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Thread: Deep cut on arm/blood loss/unconscious

  1. #1
    New Fish; Learning About Thick Skin
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    Deep cut on arm/blood loss/unconscious

    Okay, I have a character that was in a car accident and I need to make sure her condition is realistic.
    She has a large cut on her forehead, a long, deep cut on her left forearm, three broken ribs, and a partially collapsed (but not punctured) lung.
    She is unconscious right away and it's very important to the plot that she remains so for about 2-3 days (2 and a half, roughly).

    My current thought is that a combination of blood loss and pain medication would keep her pretty out of it. Also possible sedatives when she first gets to the hospital to give her lung a chance to heal. Is that reasonable?
    She's not in a coma, because she wakes up for a few minutes at a time, enough to make eye contact/say a few words, but doesn't remember any of it. Her brother describes it as "“You were out for two and a half days. On and off I guess, but you weren't really awake when you were awake, you know?”

    My biggest concern is the cut on her arm. It has 15 stitches, and I want to know where to place it so that her condition for those days lines up, but without her losing any of her arm/hand function.

  2. #2
    practical experience, FTW MaeZe's Avatar
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    If one's lung collapses, it can be internally, it doesn't need to be from the outside in. You then get either a pneumothorax (air) with the space between the lung and the chest wall filling with air allowing the lung to collapse. Or you can get a hemothorax (blood) where blood fills the space collapsing the lung. I'm not sure what your point is when you say the lung collapses but it's not punctured.

    A better way to approach medical injuries in a story is to decide what you want to happen, then choose injuries which give you that outcome. Trying to choose the injuries first (deep cut on arm/blood loss/unconscious) doesn't make sense unless there is some particular thing those specific injuries add to the story. Do you care that her arm and head are cut or do you care that she's unconscious for a couple days? Why do you want her to have broken ribs then say her lung isn't punctured?

    A similar question was just asked a day or so ago. Blood loss does not render one unconscious for several days. You need a head injury for that. And no, we don't keep people out of it with pain meds. Maybe a patient with really extensive burns, but not your standard accident injuries.

    For the record, we crack a chest (meaning open up the chest to work on the heart and within 24 hours you try to get the patient to sit up on the side of the bed. In 48 hours you try to get them walking. In a week or less, as long as there are no complications, you send them home on oral pain meds.

    It's the terminal cancer patient we send home with a setup to self administer IV pain meds.

    I'm not sure where people get the idea a patient with bruises and broken bones is kept snookered on pain meds for a few days but you are not the only one with this misconception.

    Tell me the outcomes that matter and I'll try to help suggest some injuries for your character that will give you that outcome.

    She can be in and out of consciousness with a head injury. I had a patient that slept unless we woke him up for a couple days after being smacked in the head with a bat. Beyond that he didn't have any permanent brain damage. Give your character a head injury.
    Last edited by MaeZe; 11-22-2017 at 10:15 AM.

  3. #3
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    This is so helpful, thank you!
    I really liked your suggestion for a head injury. That was my initial thought, but I didn't want her to end up with any permanent brain damage.

    It is important to me that the cut on her arm exists. The circumstances around the car accident are incredibly confusing and stressful and having an easily visible scar from it is something I use on several occasions later. I liked the idea of a couple broken ribs simply to slow her down a little. She's a pretty active person and she needed to not be for a little while.
    It's also super important that she's almost entirely unconscious for a few days. The car accident is my inciting incident and there's a few practical matters that need to be sorted out before she's conscious. She doesn't remember the accident at all, which drives much of what she does. (It's a pretty bad accident, both people in the front seat died).

    Obviously, I threw these details in pretty quickly, because it all shows up in the first few pages of the novel and I needed to move on and get the rest down before I started revising (which is where I'm at now). I really like the idea of a head injury. Do you have any suggestions on what that would look like in a car accident? Or how long it would take for her to return to her normal routine, like school, after getting home?

  4. #4
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    I know of a young woman (mid-20s) who suffered trauma in a traffic accident (rear seat passenger in a T-boned sedan, not wearing a seat belt). Injuries (that I'm aware of) included a concussion, assorted contusions & sprains, some cracked ribs, and some lacerations. Unconscious at the scene and transported to the local hospital E.D. She was periodically conscious by the following day, but kept under (mild?) sedation for a few days (pain mgmt?). I don't have details (HIPAA constraints), but I knew she was under a neurologist's care. Released from the hospital in something like ten days (if memory serves), she made a full recovery.

    I used similar circumstances in a novel. Beta readers in the medical field had no problems with the concept, so long as I kept the treatment protocols appropriately vague.

    The point is that you can keep things relatively plausible, if you forgo too much detail. You'll have to decide what and how your story needs. Best of luck!

  5. #5
    practical experience, FTW MaeZe's Avatar
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    Quote Originally Posted by rachelpaige98 View Post
    This is so helpful, thank you!
    I really liked your suggestion for a head injury. That was my initial thought, but I didn't want her to end up with any permanent brain damage.

    It is important to me that the cut on her arm exists. The circumstances around the car accident are incredibly confusing and stressful and having an easily visible scar from it is something I use on several occasions later. I liked the idea of a couple broken ribs simply to slow her down a little. She's a pretty active person and she needed to not be for a little while.
    It's also super important that she's almost entirely unconscious for a few days. The car accident is my inciting incident and there's a few practical matters that need to be sorted out before she's conscious. She doesn't remember the accident at all, which drives much of what she does. (It's a pretty bad accident, both people in the front seat died).

    Obviously, I threw these details in pretty quickly, because it all shows up in the first few pages of the novel and I needed to move on and get the rest down before I started revising (which is where I'm at now). I really like the idea of a head injury. Do you have any suggestions on what that would look like in a car accident? Or how long it would take for her to return to her normal routine, like school, after getting home?
    You can make the head injury anything you want, they are quite variable. Many people recover fully from head injuries, many don't. Some are OK within hours, some within days and some need months to a year to recover as much as they will eventually recover. And she can have her seatbelt on or off. Sometimes your head smacks into the side window even with a seatbelt on, or some item from outside the car can go through the windshield and hit a person in the car.

    No need to give the reader too many details on the medical side, have them induce a coma because of the brain swelling and wake her up when you are ready.

    As for the arm injury, you don't need massive bleeding to get the scar you want. Again, you can write that injury anyway you want.

    You can have broken ribs without puncturing a lung. If you want to gin up the injuries, add the lung injury and chest tubes. Just look up treating a hemothorax or pneumothorax.

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