Hand damage - psychiatric issues

jeseymour · Aug 11, 2009

I have a character who decides to punch a tree. Repeatedly. He's suicidal, and he's decided that if he wrecks his hand he won't be able to shoot himself. (I didn't say he was thinking logically.) Anyway, I'm wondering what sort of damage one might do to one's hand by punching a large tree several times. The way I've written it, his hand is a pulpy mess of broken bones and torn skin. Would he have broken the fingers or the knuckles or the long bones in the hand itself or all of the above? What about the wrist? I don't want significant permanent damage, is there a chance of that? Nerve damage? Some residual nerve damage would be okay, but he has to be able to use his hand. Any thoughts on recovery time? Would it be in a cast? If somebody comes into a hospital with this kind of injury would there be someone asking him questions about how it happened and why he did it? Might he get some sort of psychiatric attention? If he gives the right answers, can he get out of there without being held for evaluation? He knows he needs help, but he's not ready to be in an inpatient setting. (Truthfully, I'm trying to avoid the complications of trying to write about inpatient psychiatric stuff as I have no clue about any of that.)

Thanks for any info you can offer.

Nivarion · Aug 11, 2009

He would likely have boxers break. The long bones would be broken and he would also likely rip the skin away from the knuckles. He wouldn't be able to even close his hand without excruciating pain.

ETA: People go into the hospital with that a lot more than you'd think. They might question why he hit it Again, since it tends to break it the first time.

by "If he gives the right answers" you mean "Lies out his arse" then yes he could. Especially if he's a teenager. Happens all the time.

redpbass · Aug 11, 2009

Yeah, skin would break easily, especially hitting a tree with rough bark. Does he know how to hit things properly? If not, it's easy to mess up his wrist too. Also, if his fist doesn't hit the tree flush, all sorts of fun things can happen to the fingers and bones.

BillTrain · Aug 11, 2009

He'd probably have a boxer's fracture (like Nivarion said). That's a break of the 5th metacarpal - between the pinky and the wrist. Sometimes the 4th breaks too. He might wind up in a cast, depending on how bad the break is - but they'll often do splints, especially if the swelling is bad. Friday and Saturday nights, a lot of these come in to ERs. They'll never get a psych consult - unless the person is suicidal, psychotic etc etc on top of it.
Cheers,
BT

Kalyke · Aug 12, 2009

I think that the pain of the first broken bone, or even the first skinned knuckles would stop him from totally pulping his hand. If he pulps his hand he will have lifelong problems-- it is silly to think he would not. There is a difference between simply breaking a bone and breaking a bone so badly that it masicates the tendons, nerves and muscles around the bones. The hand is a very delicate mechinism filled with lots of little muscles and tendons that must be hooked on exactly. Also he would have to be totally nerveless to get past the first break. Would he be asked psychological questions? Sure.

I suggest doing something like letting a heavy object fall on the hand if he really wants to screw himself up. Why not just quit his job and go bankrupt? He'd probably screw himself up pretty bad as a street person. If he takes to alchohol or crack, that's a plus. No one would ever ask hip psychatric questions about that.

shizukana · Aug 12, 2009

depending on how he holds his thumb and depending on the angle at which he hits the tree he might also dislocate his thumb and/or break the os naviculare (middle hand bone). But any fracture of the hand hurts really bad, so unless he is seriously drunk or drugged I wouldn't think he might hit the tree more than once. And most certainly, with enough force that he breaks something, he splits his skin.
also a depends on: whether he might be questioned or not. If he shows up in an ER in a big city at any time, especially in nighttime: no. A small city on the night of a country fair : no. I'd suggest he doesn't mention it was a tree he hit, though.

blacbird · Aug 12, 2009

Use Her Name said:
I think that the pain of the first broken bone, or even the first skinned knuckles would stop him from totally pulping his hand.

I have broken the same hand, twice, in exactly this fashion owing to athletic accidents (first time hitting hand against football helmet in high school, second time getting hit flush with softball line-drive in same exact spot, with same exact results, broken 4th and 5th metacarpals, at the knuckles). I can pretty much guarantee nobody would hit the tree more than once. But unless your hero is acting weird in some obvious way other than from hand pain, I doubt if anyone would look at him for any psychiatric evaluation. This kind of injury is quite common, non-life-threatening, and would be handled in a very routine way. It might or might not require surgery, depending on the extent of damage, but one really good slug on the tree would suffice to do a fair amount of harm.

caw

jclarkdawe · Aug 12, 2009

A psych patient can do things mere mortals would dread. I had a medical call for a suicidal individual, who we spent a while trying to talk into cooperating. Finally he blew and started pounding on a cement wall (he was in the basement of the house). Before he disappeared under three cops and four firefighters, we figure he hit the wall at least five times. (Most of us weren't exactly watching other to make sure he didn't hit us.)

Hand was pulped. Bone fragments, deformed fingers, as soon as possible a call was made to the hospital to have an ortho surgeon in the ER. All we could do for him in the ambulance was duct tape his arms to the side rails, and put cold packs on his hands after we mittened them.

I have no idea what his long term damage was. Hospital transferred him to state hospital almost immediately. He was probably in massive pain in the rig, but he didn't say a word to us.

Best of luck,

Jim Clark-Dawe

jeseymour · Aug 12, 2009

Thanks folks, this is very helpful. Maybe he won't hit the tree more than twice. I don't want permanent damage.

Much appreciated!

Tsu Dho Nimh · Aug 13, 2009

jeseymour said:
I have a character who decides to punch a tree. Repeatedly.

He'll probably only punch the tree once or twice. The little bones between the knuckles and the wrist break - one or more of them, into one or more pieces - and it's extremely painful.

I've seen a few of them - drunk punched his car because it wouldn't start, drunk punched at his wife and missed and hit the wall behind her, drunk punched his snowboard ... whatever - but they were all drunk and screaming in pain. And despite the drunken anger, they only punched once.

Look up treatment of "boxer's fracture" ... it may often take pins and surgery and weeks in a cast to heal. Nerve damage is possible - it's a real worry for the surgeons doing the repairs. If the fingers are blue or tingly, it becomes a real emergency because you are losing function.

The immediate first aid is to "splint" the hand and forearm - just support the hand and fingers in a comfortable position on something long enough that you can immobilize the wrist too, put a sling on.

Put a baggie of ice on it and go get some decent pain meds.

styloviolet · Aug 16, 2009

Tsu Dho Nimh said:
I've seen a few of them - drunk punched his car because it wouldn't start, drunk punched at his wife and missed and hit the wall behind her, drunk punched his snowboard ... whatever - but they were all drunk and screaming in pain. And despite the drunken anger, they only punched once.

Agreed. Most people who are either drunk or angry tend to stop after the first one. It's the ones with real psychiatric issues who continue.

Depending on the angle and severity of the punch, you may or may not end up with nerve damage. Also agreed that he will most likely end up with what is referred to as a boxer's fracture. Hand therapy will be in his future post-surgery.

BigWords · Aug 16, 2009

When I was thirteen or fourteen I was dumped by a girl outside her back door. As I walked back to the street through the close I punched out both arms (to my sides) in frustration and hit the walls. It hurt like hell, and I couldn't close my hands for the better part of three hours. I didn't break the skin though, despite the harling being much harder than bark.

Hand damage - psychiatric issues

jeseymour

Nivarion

Brony level >9000

redpbass

BillTrain

Kalyke

shizukana

blacbird

jclarkdawe

Feeling lucky, Query?

jeseymour

Tsu Dho Nimh

styloviolet

Relentless Wisecracker

BigWords

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