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StarryEyes
05-24-2014, 01:13 AM
It seems I always come on here to ask about horrible things happening to my characters… In any case, I'm working on a scene and I need a bit of insight from the experts out there :)

The character in question is a 15-year-old male, very fit, who gets stabbed in the chest with a sword. None of the main blood vessels are hit, but his lung is punctured. There is no medical help available and he eventually dies. It's a fantasy story, and the society closely resembles that of Ancient Egypt or Mesopotamia, so there is little medical knowledge. Not sure if that's relevant since he doesn't receive help anyway, but I thought I'd include it just in case.

My questions are:

1. Plot-wise, he can take anywhere between an hour and a day to die. Considering the injury, what would be the most plausible time?

2. How would it feel? What amount of pain would he be in?

3. What physical reactions might he have (pale skin, coughing up blood, etc)?

4. What would he be able to do in the time leading up to his death? Would he be able to stand up, would he be conscious, could he talk?

Thanks a lot :D

sheadakota
05-24-2014, 01:59 AM
It seems I always come on here to ask about horrible things happening to my characters… In any case, I'm working on a scene and I need a bit of insight from the experts out there :)

The character in question is a 15-year-old male, very fit, who gets stabbed in the chest with a sword. None of the main blood vessels are hit, but his lung is punctured. There is no medical help available and he eventually dies. It's a fantasy story, and the society closely resembles that of Ancient Egypt or Mesopotamia, so there is little medical knowledge. Not sure if that's relevant since he doesn't receive help anyway, but I thought I'd include it just in case.

My questions are:

1. Plot-wise, he can take anywhere between an hour and a day to die. Considering the injury, what would be the most plausible time?

2. How would it feel? What amount of pain would he be in?

3. What physical reactions might he have (pale skin, coughing up blood, etc)?

4. What would he be able to do in the time leading up to his death? Would he be able to stand up, would he be conscious, could he talk?

Thanks a lot :D
Oh Boy I hate to tell you this but with no other injuries, this is a very survivable injury. A healthy fit 15 yr old can easily compensate for the loss of a lung. Sometimes the injury will even seal itself off and the lung may partially re inflate. If you want him to die you need to be nastier.

How long do you want him to survive before he dies?

Of course he could always get an infection, any number of complications could happen that in time could kill him, he could develop a massive pneumo thorax with a medial-stinal shift causing tearing of his aorta.or a hemothorax which could cause the same- but that would require a bleed somewhere.

The injury alone- a punctured lung- most likely will not be fatal.

StarryEyes
05-24-2014, 02:42 AM
Oh Boy I hate to tell you this but with no other injuries, this is a very survivable injury. A healthy fit 15 yr old can easily compensate for the loss of a lung. Sometimes the injury will even seal itself off and the lung may partially re inflate. If you want him to die you need to be nastier.

How long do you want him to survive before he dies?

Of course he could always get an infection, any number of complications could happen that in time could kill him, he could develop a massive pneumo thorax with a medial-stinal shift causing tearing of his aorta.or a hemothorax which could cause the same- but that would require a bleed somewhere.

The injury alone- a punctured lung- most likely will not be fatal.

Thanks for your reply! I guess I will have to make it nastier then. Apart from an infection (which I don't think would fit with the plot, I need him to die from the injury itself) what could I do to make the injury worse? Tearing the aorta would kill him rather too quickly, I imagine?

It would need to be something that would cause him to die slowly, but still die.

sheadakota
05-24-2014, 02:50 AM
well if you want him to die ugly ( painful and slow) have his stabbed in the gut. the sword would cut through intestines and spill the contents into the peritoneal cavity causing sepsis and a horrible death.

He would live three to five days, have a high fever and terrible pain. he could probably walk with some pain for the first day or so after that, not so much. at the end he would be delirious, his mid section would be swollen and very painful. death at that point would be a mercy.

boron
05-24-2014, 05:58 PM
Lungs have two wings and a puncture in one in a fit 15 years old would result in virtually nothing. You can walk, talk, breath normally, but deep breathing, coughing and laughing would hurt. Punctured lungs by themselves do not hurt - it's a changed chest architecture due to deflated lung wing that causes some pain around the shoulder, scapula and sternum, which makes using arms, turning around and lying in bed uncomfortable but not really very painful.

Punctured lung artery (image (http://media-2.web.britannica.com/eb-media/20/125820-004-8A68E19D.jpg)), for example, from a stab in the middle, right part of the chest close to the sternum, would cause slower bleeding that bleeding from aorta, resulting in death like within 1,2,3-? hours, depending on the exact puncture spot.

Symptoms:
- chest pain from the stab
- minimal or no bleeding out from the chest wall wound
- coughing up blood and choking on it within minutes of the stab
- progressive paleness, fatigue and feeling of cold and thirst due to lost blood
- progressively weaker artery pulses in the wrist if someone would check
- anxiety > confusion > stupor > coma > death

StarryEyes
05-24-2014, 06:52 PM
Lungs have two wings and a puncture in one in a fit 15 years old would result in virtually nothing. You can walk, talk, breath normally, but deep breathing, coughing and laughing would hurt. Punctured lungs by themselves do not hurt - it's a changed chest architecture due to deflated lung wing that causes some pain around the shoulder, scapula and sternum, which makes using arms, turning around and lying in bed uncomfortable but not really very painful.

Punctured lung artery (image (http://media-2.web.britannica.com/eb-media/20/125820-004-8A68E19D.jpg)), for example, from a stab in the middle, right part of the chest close to the sternum, would cause slower bleeding that bleeding from aorta, resulting in death like within 1,2,3-? hours, depending on the exact puncture spot.

Symptoms:
- chest pain from the stab
- minimal or no bleeding out from the chest wall wound
- coughing up blood and choking on it within minutes of the stab
- progressive paleness, fatigue and feeling of cold and thirst due to lost blood
- progressively weaker artery pulses in the wrist if someone would check
- anxiety > confusion > stupor > coma > death

That sounds exactly like what I need. So would that actually puncture the lung, or just the aorta? Either way the symptoms and progression to death are perfect for the plot.

sheadakota - I considered having him stabbed in the gut, but that already happens to another character, so for this one I picked a chest/lung injury instead.

boron
05-24-2014, 07:06 PM
That sounds exactly like what I need. So would that actually puncture the lung, or just the aorta? Either way the symptoms and progression to death are perfect for the plot.

Practically every deep chest stab breaks the lung (one wing only, usually). So, what can break:
- a lung wing alone
- a lung wing plus the pulmonary artery
- a lung wing plus aorta
- a lung wing plus the artery that runs from the chest and then near the armpit to the arm (this would be hit by a stab below a shoulder). This would cause the slowest bleeding from all arteries mentioned, with death within several hours.

So, it's you to decide what's gonna be.

sheadakota
05-24-2014, 07:11 PM
Every deep chest stab breaks the lung (one wing only, usually). So, what can break:
- a lung wing alone
- a lung wing plus the pulmonary artery
- a lung wing plus aorta
- a lung wing plus the arteries that run from the chest near the armpit to the arm (these would be hit by a stab below a shoulder). This would cause the slowest bleeding from all arteries mentioned, with death within several hours.

This will also cause a hemothorax- a collection of blood in the pleura- the space between teh chest wall and the lung- making it difficult to breath. as boron said the only way to make this a lethal injury is to lacerate the pulmonary artery- but death will occur in minutes not days, if only one lobe of the lobe is punctured you can an incomplete collapse but still non-lethal- if you still want a chest injury and the victim to linger for days then I would suggest having the weapon poisoned or having the vic die of sepsis caused from an infection in the wound-

jeseymour
05-24-2014, 07:34 PM
None of the main blood vessels are hit, but his lung is punctured.



2. How would it feel? What amount of pain would he be in?


4. What would he be able to do in the time leading up to his death? Would he be able to stand up, would he be conscious, could he talk?

Thanks a lot :D

Okay. I've shared this story before, but here goes. In 1987, when I was a very fit 24 year old equestrian, I was riding cross country when my horse flipped over a jump. When he stood up, he stepped on my chest. Broken ribs punctured my lung. There was no external injury in my case, so no sucking chest wound. I sat up right away, but couldn't stand. I couldn't breathe. I did remain conscious. I could talk, sort of, the EMTs asked me if I wanted to go to Brattleboro or Dartmouth Hitchcock and I told them rather emphatically to take me to Dartmouth. The pain was pretty bad, but the whole non-breathing thing was really scary. I could not take in a breath. I did not want to lie flat, needed to be upright. At the hospital, again, I was conscious, they cut a hole in my side to insert a chest tube and start draining the blood out of my chest cavity. That pain was worse, but at least I could breathe again. I spent 11 days in the hospital, 9 of those in intensive care. Broken ribs just missed lacerating my spleen.

I would not expect your character to be walking around. Sitting up, guarding the chest (arm across the chest,) struggling to breathe. Coughing really hurt. Laughing hurt. I was one of the first people to try out a special machine for the administration of morphine, you push a button, it gives you a dose and it locks out for a while, but you can push the button any time you want. They found people use less when self-administering it.

As an interesting aside, I had to have lung surgery in 2001 because of a large mass in my lung that turned out to be a fungus. The fungus ball formed because of the prior damage to my lung. You want the guy to die, so this wouldn't be relevant.

Hope this helps.

boron
05-24-2014, 07:43 PM
Just to prevent confusion.

Jeseymour mentioned severe pain - that was probably from broken ribs. When you get stabbed with a sword, the rib(s) may or may not break, so it can be painful or not.

When I was 24, yes, I had spontaneous pneumothorax, no injury, just one of my lung wings broke from no reason. It was completely painless and I actually had no idea when exactly it happened. I realized only when I went to bed and I found rising arms about the shoulder level painful and lying in bed was uncomfortable. The next day I took a shower, which was a bit tricky, then went to the doctor by foot and then to the hospital by bus like nothing seriously happened.

WeaselFire
05-24-2014, 08:28 PM
... and the society closely resembles that of Ancient Egypt or Mesopotamia, so there is little medical knowledge.
Okay, since the Egyptian and Mesopotamian medical knowledge was quite good and well experienced with battle wounds, forget this part. In fact, forget your entire set of questions, they're the wrong ones to ask.

Start with your plot. What do you need to happen? How long does he need to live? What does he need to do? How does he need to feel?

When you know that, come back and ask for a wound that fits your story.

Jeff

StarryEyes
05-24-2014, 11:41 PM
- a lung wing plus the artery that runs from the chest and then near the armpit to the arm (this would be hit by a stab below a shoulder). This would cause the slowest bleeding from all arteries mentioned, with death within several hours.

That sounds good.

I need him to survive for another hour, but after that he can either die immediately or take his time. He just needs to be dead within 24 hours. I've already done quite a bit of research and this seems like the right injury for the plot, I just needed the specifics of how exactly it would go down, and I think I've got a good idea of it now.

Thanks for all the information guys :)

StarryEyes
05-24-2014, 11:44 PM
Okay, since the Egyptian and Mesopotamian medical knowledge was quite good and well experienced with battle wounds, forget this part.

I included that because other posts I saw did, but considering the situation I don't think medical knowledge is very important. There is no-one to help him, so whether people heal wounds using surgery or prayer doesn't matter since he is going to die anyway.

jeseymour
05-25-2014, 05:41 AM
Just to prevent confusion.

Jeseymour mentioned severe pain - that was probably from broken ribs. When you get stabbed with a sword, the rib(s) may or may not break, so it can be painful or not.



Actually, the pain from when they cut the hole in my side to insert the chest tube was pretty severe too! I can't imagine getting stabbed by a sword and not being in pain.

boron
05-26-2014, 10:13 AM
Yes, of course, the wound in the chest wall would hurt, I guess. But punctured, collapsed lungs by themselves do not hurt. They made a small incision in my chest wall as well and inserted the tube and I did not feel a thing due to a small injection of local anesthetic.