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The Character Clinic



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Sun Dec 27, 2015 11:27 pm
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StellaThomas says...



Do you need to make your character sick in a certain way, or give them a specific injury? Or do you need to know how to treat a specific illness or injury?

I'm your gal. Hopefully.

Here is a place for you to ask about any medical queries that you have and I hope that I'll have the ability to answer, but I might not. If you're looking for ideas for illnesses, or if you want to know how a certain disease or injury might be treated, I hope that I'll be able to guide you on your way!

I can also help with things like hospital protocol. If you need to know what happens when someone is brought into the emergency department, or when they go for a primary interview with a psychiatrist I can try my best to help with those things as well. Obviously I only have my own experiences to go off, but it might be helpful to get a view from "the other side of the fence" as it is about hospitals and what they do.

Sadly my job currently involves a lot of paperwork, but answering these questions get me to use the knowledge that I've obtained over the past nine years, so don't see it as me helping you as much as you helping me.

So fire away! The doctor is in.

NB - disclaimer Yes, I am fully qualified and registered, but this thread is purely for fun. This is only for fictional problems and nothing I say here should be taken as actual medical advice. If you need a doctor, go and see your doctor, don't ask me!

-Stella x
"Stella. You were in my dream the other night. And everyone called you Princess." -Lauren2010
  





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Mon Dec 28, 2015 12:09 am
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Deskro says...



Oh this is awesome!

The novel I'm working on is pretty graphic, but having no medical experience myself I often worry about how legit it sounds.

One particular injury has been bothering me (which will happen at the climax).

My character gets shot in the back (through the spine specifically). I want to know if spinal fluid is actually a liquid, and if it leaks out if the spine is ruptured. Also any other information on back injuries will be greatly appreciated... do note that the character will become paralyzed, not every hero can be invincible after all.

P.S. I'm not a psycho... the character's told me to do it *Crazy laugh*
  





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Mon Dec 28, 2015 12:40 am
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StellaThomas says...



Hey @Deskro! Thanks for being my first client :)

Yes, cerebrospinal fluid (CSF) is indeed a fluid! If you're not squeamish, you can look up lumbar punctures/spinal taps and see samples of it being taken. (It's not actually that gross at all). It's generally clear in colour, but it can be bloodstained if there's trauma or injury in the area. (Or it can be cloudy if there's an infection). If they're going to be shot, there'll probably be a lot of blood and other things to worry about, so you wouldn't see the fluid itself as there'd be such little volumes of it compared to blood etc.

One thing you have to be aware of with spinal trauma in the acute setting - that is, not worrying about further paralysis or anything - is a thing called neurogenic shock. This happens when the spine is damaged and the areas below that level - the bits that are going to be paralysed - all lose their nervous supply and lots of fluid is rearranged in the body, making the patient go into a state of shock - which is really serious. If this is modern day, the patient will need lots of fluids, oxygen and might need special drugs called inotropes to make their heart pump more effectively. This is life-threatening, and would need to be dealt with before any other injuries are managed.

As for other injuries, I don't know much about guns, but I'm hoping it's possible for a bullet to be lodged in the vertebrae itself, because otherwise, sheesh, your person is in trouble. If a bullet were to rip through from back to front, it would rip through your aorta- your main blood vessel, not to mention other organs depending on what level you want the bullet to hit. If your aorta is ruptured, you are going to die extremely quickly, so if there's a way to have your bullet not get past the vertebrae, I think that's your best bet!

Be aware of the level of spine you choose - do you want them to lose power in their legs, or arms and legs? Do you want them to have control over their bladder and bowel? I'd recommend having a look at levels of spinal cord injury and their various effects, and get back to me if you have other questions :)

-Stella x
"Stella. You were in my dream the other night. And everyone called you Princess." -Lauren2010
  





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Mon Dec 28, 2015 1:03 am
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BluesClues says...



If I want a character to get stabbed and die but I want him to live long enough for some touchy-feely last words, is the abdomen better than the chest or are they about the same?

Also, I'm sure there'd be some amount of shock, in which case would the character actually come to long enough for some touchy-feely last words? What amount of shock would he go into from being stabbed in the abdomen or the chest? Is it different?

I've read that part of what kills you in a stabbing is the removal of the blade because that allows for greater blood loss than while the blade is still in the wound, but I assume organ damage is part of it? It's not like I'm going to get all into detail in the midst of the writing, but it's probably good for me to know.

Note: modern medical treatments are unavailable.
  





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Mon Dec 28, 2015 1:22 am
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StellaThomas says...



Hey @BlueAfrica! Mm, stabbings.

Okay so being stabbed in the chest and the abdomen are going to kill you in different ways probably. Abdomen, they're going to die of blood loss. There's a super fun memory aid - "On the floor and four more" meaning there's five places your patient is going to lose massive amounts of blood (big enough to kill them) - chest, abdomen, pelvis, long bone fractures and... the floor.

In moments of stress - like when you're about to get stabbed, blood isn't really flowing to your gut, because you don't need it, so unless you get stabbed in a major blood vessel (eg. the aorta or the inferior vena cava), you're hopefully going to have a few minutes to talk. Especially if the knife is left in long enough to combat the "the floor" situation for a while. Organ complications in the abdomen would not kill you particularly quickly - your kidneys will fail because of blood loss, but probably long after other things have already failed. The other big killer in an abdominal stab wound would be infection, but that way they would hold on for a few painful days.

Chest you have a few more options. You can combine blood loss and organ dysfunction with a massive haemothorax. This is where blood builds up and builds up inside the chest and compresses your heart and lungs. Compression of the heart so that it can't pump is called cardiac tamponade. But this might in part be relieved by the knife being removed -though then the blood is just going to move from the chest to the floor. But it will relieve the haemothorax a little so that way it might actually relieve their symptoms - hence taking it out (if the attacker left it in) - but they still die. Something to think about?

Organ damage in this situation is largely going to come about from blood loss, and if it's the chest, potentially lung collapse.

I think, for the sake of your character wanting to have some sort of conversation, abdomen is better, because a chest wound would also make it difficult for them to breath and thus even harder for them to talk. But it's up to you!

As for shock - if this is a young, fit patient getting stabbed, they can actually hold onto their blood pressure for quite a while - they can seem fine despite their injuries, and then just crash all of a sudden. So having a few last words is definitely possible.

Sorry that was definitely a ramble, feel free to shout for clarification!

-Stella x
"Stella. You were in my dream the other night. And everyone called you Princess." -Lauren2010
  





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Mon Dec 28, 2015 1:59 am
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BluesClues says...



Nope, that was great! Last question is: guesstimate on how long he would live for each (abdomen or chest)? He is indeed young and fit, except for having a knife lodged in his body at this point. I know it would probably depend on several factors including the precise location of the stabbing, but...just a general idea? Like would it be more like minutes to live or hours?
  





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Mon Dec 28, 2015 5:59 am
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Charm says...



Two of my characters almost drown. Is there any side effects that could affect them afterwards? I made them quit their sport after they almost drowned but is there anything else I need to explain or know?

Thanks!
Even if I'm slow I will walk with my own feet, because I know this path is mine to take, I will never lose my dream.

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Mon Dec 28, 2015 6:30 am
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Storygirl95 says...



One of my characters gets a nasty cut on her ankle, but it isn't serious enough to need stitches.

I'm sorry, but I have like eight million questions haha. How do you know that it doesn't need stitches? How do you treat that? Do you clean it and wrap it or what? Do you put antibiotic ointment on it? If you wrap it, what would you wrap it in? And how often would you have the change the dressing?

How long will they be incapacitated? Can she walk on it quickly afterwards or should she rest? Will movement cause it to bleed again, or is she fine to stroll around so long as she isn't doing jumping jacks?

Sorry, once again. I thank you for your help in advance! ^_^
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Mon Dec 28, 2015 10:30 am
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Mea says...



Okay, I have a character who needs to get stabbed in front of an entire courtroom and die quickly enough that there isn't time for medical help to arrive (so maybe a 5-10 minute window), since their technology is advanced enough that with it it would be easy to save his life.

So, where would he need to be stabbed? It would preferably be some sort of stab wound, simply because it would be much easier for the murderer to bring something pointy rather than a gun.

Thanks in advance!
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Mon Dec 28, 2015 10:54 am
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Apricity says...



Hi Stella, this question is probably slightly different to the others. But my story involves a set of characters being sent into an alternate reality. So I sort of want to know what happens inside a person's brain when they go into a coma, I once talked to a coma patient and apparently they could perceive everything that was happening around them. Is it possible to induce a person into a coma by using a certain dosage of drugs (if so, what kind?)
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Mon Dec 28, 2015 2:55 pm
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StellaThomas says...



@BlueAfrica - for the chest I would say minutes. For the abdomen, I think you could stretch to hours without raising too many eyebrows if you needed to, but equally he could die within minutes.

@MadWriter7 - I guess it depends on how close they come to drowning. If their hearts stopped and they required CPR, the biggest risk is brain damage - hypoxic ischaemic brain injury where the brain doesn't get enough oxygen. This can present in manifold different ways - intellectual disability, paralysis, speech difficulties, depending on what parts of the brain are affected, and it tends to be permanent. Other than that, if they were saved there might not be many sequelae from it.

@Storygirl95 - I guess my main question is why you think it doesn't need stitches? I mean, if you want to incapacitate her for a few days, why not just go with the stitches - or is it just that they aren't available to her? Usually, we stitch up a cut if it's big and nasty and leaving it open is leaving the person at risk of infection or other complications of having an open wound. If it was looked at and she was told "nah, that doesn't need stitches" - then it wouldn't be that serious. However there might be reasons why it can't be stitched - if it's too big and the edges won't meet, for example, or if it's over a joint - like the ankle - and they're concerned about putting a big scar over skin that needs to be supple and elastic, so they might leave it to heal by itself. However, if it's being left open, I think they would definitely give her some antibiotics - to take in pill form (probably flucloxacillin). Again, if it's just that she can't get medical help, I think it would be cleaned with something antiseptic (e.g. iodine) and bandaged up. That might be changed every few days so they can get a good look at how it's healing and check for signs of infection. As for how long she's going to be incapacitated, again I guess it depends. Since this sounds like it's just a flesh wound, she might be told to rest it for a couple of days to give it a good chance of healing over, but I think after that she'd be okay to hobble about, just nothing so strenuous that it's going to rip it open again.

@Meandbooks - if you read over my answers to Blue, hopefully there's something to help you there as well :) I'm a little unclear- do you want them to die straight away, or hang on for like five minutes (but not long enough for them to get help)? Either way, stabbing them in the heart or a major blood vessel (e.g. the aorta) is likely to make them bleed out before they get any help. If you go for the heart, remember it's in the centre of the chest and the stabber would have to go in at a particular angle to reach it. If it's the aorta, it essentially runs right down the centre of your abdomen, just in front of your spine. Those would kill incredibly quickly. A chest or abdomen wound like the ones I talked to Blue about might give him a little while longer. Another option - it's a bit out there - but the neck. That would cause a pretty gruesome, blood-spurting injury if you hit the carotid artery, which is really high pressure, and if you injured the trachea (windpipe) that might speed things up even more. The thing is with that as an injury is that it might be easy enough for someone to go put pressure on the artery until it stops bleeding.

@Hiraeth - I'm afraid I don't know much about comas! Some people report being able to hear, and being "awake" in a way even though they aren't awake. As for drugs to induce coma - of course! It's what is used in intensive care units all the time (some of those patients are in comas of their own but a lot have to be sedated and put to sleep so that they can be ventilated etc.). These include propofol, benzodiazepines, barbiturates (though those are really old). Propofol is probably the one I would go for if I were you, though benzos are a good second option. The thing is with all anaesthetics - well, with any unconscious person - you run the risk of that person stopping breathing for a few reasons - they lose the muscle tone in the back of their throat so that can collapse and also, well, they just sort of forget about it. So just be aware of that and ask yourself questions about whether your characters are going to need to be put on breathing machines.

As for the coma, I really don't know enough to help you, but the truth is I don't really think many people do, and you should feel free to take free reign on that bit.
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Mon Dec 28, 2015 5:41 pm
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Charm says...



Okay! Thanks so much Stella
Even if I'm slow I will walk with my own feet, because I know this path is mine to take, I will never lose my dream.

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Mon Dec 28, 2015 6:29 pm
Deskro says...



Thanks, Stella, very informative :D

So yeah, I'm hoping the character just loses control of their legs. So they become wheelchair bound but not messy...I'm thinking the lower lumbar(?) is this accurate?

Wondering, if the character's spine is damaged, will they stumble forward a few steps or collapse immediately? I assume they will be in shock - envisioning: shot in the back > falls forward > has a conversation with a dying comrade (will probably be one-way i.e. character is out of it and can't really respond) > comas out

Also I should have mentioned that this takes place in the far future but my characters exist in an impoverished area, as such they won't receive any decent medical attention immediately, but when they do it will be advanced.

I will edit this if anything further comes to me :)

Thanks in advance :3
  





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Mon Dec 28, 2015 11:23 pm
StellaThomas says...



@Deskro - lumbar sounds good!

They will collapse immediately because they won't have the nervous supply to take those few steps. When you think about it, the signal has to go to the brain and back again for every single step, so those probably aren't an option. So falling flat on their face is probably more accurate - and after that your estimation sounds just about right :)

The bowel and bladder are nearly always affected ,on further inspection, because they're so low down on the cord. That can be managed with a catheter etc etc but it's just something to keep in mind.

Hope I helped! :)
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Thu Dec 31, 2015 2:13 am
Lefty says...



Hey, Stella!

I have a character who gets fatally stabbed and he needs to stay alive for about twenty-thirty minutes before dying. I would prefer that the blade not stay in after he's stabbed, but I can work it in so it does if that makes it more plausible. He's a strong, fit, sixteen-year-old guy. Where do you think would be the best place for him to be stabbed given the circumstances? Thanks a bunch!
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