Medical questions (quite a lot of them)

grenouille said:

3, What would be the injury that would cause her not to be able to have children? I thought of an injury of the womb so she would have to have it removed, but is there anything else or is it relevant?

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I'm a biologist, not a doctor, but...

I think any kind of serious trauma to the uterus could make childbearing next to impossible, regardless of whether it had to be removed or not. The womb undergoes a lot of stretching during pregnancy, so any weakness would seriously increase the risk of miscarriage and/or danger to the mother.

Damage to both ovaries is another possibility if you don't want her to have her own children (as distinct from childbearing via IVF and donated eggs). But you only need one to function, so taking them both out seems a longer shot than damaging the uterus.

Most likely cause of needing to remove the uterus or ovaries is some form of cancer (ok, not caused by the 'accident' but a malignant ovarian tumour could be discovered by the doctors on an examination - say if they used an MRI to examine her as part of the investigation into what is damaged) or some form of infection to the womb. Now, an infection could be secondary to the injury if she is left lying for a while before it is made sterile and would also put her in severe danger of death (septicaemia and other infections are a major cause of death in hospitals, after shock due to blood loss).

Again, not a doctor but I am a clinical scientist.

One thing to consider - different hospitals in different countries in different times have different procedures. So you may have to research the area you are setting your story in if you want accuracy - ask some local medics what they think.

Hi Grenouille,

I'm a psychiatrist. i'll have a go at a few of your questions but i know we have a few trauma specialists and paramedics hanging out here that will do a better job for several of them.


From my point of view, I'd start wondering how she got to the bottom of the bridge. A car accident is the least likely thing to make the doctors wonder about suicide. in general adults don't fall from bridges. Teenagers sometimes climb and slip, criminals may occassionally throw someone off, but a normal sensible adult would have a hard time "tripping" off one.,,,plus they tend not to link things that people walk between.

I'm not going to try to pretend to be an expert on how different the injuries would be if she was in a car.

The memory thing.....depends on how long she'd plannned to kill herself for. If it was a drunken thought from that evening then you could easily explain not remembering the evening. Alchol alone would help with that, but if she'd deliberately planned for a month to kill herself on a specific date and in a specific way then you'd have to wipe away a month's worth of memory and that's less plausible. Disrupting memory beyond that evening is going to need increasing degrees of head trauma.

About the overdose...i usually breathe a sigh of relief whenever i hear someone overdosed on modern antidepressants (SSRIs) as they're bloody hard things to kill yourself with. Experience has shown people can typically survive handfuls. Older antidepressants, especially the tricyclic antidepressants are much more harmful and have significant heart effects. it's rare to come across someone on a tricyclic who hasn't been on it for years and years though. Very few people would choose them over an SSRI and in my experience it's elderly doctors wo haven't kept as up to date as they might have who still prescribe them.

When i used to be on crash teams (the people you call for stopped hearts) we didn't have an anesthetist on the team. it was led exclusively by medics in the UK who'd call an anesthetist if they were having problems getting venous access or needed airway or ventilation support.


Then you're into an algorithm

If her heart stops at any time then wherever she is someone will try to restart it. Paramedics and A&E doctors are great at this, so are most physicians. Most hospitals have a crash team they call. it needs to be done quickly.

http://www.ncbi.nlm.nih.gov/books/NBK2207/ this is a link to uk and us cycles for how to approach cardiac arrest. Shocks are only really useful if the heart is in particular electrical patterns. A good thunp to the chest can be effective if you see someone collapse in front of you. injections and shocks depend entirely on what pattern the heart is in.

Paramedics are well trained in it if she isn't in hospital. If her heart stops in hospital then it will be done wherever she is.

If her heart is fine when she's admitted but they know she's taken something that could effect it then they'll stick her on a ward wired up to a monitor and watch. There is no procedure to be done if the heart is still going, but they might consider pumping out her stomach if the overdose was very recent, or a few medications have "antidotes"

when the heart starts beating again then everyone breathes a sigh of relief, they hook her up to a cardiac monitor and watch her. they'll do a few blood tests, and they might book a few tests like an echocardiogram for the next day. She'll probably sleep for a while, they wouldn't sedate her though.

Your other questions need a little more info on exactly which meds she overdosed on. They're all a little different.If all they did was cause rhythm problems then she'll probably be fine once they're out of her system. if they caused a heart attack she'll have to deal with the consequences of that.


Craig

About the taking pills thing... agree about the modern antidepressants. The usual method of old was alcohol mixed with painkillers like paracetamol. Because the liver cannot so easily process both at the same time, there is a good chance one of them will kill you Though something I was once told by a lecturer was that if you survived an overdose of paracetamol, you were effectively dead anyway due to massive liver damage - eventually (days, months, years maybe depending on how much you took) it would fail and kill you and not in a particularly nice or pretty way.

grenouille said:

3, What would be the injury that would cause her not to be able to have children? I thought of an injury of the womb so she would have to have it removed, but is there anything else or is it relevant?

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Realistically there doesn't need to be one. Many of the evaluations for infertility result in, "Idiopathic Infertility," which means we don't know why. It's also not unusual for both partners of a couple to check out, "ok," and still never conceive. They separate and each in turn has children with a different spouse.

If you need an esoteric cause, there are billions, far in excess of what is feasible for a post. Not in any particular order off the top of my head...

1. massive trauma leading to Disseminated Intravascular Coagulation causing clotting in the gonadal veins resulting in destruction of the germ cells (eggs).

2. Uterine rupture eventually resulting in endometriosis.

3. Massive trauma resulting in oversewing of the gonadal vessels for control of blood loss (note, this would be exceptionally rare since normally the blood vessels are symmetrically bilateral and the chances of bilateral injuries are nearly impossible, but there are ectopic vessels and clutzy surgeons...)

2.) Not a doctor, just a psychologist. I have serious doubts that amnesia would cause your MC to forget she was suicidal because her brain chemistry would still be out of whack. She might not remember that she had a suicide attempt, but she'd would probably still feel the depression that caused the suicidal ideation. I could be wrong, but I don't know how amnesia would effect brain chemistry.

4.) In the USA, she'd likely be held for at least 72 hours on a psych was after a suicide attempt, but if she was also in for medical reasons that would "count" unless she is still a danger to herself and others.

Yes, there are cases of sperm and uterus being incompatible with each other - the micorenvironment of the uterus can be toxic to one person's sperm but fine for another's. Also, there is evidence that stress (such as during rape) can prevent conception which is why it is relatively rare (possible but rare) for children to be born out of a rape.

Another (what I consider quite silly) concept is 'killer sperm'. Read about this somewhere (think it was New Scientist, I certainly never looked at any proper journals on it). Basically, not all the sperm a man releases makes a beeline for the egg. Some of it hangs around in the uterus for a while (until it dies), waiting for any other sperm to enter. If the sperm is from the same source, it ignores it. If it is from a different source (i.e. another man) it attacks it and tries to destroy it. It amused me to read that at the time... But this is a digression.

Basically, conception is such a complicated process that any number of relatively minor things can cause the whole process to not happen. Many of these are in place due to evolution - creating a survival of the fittest style environment before conception even happens (many miscarriages, for example, are due to what are known as 'fatal mutations' in DNA - a combination of genes which cannot survive to birth).