Tuesday, July 31, 2012

Read First Chapter of The First To Say No

The First to Say No

Charles C. Anderson

The author has authorized BRH to
give free, limited  PDF copies of either 
of his books by just commenting and 
providing an EMail...First Come,

Dr. Elita Romanov’s first thought as she fought her way into consciousness was of her boyfriend in Chechnya. But he had been killed in the second war with the Russians. Her next thought was the screaming pain in the back of her head. She rolled her head to the right nd discovered a tender lump in her scalp. She wished she could reach up and touch it.Was her hair matted with blood from a laceration in this lump? She wiggled her nose. She opened and closed her eyes and mouth. She turned her head from side to side and felt her earrings
touch a table.The rest of her head seemed okay. She wondered if she had other injuries. Someone had knocked her out. She could think of no other explanation.Why was her body moving back and forth?

She looked down and identified the bobbing head of a man. He was grunting. He was lying on top of her. He was inside her. She registered the odors of bourbon, cigarettes, decayed teeth, and sex. A scream would feel good, but she knew better. She recognized the taste in her mouth and wanted to spit. She knew better than to struggle.After all,  this was the third time she had been raped, including two gang bangs by the Russians. She willed herself to be flaccid, and swallowed.

This man on top of her appeared to be Puerto Rican. He had a red bandana cap on top of his head. He was looking down at her naked chest and belly, as if her face was not attached. She was being raped by a member of the Plagues, the local gang that ruled the neighborhood of Parkview.

She searched for more information. The ceiling had chipped blue paint. She felt wood against her bare back. Her legs dangled from the knees. She could touch the floor with her toes. Her arms were tied over her head by cloth, probably to the legs of the table she was lying on.

She smelled wood smoke. She heard the voices of men in the next room and the steady rhythm of some kind of music. A door over his left shoulder was closed, or almost closed. This Plague was naked so far as she could see. She scanned the room for his knife or gun. No. She smelled wood smoke.  No plague ventured very far from his personal weapon. On the couch to her right she saw his pistol and a bottle of Vaseline. She noted her
work scrubs strewn between the couch and the table she was lying on.

She studied her rapist. He was becoming more excited. His palms were positioned on the table on each side of her pelvis. He abruptly moved them to her breasts, which he gripped like handles. Sweat dripped from his head onto her chest and abdomen as the pace of his thrusts quickened. The wood of the table gnawed at her back as he pulled her back and forth by her breasts.

He had failed to secure her feet. Slowly she lifted her right knee and extended her foot. He didn’t notice. She lifted her left knee. If he was aware of her leg movements, he didn’t care.

Not tying her legs was a critical mistake on her rapist’s part.Tying her slender hands at the wrists with cloth was also a mistake. She relaxed her right hand and steadily pulled it through the cloth restraint. As her left hand slid from its restraint, her rapist began to grunt loudly.

Elita gradually squeezed her thighs together to limit his penetration. He responded by removing his hands from her breasts, inserting the palms of his hands under her buttocks and lifting her pelvis off the table. He spread her thighs with his forearms as he leaned into her. At that moment, this man was her predator. In a few heartbeats, he would be her prey.

The man’s jaw fell open. His chin jutted toward her. He closed his eyes and began to tremble. Like a crouching lioness in the savannah, Elita sprang to life, elevated her pelvis and clamped the rapist’s neck between her thighs. She locked her ankles together and squeezed with the powerful muscles in her thighs.

At five feet ten inches tall, she was a finely tuned thirty-four year old athlete with honed skills at both taking lives and saving them. Elita wore her brunette hair short, combed behind her ears, and liked earrings.
Her hands were delicate and very steady for a young physician.She was a rare combination, a lioness who was as graceful as her prey, the gazelle, and as deadly as a black mamba. Not many emergency physicians had her level of experience treating the wounds of war. Only the U.S. State Department knew the details of her most remarkable skill.

Her rapist was already short-winded when Elita interrupted most of the blood flow to his head. She could feel his carotid pulses against the inside of her thighs. His heart rate accelerated. She rested her forearms on the table as he struggled to get his feet under himself. He lifted her pelvis another foot off the table, but stumbled back to his knees. She watched his face turn ashen.

He abandoned his efforts to stand. Flailing his arms around her thighs, he knocked the red scarf off his head. His chin collapsed to her pubic bone. He tried to wiggle his hands between her thighs and his neck, but he did not have the strength to pry his head out.

Elita knew that his brain could only last a few seconds without blood flow and oxygen. His efforts to free himself were already panicky and uncoordinated. He appeared to be getting some air through his mouth and nose, however, and she did not want him to cry out. Squeezing his neck from the sides had effectively cut off most of his brain’s blood supply, but his airway, in the midline of his head and neck, was still at least partially open.

Without releasing her leg grip on his neck, Elita sat up and wrapped her hands around the back of his head. She guided his nose and mouth to her vagina and pulled his face to her to make a tight seal. She watched his breastbone being sucked in with each respiratory effort. She felt the suction tug on the soft tissues of her perineum.

She concentrated on his carotid pulses against her thighs. His heart rate was now decelerating. She estimated about forty beats per minute.His head color was now blue. She looked toward the door. No one entered.
She held him as his heart rate became slower and slower, showing no more emotion than a lioness suffocating a gazelle.

Once his heartbeat disappeared, she gradually relaxed the muscles in her thighs and sat completely upright. Holding his hair in her fists, she guided his head to the floor between her feet.

She bounded toward the couch, but slipped on his semen in the floor. She caught herself on her knees with her face against the couch. The pistol was six inches from her nose.

The feel of the pistol grip in her hand brought out her first emotion, a faint smile in the corner of her mouth. She examined it carefully. It was a Glock .45 semiautomatic. She released the clip in the hand grip and counted fourteen rounds in the magazine. She pulled back on the slide of the gun enough to confirm a round already in the chamber. Gently she let the slide move back to its ready position. She inserted the magazine into the hand grip and stepped to the right of the door.

Elita gently grasped the door knob with her left hand and leaned her naked back against the doorframe.The Glock was resting against the right side of her face as she cracked the door and leaned forward.

The first thing she saw was a wood stove. It was mid-November. She recalled that the weather had been especially cold and windy recently. She felt the heat from the stove on her forehead. She scanned the room
by direct vision and by reflections from glass surfaces in the room.

There were two men in the room that she could see, a black male and a white male, both seated on a couch.They appeared to be counting money on a small table. She noted the front door and a full window
on each side of this door. It was an old house, not unlike the many Victorian houses in Parkview. She wondered where she was.

On the far side of the couch in the floor of the room where she had been raped was her own purse and overcoat.The work scrubs on the floor meant that she had been abducted on her way to or from work
in the emergency department, where she was an attending physician.She guessed that it had happened in the parking deck as she was leaving, although she had no recollection of this.

Walking to and from the car in the parking deck was the most vulnerable time for any female employee at Parkview Hospital. The Plagues specialized in preying on nurses and other female employees coming and going for the night shift.They were smart enough to disable the security cameras before acting. She recalled that an emergency department nurse named Janice Green had been abducted from the second level of the parking deck and raped about six months earlier.

Elita weighed her options. She could open the door and start shooting. But what if there were more than two Plagues in the room? What if she walked into a cross-fire? It would be better to draw everybody
in the room to the door.

She walked back to the table, sat down and spread her legs. Reaching down, she picked the dead man’s head up by the hair and positioned it between her legs, where she held it again with her thigh muscles. She arched her back and extended her arms over her head and underneath the table.The Glock was in her right hand. She began to moan rhythmically, increasing the volume quickly.

She heard the door creak open, followed by laughter.The two men at the door were still laughing when Elita sat up and shot them both in the chest.They crumpled in the doorway. She held the gun extended toward the door as she stood up. The dead man’s head between her legs fell back to the floor. No one else came to the door or ran out the front door.

Elita entered the front room with the gun out in front.There were stairs to her left and a kitchen to her right. The kitchen was empty. She leaped up the stairs and methodically moved from room to room with the gun until she was satisfied that she was alone. She looked out of an upstairs window and saw the line of tall trees that encircled River Park. She had been abducted and raped within a mile of her own home.

She moved like a cat down the stairs, three steps at a time.This waslikely one of the Plagues’ regular hangouts. Any number of Plagues could return without warning. She stepped over the two dead men in the doorway and walked toward her clothes. Everything was there except her panties. She dressed hurriedly and looked for her shoes.

She moved like a cat down the stairs, three steps at a time.This was likely one of the Plagues’ regular hangouts. Any number of Plagues could return without warning. She stepped over the two dead men
in the doorway and walked toward her clothes. Everything was there except her panties. She dressed hurriedly and looked for her shoes.

She found the second shoe underneath the couch and sat down on the table to tie the laces. She disliked having to let go of the Glock to tie her shoes. On the table were stacks of twenty dollar bills wrapped in zip lock bags.The briefcase on the table held two packages of white powder, which she suspected to be cocaine. She looked around the house for something large enough to hold the money. The briefcase would be hard to run with.

A dirty brown pillowcase from the floor of the bedroom fit the bill. The money went into the pillowcase, which she dropped at the front door. She had no use for the drugs. She put her overcoat on and felt in her pockets. Her cell phone was still there. She stuffed the Glock into the other pocket of the overcoat.

In the closet of the kitchen Elita found a five gallon kerosene can, but it was empty.The only other thing that might be useful was a tire iron. She recalled the kerosene stove she had seen upstairs. It had not been warm.

She searched the closet and cabinets for any kind of accelerant, liquid or powder—anything that was flammable. Apparently, no one cooked or cleaned much in this house.

If there were three Plagues inside, there was bound to be a vehicle or two outside. Visitors and employees at the hospital often complained that gas was removed from their cars in the parking deck. It was worth a try.

There were two vehicles outside, a yellow HUMVEE and a blue sedan. The moon was three-quarters. The streets were quiet. Not by accident, she thought, the street lamps near the house were not functional.
She looked at her watch. It was 3:30 AM. 

Elita used the tire iron to pop the trunk of the sedan, being careful not to leave fingerprints on the car.Among the clutter in the trunk her hands ran into what she was looking for—an eight foot length of clear PVC tubing, approximately three-fourths inch diameter.

She took the hose and left it next to the sedan’s rear wheel at the curb. Returning to the house she retrieved her purse, the pillowcase, and the five gallon empty kerosene can. She smashed the light fixture overhead in the front room with the kerosene can on her way out and stuffed her purse into her overcoat pocket with the cell phone.

People in America thought that country girls were resourceful. But American country girls never had to survive on their own in a war zone, where being a woman was not usually an asset.

On her knees, she fed the clear hose into the tank of the sedan until she felt resistance. She held the other end of the hose between her thumb and forefinger, gripping it as close to the end as she could.The three-quarters
moon provided the only light. She would have to be careful sucking on the end of the PVC tube. Once the gas started coming, it would come fast. She positioned herself where she could see all of the hose outside the
tank in the moonlight and began to suck. In between breaths, she moved her thumb over the end of the hose to maintain the suction.

It helped to know how long it usually took and how many breaths. When the gas was four or five inches from her mouth she moved her thumb quickly over the end of the hose and then directed the tube into the kerosene can. Gravity did the rest. She watched the gas flow steadily from the tank of the sedan into the can.

The can would weigh about forty pounds when full. But by the time it was three-quarters full, she saw headlights approaching. She pulled the hose out and dropped it behind the rear wheel.

Four Plagues piled out of the vehicle, each carrying a bag from McDonald’s.They approached the house. She wondered how many of these four had already taken their turn at her. 

She crouched in the darkness until they had all entered the door. While the four were trying to digest what they were seeing in the dim light from the stove, Elita moved to the porch with the kerosene can.

Holding the handle of the can with both hands, she turned her body counterclockwise like a hammer thrower in the Olympics. As she pirouetted, the velocity of the can increased. After two turns the can was horizontal to the wooden porch floor. After three full turns she released the can through the window in front of the wood stove.

She dived off the porch as the front room exploded in a fireball. From her crouched position in front of the house she watched two burning men stagger out the door. Resting the Glock on her left knee, she fired twice. In a few seconds it was clear that no other Plagues would be leaving alive.

She grabbed the pillowcase and the PVC hose and ran down the street fifty yards to her left before cutting between houses into an alley. She followed the alley until she emerged onto Robbins Street. She
recognized her position.

The night was suddenly filled with sirens, blue lights, and red lights. She had no doubt she would make it back to her own home unseen. No one was even shooting at her.

Back home, Elita called Dr. Katherine Taylor, her best friend and colleague in the emergency department. “I need you to come over here now. Dress for work.We’ll talk when you get here.”

“Are you all right?” Kate asked at the door.

They embraced.

“I’m okay,” she said, “but the war with the Plagues has heated up.”

Kate listened intently as Elita told her story.

“My guess is that my car is still in the parking deck,” Elita said. “We need to remove it before morning.”

Elita looked at her watch. "Let's give it another thirty minutes. The cameras in the parking deck will likely be disabled. I can probably leave without being seen.

Kate asked, “Why aren’t you trembling and crying?”

“I used up my trembling and crying years ago,” Elita said. “You should know now that this is a war to the death with the Plagues.We must kill every last one in order to stop the violence against healthcare workers at Parkview Hospital.”

“Doctors killing people,” Kate murmured. “It’s a lot to swallow, but I’ve had enough time to justify it in my own mind. I’m tired of being a victim. I just don’t know how to do it yet.”

“In war you cannot consider your enemy a person,” Elita said. “The Plagues are not people.They are wild animals. No one is going to protect us from them. But we must delay further plans until we know the consequences of killing seven Plagues in one night,” Elita said.

“Why do you care about getting your car now?” Kate asked.

“You can never tell what will survive a fire,” Elita said. “Something could point to me. Somebody out there has my panties, or at least he did at one time. Someone could connect my car left in the parking deck to the Plagues. Maybe someone saw my abduction. I don’t want my car found and searched by the police. I don’t want to be targeted again by the Plagues in retaliation.”

“What’s that smell?” Kate asked, looking into Elita’s fireplace.

“It’s all the clothes I had on, a pillowcase, some PVC tubing, and my overcoat.The smell is PVC.As you know, it gives off toxic fumes, so let’s go into the kitchen.”

“Let me fix you some coffee,” Kate said as she entered the kitchen.

“What I really need is some antibiotics,” Elita said. “I’m glad I’ve had my hepatitis vaccines. I need a morning-after pill and some shells.”

“Some shells?”

“It’s okay. I’m going to lay low for a few days.Tell everybody I have the stomach flu.We have no idea how many Plagues know whom they abducted tonight.The seven I killed may be the only ones who know. On the other hand, the Plagues may come looking for me in force in the morning.There’s about forty-five left out there. I’ve packed a few things to take with me.You just need to drop me off at the parking deck.”

“I’ll have my cell phone. If nothing happens to my house by day

"Where will you be?"

"I'll have my cell phone. If nothing happens to my house by day after tomorrow, I’ll be at work Thursday morning.”

“You need any money?”

“I have plenty of cash. In fact, we need to put the money I recovered tonight to work. I took a few dollars.The rest is in the refrigerator in a brown bag. Hide it in a safety deposit box.We can talk more strategy
if I’m still alive in two days.”


This is a work of fiction. The events and characters described herein are imaginary and are not
intended to refer to specific places or living persons. The opinions expressed in this manuscript are
solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The
author has represented and warranted full ownership and/or legal right to publish all the materials in
this book.

Monday, July 30, 2012

Linda Rocker Uses Legal Expertise in Romp Through Mayhem...

"There wasn't an empty seat in Judge Clarke's chambers.
Every attorney involved in the case was there, as was every
law clerk, staff person, and deputy sheriff assigned to the
judge's courtroom. There was also not a lot of conversation.
No one seemed to know what to say, at least until the judge
and her bailiff, Casey, entered the room.
"I don't know who wrote the script for this farce, but whoever
it is has a warped sense of humor. Why don't you tell us, Mr.
State Attorney, how the wheels of justice have taken this
latest turn toward mayhem?..."

By Linda Rocker

BRH has been authorized to give a signed copy of Punishment: A Legal Thriller... Leave a comment with an email that you are interested. Comments can be made through August 10th!  

America is a litigious nation, don't you think? I realized it most when I wasn't even surprised about the case covered in Linda Rocker's Debut...

Rocker graduated magna cum laude from Cleveland Marshall Law School, practiced as a defense litigator and then was appointed in 1989 to the Common Pleas Court of Cuyahoga County...Talk about writing what you know... I love to read thrillers, mysteries and suspense from writers with that respective background. I know I will always learn something...or be intrigued by the slant that professional takes in presenting their credentials.

Linda Rocker chose to make her novel informative but fun...

After all, it is not every day that a Bailiff is the main character of a legal thriller. Nor is it usual to present the personal or illegal issues of sitting judges and others involved in the court system... But, most of all, it is very unusual to be working a court case about Dogicide!

You know it wasn't hard to pick the type of dog--that is, a pit bull--that would be selected as a character. Actually, I had never seen one so when I saw the picture in Wikipedia, I thought he looked kind of cute...Then I scrolled down to see the one that more closely matched my image. But, no matter what, we all know that it is the owner (or trainer) who has made that dog what he was...

And there were many neighbors who testified that they had heard the victim's husband practicing attack commands with his dog...

But that didn't explain why the courthouse had been bombed, that one of the bailiffs had been murdered, nor why our main character was being looked at as possibly who killed the bailiff!

OK,  I've set the staged for quite a bit of mayhem, as one judge called it, and I haven't even mentioned the one jurist who was constantly texting...of course, out to somebody other than jury members and sharing all that was happening...or the witness who came to court wearing advertisements for her business...

Check out the happy grin on the picture of this author...she surely picked many issues that would, or could, happen to those involved in a criminal case and brought them to readers who will be following the clues to what was really happening, just as those jurists were learning and listening, to judge whether the owner of the dog who killed his wife was guilty...duh...

I must say that the thought of the Keystone Kops came to my mind often, only all the "Kops"  were those involved in the case, if that gives some of you a clue. This is not a Law and Order type of book. And expect having a smirk or two as you stumble through everything happening...thinking, "I just knew that was going to happen!"

Selecting the bailiff as the individual is most involved was enlightening to me. Most of us see that individual off in the corner, just standing and watching... Casey Portman, however, wasn't one to step back and just watch...Could this be an upcoming series similar to that provided to us by Janet Evanovich? If so, this could get verrrry interesting. In any event, I enjoyed this romp through one of the strangest set of court scenes you may ever see. Highly recommended...


Meet Linda Rocker

Linda Rocker has been in the center of the action since she graduated college with a degree in English. When she wasn’t teaching, she was leading “teach-ins” against the war, writing and publishing poetry and music and joining the fight for civil rights and women’s access through politics. Law school and practice opened the door to professional success and to new opportunities, including arguments before the Sixth Circuit Court of Appeals and the U.S. Supreme Court. Appointed to Ohio’s Common Pleas Bench, she served as a trial judge for a number of years and has continued to hear cases as a retired Judge. A prolific writer, many of her legal opinions have appeared in print, along with articles in local bar association magazines.

Rocker has been honored as a leader, a fighter for equal rights, and an advocate for the homeless. She has been recognized by Who’s Who in American Women, Cleveland Magazine’s Most Interesting People and The Ohio Women’s Hall of Fame to name just a few.

“Punishment” is her debut novel. It is the first of a trilogy about criminal justice. The second novel, “Blame” is in progress and she will be publishing a collection of short stories, “Is Anybody Listening?” in early 2013.

Rocker and her husband travel widely and spend time in Cleveland, Florida and Chautauqua, New York.Visit LindaRocker.com

Sunday, July 29, 2012

Doctor's Tell-All Receives Praise!

Want to learn more, BRH has been authorized to give a PDF copy of The First to Say No...just leave a comment that you are interested. You can comment each day an article runs at BRH.
If you have already read The First to Say No, ask for The Farm...both by Charles C. Anderson. Let us know what you think about this issue!

The Reality Behind the Book...

(Please note that I've added more reviews here - I've told Dr. Anderson to let people know what others are saying...so I'm starting here!)

May 16, 2012
"Reveals a dirty little secret...how really unsafe it is to work in an ER!", May 29, 2012
By Linda Whitt (Virginia Beach, VA United States) - See all my reviews

This review is from: The First To Say No (Hardcover) I am an ER nurse, and have been assaulted several times at work; most of my coworkers realize the danger in our job, that we are more likely than most professions to be assaulted at work. This story of an ER staff who received neither aid nor protection from their hospital administration, has a Charles Bronsonesque flavor, in that they did what they had to do to eliminate persistent violence. The book opens with the descriptive rape of an ER physician, and the surprising retaliation by her as she brings justice to her assailant before leaving the room! The ongoing methods are intriguing, and as the teamwork of staff members and other locals comes together to clean up the ER and the neighborhood... I was OK with it! I just love a good comeuppance, and as I turned the pages, I got one! Looking forward to reading the other book by this retired ER physician!

A Must ReadJune 7, 2012 
Shirley Priscilla Johnson "Author/Reviewer -... (USA) - See all my reviews

This review is from: The First To Say No (Hardcover) I was quickly drawn into this read by author, Charles C. Anderson. The story, if you will, is set in Parkview Hospital emergency department in Virginia. It is here that we meet Dr.Kate Taylor as her story and so many others begin to unravel. It seems many of the doctors and nurses are being raped and other acts of violence are occurring that are not being dealt with. People come in and use the hospital to 'get fixed up' so they can go back out and do their drugs, stealing and killing, all at others expense.

Kate lost her father at a young age and the one tender memory she had was with him at the local park. Now that memory has been tarnished by a gang called the Plagues who are overtaking the city. The danger or going to the Park, or anywhere alone is wide spread. This gang kills, steals and rapes at will, not being stopped, even by the local police, who are now on their payroll. In this story Kate decides enough is enough and gathers those she can trust to fight back. She does not have the backing of the hospital, or the police, but she has behind her what is right.

I was amazed at this read and upset. I suppose I do not want to think that there are so many who will turn their heads not to stop evil just for the mighty dollar. I was also upset to finally understand how much of our nations finances are being thrown away just to help heal druggies who will not accept help to stop their habit. There are so many needy elderly people that are not receiving help or just the poor that are turned away, this truly is not fair and should be stopped. This is a great book, although troubling, the truth that is brought forth should be read by every American. Thank you Dr. Anderson.
Inspirational Eye Opener!, June 14, 2012
By InGodITrust - See all my reviews

This review is from: The First To Say No (Hardcover) This book helps start the very necessitated [sic] conversation surrounding emergency medical professionals in today's society. More often than the general public would like to believe, scenes from this book are the reality for many nurses, doctors, EMTs, and techs. "First To Say No" astoundingly illustrates the emotional and physical dilemma involved in working in the medical field.

It is my hope that this book is read and regarded on a grand scheme to help those who have the heart to CARE for others. Great read, quick read, informative read. We should distribute this to all politicians, socialites, administrators, and board members.4.0 out of 5 stars 

What people don't want to believe - A jaw-dropping medical thriller May 11, 2012
By The Paperback Pursuer

Doctors Kate Taylor and Elita Romanov are sick and tired of the constant abuse the community suffers at the hands of a local gang - the Plagues. The vicious gang members not only cost the hospital hundreds of millions of dollars in unpaid medical bills, but they are notorious for abducting, terrorizing and raping staff members on and off the property of Parkview Hospital. The local police are paid to look the other way, and hospital management refuses to acknowledge the problem, but the gang's victims are ready to fight back; ready to finally say, "NO!". Can Kate, Elita and the people they care about find a way to "cleanup" the streets without getting themselves killed? Will risking their own lives and reputations save the place they call home?


I think I have found my new favorite genre! I am in the medical field, so it should come as no surprise, but until recently I had not found a modern medical thriller that lived up to my expectations. Maybe it is because I define a thriller as 'action-packed', 'suspenseful', 'gritty', 'compelling', and, I daresay, 'thrilling'. I dislike when a book is labeled as as a certain genre and doesn't deliver - especially when the book ends up being sleep-inducing instead of heart-pounding. The First To Say No is one of a string of medical thrillers I have read recently that stands behind its cover blurb. It started quickly and unexpectedly, the problems the characters faced immediately evidenced; I was slightly appalled, but the rough reality immediately caught my attention. Elita's character is introduced in such a way that the reader can't help but wonder about her abstruse past, and Charles C. Anderson does a great job leading to the answers; (no spoilers). The same is true with Kate and Margaret - complex, realistic and well-developed characters that the reader can't help but cheer for. The plot definitely encompasses my definition of thriller, particularly in the levels of action and suspense. I knew what was coming, especially the ending, but I was still excited to read it! The dialogue was also appropriate and believable; I really appreciated the medical terminology. However, I do find it horrifying that there are places in America where violence escalates to the heights discussed in the book. Recommended to adult readers into the medical thriller genre, or those in the mood for some well-deserved vengeance.

GREAT read!May 29, 2012
This review is from: The First To Say No (Paperback)
It is a shocking look into the world of medicine that I never thought existed. After reading the book, I decided to do some research and found out that it is actually more common than you would think!

Back to what I thought of the book. Sexual abuse against nurses and doctors run rampant in Parkview Hospital, and with the police being of no help at all, tension is high while Romanov and Taylor decide what to do against the local gang, the Plagues. The Plagues pretty much run the city- even turning what was once a beautiful park into a place for drug dealers, drug users, and gang members. Citizens are afraid to go near the park for fear that they may end up hurt, or worse.

But once Taylor comes up with a plan, it is a race against time to rid the city of the gang and help the hospital from closing while not getting caught. Will their plan work or will it backfire?

So next time you're at the hospital, you will see everything in a different light. I finished the book about a week or so before Mom ended up in the hospital. I saw things a little differently this time.

NO BETTER FRIEND, July 11, 2012
HIS BEST FRIEND - See all my reviews

This review is from: The First To Say No (Paperback)I am a personal friend of Dr. Anderson's; trained with and worked with him for many years. Everything that he has written is TRUE. Chapter 9 sums up our health care system so so well. For those of you who can not believe what he has written, then please visit any Emergency Room in our large Metropolitan centers. These places are not for the faint of heart. Assaults on healthcare workers continue as I write this review. I too have been a practicing Internest, Pulmonologist, Intensivist, and Emergency Medicine doctor for over 40 years including medical school. I have witnessed what he describes in this book. It will continue unless we as a society are the "FIRST TO SAY NO!"
Charles, Great JOB!!!!!!!!!!!!!
AMERICA "WAKE UP!!!!!!!!!!!!!"
Dr. Ted Georges

Enough Is Enough; You NEED TO Read This Book!, May 13, 2012

Glenda A Bixler “Glenda” (Pennsylvania) – See all my reviews (VINE VOICE)

This review is from: The First To Say No (Hardcover)

You may have noticed that, upon reading the first few pages of this book, I stopped and put out an advance notice in my blog and declared it a must-read. I feel even more strongly that it is, now that I’ve finished reading!
I recognize that Dr. Anderson has dramatized his novel by using many samples of what he’s seen as an emergency room doctor, within just one novel. (Or maybe not?) The timing is not important, rather it is the fact that I believe that every shocking example case that he has used is real, in this agonizingly realistic story …
All you have to do is read a newspaper or watch the news! America has become a violent nation! Violence of one type or another happens faster than can be reported!
Dr. Kate Taylor, head of the Emergency Department, in a small Virginia city, had lost her father too early in her life. One of her fondest memories was his walking with her to a local park where a beautiful fountain with fish was her favorite place to spend time with her father, sitting along side, looking down at all the wishes that had been made by visitors throwing in pennies…
Now that park could no longer be used by the town’s residents…
It was filled with drug dealers, prostitutes, and a place where anybody who wandered in might be brutalized or worse. It was owned, now, by the Plagues, a gang of violent criminals…
And they routinely paid off the majority of the police officers to stay away from that once-beautiful park…

Friday, July 27, 2012

Charles C. Anderson Shares--Safety Vs. Money...with Offer for Free Copy...

"On the far side of the couch on the floor of the room where
 she had been raped was her own purse and overcoat.
The work scrubs on the floor meant that she
 had been abducted on her way to or from work
in the emergency department, where she was
an attending physician. She guessed that it 
had happened in the parking deck as she was leaving,
although she had no recollection of this. 
"Walking to and from the car in the parking deck was 
the most vulnerable time for any female employee
 at Parkview Hospital. The Plagues specialized in preying
 on nurses and other female employees coming and going 
for the night shift.They were smart enough to disable
the security cameras before acting. She recalled that an 
emergency department nurse named Janice Green had
 been abducted from the second level of the
 parking deck and raped about six months earlier." 
Want to learn more, BRH has been authorized to give a PDF copy of The First to Say No...just leave a comment that you are interested. You can comment each day an article runs at BRH.
If you have already read The First to Say No, ask for The Farm...both by Charles C. Anderson. Let us know what you think about this issue!

The Reality Behind the Book...


I have had a close working relationship with six hospital administrators, close enough to figure out some of the things that make them tick. The easiest administrator to deal with is not the CEO of a hospital that is part of a large hospital corporation. The corporate administrator is a puppet. He wants only two things from the ED– happy patients and getting paid. After all, this is a big part of how he is judged by his corporation.

The administrator in an independent hospital is more likely to care about his employees, to institute policies that protect them, and stand behind the ED staff. He is accountable only to a local board, to which he can justify measures to protect employees. Let’s examine a couple of examples where administrators undermine their own ED.

Corporate CEOs in hospital chains are competing with their colleagues in other hospitals. In their race to keep their Press Ganey scores up, increase revenue, and capture as much market share as possible, the corporate administrator often makes promises to the public that the staff in their ED cannot keep. Have you noticed the battle of the billboards, where each hospital administrator tries to outdo his competitors by promising that a patient will be seen in his ED even before he take his clothes off. They have reduced themselves to competing over the number of minutes before a patient is greeted by a physician. Somebody forgot that our mission is to provide the best care possible for each patient and to concentrate on the sickest people first.

The ED is not a cattle drive or a theme park. Its purpose is not to entertain you or make you happy. Its purpose is not to leave you satisfied. Its purpose is to deliver the most appropriate care to each patient, as quickly as possible given the overall requirements of the sickest patients. When patients are given impossible promises and told that they are entitled to satisfaction they frequently become angry when they find that the waiting room is packed and they have to wait a half hour. The average ED patient is not known for his patience. He is noted for being demanding. Guess who is teaching him this? So the administrator sets up a confrontation between the ED staff, who are working as fast as they can, and the patient and family, who actually believe the billboards.

The best solutions to most ED problems have been known for decades. They are just trampled by the desire to make more money. One good answer to diffusing potential violence is a dedicated concierge whose only job is to advise patients and families about the progress of their relative or how long it will be until they are seen and why. Hospital administrators do not want to waste money on concierges any more than they do on adequate security. It’s always about money.

I was so happy when Virginia developed the first prescription monitoring program. At last doctors could track drug seekers from pharmacy to pharmacy. We did not have to make an educated guess who was a drug seeker. We could have the data in front of us before we confronted the patient. Guess what? Administrators have no interest whatsoever in the fight against prescription drug abuse, even though more people kill themselves from prescription drugs than heroin and cocaine combined. Remember, they want happy patients who pay their bills. The administrator does not care if you give the drug seeker 40 tablets of Dilaudid as long as he leaves happy with a smile on his face. He will be given a survey as he leaves and a follow up call later to make sure he was satisfied with the service from his pusher. Press Ganey calls this measuring quality of care.

I always take a nurse into the room with me when I talk to someone about their overuse of drugs, usually narcotics. I want double documentation that the patient was properly informed, that he was referred to a pain management specialist, or to his private doctor, or to drug rehab. It doesn’t matter where he is referred. He will be angry. He was promised a happy visit to the theme park and now he has to leave without the prescription he came for. He is not satisfied.

Again, the administrator has promised a service that I cannot deliver. I have a moral obligation to do the right thing for each patient, even if he doesn’t like my treatment. Thus, the ED physician has a difficult choice. He can generate great Press Ganey scores and turn out happy patients with no personal concern for the harm he is doing, or he can stand his ground, be branded as a trouble maker by the administrator, and generate confrontations where he is the most at risk. Are you beginning to understand why we are not making any progress in the prescription drug epidemic? Ideally, the uniformed police officer should accompany the ED physician into the room and escort the patient off of the premises. When a patient is in withdrawal and wants only one thing, he can turn violent in a heartbeat. The officer by your side is an effective tool. But the real culprit is the administrator. He is the one who is inviting the drug seeker to keep coming and to expect to go away happy. If these drug seekers were disappointed regularly, and the administrator stood behind you and what you were trying to do, they would not come back.

I have some more bad news for those of you who thought the administrator cared about best practices for common diseases. You know, all that stuff you spend hours learning in CME courses. If you have a determined mom who wants antibiotics for her kid’s cold, it is not in your best interest to try to educate the mother. Mom’s own doctor and other ED physicians have so thoroughly indoctrinated her that all URIs require a visit to the doctor and an antibiotic that your attempts at education will only produce another unhappy patient. And, of course, producing happy paying patients is the administrator’s priority, not providing care based on best practices.

Press Ganey scores have proven that doctors who pass out more drugs get higher scores. The administrator and the patient want you to order as many tests and X-rays as possible. It doesn’t matter that the patient doesn’t need them. Press Ganey measures satisfaction, not quality of care. If mom thinks junior needs an X-ray, and that is why she came, then you, the physician, are trapped. The hospital makes money on the tests you order. This is why it does not bother the administrator that the same alcoholic gets 25 head CTs per month for evaluation of altered mental status. Each physician is judged by the amount of money he can generate per patient and the number of patients he can satisfy. What does this have to do with quality of care?

Many of the basic safety measures that are unavailable in many EDs are missing simply because they cost money. Three uniformed off-duty cops per day cost money. Metal detectors cost money. Your safety as an ED employee is not as important to Mr. Administrator as saving that money. Having officers interferes with the administrator’s view of the ED as a theme park. So do metal detectors. One of the problems with the average administrator is that he has never experienced the emotional trauma of a sudden, unexpected shooting or stabbing of a real person, someone he cared about, right in front of him. He is under the same illusion as the administration at Virginia Tech—“That couldn’t happen here.”

I have been in the ED or trauma center on six occasions when bullets were flying. I have seen five people killed in the ED with guns and two shot in their beds on floors upstairs. I have seen a nurse stabbed in the parking lot and a physician’s brain turned to hamburger with a baseball bat just outside the ambulance entrance. Let me tell you what I have learned. If your uniformed officer is not in the ED when these events start, he is useless. If he is not armed, in some fashion, he is useless. Having a team that responds to “Code Atlas” is too little, too late for the type of patients that EMTALA has herded into our EDs. The pen on all those policies for response to violence has not been mightier than the sword in my 38 years of experience. You can write all of the policies you want, but if you do not have a weapon that you can access in a few seconds, you have no chance to prevent further tragedy.

Think about it. The average fight is over in less than 30 seconds, usually in half that time. It doesn’t take long to pull a knife or shoot a gun. If you believe that no one in your waiting room has a loaded gun or a knife, you are a fool. Sociopaths and deranged schizophrenics do not care about policies. They can clear out your waiting room for no other reason than they are tired of waiting. I guarantee that you will never forget it.

I spent the greater part of my career working the night shift in large hospitals. That is one of the reasons that I am more attuned to the potential for sudden violence. Most of the very worst tragedies I have seen occurred at night. The only good thing about nights is that the administrator is not around to babble on about satisfaction surveys from a group of patients who are intoxicated, psychotic, drug seeking, and drug abusing. I have never figured out how those comatose, septic nursing home patients filled out their surveys, but I appreciated them.

What is the point of having uniformed guards, or any security guards, or any action team, if no one is allowed to touch the patient? In a subsequent post, I will discuss the effect of fear of litigation on violence in the ED and how this constant over-concern with being sued prevents us from giving any useful guidelines to our own employees. Many employees feel that anything they do to help a colleague who is under attack will result in being fired. They are often right.

I just finished reading the position statement of the Emergency Nurses Association on violence in the emergency setting. I was shocked at the list of generic recommendations. Even the ENA does not demand uniformed, armed (in some fashion) officers. They do not specify concierges. They do not ask for relief from charges of assault if they are forced to come to the aid of a colleague. They do not ask to be able to defend themselves without fear of being charged with a crime. They do not provide the specifics that are necessary to take to the legislature.

I still contend that it is better to prevent an assault than respond to one. Preventing assaults requires a constant show of credible force. Administrators are standing in the way of this with their emphasis on satisfaction, speed, and theme park environments.

In summary, hospital administrators are one of the chief barriers to having a safe workplace in the ED. They put their money into television sets, security cameras, lights, and policies. Happy patients and paying patients. These are some of the reasons you are being assaulted. I pray that no nurse ever has to look down at her dead colleague in the floor of the ED before insisting on protection in specific terms.
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Thursday, July 26, 2012

Native American's Lives Portrayed in Early Times Great Read!

Nez Perce warrior on horse, 1910.
"Black Raven took her baby from his hands; then sheremoved the rabbit skins revealing the mark. The grandfather stared long and hard at the mark; then looking up at Black Raven he whispered. "It is a mark of a wolf. Black Raven then told him about the mother and child, who had been banished from their camp for the same mark. She told him that because of the mark, Q'ull-Q'ull would not name the child.
"So that is why my son must find this spirit man for a name...
"The Ya-Ha-Tinda Mountains were feared by all the tribes, it was saturated in deep taboos, impregnated with stories of evil spirits that took the form of wolves, and roamed only the highest stretches of the mountains. It was said that animals of stone walked the earth nearest the sun. To ride above the timberline was instant death..."

Nez Perce warrior on horse, 1910. (Photo credit: Wikipedia)

The Society of Wolves

By Robert E. McHaney

Far in the past before America was fully colonized, most of the west was the hunting grounds of Native Americans...They believed that the land, the waters--the earth did not belong to anybody, that it was for the benefit of all... As we all know, the people who first landed on our shores were there representing governments from overseas or those people who had fled from their countries to find land they could claim for their homes and communities.

And as they moved from the east to the west, those lands normally hunting grounds for those that lived here before any of us, were stolen or, worse, the Indians were killed defending that land.

It has always intrigued me that people felt they had a right to do this. Obviously, the Indians did not accept those who moved further and further across the lands, and, sometimes, special people were born, chosen, to act on their behalf. Gray Wolf, ancestor to Crazy Horse could have been one of those!

Fiction based upon historical research and facts has a growing interest to me. This fast-paced, thriller is exciting, terrifying and also disturbing--especially knowing that it is based on fact to a great extent. I believe this book will be of interest to not only those who are interested in reading historical novels, but those who enjoy action/adventure thrillers. This novel is highly recommended.

Iron Belt and Black Raven were the parents of Gray Wolf. He was a beautiful boy but he had been born with a mark that looked like a wolf! Q'ull-Q'ull was supposed to decide the child's name, but he knew Iron Belt would kill him if he went against him in any way. Besides, when he accepted the baby in his arms, he experienced a "shocking and frightening reaction. It was as if he was holding a small animal..." He quickly wangled out of it by referring Iron Belt to the great shaman who lived on Ya-Ha-Tinda. At least Iron Belt was relieved that he wouldn't to take action against a man of his tribe, but now had to try to find this shaman. A long, dangerous trip into land that was considered taboo...

The Shaman had been expecting him...and the name Gray Wolf was given... A name that meant much more than anybody knew except the shaman...and the boy as he began his training as a warrior...

I was somewhat disheartened that there were wars between tribes but the author spends time for readers to settle in and learn about the lives of members of various tribes--mostly hating each other and killing...Guess we humans are all alike! Anyway, soon the settlers started moving close to the Oglala Tribe's, most commonly known today as Sioux, land used for Buffalo hunting...

Gray Wolf had grown into a man who was both feared and respected by tribe members and when his father is killed, he is asked to become one of the chiefs and specifically to fill his father's place and to prepare for the coming of the white man. At that time, he chose 20 of the finest braves and, instead of going out to scout, took all of them into the forest. There he trained them, and when they came back, all wore the headdress of a wolf...they sat tall and serious on their horses and everybody knew that they were ready! They called themselves The Society of Wolves and their reputation soon spread to both other tribes and the white men.

I enjoyed the inclusion of a trapper Murdoch who became Gray Wolf's friend and blood brother as well as the relationship of both of these men with the women who they ultimately married. I also found the portrayal of ranking officers in the military an interesting choice--most of them power hungry and totally uninterested in trying to negotiate some type of relationship with the Indians as anything more than scouts...

But when they met The Society of Wolves, only one thing happened. Gray Wolf led his men to victory...quite cunningly in fact! Of course I don't know how much of the story is factual, but I have to say that I learned much about the culture of our early Native Americans. The story of their lives rang true and we do know that there were many wars...We also learned the reason why, perhaps, Crazy Horse became such a great chief! Was he also born with the mark of the wolf? We learn his father, Ghost Wolf also became a member of the Society of Wolves...Only his name makes me think differently and I admit that I looked up Crazy Horse and read contradictory information since Crazy Horse was also his father's name (although his Indian name was Cha-O-Ha ("In the Wilderness" or "Among the Trees") which in many ways supports the book's story...

But you know what, no matter whether the underlying history is not correct, I think the author has done a wonderful job in hypothesizing those early days in American history.I thoroughly enjoyed it, even though some parts are gruesomely detailed! Albeit adding to the reality of it all...


Author Robert E. McHaney  was a corporal, a soldier during the Battle of the Bulge. Decorated with the Congressional Medal of Honor, the French Medal of Honor, a Bronze Star, Two Purple Hearts, Combat Infantry Badge, and Legion of Honor. 

He also wrote I'll Fight But Not Surrender, which tells the story by one who was there. It vividly brings to light the horrors of World War II, by a soldier who faced death almost every day. This is a story of tough young men from the rough side of East Los Angeles, who were thrown into the cauldron of war. Of the fifteen original members of Dolphin Company, First Platoon, Second Squad, who landed in Oran, North Africa, only three survived the battles of World War II.

The Second Squad often asked, "Are we all going to die before this war is over?" The tour of duty in World War II was, "For the duration." Superb combat units such as Dolphin Company served for years, not months of combat. "When a soldier is wounded they sewed you up, and he is returned back to combat to bleed some more!" 

Stories like I'll Fight But Not Surrender are needed today to tell us who sacrificed themselves to establish freedom in the world. These WWII warriors are vanishing before our eyes, but thanks to books like these, we will have the precise knowledge of why they killed and died...

Corporal Robert E. McHaney
So, too, do we now have a history of those Native Americans who killed and died... God Bless all Servicemen and women!

Wednesday, July 25, 2012

Do People Listen When One Man Speaks? I Do...

U-M Emergency Department
U-M Emergency Department (Photo credit: UMHealthSystem)


The most important factor responsible for violence in the ED today is a law passed in 1986 called EMTALA (Emergency Medical Transfeer and Labor Act).  The original purpose of the law was to prevent one hospital from referring or transferring indigent patients to another hospital solely for financial reasons.  For that reason it was referred to at the time as an “anti-dumping” law.
Most federal laws operate under the principle of unintended results.  I do not believe that the legislators who drafted this law realized that it would put healthcare workers, particularly ED nurses, in grave danger.  The law stated that any patient could go to an ED any time he wanted to, 24/7, as many times a day as he liked, and that he had to be re-evaluated each time he presented.  No money was provided to fund all this extra care, nor were patients given any responsibilities for this extraordinary access to medical care.
At approximately the same time our federal government decided that most paranoid schizophrenics with a history of violence could live on their own, with minimal supervision. Psychiatric institutions and hospital psychiatric beds decreased due to lack of funding. This theory, that a person who has been violent in the past will take the anti-psychotic medications prescribed for him regularly, has turned out to be a farce.  The most common reason for a schizophrenic to require hospitalization is non-compliance with medications.
From the time that EMTALA was enacted, violence against healthcare workers has steadily climbed.  Climbing parallel to the number of assaults in the ED is the number of drug and alcohol related incidents in the ED.  In fact, from 2005 to 2008, only three years, the number of violent incidents related to drugs and alcohol increased from 1.6 million to 2 million.  Policemen discovered that they no longer had to take responsibility for street drunks, whether they were violent or not.  In the metropolitan area I worked in for the past ten years it is standard practice for a policeman to ask the drunk if he wants to go to jail or to the emergency room.  Duh.
Can you imagine the same street drunk calling 911 for 30 consecutive nights at 11:00 PM for an ambulance ride to the emergency room, where he could sleep (hopefully) in a climate controlled atmosphere.  This is not uncomon.  He cannot be discharged alone while intoxicated and he has no friends who can drive. The ED physician is forced to work this patient up for altered mental status every night, spending thousaands of dollars per night, usually paid for by taxpayers.
As the economy faltered, mental health facilities closed, addiction programs lost funding, and the “drunk tank” at the police station was decommissioned. The ED became the final common pathway for every unsolvable social and behavioral problem in America.  EDs are precluded by this law from turning anyone away, no matter how abusive he is, no matter how many times he has assaulted a member of the ED staff before.  Given the frequency with which each alcoholic appears, and the demanding nature of many of them, it is not hard to imagine how friction could develop when the same patient urinates next to the bed every night or gropes the female employees regularly.
The number of psychiatric beds has shrunk to the point that multiple suicidal and homicidal patients must sit on a stretcher in the ED for entire shifts, sometimes two shifts, before a bed is found in a psychiatric hospital.  Even if you had fairly normal coping skills I challenge you to lie on any ED stretcher for 8-24 hours.  If you weren’t crazy before…Should we be surprised that these patients decompensate under these conditions and lash out at ED employees? The majority of patients waiting on a psychiatric bed just walk out of the ED.  That’s right. And no one is going to lay a hand on them for fear of being charged with something themselves.
On the night shift in an inner city hospital a good description of the nurses’s job is “a waitress in Hell.” No matter how much compassion you start out with, how long would you want to work in a cauldron of intoxicated, belligerent, uncooperative, psychotic, or violent patients?  Keep in mind that these patients are taking up a disproportionate amount of nursing time, leaving less time to see new patients and real emergencies.
Nothing in the EMTALA law and no other law requires a hospital to protect its own employees.  You would think that this would be a given.  It’s not.  Certainly there are a few hospitals that are beginning to offer support and some protection to ED employees, but these are in the minority.  I am saving a special post about hospital administrators, and what they care about, but let me make it clear that they are not concerned about the safety of ED employees.
One of the first things I learned about controlling a large number of potentially violent patients was to maintain a constant show of force to meet any threat.  Instead of posting off-duty uniformed policemen in the ED, most hospitals employ non-uniformed women or non-uniformed elderly males, who spend their time walking the halls and watching cameras.  Most are specifically instructed not to touch patients.  The hospital is more concerned about being sued than it is about the nurse’s face being smeared into the floor.  They don’t want the ED to look like an “armed camp”.  They dislike metal detectors, even though they produce outrageous numbers of weapons on patients and visitors when they are employed.  ED employees are told that they cannot strike back or defend themselves with fists.  Under no circumstance are they allowed to hit a patient.
Let me digress here a moment on the subject of hitting patients.  Now that I am retired I can freely confess that I have rendered four patients unconscious with a blow to the head during my 38 year career.  In each case, the patient was strangling a nurse (2) or on top of her, beating her repeatedly (2) with his fists.  Thankfully all four incidents occurred in a closed room.  I was really sorry to see those big heavy bed pans retired.  In each case, the nurse thanked me, we hugged, and I ordered a head CT on the patient.  None of these four suffered significant injuries.  We offerred up our middle fingers to the administrator and added head injury to the patient’s problem list.  God knows how these guys get injured.  I would do it again.  And I would get fired if caught.
Back to uniformed officers. Without a symbol of authority and a non-verbal message that there will be consequences to unacceptable behavior, there is little to constrain patients with a tendency toward violence.  They know that the laws that apply outside the ED do not apply inside the ED. They know that they can slap, punch, kick, grope, scratch, spit, and throw urine and feces at ED employees with impunity.  The administrator insists that they are patients, and that they are “sick.”  Thus, it is permissible for them to exhibit bad behavior.
It is my own position that no illness, no fever, no amount of pain, no amount of intoxication, no altered  mental status from any drug, and no degree of impatience gives anyone the right to assault a nurse, or any other healthcare worker.  DUIs are not excused from their behavior because they are drunk.
In summary, EMTALA has herded the most violent, mentally ill, intoxicated, drug-seeking, and drug abusing people on this planet into our EDs, and given them a green card to assault us without consequences.  Should it be surprising that assaults abound?  Since no protection is given to the ED employees, is it surprising that they are being abused at an alarming rate?
At the presnt time there has been some headway in legislatures establishing some type of punishment for assaulting a healthcare worker.  In some states it is already a felony.  Let me ask you? Would you rather be beaten up and then go to hearings for two years before the perpetrator makes a plea bargain, or would you rather have some protection, and never get assaulted in the first place?
Charles C. Anderson M.D. FACP, FACEP

Charles C. Anderson is a 38-year veteran emergency physician, critical care physician, and trauma specialist who has directed multiple hospital ED’s and emergency medical transport systems. He is the author of original medical research articles, has patented several medical devices, and published two novels. 

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