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Life Imitates Art: A Writer’s Question

12 Jul

Recently, Thomas D. went missing. He had last been seen leaving a party and did not turn up again for four days. This was when a state trooper found his car some 480 feet off the Taconic State Parkway. He was found some 120 feet from his crashed BMW suffering from a back injury and dehydration. He apparently been able to crawl out of his car, which was stuck in a marshy area, but was unable to get to the roadway. He apparently was taken to the hospital and is now doing well. This story reminded me of a question that I receive many years ago from Lee Goldberg and used in my book Forensics & Fiction. Here is the question.

How Long Could a Man Survive in the Desert After Major Injuries from an Automobile Accident?

Q:    Here’s my scenario: A man loses control of his SUV and drives off a cliff on a remote, dirt road outside of Kingman, Arizona. Nobody notices the accident. He breaks his pelvis, maybe his legs, maybe a couple of ribs. Due to his injuries he is unable to climb back up the hill to the road. He survives on water from his windshield wiper reservoir, and eats bugs and lizards and whatever else he can find. He uses the wreckage for shelter in the sweltering heat and isn’t found for five or six days.

What condition would he be in? Dehydrated? Badly sunburned? Unconscious? What would he look like? Once the guy is back in the hospital in Kingman, what treatment would they give him?

Lee Goldberg, Los Angeles, California
Author of the Diagnosis Murder and Monk novels
www.leegoldberg.com

A:    Yes, he would be severely dehydrated. More so if the temperature was high, as it is in summer there, and less so if in winter. In fact, in winter he could die from hypothermia.

If he broke his pelvis and/or a leg or two there would be some internal bleeding, which would only add to his problems. If he then had only a little water and some berries and bugs he would become severely dehydrated, and would likely slip into shock and could die. But you want him to survive, so a pelvic fracture would work well. Or a fracture to his lower leg. The bones there are the tibia (big one) and the fibula (little one). I would not have him fracture his femur (upper leg bone), since this is often associated with a great deal of internal bleeding into the leg, and his survival under the conditions you describe would be much less likely. A pelvic fracture might prevent him from climbing or crawling back up to the road and would limit his mobility greatly.

Dehydration is the loss of body water. The rate at which we lose water depends upon several factors, such as the ambient temperature (the higher it is the faster the loss from sweating), activity (water is lost through the lungs with each breath and exercise increases breathing), medications or drugs (alcohol and diuretics cause water loss through the kidneys), and other factors. The symptoms of dehydration are thirst, fatigue, dry mouth, nausea, sleepiness, confusion, disorientation, and finally shock (low blood pressure), a rise in body temperature, and finally death, more or less in that order of appearance. He may also hallucinate or see mirages, which are due to a bending of light rays. The heat rising from a desert bends light rays due to changes in the density of the air. The result is that you see blue sky below the horizon and it looks like a body of water. Often a person who is dehydrated and confused will rush (with your character crawl) blindly toward it, but can never reach it because it doesn’t exist, and because the optical illusion keeps moving away.

The rapidity with which dehydration occurs will dictate how quickly these symptoms appear and how severe they are. Organ damage is primarily to the kidneys, which can be severely and irreversibly damaged with severe or prolonged dehydration.

In your scenario the dehydration would come on slowly, over a day or two, and would not become severe for as much as three or four days. Of course if he lost considerable blood from his injuries, this process would occur much more quickly. Also, at higher altitudes dehydration comes on more rapidly because the air at high altitudes tends to be drier. This means that more water is lost through the lungs than is lost in damper air at sea level. Kingman is fairly high and dry. His movements as he crawled around and searched for food would also dehydrate him more quickly.

Since your victim is young and healthy, and I assume is not taking any diuretics and has not consumed any alcohol before the beginning of his ordeal, two days would be a good average time frame for him to get into trouble but survive without major problems. You could stretch this to three or four days if necessary, but no longer. Not in the sweltering heat you described. Otherwise he could develop heat prostration or heatstroke and die.

When found he could be awake and alert, confused and disoriented, or in a coma. All of these are possible. The rescuers would wrap him in a blanket if he were cold, or douse him with water and fan him if he was suffering heat prostration or heatstroke. They would give him sips of water, stabilize any leg fractures with splints, and call for help. Once in the hospital he would get IV fluids and X-rays. Blood work would be done to determine how much blood he had lost and to check for kidney problems from the dehydration. He could require a blood transfusion, and his leg or pelvis could need a surgical repair. This would depend upon the type and extent of the fracture. Or he could need neither.

Yes, he could be sunburned unless he remained in his shelter during the day and scratched for food at dawn and dusk.

 
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Posted by on July 12, 2010 in Medical Issues, Q&A

 

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