/03_99/swain.htm Wikipedia, the Free Encyclopedia. (2007) Compartment Syndrome. Retrieved 4/12/07 from http://en.wikipedia.org/wiki/Compartment_syndrome
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