The Character Clinic

Thanks for the help, Stella.

Would you be annoyed if I were to private message you some more queries as I need? I don't want to hog all the attention from this thread, but I have so many questions, etc.

p.s. Happy New Year

Apologies, I've been away from the computer the past few days.

Hey Deskro! For sure - if you can catch me on the chamber that's even better - I'm terrible at checking my PMs!

@LeftyWriter - see my previous replies regarding stabbing for a little bit more information. The thing with the blade not staying in can be helped if you have someone on scene who's smart enough to apply pressure to the wound. That way the blade is gone but they're still staunching the bleeding onto the floor. However, that still leaves internal bleeding. I'm inclined to say that abdomen is best - if he does get a pneumothorax or haemothorax from being stabbed in the chest those can kill him quite quickly. If he were to get stabbed in the side, it could snip some arteries, some colon, and he'll die of blood loss and maybe peritonitis, which is where the lining of your abdomen gets inflamed from infection (e.g. from having your colon opened up). Bowel is apparently my go-to stabbing position Remember though that he won't be awake up until the very end and then die. Because he's young, he might be able to hold on for a while and stay conscious, but then he might start to get drowsy, become unconscious and then slip away. Just something to keep in mind while you're writing

Thanks so much, Stella! That helped a lot.

Thinking of having one of my characters use drugs to make another more... eh compliant/dependant/desperate and was wondering

1 - can you become dependant on a drug (probably cannabis, though maybe a fictional) from one OD?
2 - what are the symptoms of an OD?
3 - if the victim is not of a tendency to addiction, how long(ish) would it take to make them dependant, or would that depend on a lot of variables?

Hi @Auxiira!

Dependency starts from the very first time, though obviously it gets worse as time goes on. Overdose might be hard because dependency has two components:

1) physical dependence
2) psychological dependence

Physical dependence is what causes people to go into withdrawal. It's a lot stronger with some drugs than others - see heroin and alcohol. But say you had a horrific experience the first time, you mightn't have a psychological dependence, and your aversion might actually overcome the physical part of it. A physical dependence is unlikely to be very strong after just one dose, so I think (sorry I'm sort of answering all three questions at once), you would really have to play up the addictive personality component to make someone think that, in some way, the experience had been quite nice.

Symptoms of an overdose generally depend on the drug - feel free to look it up and get back to me if you have further questions In general though, pupils get dilated or constricted, breathing can be affected - either fast or slow - and most drugs cause heart arrhythmias. The most dangerous ODs are the ones that make you drowsy and quiet, since you could go into a coma and stop breathing. But there are others that might make you agitated, confused/delirious, panicky etc. So I would just recommend having a bit of a look around at various drugs - cannabis, opioids, ecstasy, cocaine etc etc and seeing which are stimulant and which are depressant and which ones you want to emulate

In terms of addiction, I guess it changes for everyone, in every situation. What's more, it's a process. There's seven criteria for substance dependence, and the deeper the addiction get, the more pronounced these become and the more become involved in it. I hope that will get you started. Other things to consider are, what's there to stop them spiralling into addiction - do they have a lot of other things going for them, like a strong family or friend support system and a job they love, or do they have nothing? We are taught in looking at mental illness to make a grid of nine boxes: biological, psychological and social factors, split into predisposing (something always going on in the background), precipitating (something that happened RIGHT before the problem started) and perpetuating (things that are going to keep the problem being a problem). That's a really useful way of looking at things

Anyway, that was literally no help in answering your question. xD I guess addiction can start straight away, it's just that they're going to get progressively deeper into the addiction, so you have to define when you consider the addiction to be a problem for them - is it when they have to use everyday, or twice a day instead of once, or is it when they lose a friend over it, or when they wake up one morning and realise they can't go without?

Thanks Stella! Definitely helped and gave me some more things to think about ^^

I have some questions about starvation.

In my story a character is kidnapped in a foreign country and she is there for roughly six months. If she were given a cup of white rice and a cup of water every day, would she be able to survive on that? (Assuming that before she was taken she was an average weight, healthy person). Obviously she would lose a lot of weight, but what other effects would it have on her body? Would any of the effects be long term?

And then once she is rescued, what would the process be like of getting her physically healthy again? How would food be re-introduced and generally how long would it take for her to reach a healthy weight again?

Hi @Carlito!

Sorry I took so long, I never saw your post!

It sounds like she would probably survive - she would be miserable, she wouldn't have much energy. She'd lose weight - not just fat weight but muscle weight too. She might develop lanugo - a soft downy hair that babies are covered in but is also seen in patients with anorexia nervosa - that covers the body to try keep it warm. Eventually she'd stop feeling hungry. She would stop menstruating too, if she's a woman who is currently menstruating. She'd be very fatigued, and prone to infection. Think of skin infections, fungal infections, things people don't normally get.

There's also particular vitamin deficiencies. She'd be deficient in basically everything - iron, vitamin C, vitamin D from being locked up, the list goes on and on. So think pale and bruising, bleeding gums, all that jazz. Just when you mentioned rice I couldn't help but think of beriberi disease. This is a sort of footnote, because it's something that people in Ireland get from being alcoholics, but something that happens in Asia where people eat nothing but rice - it's a thiamine deficiency. Anyway, the important thing about this is that it can cause mental problems, and that might be something you'd like to enjoy.

Most effects of starvation are temporary, considering she hasn't actually gone into full full starvation or dehydration where she would eventually die. If she's young and healthy she'll probably recover over time. Keep in mind that the heart is a muscle that might be affected. Her bones might also be broken down and brittle, which means they might fracture easily. It'll take a while for her to build her weight back up - I'm afraid I don't know how long, and that would depend on her conditions for recovery.

Something to keep in mind however is refeeding syndrome. In fiction often we see starved characters being told not to eat too much too soon because they'll be sick. Very true! But this can actually be really dangerous, it causes upset of your electrolytes and organ damage and can happen for a week or two after refeeding begins. So here's a favourite motto of physicians everywhere about almost everything - start low, go slow.

Hope that helps, sorry for the delay!

Thank you so much @StellaThomas! Very helpful

Hey Stella! So I have a question. Okay, two, so I hope I'm not burdening you. If I am, I apologize - you can answer either one.

My character has experienced one incident and one accident. The incident was that she stepped on the fragile part of the ceiling and fell through it when the ceiling broke. She fell on her back. The injury should be severe, but I'm not sure if there'd be long lasting pain following the incident. Can you theorize if there is? How do you treat it?

She experienced the accident while riding a motorcycle. When she was riding it fast, she hit the butt of another motorcycle and went rolling to the ground rapidly. My question's the same as the first - would there be long lasting injury she might get? How do you treat it?

Hey @Lightsong! Thanks for dropping by.

Ah, falling through the ceiling. A similar incident nearly occurred to me. Okay, not really. I put my foot through a rotten floorboard. But it DID happen to a friend of mine, who fell through a garage roof and who fractured his pelvis in two places and had to be in a wheelchair for a while followed by crutches. He's all good now.

In general, I feel like "pelvis fracture" is one you should look up, because it happens a lot to motorcyclists as well. If you do break your pelvis, it's quite acutely serious because you can lose a huge amount of blood into your pelvis because all of a sudden it's this expandable area. If you're wearing motorcycle leathers, you won't bleed out until they're cut because they hold you together. If not, we've been taught this bit of field medicine where you grab a bedsheet, twist it and tie it with a cable tie as tight as you can around a person's hips to stabilise the fracture and keep them from losing blood until you get to hospital.

After that, fractures of any sort take at least six weeks to heal, probably twelve, maybe more. Pelvis fractures don't always need surgery, but they might (and might get repaired with screws or external fixation - think a 'cage' around the bones, or traction), and will need physiotherapy, rest and painkillers.

If that's not what you're looking for, other fractures are always good calls. I've just had several tutorials on open fractures - where the bone comes out through the skin, and how to treat those (with surgery and antibiotics by orthopaedics and plastics surgeons), and the risk of complications (such as compartment syndrome). If you want one of her limbs out of action that's a good call, but she won't have any lasting pain once the fracture has been reduced - ie. the bones have been shoved back into place.

Both of these incidents could result in brain haemorrhages too, and internal organ damage. For instance, falling on her back could cause her to damage her kidney by bruising it, she might break a few vertebrae - meaning she might have to wear a back brace, or/and even a few ribs. Rib fractures, clinically, are indistinguishable from just bruising your ribs, they'll cause severe pain and there's not much that can be done except waiting for them to heal. The risk is that a jagged end of a broken rib might puncture a lung, or lacerate the liver or the spleen and cause bleeding.

Remember in both these cases, if she's picked up by an ambulance, they will immediately put her in a neck brace, check her airway, breathing and circulation before they do anything else. The neck brace won't be removed until they've assessed her cervical spine with an X Ray, because there's a chance that her moving her head will make her break her neck and die.

Of course, severing her spinal cord is also, regrettably, always a risk with any type of injury.

Hope that's some food for thought, if there's anything more you want to know, or you settle on a specific type of injury, let me know!

Thanks for the input! I'm going to ask some more question via PM.

Hey Stella!

So I've started editing my novel and I realised that there are a bunch of injuries and so on mentioned in it that I have no idea how to handle DD: It's a pretty long list, so if you do want to take your time in replying, then that's perfectly fine :3 Here's the questions I have for you:

1. What are gradual stages/changes/things the character would feel if they were going through starvation and dehydration? They get food every day, but not enough and only one meal a day. They also get one drink of clean water a day as well. Would the effects be different for someone who was 15 than someone who is seven?

2. What happens when you have a concussion? What would they be feeling/how long would it last? And is the butt of a gun whacking them in the head enough to give them one? (I thiiink that it is, but I'm just checking ^.^)

3. She gets a deep cut into the side of her stomach. The only thing she has to stem it a little is a cloth that was part of a shirt. Would that get infected and if so, what could be done when there are no medical supplies around to keep the pain level as low as possible?

4. If someone jumped off the top of a building and was caught by a net a few meters down, how would this affect them? Would they have cuts/bruises or anything else to deal with? Any broken bones?

5. THIS IS THE LAST ONE I PROMISE. But I think the hardest too? So let's say this fifteen year old girl who has been through a terribly traumatising event, is starved, and is pregnant shows up at hospital. How long would they have to be there for? What diet would they be placed on to keep themselves and the baby healthy? And what could be done for their mental state?

Sorry to ask so much >.> You're covering basically every illness/mental issue these characters come across in the novel >>

Hi @Deanie! Sorry for taking so long to get back to you!

1. What are gradual stages/changes/things the character would feel if they were going through starvation and dehydration? They get food every day, but not enough and only one meal a day. They also get one drink of clean water a day as well. Would the effects be different for someone who was 15 than someone who is seven?

I answered a little bit of this up above for Carlito, so feel free to read that. The body has an amazing ability to survive without food, not so much without water. An adult needs 2-3 litres of water a day to survive - we get a lot of our water from food hence why you're not always drinking that much. Children need a little less, but if anything is going to kill your characters in this situation, it's more likely to be the dehydration than the starvation.

But okay. Stages of starvation - roughly, it can be split into three physiological parts, sorry if this bores you but it might help xD:

One: this happens in a matter of hours. You run out of glucose - glucose is what your body runs on, in particular your brain. But never fear! Your body has set down lots of glycogen in your liver and fat cells that can be used to make new glucose. This happens super quickly, and you run out of glycogen quite fast.

Two: Okay, your body gets the sense that it might not be getting much more glucose. Instead, it starts breaking down your fat. It's hard to get glucose from fat, so instead it turns it into ketone bodies, and your brain uses these instead. This would have an effect on your mental state, because that's not how your brain is meant to function. This can last several weeks. Your characters will lose all their fat weight, and they'll get brittle skin and hair, and might get lanugo - a downy hair - over their limbs to keep them warm with the loss of subcutaneous fat.

Three: you're out of fat. Uh oh. What do you have left? Protein. Muscle. Your body digs into that next, and finally. Your muscles are essentially pure protein, but your cells need every ounce that they can get. This part doesn't last long. You'll get fluid shift, causing you to have a big swollen belly, and your joints will become the widest part of your limbs instead of the narrowest part.

Overall, remember your characters will be thin, tired, no energy, no enthusiasm. They may have altered mental state. The dehydration will cause them to have dry skin and dry mouths, sunken eyes, their skin will lose its elastic capabilities, and again, may cause them to be drowsy. There's also specific vitamin deficiencies and immunosuppression - think mouth ulcers, think skin infections and thrush coating their tongues.

In terms of if it will affect the 15 year old and the 7 year old differently, I think that it's really about the same. The seven year old will stop growing, but should start again once their food is returned to them. The 15 year old will stop menstruating if she's started already. Children are more susceptible than adults to dehydration, but if they're getting water every day hopefully it won't affect them too badly.

2. What happens when you have a concussion? What would they be feeling/how long would it last? And is the butt of a gun whacking them in the head enough to give them one? (I thiiink that it is, but I'm just checking ^.^)

So, concussion happens because your brain is a big gooey soft marshmallow trapped inside a leadlined box. Think of that. Now think of shaking that box. The concussion isn't actually from the hit itself, it's from the hit causing your brain to move inside the skull and hurt itself, generally on the side opposite to that of the force but that's really non-specific and honestly, any symptoms are a go.

Symptoms theoretically depend on the site of the concussion but as I say, I wouldn't worry about hitting them in a particular spot to get certain symptoms or anything. They can be a lot of things, people generally report visual disturbances, problems with memory or concentration, confusion, nausea and vomiting (yeah, weirdly, this is super common for head injuries since you have 'vomit centres' in your brain), slurred speech, trouble walking. The person may or may not lose consciousness- it's considered more severe if they do.

Again, concussion can last just a week or so, or it can last months. I have two classmates who weren't able to sit exams because of concussions months previously, as anecdotal evidence. You don't have to keep someone awake afterwards, that was just a way of seeing if you got worse or not. Now that we have brain imaging it's not such a big deal.

The butt of a gun and a good hard whack seem sufficient.

3. She gets a deep cut into the side of her stomach. The only thing she has to stem it a little is a cloth that was part of a shirt. Would that get infected and if so, what could be done when there are no medical supplies around to keep the pain level as low as possible?

Being stabbed in the side is an interesting one - if you get stabbed in the colon, BOOM, faecal peritonitis everywhere (And by that, I mean poo all over your organs. It basically spells death.) So avoid that, yeah? If she gets stabbed in the side and it avoids her colon, the chances of infection come only with the knife and her ability to fight off every day bacteria. Staunch the bleeding - either with the cloth or even just with her hands - sometimes fingers are better than anything, honestly, because they can apply direct pressure to the bleeding vessels, clean the wound and cover it up for it to heal. Infection isn't a guarantee at all. It could definitely happen. But if she's smart she should be able to get around it.

In terms of pain, humans are designed so that we don't really have pain receptors on our organs, only on the lining parts of our abdomen. So the pain will be sort of superficial. I don't know much about the likes of going out in the woods and making yourself a painkiller from berries but I'm sure it's possible? xD It'll hurt, but if she lies still and lets it heal it should get better.

Keep in mind the worst thing she can do is probably rip it open again. Your abdominal muscles are working all the time, so she'll need to rest them. If she's running about afterwards, she'll have Dr Stella to answer to

4. If someone jumped off the top of a building and was caught by a net a few meters down, how would this affect them? Would they have cuts/bruises or anything else to deal with? Any broken bones?

Okay so a handy thing I learnt this week is that you can tell if someone has bone disease if they got a fracture from falling from their own height or less. Normal people should only get fractures when falling with impact by more than their own height. The thing with the net is that if it's just a few metres down, the impact isn't going to be too much - that's why the net is there, right? I'm trying to think of a mechanism by which bones would break and I can't, but maybe I'm not creative enough. A dislocated shoulder if they landed that way could be an option if you want something. Other than that - friction burn/grazing from the net is a possibility, and I'm sure that even though it's a relatively soft landing, they'll probably have bruises.

5. THIS IS THE LAST ONE I PROMISE. But I think the hardest too? So let's say this fifteen year old girl who has been through a terribly traumatising event, is starved, and is pregnant shows up at hospital. How long would they have to be there for? What diet would they be placed on to keep themselves and the baby healthy? And what could be done for their mental state?

Deanie, what have you done to this poor girl xD Okay. Right. Let me run through a pathway:

-she arrives at accident and emergency. She's assessed for airway, breathing, circulation. Presuming she's still dehydrated, she's probably started on fluids. A full history is taken to try and assess what happened to her. They'll examine her, checking all of her systems for signs of disease, infection, malnutrition etc etc. They might ask her if she wants them to call the police. They might call them anyway.

-we have a buzzword, it's called multidisciplinary team. It means once she's out of the woods, they're going to call a ton of people to come and see her.

-they'll call an obstetrician/gynaecologist if there's one in the hospital (or she might be transferred to a maternity hospital, or they might keep her). My own teaching maternity hospital ran a special clinic for teen pregnancies, so they might get someone trained in that sort of thing to see her. They will probably ask her about trauma she's had, because it's their job to make sure that pregnant women are safe and there's no outside threat to them or the baby. They'll ask her when her last period was (and actually, this ties into above - if she's stopped menstruating, she can't get pregnant). Depending on how far along she is, they might do a few tests of her abdomen, checking its size, checking the lie of the baby. Then they'll do an ultrasound scan to see how baby is getting on.

-they'll call a dietician. The dietician will work out a diet for her - again this isn't my area of expertise, but she'll probably be gradually put onto high-calorie drinks. Gradually because there's a risk of referring syndrome from going too fast. The dietician will probably visit every day and try titre her up.

-they'll call a psychiatrist, if she's agreed that she might like to see one. Maybe they mightn't even ask her (but they probably will). These psychiatrists are called "liaison psychiatrists" - they see patients who are sick with something else. They'll take a full psychiatric history from her, about her mood, her anxieties, about what's happened, about how she feels about it. In the long term, they might recommend she sees a therapist. In the short term, if she's depressed they might give her anti-depressants but probably not because it's too soon after a traumatic event to say that she's suffering from depression when it could just be a normal reaction. Otherwise, they might give her something to help her sleep (but this mightn't happen as she's pregnant), but largely the best thing for her mental state at this point is that she's now safe and being looked after. She might get a one-to-one nursing care assistant if they're worried about leaving her alone, and the psychiatrist will visit again.

-they'll call social work, because starved pregnant fifteen year olds need to see social work.

-she'll probably be in for a few weeks while they try and build her up from her malnourished state and treat her for any infections. Depending on how far along she is with the baby, and her social circumstances (does she have anywhere else to go?), they might keep her until she delivers. Hospitals aren't in the business of turning vulnerable people out onto the street if they can help it.

OKAY SORRY I probably went way overboard but I hope I helped in some way

-Stella x

STELLA, YOU ARE THE BEST <3

Thank you ever so much <3 Really, so much! I am bookmarking this page and can finally make this more realistic. In the first draft she gets to the hospital and she is out in a few weeks ahaha. Now I can actually put in a bit more detail.

Also, I'm not nice to my characters at all >.>