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inspiredbymusic
01-03-2014, 10:10 PM
New question in post#9

Hello,
I had a thread on this scene a few months ago and received some very helpful feedback. http://absolutewrite.com/forums/showthread.php?p=8528023#post8528023 Thank you! The feedback also raised more questions and issues. I am slowly working on revisions to my ms, and I am reworking the scene that pertains to my original question. I thought it would be best to start a new thread rather than confuse the original thread.

The situation: After leaving prom, a teen couple are in a car accident. The girl is seriously injured and dies during emergency surgery at the hospital. The boy suffers a concussion and drifts in and out of consciousness at the crash scene (which is very near the hospital). Both are taken to the same hospital.

For the purpose of the story, it is necessary that the boy not only find out or figure out quickly that the girl is dead, but he also needs to learn quickly that emergency surgery to repair the girl’s severed carotid artery was successful, but that she died of blood loss and/or shock during surgery. (It is necessary that her injuries were successfully repaired and that he find this out, in addition to finding out that she died.)

What I would like to do is have him drift in and out of consciousness as emergency personnel work at the crash scene and at the hospital, picking up on actions and snippets of conversation that let him know what’s happened. This boy is highly intelligent and is familiar with a great deal of medical/scientific terminology, so he should be able to pick up on things that others wouldn’t.

What I am looking for is suggestions on what he could plausibly witness and/or overhear that would allow him to become aware of what happened. Any and all input appreciated!

For the record:
. This is in the U.S.
. The girl who is killed was the driver, but not at fault. (They were hit by a drunk running a red light).
. The boy’s only injury is a concussion, and I would like it to be pretty mild. Medical personnel want to keep him for observation but he defies doctor’s orders and sneaks out of the hospital after finding out what happened to the girl. (If a mild concussion and drifting in and out of consciousness isn't plausible, maybe an alternate possibility would be for him just to be stunned and in shock and picking up on things sporadically?)

MagicWriter
01-03-2014, 11:26 PM
He won't overhear anything. It is against HIPAA for the hospital personnel to be discussing anything about the girl, while in his presence.

However, you could have the parents of both the boy and the girl talking about the accident, and he would be able to overhear that.

ULTRAGOTHA
01-04-2014, 12:18 AM
You could make his injuries LESS severe and he could find out what happened from the girl's parents.

The more he's unconscious, the worse his injuries are. Prolonged unconsciousness, despite what you see on TV, is really serious.

MagicWriter is correct that HIPAA would forbid the hospital from discussing the girl's condition with him. Plus with the difference in their injuries, the people who work on her probably won't even be the same people who work on him. The ones who work on him probably won't know what happened to her.

(I will note, however, that if she was still in the emergency room, which she wouldn't be because of her injuries, his overhearing is totally possible. I know quite a bit about a baby that came into the emergency room when my wife was there who was evidently abused by her grandmother who was babysitting her. Contusions, bruises, who found her, how they found her, what the police thought at that time. It was all discussed two cubes over. Those cubes only have curtains. But since inspiredbymusic wants him to know what happened during and after her surgery, that scenario won't work.)


But if he's shaken up but goes home that evening with his parents, it's perfectly plausible that he'd want to find out what happened to her. He'd have to find her parents on his own, though. Or encounter them on their way out of the hospital. The medical personnel won't suggest he speak with her parents if she's just died and they won't tell him what happened.

Alternatively, if her parents wanted to talk to HIM to find out what happened that's also plausible.

Don't forget the police will talk to him, too, as a witness to a fatal crash. They might tell him she's dead but they wouldn't discuss the surgery with him.

Dandroid
01-04-2014, 12:24 AM
I have brought several people from accidents that involved fatalities to hospitals...those that were conscious certainly didn't find out much very soon...

iLion
01-04-2014, 12:28 AM
On the other hand...
you could reasonably have an ER situation where both teens were in the same room being worked on at the same time. I work at a hospital where the ER beds are side-by-side, and separated by only a sliding curtain and just enough space for the many caregivers to manuever.

I can envision a scene where the two are side-by-side in separate beds (of course) and the boy can get glimpses of the girl as the curtain gets bumped and brushed by her ED crew. Of course, he would also hear pieces of the ER conversations and orders from MD etc, and finally maybe even pronouncement of death. It's chaotic to the outsider though, so you might not get a lot of detail that way.

When the two initially are brought into ER, the extent of injury is unknown, so they could easily be worked on side-by-side simultaneously - and with all the profuse blood from the boy's concussion that involved scalp lacerations (they often beed tons), it can look much worse than it really is - therefore being wheeled directly into ER with the girl.

ULTRAGOTHA
01-04-2014, 12:32 AM
I can envision a scene where the two are side-by-side in separate beds (of course) and the boy can get glimpses of the girl as the curtain gets bumped and brushed by her ED crew. Of course, he would also hear pieces of the ER conversations and orders from MD etc, and finally maybe even pronouncement of death. It's chaotic to the outsider though, so you might not get a lot of detail that way.

The OP wants:

but he also needs to learn quickly that emergency surgery to repair the girl’s severed carotid artery was successful, but that she died of blood loss and/or shock during surgery.

Can that sort of surgery be done in the ER? I didn't think so. But if so, then it's very possible he would overhear a lot if she's in the same ER.

Dandroid
01-04-2014, 01:26 AM
Yeah, by the time she dies she's in another part of the hospital

Dandroid
01-04-2014, 01:26 AM
I'd go with a different injury

inspiredbymusic
01-04-2014, 05:59 AM
Thank you all so much!

It is important for the sake of my story that the boy find out about the girl's death, etc. before he leaves the hospital, soon (within an hour) after her death.

I guess MAYBE it could work for him to find out from the girl's father. It's important that his parents not be involved at this point. (As I've written it, the hospital is initially unable to contact his family.)

I like the idea of the boy and girl being worked on side by side in the ER, but it wouldn't work as I've currently written it, since she dies during surgery to repair her carotid artery.


I'd go with a different injury
Yes, going with a different injury makes sense! It is important for the story that she dies but that whatever injury she has is repaired prior to her death.

So, NEW QUESTION: Does anyone have suggestions for a type of injury from a car accident that could be quickly repaired in the ER but serious enough to still result in death? (It would be a bonus if this injury would leave a neck wound.) (Sorry this is sounding awfully gruesome ...)

melindamusil
01-04-2014, 06:48 AM
This is probably not what you're looking for, but you can always go with a severe traumatic brain injury. It's not exactly "repaired" in the ER - more like "managed" - but can still easily result in death. When I had a severe TBI (at age 17), I was brought into the ER in a neck collar and on a backboard (and totally unconscious). Mine was a closed brain injury with minimal blood, but you could make it open and have plenty of blood (and/or you could give her plenty of gnarly lacerations). It's possible that she might come into the ER, be put on life support, be sort-of-okay - but then a few hours later, she tanks and dies.

Dandroid
01-04-2014, 06:52 AM
Liver or spleen lacerations....strong coincidence with mvcs...especially in the"up and over"pathway

NeuroGlide
01-04-2014, 06:58 AM
So, NEW QUESTION: Does anyone have suggestions for a type of injury from a car accident that could be quickly repaired in the ER but serious enough to still result in death? (It would be a bonus if this injury would leave a neck wound.) (Sorry this is sounding awfully gruesome ...)

Yes, lots of them. It's quite easy for an accident victim to have so many injuries that they succumb to secondary injuries after the major injuries are treated. Just to pick one, cerebral edema or swelling of the brain. She wasn't buckled up and her head became a pinball. If there were any sign of head trauma they would worry about it and try to check on it, but neck wounds are so critical they would focus on that.

ArtsyAmy
01-04-2014, 06:41 PM
This is in response to your first question. Would the following work?

Someone who knows both the boy and the girl is staying with the boy in the hospital. The boy appears to be unconscious, but is actually regaining consciousness when someone else enters the room. The someone else (thinking the boy is unconscious) tells the first someone that the girl just died, that the surgery had been successful, but the girl had lost too much blood, etc.

Perhaps the "someones" could be people who also were at prom and witnessed the accident (perhaps adults who had been chaperones at the prom). This scenario gets you around HIPAA requirements that the hospital staff would be aware of, and the issue of where in the hospital the patients would be so the boy could overhear.

inspiredbymusic
01-04-2014, 09:17 PM
Thanks again for the responses!

It's important that her injury or injuries are repaired before she dies (so that her body and brain are in functional condition even though she's dead), so it wouldn't work for her to have multiple serious injuries or severe brain injury.


Liver or spleen lacerations....strong coincidence with mvcs...especially in the"up and over"pathway Would it be possible for liver or spleen lacerations to be quickly repaired in ER? (Also, what is mvcs? And by "up and over" do you mean that the victim goes through the front windsheild of the car? Thanks!)

What I am looking for is an injury that could plausibly be quickly repaired in the ER, but that could result in death (maybe from blood loss or shock?). What I need is for her body to be in working order even though she has died.


This is in response to your first question. Would the following work?

Someone who knows both the boy and the girl is staying with the boy in the hospital. The boy appears to be unconscious, but is actually regaining consciousness when someone else enters the room. The someone else (thinking the boy is unconscious) tells the first someone that the girl just died, that the surgery had been successful, but the girl had lost too much blood, etc.

Perhaps the "someones" could be people who also were at prom and witnessed the accident (perhaps adults who had been chaperones at the prom). This scenario gets you around HIPAA requirements that the hospital staff would be aware of, and the issue of where in the hospital the patients would be so the boy could overhear.

I like this suggestion too. However it is necessary for my story that everything happen very quickly. Maybe this would make sense if it were someone else at the prom who witnessed the accident (or even another prom couple in the back seat, who escaped injuries?) But then how would they know what happened to the girl since HIPAA would prevent staff from telling them either, right? Hmmm ...

Still open to any and all ideas!

BrightSera
01-04-2014, 09:37 PM
Thanks again for the responses!

It's important that her injury or injuries are repaired before she dies (so that her body and brain are in functional condition even though she's dead), so it wouldn't work for her to have multiple serious injuries or severe brain injury.

Would it be possible for liver or spleen lacerations to be quickly repaired in ER? (Also, what is mvcs? And by "up and over" do you mean that the victim goes through the front windsheild of the car? Thanks!)

What I am looking for is an injury that could plausibly be quickly repaired in the ER, but that could result in death (maybe from blood loss or shock?). What I need is for her body to be in working order even though she has died.



I like this suggestion too. However it is necessary for my story that everything happen very quickly. Maybe this would make sense if it were someone else at the prom who witnessed the accident (or even another prom couple in the back seat, who escaped injuries?) But then how would they know what happened to the girl since HIPAA would prevent staff from telling them either, right? Hmmm ...

Still open to any and all ideas!

Hmmm. You may have written yourself into a corner if you want to preserve her body and brain with this scenario. An accident bad enough to kill a young, healthy woman will involve usually involve complex multi-system trauma, and any singular piece, like a severed carotid artery, will be fatal within minutes.

The only thing I can think of is a slower arterial bleed managed by EMS, gets her to the ER, she's showing signs of blood loss, the high heartrate masks an arrhythmia of the heart (not sure if this works either, wouldn't someone notice?) she goes up for a surgical repair and codes because of the v-fib, an undetected heart defect, the combined blood loss makes saving her difficult, etc. But that's not straightforward either, since she's young and healthy, and trauma hospital personnel usually know what the hell they're doing on complex cases. It's like they love to be surprised, at times.

melindamusil
01-04-2014, 10:04 PM
I like this suggestion too. However it is necessary for my story that everything happen very quickly. Maybe this would make sense if it were someone else at the prom who witnessed the accident (or even another prom couple in the back seat, who escaped injuries?) But then how would they know what happened to the girl since HIPAA would prevent staff from telling them either, right? Hmmm ...

Her parents tell them, or her parents tell someone else who tells them (you know how teenagers love their rumors). Does the dead girl have a sibling? Dead girl's sibling tells his/her friends that his/her sister is dead.


Hmmm. You may have written yourself into a corner if you want to preserve her body and brain with this scenario. An accident bad enough to kill a young, healthy woman will involve usually involve complex multi-system trauma, and any singular piece, like a severed carotid artery, will be fatal within minutes.

I'm with BrightSera on this. Why does her body and brain need to be in functional condition? Maybe if you share a little bit more, we can help you find injuries to fit your scenario. Is the survivor of the accident planning to steal her body and Frankenstein her back to life?

If she dies from blood loss, that usually implies that blood is leaving the body faster than the doctors can put it back into the body - which in turn implies that something (artery? liver/spleen?) is still bleeding and hasn't been repaired.

"Shock" usually refers to hypervolemic shock, which occurs when the blood volume drops too low. As I understand it, dying from shock is akin to dying from massive blood loss or massive plasma loss (as in severe burns). (Medical people are welcome to correct me.)

Now, I suppose it's possible that she loses massive amounts of blood and suffers additional trauma due to the loss of oxygen that is not immediately apparent - but that would not work under your desire to leave the body and brain in functional condition.

CoolBlue
01-05-2014, 01:06 AM
What I need is for her body to be in working order even though she has died.


This is belaboring the point, perhaps, but: The reason we die is because a part of our body is not working.

The things that kill us suddenly with a working body are things that are easily fixed in a hospital setting. Sudden arrhythmia, perhaps caused by an elecrolyte imblance that should have been noted before. Congenital error of cardiac conduction, such as Wolf Parkinson White.

You don't die with a healthy body!

HTH
CB

ULTRAGOTHA
01-05-2014, 02:12 AM
Maybe she could be patched up and surgery over and then she dies later from complications.

It sounds like the OP wants a body that, if re-animated, isn't going to die again immediately because there are leaks in the plumbing or somesuch. That's tricky but it sounds like it's SF/F so we can roll with it.

Is this zombies? Am I helping with a zombie story?!? OMG, zombies.
:chair

NeuroGlide
01-05-2014, 02:26 AM
You don't die with a healthy body!


I'll grant you it's atypical, but there are always the oddball cases that haunt the doctors involved where the patient was successfully treated, but still died.

A far more common situation, however, is hypothermia. Rule for hypothermia is you're not dead until you're warm and dead. They'll treat injuries as they warm her up hoping to get her heart restarted.

CoolBlue
01-05-2014, 02:35 AM
I'll grant you it's atypical, but there are always the oddball cases that haunt the doctors involved where the patient was successfully treated, but still died.

A far more common situation, however, is hypothermia. Rule for hypothermia is you're not dead until you're warm and dead. They'll treat injuries as they warm her up hoping to get her heart restarted.

Hypothermia does not kill directly, if you are to survive at all. If her body is "in working order" after being resuscitated, and she dies later, it still isn't working when she dies! She died from what caused the hypothermia, perhaps, such as a stroke causing her to lay outside. She develops pneumonia.

Remember, the OP said she survives. You don't die with a functioning body in a hospital. Even if you get shocked by a power cord, let's say, and aren't found soon enough, you die from brain anoxia.

HTH
CB

NeuroGlide
01-05-2014, 04:26 AM
Hypothermia does not kill directly, if you are to survive at all. If her body is "in working order" after being resuscitated, and she dies later, it still isn't working when she dies! She died from what caused the hypothermia, perhaps, such as a stroke causing her to lay outside. She develops pneumonia.

Remember, the OP said she survives. You don't die with a functioning body in a hospital. Even if you get shocked by a power cord, let's say, and aren't found soon enough, you die from brain anoxia.


Like you said, a dead body in working order is nonsensical. If it were working, it wouldn't be dead, but his original request was for a person how died despite the injuries being repaired. A person who was hypothermic (is that a word?) can fit that bill as they can't be sure that she's dead until they get her warm, but they will repair any life threatening injuries on the hope that the cold preserved her. Since this is a car accident that someone else (the MC) was pulled alive from, they have good reason to hope.

CoolBlue
01-05-2014, 07:32 AM
A person who was hypothermic (is that a word?) can fit that bill as they can't be sure that she's dead until they get her warm, but they will repair any life threatening injuries on the hope that the cold preserved her. Since this is a car accident that someone else (the MC) was pulled alive from, they have good reason to hope.

Yes, it is a word. Your scenario does not really make much sense, in that you are describing that one person does not become hypothermic, yet the other does.

They are also, according to the first question, quite close to a hospital. So, I suppose you are suggesting that perhaps the one person was thrown from the vehicle, into a snowbank, and that it was cold enough for this person to become so hypothermic that they would be protected from a severe injury (but also not suffering any frostbite), while the other remained in the vehicle did not? Perhaps the engine remained running, and kept the vehicle warm after the accident.

If the setting is a very cold climate, perhaps. On the other hand, you would need a ton of 'splainin to make it work, and not seem contrived. I suppose if the hypothermic person fell into water that was liquid, yet did not drown, it would happen fast enough without causing frostbite. (Think "The Abyss").

Interesting hypothesis, nevertheless.

:)

CB

NeuroGlide
01-05-2014, 07:03 PM
Yes, it is a word. Your scenario does not really make much sense, in that you are describing that one person does not become hypothermic, yet the other does.

They are also, according to the first question, quite close to a hospital. So, I suppose you are suggesting that perhaps the one person was thrown from the vehicle, into a snowbank, and that it was cold enough for this person to become so hypothermic that they would be protected from a severe injury (but also not suffering any frostbite), while the other remained in the vehicle did not? Perhaps the engine remained running, and kept the vehicle warm after the accident.

If the setting is a very cold climate, perhaps. On the other hand, you would need a ton of 'splainin to make it work, and not seem contrived. I suppose if the hypothermic person fell into water that was liquid, yet did not drown, it would happen fast enough without causing frostbite. (Think "The Abyss").

Interesting hypothesis, nevertheless.

:)

CB

Yes, I'm thinking near freezing weather, car rolls into marsh and is partly submerged, survivor climbs out before passing out, passers by drag him to safety/warmth, but can't get to her. That is as far as I can bend reality to fit the author's requirements.

ULTRAGOTHA
01-05-2014, 07:16 PM
Or even that the EMTs get him out and off to hospital before they can get her untangeled from the wreck. That precludes a bleed as she'd die from a major bleed before they could get her out but would fit hypothermia.

inspiredbymusic
01-05-2014, 07:17 PM
Thanks you all so much for the input! It really is amazing to have others thinking about this and willing to try to help. :)


Hmmm. You may have written yourself into a corner if you want to preserve her body and brain with this scenario. An accident bad enough to kill a young, healthy woman will involve usually involve complex multi-system trauma, and any singular piece, like a severed carotid artery, will be fatal within minutes.
Yes, and it seems that solving one issue opens up another can of worms!

I get the point that a healthy functioning body does not result in death, but would it be at all possible for someone to die (of blood loss ?) during surgery and that staff could be unable to resuscitate the victim even though surgery successfully repaired the injury?

. Hypothermia will not work. The setting is Phoenix, AZ. (I appreciate the creative suggestion though!)

. And, yes, as most of you have guessed, this is a Frankenstein(ish) story.

I originally based my idea for what happened to the girl on information I read about a freak hockey accident in which the goalie’s carotid was severed, but he was saved by emergency surgery. So the way I wrote it, the girl’s carotid is severed (or partially severed) in the accident, she’s rushed into emergency surgery and the surgery is a success, but she flatlines due to blood loss near the end of surgery and they’re unable to resuscitate her.

As I wrote it initially, the hospital staff won’t tell the boy anything, but he becomes extremely agitated and pressures them into telling him.

Does any of this make any sense whatsoever??

At this point I am leaning toward keeping it pretty much as I originally wrote it, but changing the way the MC finds out to a combination of picking up on clues and then talking to the girl’s father.

Thanks again, everyone, for all the information and suggestions!

NeuroGlide
01-05-2014, 07:45 PM
The problem is that she would die of blood loss before they finished the surgery, at which point they would stop surgery-ing. (Yes, that's a word. Now.) So it doesn't work straight out, you have got to throw something else into the mix. What do you have in the way of poisonous plants out Phoenix way? (Coming back from the dead in Phoenix? Grooooooan!)

edit: Something that just occurred to me, if she dies for unexplained reasons, there's a good chance of an autopsy. That would involve cutting her open again, taking out and inspecting most vital organs and placing, just placing, them back in the body. The only things that would stop this are religious reasons, usually ones involving swift burial.

CoolBlue
01-06-2014, 03:56 AM
I get the point that a healthy functioning body does not result in death, but would it be at all possible for someone to die (of blood loss ?) during surgery and that staff could be unable to resuscitate the victim even though surgery successfully repaired the injury?

No, this is not particularly realistic. Surgery is not usually done on dead people. If the surgery got to the point of repairing this vascular injury, they would be able to stop the blood loss, and the likely reason for death BEFORE repairing the laceration.

OTOH, is Frankenstein realistic?

HTH
CB

MDSchafer
01-06-2014, 04:22 AM
So, NEW QUESTION: Does anyone have suggestions for a type of injury from a car accident that could be quickly repaired in the ER but serious enough to still result in death? (It would be a bonus if this injury would leave a neck wound.) (Sorry this is sounding awfully gruesome ...)

Fatty embolism. In a long bone or pelvis fracture you could repair the damage relatively quickly, but so long as the bone is broken marrow can escape the bone travel to the brain and can cause brain death within six minutes.

CoolBlue
01-06-2014, 04:43 AM
Fatty embolism. In a long bone or pelvis fracture you could repair the damage relatively quickly, but so long as the bone is broken marrow can escape the bone travel to the brain and can cause brain death within six minutes.

You have a reference for that? I have never experienced fat embolism like this.

Here is a link (http://j.mp/1i8HCNr) to an article describing the usual presentation of fat embolism.


Clinical Presentation
Fat embolism syndrome typically presents 24-72 h after the initial injury. Rarely, cases occur as early as 12 h or as much as 2 weeks later.[4] Patients present with a classic triad:

respiratory changes;
neurological abnormalities;
petechial rash.

ETA: And you do realize that for a massive fat embolism to happen, there would have to be a PFO (patent foramen ovale) present in the heart. (Follow the circulation, not the money!)

Not a bad thought. I wonder about a massive air embolism. But they'd have to be pretty incompetent to do that in the OR, I would think.

HTH
CB

NeuroGlide
01-06-2014, 05:33 AM
Well, "magic" is present in bringing her back (it has to repair the molecular damage caused by her death) so you could have it repair that damage as well. It already has to replace a good amount of her blood .

NeuroGlide
01-06-2014, 05:47 AM
If the surgery got to the point of repairing this vascular injury, they would be able to stop the blood loss, and the likely reason for death BEFORE repairing the laceration.

CB, you're over reliance on IV comment in that other thread got me thinking. What if they blow through their supply of whole blood and platelets before she arrives (unrelated accident) and end up having to IV her? She ends up bleeding out, not from one major gash but hundreds of little ones? Would they call for walking donors to stop that?

CoolBlue
01-06-2014, 06:51 AM
CB, you're over reliance on IV comment in that other thread got me thinking. What if they blow through their supply of whole blood and platelets before she arrives (unrelated accident) and end up having to IV her? She ends up bleeding out, not from one major gash but hundreds of little ones? Would they call for walking donors to stop that?

Just to clarify nomenclature:

IV: Intravenous. Can be either crystalloid or other products, such as red cells, platelets, plasma, other.

Crystalloid: Clear water with some or other electrolyte or sugar added.

Colloid: Non-crystalloid, for the most part blood products (Whole blood, red blood cells, platelets, plasma, others), or artificial osmotically active substances, such as Pentaspan.

It is always great to see a patient make it from the street into the ER, and then leave the ER for the ICU. Depressingly few patients who arrive "dead", and are successfully resuscitated make a meaningful recovery. Sometimes EMS and ER staff can be over-enthusiastic in their efforts.

An over-enthusiastic resuscitation can cause coagulopathy. This is present in almost all severely traumatized folks, and often ends up in what is known as DIC or disseminated intravascular coagulopathy. There is a constant balance between clotting and bleeding going on in the body. There is constant micro-bleeding that is constantly repaired by constant micro-clots. When the balancing act is impaired, bad things happen. (There are many other concerns as well.)

So, currently (and I stress currently), the practice is tending to favour "permissive hypotension" in hemorrhagic shock, rather than over-resuscitation. Not only over-resuscitation with crystalloids either, as blood products are a double-edged sword, and cause their own troubles when given in large quantities.

There is a ton of new literature out there that is saying that there is little difference in whether you use mainly crystalloid or a balance of crystalloids and colloids. Many of these studies have looked at hypovolemic shock secondary to things like sepsis, so that may not be exactly correct in shock due to blood loss.

The current guidelines for the ATLS (Advance Trauma Life Support) are easy to find on the web. Here is a link to a blog (http://j.mp/1i8VKpW) that talks about the currently acceptable standard.

You can read a more scholarly article on resuscitative strategies in traumatic hemorrhagic shock (http://j.mp/1lJsJRM) as well.

Currently, I guess you could summarize it by saying: give as little as possible, and give what is as close as possible to whole blood, when it is all added up, to have the best outcomes. However, there is still much controversy surrounding this topic. Cost is, as always, also one of them.

Walking donors? They had protocols for it when I was in the forces, many moons ago. Not sure about today. Not in civilian cases, AFAIK, except in highly unusual circumstances.

HTH
CB

MDSchafer
01-06-2014, 06:59 AM
You have a reference for that? I have never experienced fat embolism like this.

Here is a link (http://j.mp/1i8HCNr) to an article describing the usual presentation of fat embolism.



ETA: And you do realize that for a massive fat embolism to happen, there would have to be a PFO (patent foramen ovale) present in the heart. (Follow the circulation, not the money!)

Not a bad thought. I wonder about a massive air embolism. But they'd have to be pretty incompetent to do that in the OR, I would think.

HTH
CB

It's fiction, it's not a entirely unrealistic scenario, although it's extremely unlikely. Honestly, I was watching football and drinking at the time. Also, now that I thought about it they used something similar in an episode of House.

It can happen without a PFO. I read a case study that describes a similar scenario where a teenage woman suffered multiple micro fat emboli. If there is a collection of microemboli in the Circle of Willis somewhere and it could theoretically happen right?

http://stroke.ahajournals.org/content/32/12/2942.full

Another option is that she had an aneurysm that burst as a result of the surgery or car accident.

CoolBlue
01-06-2014, 07:15 AM
a teenage woman suffered multiple micro fat emboli. If there is a collection of microemboli in the Circle of Willis somewhere and it could theoretically happen right?

http://stroke.ahajournals.org/content/32/12/2942.full


The critical word is "micro". For a person to die I believe you would need a massive embolus, and a PFO. I am not sure a collection of micro-emboli would do it. In the article you reference, the patient made a complete recovery.

Also, the person would have brain tissue that died. The ultimate lesion in any type of embolus to the brain is anoxic brain damage.

Same if she had an aneurysm go "pop".

I hope this does not sound too harsh, or critical, but this is a thread for authors seeking authenticity, and I think the onus is on responders to provide that. Yes, it is fiction, as you point out. But there is good fiction and, well, there is other fiction too.

Sad to say, but there are so many responses on this forum that help the researcher from the shoulder into the ditch, so to speak. Now, by this I do not refer to your response at all, MDSchafer. But inaccuracies abound online. As authors we stand by our words. There is a place for fiction. But research is not one of them, surely? :)

Not a rant, just my 2p, worth much less at the current exchange rate.

Have a cold one on me! :)
CB

NeuroGlide
01-06-2014, 09:21 AM
Ok CB, if I understood you correctly, over use of crystalloid by the EMTs is a viable, if unlikely, cause for our temp dead girlfriend to be temp dead. Let us also assume she took some aspirin for a headache and drank some punch at the prom before realizing some one spiked it with vodka (she's below the legal limit). Does this get us up to plausible?

I don't like bending reality either, but we have someone coming back from the dead, reality here ain't just bent, it's warped! ;)

CoolBlue
01-06-2014, 09:29 AM
Ok CB, if I understood you correctly, over use of crystalloid by the EMTs is a viable, if unlikely, cause for our temp dead girlfriend to be temp dead. Let us also assume she took some aspirin for a headache and drank some punch at the prom before realizing some one spiked it with vodka (she's below the legal limit). Does this get us up to plausible?

I don't like bending reality either, but we have someone coming back from the dead, reality here ain't just bent, it's warped! ;)

Nope, not plausible. We have tangentialized. ;)

Significantly.

Seriously, I think OP has written a corner into which plausibility will not go.

Time to backtrack a little, methinks.

CB

NeuroGlide
01-06-2014, 10:15 AM
Seriously, I think OP has written a corner into which plausibility will not go.

Time to backtrack a little, methinks.

CB

Yea, that death without remaining trauma is a high hurdle. Septic induced MODS is out, no infection is that fast (turns towards ULTRAGOTHA and says in a scary voice "except zoooombiiieee"). Anaphylactic shock is unlikely without something masking the symptoms and that's beyond my knowledge. Same with possible drug interactions. Yea, it looks like she'll like the rest of us, messily.

kaitie
01-06-2014, 08:58 PM
Anaphylactic shock could work, though, right? It's not related to an injury but it could work. Maybe she has a serious allergy and doesn't have her epipen. There have been two cases recently of young people dying in those cases. One was a school where the girl was on the playground and the girl hadn't had her own, and the nurse wouldn't administer someone else's. The other was in front of a pharmacy just the other day. The pharmacist wouldn't give the girl one without a prescription.

Yes, people with allergies are supposed to carry around a pen at all times, but she could forget, or be complacent, or maybe not even know she had an allergy. If you want the guilt involved, the boy could feel guilty for giving her the food or something like that?

A similar story was a boy who died of asthma because the school nurse kept his inhaler and he wasn't allowed to carry it on him. By the time someone got the nurse and the inhaler, he had already died. Maybe she has severe asthma and her inhaler is almost out. Without that she could die right in front of the boy before help gets there. He wouldn't be injured, but he'd feel awful because he couldn't do anything for her.

Both are a far cry from a car accident, but more realistic. I have a hard time imagining the boy having a fit and being able to convince the hospital staff to tell him the girl was dead, especially if he was injured. In many cases they'd want to avoid telling him until he was on the mend because they don't want to upset him too much. He's also not family, so I'm not sure they would be legally allowed to tell him, but I'm not really feeling the idea of him begging to know until they tell him. If he was really upset, I'd think they'd give him a sedative before telling him what's going on. I could be wrong, but the scenario described before would mess with my suspension of disbelief.

inspiredbymusic
01-06-2014, 10:07 PM
Thanks again everyone! I really do appreciate the input. It seems, though, that the conclusion here is that my basic concept for this situation just isn't workable. (I am still going to give some thought to Katie's new suggestion though.)
In the meantime, though, I'm going to start a new thread looking for input on a slightly different idea. I thought it would be better to start fresh so that all the ideas put forth here so far don't add confusion.
Thanks to everyone who helped out in this thread!