Paralysis, concussion, and 1940s-era medicine, with no available doctors

Hi there, I'm writing a novel about a couple surviving a siege of a big city during WW2 (alternate-history). The man falls, paralyzing him from the waist down, and the woman has to take care of him.

That bedside-loved-one-suffering experience is central to the novel, so I could use some help with the medical research to make their experience as realistic as possible.

Situation:

• the streets are extremely dangerous: frequent bombing, block-by-block warfare, and predatory enemy soldiers (sort of like Nanking or Sarajevo)
  • so venturing out to find a doctor is out of the question
• a fire forces the the man to jump from a 3rd story window...he lands on his back and:
  • is paralyzed from the waist down (permanently: broken spine fragments sever his spinal cord)
  • breaks some ribs
  • suffers a concussion
• stranded in an abandoned office building (with greedy survivors), the woman's supplies are limited to what she finds in people's desks, and the streets nearby
• available painkillers:
  • ice (1940s ice box)
  • alcohol
  • aspirin (few alternative painkillers in the 1940s)
  • morphine

Actions:

• her plan is simply to treat his pain and keep him lying still while she forages around for food, painkillers, etc
  • they're both young and poorly educated - not stupid, but not medical experts either
• immediately after falling (and being carried into the adjacent office building), mad with pain, the man begs for alcohol and guzzles it
  • this is generally "bad" for his concussion, yes, but I hope that it:
    • knocks him out for a few hours
    • makes the concussion hurt more, but does no real damage, and fades in time
• naturally, she first treats his swelling with ice
• then she tries aspirin (found in people's desks)
  • which, as a blood-thinner, is certainly bad for concussions, increasing the bleeding/swelling
• then she braves the warzone streets and finds morphine (picked off soldiers' corpses)
  • morphine is a bit outdated, thus it's harder to find information on it, but so far I can't find any reason NOT to treat a concussion with it (other than doctors avoiding it because morphine puts you in a state of mind so similar to a concussion that it interferes with their ability to diagnose and treat the patient)
• morphine proves an effective painkiller treatment, ending this section of the plot
  • (the rest of the plot is them surviving greedy fellow survivors and aggressive enemy soldiers - the battle lasts another 3-5 days, after which they get him to a doctor)

What do you think - is my logic correct and realistic? Am I missing anything?

I appreciate your time, thank you!

Thanks!

Thought about your post, did some more research, and made some changes:

1. He doesn't black out (you're right, drinking that much would be insane), he's just in horrible pain for 12 (?) hours after the fall, after which I guess he finally falls asleep...?
   1. He does drink some alcohol, desperate to dull the pain. (Realistically stupid: they're desperate and scared, plus "trial and error" is all they can really do, since neither has much medical knowledge.)
   2. His concussion hurts, worsened by alcohol and aspirin, but with ice and rest it gradually heals on its own. No dangerous developments, just pain.
2. He breaks an arm/elbow, NOT his ribs.
   1. I needed a source of excruciating pain* that leaves him a little movement. Ironically, broken ribs seem to be more crippling than a broken arm. (Can't splint your ribs, and every little movement risks re-breaking it. Even sitting and sleeping are risky. Plus it's harder to breathe. Also no risk of lung puncture.)
   2. *Pain: paralysis victims sometimes feel little to no pain from the injury itself, just a sudden realization they can't move their legs. And a concussion hurts, but not nearly as bad a broken bone.

All of the short-term side effects of non-life-threatening concussions (vomiting, headache, blurry vision, weak memory, problems concentrating, that sort of thing) and paralysis (variety of pain types, spasticity, bedsores, assisted living) seem to be things I can add on top without affecting the story logic.

Appreciate the responses.

From what I've researched, so far I'm surprised by what people can survive in falls. This page helped me a lot: it lists the injuries sustained by 8 very lucky people who fell 7-14 stories and came away with surprisingly little injuries. More than one simply got up and walked to the clinic.

Obviously they're all extremely lucky, but it left me impressed with how variable fall injuries are, and how much it matters (a) your body's position as you fall, and (b) what you land on. Most of those fall survivors broke their fall on freshly tilled earth, the hood of a car, a chain link fence that crumpled under the body's impact, etc.

Which led me to think (correct me if I'm wrong!) that an NFL-caliber concussion, broken arm, and waist-down paralysis was a plenty believable amount of damage for a 3-story fall, especially if he doesn't hit concrete:

• I imagine he lands on something that crumples, breaking much of his fall (probably the roof or hood of a car, like Case 6 on that webpage)
• he lands on his back, or his side; his head doesn't actually land that hard (his arm and spine get the worst of it)
• I don't watch football, but I've heard stories of players who get a concussion, then re-enter the game 2 plays later

As for keeping concussion patients awake...either way it doesn't affect the story logic, I just doubt my characters would know to do that. But in any case, I imagine the excruciating pain of his broken arm will keep him awake anyway.

So if you subsequently have him do things to aggravate it, and hinder his healing process, you may be hard pressed to show him right as rain shortly thereafter with no behavioral or cognitive impacts. Might need to ponder how it could affect his characterization.

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I mean, it definitely screws with him for the next 4-5 days (then they get a doctor and the novel ends) - it just doesn't kill him, doesn't develop any emergency complications that require the intervention of a doctor they can't reach. It's the kind of concussion that gradually heals itself in time (and ice).

It's like an NFL linebacker smashed into him; yeah it sucks, it hurts a lot, it does some crazy things to his mind, but ultimately as long as he stays in bed at least a week he'll be alright even if he doesn't see a doctor.

As for the alcohol and the aspirin, they're taken 24 hours apart, and I imagine he realizes fairly quickly they're intensifying the already splitting pain in his head, so he only takes one "dose" of each.

Worst case I could cut the concussion (all I really need are the paralysis and the pain) but his fall just didn't seem serious or realistic enough without it.

Again, please correct me if I'm wrong!

Clarabeth said:

One question you might want to consider is if there is any blood loss. An open fracture (where it sticks out of the skin) could cause that, or he gets cut pretty badly could cause that. If the blood loss is severe, he could go into shock. It's harder to treat, but if you find your story lacking tension you could try that.

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Now that I'm relying on his broken arm for the extreme pain, I like this idea. I'll think about it, but I probably can't do it...I have to avoid major open wounds as hard as I can because infection is just too much of a risk in a filthy ruined warscape, and there's nothing these characters could do about it. And without major open wounds, I can't do blood loss...maybe an open fracture if the opening is tiny.

Appreciate all the options; it helps as I'm developing the story logic.

ColoradoGuy said:

I've been an ICU doc for 35 years and it seems to me you're describing a spinal cord injury, not a concussion. Concussions cause depressed consciousness, not paralysis. Spinal cord injuries are generally not painful. Inability to move the legs would locate the injury in the thoracic or high lumbar spinal cord. Injuries like this usually require some high energy impact. I've never seen one with just a fall. You could have a chunk of a building fall on him or something.

Hope this helps

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Absolutely does, thank you.

The man's main injury is indeed the waist-down paralysis (L3 complete). But paralysis by itself wasn't enough to force the woman to brave the streets to find morphine, so I needed the nasty broken arm for extreme pain, and the concussion to rule out other available painkillers (alcohol and aspirin).

Which brings me to a question that's still killing me: Is it safe to give morphine to someone with a concussion?

1. If I'm wrong about this, my logic falls apart.
2. As far as I can tell, aspirin and alcohol are dangerous for concussion victims because they're blood thinners (more bleeding = more swelling). Morphine dilates blood vessels, but it's not a blood thinner, so I assume it doesn't hurt the concussion...?
3. Google turns up very little...Yahoo! Answers, of all things, tells me that morphine is contraindicated for concussions NOT because it does harm, but because it drugs the patient out so much that it becomes near impossible for the doctor to tell the concussion symptoms apart from the morphine effects.

As for the cause of his paralysis, I'm afraid a high energy impact would cause other major injuries too serious for my characters to treat. My original idea came from this thread of paralysis victims sharing their injury stories, which indeed are mostly car/motorcycle/sports accidents, but a few became paralyzed from falling off trees or ladders. So as long as paralysis from falling isn't crazy unlikely....

Right, yeah, he falls 3 stories.

ColoradoGuy said:

But if you just injure his spine and break his arm and not give him a head injury of any sort we would be free with the morphine. Why not just do that?

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Worst case, I could do that, but I'd lose a good dramatic section without it:

Twice they reasonably try to treat his awful pain, him with alcohol, her with aspirin.
- Without the concussion, these might actually work, end of story, zero drama.
- With the concussion, both well-meaning attempts only hurt him more, continuing his agony, even threatening his life. "Honey, look, it'll be okay now, I found this aspirin upstairs, this should help ease the pain."

Also, I don't see the problem with morphine...if morphine's only disadvantage is preventing neurological assessments, well, he's not going to be seeing any doctors soon anyway; he's stranded in an office building amidst a 1940s Stalingrad-esque battle for a week. As long as his girlfriend can treat his pain with morphine without killing him, that's all that matters.

But if morphine causes actual damage to a concussion the same way alcohol or aspirin would, then I would probably have to cut the concussion.