Criminal Mischief: Episode #13: Alice in Wonderland Syndrome

Criminal Mischief: Episode #13: Alice in Wonderland Syndrome

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One pill makes you larger, and one pill makes you small

And the ones that mother gives you, don’t do anything at all

Go ask Alice, when she’s ten feet tall

White Rabbit, The Jefferson Airplane

And then there was this excellent question from my friend and wonderful writer Frankie Bailey that was published in SUSPENSE MAGAZINE as part of my recurring Forensic Files column:

What Drugs Might Cause Side Effects in My Character With Alice in Wonderland Syndrome?

Q: I have a question about Alice in Wonderland Syndrome (AIWS) My character is in his mid-30s. From what I’ve gathered from reading about this syndrome, it is fairly common with children and with migraine sufferers and it is controllable. However, I want my character to have side-effects. In other words, even though the AIWS and his migraines are under control, he is increasingly erratic. Insomnia, impotence, and irritability would all be a bonus. Could he be dosing himself with some type of herb that he doesn’t realize would have these side-effects when combined with the medication prescribed for AIWS. Or is there a medication for AIWS that might cause these kind of side-effects but be subtle enough in the beginning that the person becomes mentally unstable before he realizes something is wrong?

FY Bailey

A: Alice in Wonderland Syndrome is also known as Todd’s Syndrome. It is a neurologic condition that leads to disorientation and visual and size perception disturbances (micropsia and macropsia). This means that their perception of size and distance is distorted. Much like Alice after she descended into the rabbit hole and consumed the food and drink she was offered.

AIWS is associated with migraines, tumors, and some psychoactive drugs. It is treated in a similar fashion to standard migraines with various combinations of anticonvulsants, antidepressants, beta blockers, and calcium channel blockers. Both anticonvulsants (Dilantin, the benzodiazepines such as Valium and Xanax, and others) and antidepressants (the SSRIs like Lexpro and Prozac, the MAOIs like Marplan and Nardil,, and the tricyclic antidepressants like Elavil and Tofranil, and others) have significant psychological side effects. Side effects such as insomnia, irritability, impotence, confusion, disorientation, delusions, hallucinations, and bizarre behaviors of all types–some aggressive and others depressive. Beta blockers can cause fatigue, sleepiness, and impotence. The calcium channel blockers in general have fewer side effects at least on a psychiatric level.

As for herbs almost anything that would cause psychiatric affects could have detrimental outcomes in your character. Cannabis, mushrooms, LSD, ecstasy, and other hallucinogens could easily make his symptoms worse and his behavior unpredictable.

Your sufferer could easily be placed on one of the anticonvulsants, one of the antidepressants, or a combination of two of these drugs and develop almost any of the above side effects, in any degree, and in any combination that you want. This should give you a great deal to work with.

What is Alice in Wonderland (AIWS) Syndrome?

A neuropsychiatric syndrome—also know as Todd’s Syndrome after Dr. John Todd, the physician who first described it in 1955—in which perceptions are distorted and visual hallucinations can occur. Often objects take an odd size and spatial characteristics—-just as Alice experienced. They can appear unusually small (micropsia), large (macropsia, close (pelopsia, or far (teleopsia).

It can be caused by many things including hallucinogenic drugs, seizures, migraines, strokes, brain injuries, fevers, infections, psychiatric medications, and tumors.

Migraines are often preceded by auras—visual, auditory, olfactory.

Lewis Carroll was known to suffer from migraines. His own diary revealed he had visited William Bowman, an ophthalmologist, about the visual manifestations he regularly had when his migraines flared. So it just might be that he himself experienced AIWS and took his experiences to create Alice.

AIWS Wikipedia: https://en.wikipedia.org/wiki/Alice_in_Wonderland_syndrome

AIWS Healthline: https://www.healthline.com/health/alice-in-wonderland-syndrome#outlook

AIWS NIH Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520/

AIWS and Tumor: https://www.livescience.com/64520-alice-in-wonderland-brain-tumor.html

AIWS and Visual Migraines: https://www.webmd.com/migraines-headaches/alice-wonderland-syndrome#1

 

Q&A with Expanded Audio Discussions Now on the Suspense Magazine Website

Q&A with Expanded Audio Discussions Now on the Suspense Magazine Website

Check out the new posts John Raab of Suspense Magazine and I put together. Read the Q&As and listen to the expanded discussions. Hope each proves helpful for your crime fiction.

Can DNA Be Used To Identify Multiple Assailants In a Three Decade Old Rape?

http://suspensemagazine.com/blog2/2016/12/20/d-p-lyles-forensic-file-episode-1/

In 1863, Could An Autopsy Accurately Determine the Cause of Death?

http://suspensemagazine.com/blog2/2017/01/09/in-1863-could-an-autopsy-accurately-determine-the-cause-of-death-d-p-lyle-answers-this/

Can My Female Character Cause Her Pregnancy To Become “Stone Baby” By Shear Will?

http://suspensemagazine.com/blog2/2016/12/31/can-my-female-character-cause-her-pregnancy-to-become-stone-baby-by-sheer-will/

More to come.

Want more cool questions from crime writers? Check out my three Q&A books.

More Info and List of Included Questions

More Info and List of Included Questions

More Info and List of Included Questions

 

Q&A: Will a Decaying Corpse Actually Produce Alcohol?

 

Q: Is it possible or likely for blood alcohol levels to increase or decrease in a decomposing body, and if so during what stages of decomposition?

A: Alcohol is usually consumed in the decay process but may actually be produced and this might cloud any toxicological examinations on the corpse. Make it look as if the victim consumed more alcohol than he actually did.

I must point out that alcohol is not commonly produced but it does happen in rare cases. The alcohol is a byproduct of the action of some types of bacteria that are involved in the decay process. This means that alcohol can only appear during active decay. What is that time period? A little about putrefaction.

The decomposition of the human body involves two distinct processes: autolysis and putrefaction. Autolysis is basically a process of self-digestion. After death, the enzymes within the body’s cells begin the chemical breakdown of the cells and tissues. As with most chemical reactions the process is hastened by heat and slowed by cold. Putrefaction is the bacterially mediated destruction of the body’s tissues. It is this decay that might cause some alcohol formation. Not always, but sometimes. The responsible bacteria mostly come for the intestinal tract of the deceased, though environmental bacteria and yeasts contribute in many situations. Bacteria thrive in warm, moist environments and become sluggish in colder climes. Freezing will stop their activities completely. A frozen body will not undergo putrefaction until it thaws.

Under normal temperate conditions, putrefaction follows a known sequence. During the first 24 hours, the abdomen takes on a greenish discoloration, which spreads to the neck, shoulders, and head. Bloating follows. This is due to the accumulation of gas, a byproduct of the action of bacteria, within the body’s cavities and skin. This swelling begins in the face where the features swell and the eyes and tongue protrude. The skin will then begin to “marble.” This is a web-like pattern of the blood vessels over the face, chest, abdomen, and extremities. This pattern is green-black in color and is due to the reaction of the blood’s hemoglobin with hydrogen sulfide. As gasses continue to accumulate, the abdomen swells and the skin begins to blister. Soon, skin and hair slippage occur and the fingernails begin to slough off. By this stage, the body has taken on a greenish-black color. The fluids of decomposition (purge fluid) will begin to drain from nose and mouth. This may look like bleeding from trauma, but is due to extensive breakdown of the body’s tissues.

The rate at which this process occurs is almost never “normal” because conditions surrounding the body are almost never “normal.” Both environmental and internal body conditions alter this process greatly. Obesity, excess clothing, a hot and humid environment, and the presence of sepsis may speed this process so that 24 hours appear like 5 or 6 days have passed. Sepsis is particularly destructive to the body. Not only would the body temperature be higher at death, but also the septic process would have spread bacteria throughout the body. In this case, the decay process would begin quickly and in a widespread fashion. A septic body that is dead for only a few hours may appear as if it has been dead for several days.

As opposed to the above situations, a thin, unclothed corpse lying on a cold surface with a cool breeze would follow a much slower decomposition process. Very cold climes may slow the process so much that even after several months, the body appears as if it has been dead only a day or two. Freezing will protect the body from putrefaction if the body is frozen before the process begins. Once putrefaction sets in, even freezing the body may not prevent its eventual decay. If frozen quickly enough, the body may be preserved for years.

So, whether a particular corpse actually produces alcohol or not is totally unpredictable. How long it takes depends upon the conditions the corpse is exposed to. In a corpse in an enclosed garage in Houston in August, this process will be very rapid and the corpse will be severely decayed after 48 hours. If parked in a snow bank in Minnesota in February it might not even begin the decay process until April or May when the spring thaw occurs. And anything in between. The appearance of any alcohol would coincide with the time frame of the bacterial activity.

So how does the ME get around this possibility? How can he determine the actual alcohol level that was present prior to the decay process kicking in? He can’t with any absolute accuracy, but he does have a tool that will help him make a best guess. He can extract the vitreous humor from the victim’s eye—this is the jelly-like fluid that fills the eyeballs. The alcohol level within this fluid matches that of the blood with about a two-hour delay. That is, the level within the vitreous at any given time reflects the blood alcohol level that was present approximately two hours earlier. And the vitreous is slow to decay so it might be intact even though the corpse is severely decayed. By measuring the vitreous level the ME will know the blood alcohol level two hours prior to death and he can then estimate the blood alcohol level at the time of death.

 

This question originally appeared in MORE FORENSICS AND FICTION

http://www.dplylemd.com/book-details/more-forensics-and-fiction.html

 

Q&A: What Injuries Can Occur With a Car Bomb?

Q&A: What Injuries Can Occur With a Car Bomb?

Q: How far away would you have to be from a car bomb (the kind that is detonated by starting the car) to survive with injuries and what sorts of injuries might you sustain in the blast?

 

A: This is a question that is virtually impossible to answer with any degree of accuracy. There are entirely too many variables involved. How big is the bomb? How big is the car? How close is close? What direction does the shrapnel fly and in which direction is the concussive force of the bomb directed? Are there any intervening walls or structures that might dampen the concussive force or block or redirect the shrapnel? Each of these variables, and many others, must be taken into account before any prediction of possible injuries can be entertained.

Lets look at a few general principles however. Big bombs cause big problems and little bombs cause less. A large bomb can produce a massive concussive force that will spread out for many yards in every direction. It can also produce shrapnel that can fly many hundreds of feet. A small bomb, needless to say, would release a smaller concussive force and any shrapnel would move at a slower rate and therefore do less damage.

Let’s assume that this is a moderate sized bomb and the victim is standing close enough to receive injuries from the explosion. There are several types of injuries that can occur with a bomb.

If the person is close enough and the bomb is of the type that produces a great deal of heat, then burns over the skin and face can occur and even the victim’s clothing might catch fire. This could produce severe injury to the flesh and the lungs.

The concussive force of the bomb is simply a wave of air molecules that are accelerated to very high speed. When the wave strikes an object or a person, damage and bodily trauma will result. This is why a bomb will destroy a building, knock down a wall, or kill a person within the concussive umbrella. If the force is strong enough it can burst eardrums, cause sinuses within the nose and face to bleed, rupture the lungs, rupture the abdomen and internal organs, and many other nasty injuries. If the person is slightly further away, or if the concussive force is dampened somewhat, then injuries to the eardrums and sinuses may occur but the other more severe injuries to the lungs and internal organs might not occur.

Shrapnel presents a very difficult and dangerous situation. With a car exploding all types of shrapnel can be fired in every direction. Chunks of metal and glass, complete doors or windows, beams of metal and even the engine can be launched in any direction. The types of injuries that someone would suffer depends upon exactly what strikes them, where they are struck, and with what speed and force they are hit. I think it would be obvious that if a car door or engine or some large piece of metal struck someone at very high velocity it would most likely kill them instantly and if not their injuries would be so severe that without very aggressive medical treatment and luck they would die from these in short order. But what about smaller pieces of glass and metal? These can penetrate the head, the chest, or the abdomen and damage vital organs and lead to death very quickly. Or they can enter the same areas and lead to massive injury and bleeding, which can then lead to death in minutes to an hour or so. Or they could simply be flesh wounds and the person could survive but would likely require surgical repair of the wounds and treatment with antibiotics to prevent secondary infections.

You can see almost anything can happen in this explosive situation.  A large explosion at a great distance could easily do the same damage as a smaller one where the person was standing close by. Any bomb where the concussive force and shrapnel were directed away from the person might produce no injuries while if the victim were standing in the path of the concussive wave and the shrapnel he could be killed instantly. And anywhere in between. This great degree of variation in what actually happens is good for storytelling since it means that you can craft your story almost any way you want.

 

Q and A: Can My Villain Cook Attempt a Murder Using Contaminated Food?

Q: My villain is a cook and he wants to kill the hero by feeding him tainted food. I want to avoid using a detectable poison, so I thought a deliberately introduced food-borne pathogen, such as ptomaine, botulism, E.coli, or salmonella, or something like those, would do it. But how do I get the bacteria/germs/whatever in the food? What will it do to him? How long would it take him to die, and what steps could the hero take to make sure he survives? What could the villain do to make sure the hero dies?

 

E. Coli Growing on a Culture Plate

 

A: This scenario will work but there are a few problems with it. First of all, using bacteria for murder is extremely unpredictable and most killers prefer a more predictable method. Just because your villain feeds contaminated food to the victim it does not mean that he will die because contaminated food rarely kills people but rather merely makes them sick. Typically people survive these types of illness—but not always. The best way to assure, or at least increase the probability, that your victim would die is to prevent him from reaching medical care.

Infectious processes most often kill by two mechanisms. The first is that they alter the function of the infected organ. For example, pneumonia can kill by infecting the lungs and filling the air spaces with bacteria and liquids we call exudates. This is simply the body’s reaction to the infection. Like a weeping wound or one that forms pus. This is what happens in the lungs and if so it interferes with the exchange of oxygen and the victim can die because the lungs fail. An infection in the kidneys can do the same thing by causing kidney failure and infection in the gastrointestinal tract, which is what would most frequently happen with ingested bacteria, can lead to severe diarrhea and dehydration or in some cases or severe bleeding and death can follow from shock.

But the most treacherous thing associated with any of these infections is the passage of the bacteria from the infected organ into the bloodstream. We call this sepsis or septicemia, big words that mean infection in the blood stream. When this happens the infection spreads rapidly throughout the body and very quickly the victim can suffer from septic shock–low blood pressure and shock from bacteria in the blood stream. This can lead to death in short order.

So regardless of which bacterium you decide to use, it would need to be added to the food and the victim ingest it. This would make him ill with gastrointestinal symptoms such as nausea, vomiting, diarrhea, abdominal pain, and perhaps bleeding in either the diarrhea or the vomiting. If untreated such an infection could then spread to the bloodstream and be deadly. But the key here is that he must be prevented from reaching medical help. Otherwise he would be treated and survive. But untreated his chance of survival is dramatically reduced. So you need to figure a way to prevent him from reaching medical care once he developed symptoms.

As for what bacteria to use, both ptomaine and botulism would be very difficult to come by. They are rare and your cook would have no access to this type of organism. He could of course damage a can of some food product and leave it sitting in a warm environment and hope that the right bacteria grew but most likely it would not be the bacterium that causes botulism. That’s actually quite rare. So there would be no way for him to predict what organism would occur under that circumstance.

On the other hand, things such as E. coli, Salmonella, and Shigella are quite common causes of food-borne gastrointestinal illness. If your chef knew someone who was infected with one of these, perhaps from a recent trip to Mexico where these are not uncommonly encountered, he could then use this individual to supply the needed bacteria. How would he do this? The best way would be to obtain some stool from the infected individual. This could be from contaminated toilet paper or an un-flushed toilet. Gross but that’s the way it is. This could then be placed into some food product and allowed to grow, which he could simply do a closet at home. He could then add some of this bacterial soup to the food product and in this way introduce a large amount of bacteria to the victim. Even better would be if he could find a way to inject this intravenously into the victim but that’s not absolutely necessary.

Again, this would make the victim very ill with gastrointestinal symptoms. Then, as I said, you’ll need to devise some scenario that prevents him from reaching medical help and if so he could easily die from sepsis.

There is an excellent non-fiction book in which a murder is committed exactly like this. It involves the murder of Joan Robinson Hill by her husband Dr. John Hill. It took place in the 1960s in Houston Texas and is an incredible story. The book is titled Blood and Money and was written by Tommy Thompson. If you can a copy of this it might help. Dr. Hill apparently grew bacteria in petri dishes at home and infected cream puffs to kill his wife. He then admitted her to a small hospital in the outskirts of Houston and he managed her care, which amounted to preventing her from getting adequate treatment since he did not offer her the treatment she needed. It became a huge and convoluted case that did indeed involved blood and money.

 

Q and A: What Happens If My character Is Shot in the Abdomen With a Crossbow?

Q: My question is if a female victim, age 17-18, had a penetrating wound to the far left side of the abdomen just below the ribs, extending 2-3 inches max into the body, what organs if any would be hit and would there be any internal bleeding (if so what major arteries/veins)? The weapon is a barbed crossbow bolt that prevents manual removal. And for the internal bleeding would cauterization be possible without lasting effects? Also, what would be the estimated recovery time for this injury (victim able to walk without assistance)?

Rachel from TN

A: There are many possibilities and in fact there are hundreds of possible outcomes here. In the left upper quadrant of the abdomen the most likely structures that would be impacted would be the spleen, the pancreas, and the bowel. It is possible that an object that only embedded two or 3 inches into the body would not strike any organs but would rather be more or less a flesh wound. In this case she would be fine and able to do anything with some pain in the area of course. The only real danger here would be an infection in the wound but this would take many days to develop and many more days to become a true medical problem.

On the other hand the bolt could penetrate into the abdomen and this would be much more painful and there could be some bleeding within the abdomen which would cause a more or less diffuse pain throughout the abdomen which would be worse with movement, running, coughing, and almost any other activity. This pain would be sharp rather than a dull ache. Once again her life would not be in danger unless a secondary infection followed and she should be able to do most things though again with considerable discomfort.

If the spleen were punctured, they would be a great deal of internal bleeding and it could even be enough to cause her to slip into shock and die. Or she could simply lose a great deal of blood can be very weak and short of breath with

any activity but survived. Here the bleeding could stop as the wound in the spleen clotted and she could recover without any major intervention. Again if no infection followed.

If she punctured a pancreas then the pancreatic digestive juices would be released in the abdomen and cause what we call peritonitis – the inflammation of the lining of the abdomen. This would be extremely painful with almost any movement are activity and this discomfort would be spread throughout the abdomen. Here a secondary infection is

very high. Would she be able to do most things? Probably but this would be even more painful than the injuries described above.

If the bolt penetrated a bowel then the leakage of bowel contents in the abdomen would cause an infected peritonitis. This would be extremely painful and deadly without fairly quick surgical intervention. The bowel contents are loaded with nasty bacteria and once they entered the abdominal cavity they would begin to grow and inflame the peritoneum,

causing a severe infectious peritonitis. Here the pain would be worse but she could still move around and do things if she were tough. Within a couple of days the infection would be severe and she would have high fevers, chills, severe abdominal pain, and would ultimately slip in the shock and die from what we call septicemia – an infection in the bloodstream.

Cautery is simply the burning of the tissues and really has no place here as it causes more damage than help. The reason is that with a bolt such as this weapon there would be very little external bleeding in the cautery he could only be used to control that. It could do nothing for the internal bleeding. To control any external bleeding simply applying pressure with a towel, the piece of clothing, wadded up paper, or anything she had handy would stop the external bleeding.

 

Q and A: Can a Crochet Hook Be Used For Murder?

Q: I’m wanting the victim in my next mystery novel to be murdered with a crochet hook. The attacker and victim would be facing each other. The hook would be grabbed off a table and could be either hook end out the thumb side of the hand or out the pinky side of the hand (depending on what you would determine to be the easiest for delivering a fatal blow). It is an impulsive act. The victim is a 5ft. 11in., 157lb. female. Murderer is a 6ft. 1in., 298lb. male. He is a chef.

What would be the most likely spots for inflicting a fatal wound? Would the hook need to be removed (the victim bleeds out)? Can the hook be left in and the wound still fatal?

The hook is a size F 3.75mm crochet hook made of Brazilian bloodwood by the Furls Fiberarts company. I know the different woods they use have different strengths as some do not come in the smaller diameter sizes. (For example: the olivewood hooks start at 4.00mm while the blackwood starts at 3.25mm.)

Pearl R. Meaker, Lincoln, IL.

A: Since this style of hook is made of wood rather than metal, the attack would have to be to a relatively “soft” area. Not likely this could penetrate the chest and reach the heart or get thru the skull without breaking or shattering. But grabbing the thick end and using the pointed (hooked) end as the weapon could prove deadly.

Two areas could work:

The eye–the skull behind the eye is thin and fairly easily penetrated. So a stab to either eye could reach the brain cavity and cause bleeding into and around the brain that could prove deadly. Here there would be some external bleeding from the eye wound but most would be internal within the skull. Here it makes little difference whether the

device is removed or left in place after the attack.

The carotid arteries—there are 2 carotid arteries–one on each side of the neck in the soft area on either side of the trachea–windpipe. This device could easily penetrate one of them. These arteries supply 90% of the blood to the brain. If punctured, the blood would spurt out in great pulses. Here it would be best if the device were yanked back

out after the stab so the blood would have a clear path.

In either case, the victim could die in a couple of minutes or, in the eye stabbing scenario, it could take some time—even 30 to 90 minutes or longer. Anything is possible.

 

Q and A: What Happens When a Person Is Exposed to the Vacuum of Space?

Q: What sort of damage does the human body suffer in the vacuum of space?  How long can one survive and what will happen to the person who does survive?  My scenario involves an astronaut whose faceplate blows out, but not before he depressurizes his suit sufficiently to prevent immediate death.

A: First of all the victim would not explode as was the case in the movies such as Total Recall. But some very bad things do happen internally and they happen very quickly. Whether he depressurizes somewhat beforehand or not, his survival once he reached zero pressure (vacuum) would likely be measured in seconds.

Space decompression sickness is similar to that of a scuba diver that rises too rapidly after a prolonged exposure to the pressures of the deep. In this case the diver is going from excess pressure to normal pressure. In space the victim goes from normal pressure to zero pressure. Same thing physiologically.

In diving, the problem is that the excess pressure causes excess nitrogen (N) to dissolve in the blood. This N will come back out of the blood as the pressure is reduced. This should happen slowly to prevent decompression sickness or the bends. But, if the diver rises rapidly, the pressure drops rapidly, and the N comes out of the blood quickly, forming N bubbles in the blood stream. This is similar to popping the top on a soft drink. Here the release of the pressure allows the carbon dioxide (CO2), which was placed into the liquid under pressure, to come out of the liquid and form bubbles. We call this carbonization. A good thing for your soft drink, but not so good for your brain and heart and muscles.

In space decompression basically the same thing happens. Apparently the culprit is water and not N in this situation, however. With the sudden release of pressure, the water in the blood “boils,” becoming a gas, and bubbles form in the system. I should point out that in chemical and physical terms boiling simply means the changing of a liquid to a gas. This can be accomplished by adding heat (boiling water on a stove) or by lowering the ambient pressure (popping open a soft drink). In the case of space decompression it isn’t that the blood gets hot, but rather that the pressure that keeps the water in its liquid state is removed and the water changes to its gaseous state, or boils. Doesn’t sound very pleasant does it?

Though studies on the effects of exposure to a vacuum have been done on chimpanzees, there are no real data on what happens to humans exposed to zero pressure except for a couple of incidents where an astronaut or a pilot was accidentally exposed. Of course, rapid decompression has caused deaths in both high-altitude flights and in June, 1971 when the Russian spacecraft Soyuz 11 suddenly lost pressure, killing the 3 cosmonauts on board, but survivors are few and far between.

On August 16, 1960, parachutist Joe Kittinger ascended to an altitude of 102,800 feet (19.5 miles) in an open gondola in order to set a world record for high-altitude parachute jumping. He lost pressurization in his right glove but proceeded with his ascent and jump. He experienced pain and loss of function in his hand at high altitude but all returned to normal once he descended via chute to lower altitudes.

In 1965 at NASA’s Manned Spacecraft Center near Houston, TX, a trainee suffered a sudden leak in his spacesuit while in a vacuum chamber. He lost consciousness in 14 seconds, but revived after a few seconds as the chamber was immediately re-pressurized. He suffered no ill effects—due to his very brief exposure—but stated that he could feel water boiling on his tongue. This was actually the above mentioned boiling scenario in which water (in this case saliva) becomes a gas on exposure to zero pressure.

A case of partial, prolonged exposure occurred during an EVA (space walk) in April 1991 on the US space shuttle mission STS-37. One astronaut suffered a 1/8 inch puncture in one glove between the thumb and forefinger. He was unaware of it until later when he noticed a painful red mark on his skin in the exposed area. It appeared that the area bled some but that his blood had clotted and sealed the injury.

So, what happens to a human exposed to zero pressure? Since there is no oxygen in such an environment, loss of consciousness occurs in a matter of seconds. Also, if the victim held his breath (don’t do this during scuba diving when coming up from depths either), the air in his lungs would rapidly expand and his lungs could be damaged, bleed, or rupture. Better to open his mouth and exhale the rapidly expanding gas from his lungs.

Water in his blood stream would immediately begin to “boil,” filling the blood stream with water vapor (the gas form of water) and stopping his heart. Bubbles might appear in the blood stream and cause damage to the body’s organs, particularly the brain. As a result, the brain and nerves cease to function. As more and more gas formed within the body, the entire body would swell but it would not explode.

Exposure to heat or cold or radiation might also occur but it will do little harm since the victim would already be dead.

But what if the exposure were brief and the person rescued? Treatment would be to immediately return him to a pressurized environment and give him 100% oxygen. He may survive unharmed or may have brain and nerve damage which could be permanent.

For your scenario, whether he partially decompressed or not, he would be in trouble very quickly. When your victim’s faceplate ruptured he would hopefully begin to exhale air to prevent the expanding gases in his lungs from rupturing them. As air, and thus oxygen, flowed from his lungs and into space, the oxygen content of his blood would rapidly drop and he would lose consciousness in 10 to 20 seconds. He would then die in short order. If he were quickly rescued, he would be returned to the spacecraft, which would be pressurized, and would be given 100% oxygen via a face mask. He could survive intact or with brain damage. It’s your call. Either way works.

 

Q and A: Will Ingestion of Bee Venom Kill Someone Who Is Allergic to Bees?

Q: If a person is allergic to bee venom and the venom is ingested, would the person be likely to die? Would the venom show up on a tox screen at autopsy?

A: Bee venom is a protein toxin and would be digested by the acids in the stomach if swallowed. And once digested it would not likely cause an allergic reaction. However, an allergic reaction would happen once the venom contacted the buccal mucosa—big word for the lining of the mouth. This could cause an anaphylactic reaction and kill the victim.

Anaphylaxis is a rapid allergic reaction to some antigen. These antigens are typically foods, drugs, or insect venoms. Common foods are peanuts and shellfish; common drugs are penicillin and iodine, which is found in many radiographic dyes; and common insects are bees as in your story. There a myriad other foods, drugs, and bugs that can cause anaphylaxis in the allergic person.

This rapid immune (or allergic) reaction involves antigens (the food, drug, the bee venom, etc.) and antibodies, which are manufactured by the body and react to the specific antigen that they are directed against. This reaction is a critical part of our defense against bacteria and viruses. The body recognizes the antigen (virus, let’s say) as foreign and builds antibodies that will recognize and attach to the virus. This reaction attracts white blood cells (WBCs), which release chemicals that kill or harm the virus, which is then consumed by the WBCs and destroyed.  This process is essential for each of us to survive in our bacteria and virus-filled world.

But, in allergic individuals, this reaction is rapid and massive and causes a release of large amounts of the chemicals from the WBCs and it is these chemicals that cause the problems. They cause dilatation (opening up) of the blood vessels, which leads to a drop in blood pressure (BP) and shock. They cause the bronchial tubes (airways) to constrict (narrow severely), which leads to shortness of breath, wheezing, and cough. This is basically a severe asthmatic attack and prevents adequate air intake and the oxygen level in the blood drops rapidly. The chemicals also cause what is known as capillary leak. This means that the tiny microscopic blood vessels in the tissues begin to leak fluids into the tissues. This leads to swelling and various skin lesions such as a red rash, hives (actually these are called bullae and are fluid-filled, blister-like areas), and what are called wheel-and-flare lesions (pale areas surrounded by a reddish ring). These are also called Target Lesions because they look like targets with a pale center and red ring.

In the lungs this capillary leaking causes swelling of the airways, which along with the constriction of the airways, prevents air intake. In the tissues it causes swelling of the hands, face, eyes, and lips. The net result of an anaphylactic reaction is a dramatic fall in BP, severe wheezing, swelling and hives, shock (basically respiratory and cardiac failure), and death.

Usually anaphylaxis onsets within minutes (10 to 20) after contact with the chemical, but sometimes, particularly with ingested foods, it may be delayed for hours—even up to 24 hours. With a bee sting it would begin in a matter of minutes. Bee venom in the mouth might take only a few minutes to instigate the reaction.

Your victim would suffer swelling of the tongue and face—particularly of the lips and around the eyes—as well as swelling of his hands. Hives and wheel-and-flare lesions would pop out over the skin. He would begin to gasp for breath and develop progressively louder wheezing. As the oxygen content of his blood began to drop he would appear bluish around his lips, ears, fingers, and toes. This would progress until his skin was dusky blue. He would sweat, weaken, and finally when his BP dropped far enough would lose consciousness, lapse into a coma and die. Unless treatment was swift and effect that is.

Untreated anaphylaxis leads to shock and death in anywhere from a very few minutes to an hour or more, depending upon the severity of the reaction and the overall health of the victim. Treatment consists of blood pressure (BP) and respiratory support, while giving drugs that counter the allergic reaction. BP support may come from intravenous (IV) drips of drugs called vasopressors. The most common would be Dopamine, Dobutamine, epinephrine, and neosynephrine. Respiratory support may require the placement of an endotracheal (ET) tube and artificial ventilation. The victim would then be given epinephrine IV or subcutaneously (SubQ) and IV Benadryl and steroids. Common steroids would be Medrol, Solumedrol, and Decadron. These drugs work at different areas of the overall allergic reaction and reverse many of its consequences. The victim could survive with these interventions. Or not. Your call.

If you decide that your victim will die, then at autopsy, the findings are non-specific. That is, they are not absolutely diagnostic that an anaphylactic reaction occurred. The ME would expect to find swelling of the throat and airways and perhaps fluid in the lungs (pulmonary edema) and maybe some bleeding in the lungs. He may also find some congestion of the internal organs such as the liver. He must however couple these findings with a history of the individual having eaten a certain food, having ingested or being given a certain drug, or having receives an insect bite or sting and then developing symptoms and signs consistent with anaphylaxis. And in the case of insects, such as the bee you are using, he may be able to find antibodies to the insect’s venom in the victim’s blood. Maybe not. So you can have it either way—yes he finds the antibodies or no he doesn’t.

Originally published in the October, 2014 issue of Suspense Magazine

 

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.