The Character Clinic

Okay, so what would happen if someone was mauled in the stomach by a big cat?Assume it's very serious; how soon would the victim die, and why exactly?

@LittleLee - depends on the mauling!

Your aorta and renal arteries are near your back, but closer to the front of your tummy the bowels run with their own blood supply. Enough damage to the bowels or a deep injury will cause someone to bleed out in minutes. How long exactly it takes for someone to die depends on their reserve - eg. how healthy they are. I'm working with ladies at the minute who can lose 2 litres of blood and not even feel it - but remember that your character will be in excruciating pain as well so that's likely to debilitate them more.

Other options for a slower death are more superficial injuries and death from sepsis a little later - a tear in the large bowel will cause overwhelming infection which would kill someone in a few days of fever and pain. Unpleasant but works.

Thanks, this is really helpful!

I have a character who gets shot. The bullet goes through her shoulder and gets stuck in her lung. I’m wondering how quickly she needs to get to the hospital before she dies. She’s an alcoholic but otherwise healthy young woman

@StellaThomas

I have a character who was hit by a really heavy door. And when I say heavy, I mean heavy. I mean the huge wooden, super ornate kind of door. She was walking through a door frame when it swung back and knocked her off her feet. She is a 14 year old girl and about 5'5. Her hands were also in front of her and she tried to catch the door with them.
What kinds of injuries would she have?
Hope this isn't too weird and you can answer it!

hey Stella! I don't k ow if you can answer this, but I have two questions. To

One: How quick can someone did of a heart attack? Is there any way they could be helped without any medical equipment/only basic medicine?

Two: Withou t any equipment, is there any way a nurse could tell if someone died because of poison?

Heyo! I need a character to be shot somewhere scary and potentially life threatening, but somewhere that will take at least 10 or 20 minutes to kill him.

Any recommends?

I need a somewhat bony woman in her eighties to break her neck and her left femur without dying. She's also going to be heavily bruised. The accident would be caused by a speeding carriage, roughly twenty miles from the nearest hospital. I can treat the bruises and the injuries of the other two characters, but I'm not sure how to make this old lady survive as long as possible without high tech care for the longest period of time.

Wow I need to get back to this.

Quick lunchtime check for @Vilnius - are you going to repair them?

Neck of femur fractures have 100% mortality especially in that age group without repair. Might take a few days but she'll die. Let alone the neck injury.

StellaThomas wrote:Wow I need to get back to this.

Quick lunchtime check for @Vilnius - are you going to repair them?

Neck of femur fractures have 100% mortality especially in that age group without repair. Might take a few days but she'll die. Let alone the neck injury.

I am a much meaner writer than I remember... I was going to attempt repair, at the very least.

Hey Stella!

I'm trying to write a child character who goes into a coma for two years after suffering a head injury. How long would it take for her to fully recover from her coma after being unconscious for such a long time and what would recovery look like? Are there any permanent or long-lasting effects that she might experience?

Also was wondering: Comas sometimes feel a bit contrived to me when I come across them in fiction. How common/uncommon are they? Are there any details I could add to make this scenario play out in a more realistic and believable way?

Hi Aly!

Thanks for the challenging question.

(By the way guys I've been really poor at updating - if you have a question above still in need of answering, ping me and I promise this time I'll do it).

Comas.

In my four years or so of practice I've seen two types of coma:

- medically induced
- following a hypoxic brain injury.

Medically induced comas are what we use in ICU so people will be able to tolerate treatment - mainly, usually, a breathing tube down their throat. Conscious people can't tolerate it - most of the time - they'll gag and fight it. Hence we put them to sleep.

Hypoxic brain injuries occur when we starve the brain of oxygen. These can happen for a few reasons - stroke, drowning, cardiac arrest.

I just went and looked online to see if there was anything I missed- poisoning is the other big cause (I would guess largely opioid) but given its high reversibility I don't think you need to think about it.

Delirium is another major, reversible, short lived form, but given that a key component of delirium is that it's fluctuating, it doesn't suit your purposes.

The other possibility is status epilepticus - it definitely happens that people are having a seizure that gets mistaken for simply being unconscious - however again two years duration is unlikely.

The other thing people often don't understand about coma and consciousness is that it's not a light, flicking on and off. It's a spectrum. Most commonly we use the Glasgow Coma Scale to assess how conscious a person is. A lot of people in hospital will score a 14/15 whether they're delirious or have an underlying dementia. 3 is the lowest you can score on the scale. I've seen 3s, of course, but most people in comas are not right down at the bottom. Anything below an 8, that person is considered not safe to protect their own airway, and will get a breathing tube, most of the time.

I think one of the biggest misconceptions about comas is that you'll wake up and be fine. Forget the cause of the coma for a second and consider instead just what would happen to your body if you didn't move, speak or eat for two years (you would be tube fed but you haven't swallowed).

Our main research comes from ICU and critical illness polyneuropathy. The importance of this cannot be understated. This is why, incidentally, we will often make a call that a patient isn't for ICU. Because we genuinely don't think they'll survive it. This has caused a lot of controversy during COVID-19 times. But the fact is that to be unconscious for a couple of weeks or a couple of months is a massive assault. Your nerves and muscles will break down. You can't shift yourself in the bed so nurses have to move you around to stop you getting pressure sores (skin breakdown and open wounds caused from lying or sitting in one position for too long, which may never heal).

Is this less likely in kids than adults? Simply put - yes, for a couple of reasons:

- kids' brains and nerves and muscles have more ability to grow and regenerate
- they tend not to be in ICU for so long.

Okay have I confused you enough? XD

So to answer your specific question: when the kid wakes up, she'll have to learn to do a lot of things again. She won't have used any of her muscles including her tongue. She'll have been tube fed, so she'll have to learn to eat, and speak. And she'll have lost two years of development too.

In terms of making it more realistic, there should be long term effects but I suppose you need to decide on what suits your story best. She may be in a wheelchair. She may have one side weaker than the other. She may have lost her language skills. Her ability to concentrate may well be out the window. 80% of brain injuries lose their sense of smell.

These patients require a lot of care. It could potentially be done at home with a full time and devoted parent. They'd need turned for the pressure sores, and probably would need physiotherapy every day to help keep their muscles at least mildly active. They would need to be kept physically healthy. Aspiration pneumonia (where food or just saliva goes into the lungs) is the biggest risk to their health. Urinary tract infections too. I'd expect that they would have a urinary catheter in so that they weren't sitting in urine stained incontinence wear/nappies which can contribute to the pressure sore problems.

The other things I'd advise in terms of making it more realistic:

- don't make their GCS 3. That is, they can be unconscious, but maybe they're opening their eyes, grunting to pain, that kind of thing.

- make their recovery very gradual.

Honestly though, someone waking up and recovering from a coma is one of those things that even all doctors would love to see. Even we want to believe in miracles. And if you want to write one - it borders on fantastical, but no one will really stop you. We've all heard the stories, and want them to be true.

Wow- thank-you so much for the detailed reply Stella! This was super helpful.

The other thing I didn't mention is splinting - people who are in comas for a long time get these things called Fixed Flexion Deformities - I actually googled there to see people who had woken up from very long comas - you'll see they have their elbows and wrists bent in an unusual way. This happens from disuse. Splints and physiotherapy throughout the time they're unconscious can help, but again it needs to be pretty rigorous.

So. If my character was exposed to chalk dust every single day of her life, inhaling it, having it on her skin 24/7, what would happen? I don't know if you'll be able to answer this.