RSS

Category Archives: Trauma

Criminal Mischief: Episode #22: Common Medical Errors in Fiction

Criminal Mischief: Episode #22: Common Medical Errors in Fiction

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-22-common-medical-errors-in-fiction

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/22-comon-medical-errors-in.html

Too often, fiction writers commit medical malpractice in their stories. Unfortunately, these mistakes can sink an otherwise well-written story. The ones I repetitively see include:

Bang, Bang, You’re Dead: Not so fast. No one dies instantly. Well, almost no one. Instant death can occur with heart attacks, strokes, extremely abnormal heart rhythms, cyanide, and a few other “metabolic” poisons. But trauma, such as gunshot wounds (GSWs) and blows to the head, rarely cause sudden death. Yet, how often has a single shot felled a villain? Bang, dead. For that to occur, the bullet would have to severely damage the brain, the heart, or the cervical (neck) portion of the spinal cord. A shot to the chest or abdomen leads to a lot of screaming and moaning, but death comes from bleeding and that takes time. Sometimes, a long time.

Ask any emergency physician or nurse. GSW victims reach the ER with multiple holes in their bodies and survive all the time. This is particularly true if it’s Friday night (we called it the Friday Night Knife and Gun Club), during a full moon (yes, it’s true, a full moon changes everything), or if the victim is drunk. You can’t kill a drunk. That’s a medical fact. They survive everything from car wrecks to gunshots to falling off tall buildings. The family van they hit head-on will have no survivors, but the drunk will walk away with minor scratches, if that.

Sleeping Beauty: I call this the “Hollywood Death.” Calm, peaceful, and not a hair out of place. As if simply asleep. Blood? Almost never. Trauma? None in sight. The deceased is nicely dressed, stretched out on a wrinkle-free bed, make-up perfect, and with a slight flutter of the eyelids if you look closely. Real dead folks are not so attractive. I don’t care what they looked like during life, in death, they are pale, waxy, and gray. Their eyes do not flutter and they do not look relaxed and peaceful. They look dead. And feel cold. It’s amazing how quickly after death the body becomes cold to the touch. It has to do with the loss of blood flow to the skin after the heart stops. No warm blood, no warmth to the touch.

Sleeping Beauty also doesn’t bleed. You know this one. The hero detective arrives at a murder scene a half hour after the deed to see blood oozing from the corpse’s mouth or from the GSW to the chest. Tilt! Dead folks don’t bleed. You see, when you die, your heart stops and the blood no longer circulates. It clots. Stagnant or clotted blood does not move. It does not gush or ooze or gurgle or flow or trickle from the body. 

Trauma? What Trauma?: You’ve seen and read this a million times. The hero socks the bad guy’s henchmen in the jaw. He goes down and is apparently written out of the script since we never hear from him again. It’s always the henchmen, because the antagonist, like most people, requires a few solid blows to go down. Think about a boxing match. Two guys that are trained to inflict damage and even they have trouble knocking each other out. And when they do, the one on his back is up in a couple of minutes, claiming the other guy caught him with a lucky punch. Listen to me: Only James Bond can knock someone out with a single blow. And maybe Jack Reacher or Mike Tyson. A car-salesman-turned-amateur-sleuth cannot.

And what of back eyes? If a character gets whacked in the eye in Chapter 3, he will have a black eye for two weeks, which will likely take you through the end of the book. He will not be “normal” in two days. A black eye is a contusion (bruise) and results from blood leaking into the tissues from tiny blood vessels, which are injured by the blow. It takes the body about two weeks to clear all that out. It will darken over two days, fade over four or five, turn greenish, brownish, and a sickly yellow before it disappears. On a good note, by about day seven, a female character might be able to hide it with make-up.

Similarly, what of the character who falls down the stairs and injures his back? He will not be able to run from or chase the bad guy or make love to his new lover the next day. He will need a few days (or maybe weeks) to heal. And he will limp, whine, and complain in the interim. And if he breaks something, like an arm or leg, he’ll need several weeks to recover.

I Can Run, and Jump, and Fight Like an Olympian: The typical fictional PI (maybe real ones, too) drinks too much, smokes too much, and eats donuts on a regular basis. He is not training for the Olympics. He will not be able to chase the villain for ten blocks. Two on a good day. And hills or stairs will reduce that to a very short distance. Yet chase montages in movies and books often seem to cover marathon distances. And then a fight breaks out. 

Of course, some characters can do all this. Not the PI mentioned above but maybe Dustin Hoffman can. Remember “Babe” Levy (Dustin Hoffman) in Marathon Man? He had to run for his life as Dr. Christian Szell (Sir Laurence Olivier) and his Nazi bad guys chased him endlessly. But early in the film, we learn that he runs around the reservoir in Central Park every day. He constantly tries to increase his distance, improve his time. He could run for his life.

Hopefully, when you run across medical malpractice in your reading you’ll be forgiving and enjoy the story anyway. But maybe not.

 

Criminal Mischief: Episode #18: Gunshot To The Chest

XRay Chest Bullet

 

Criminal Mischief: Episode #18: Gunshot To The Chest

LISTEN: https://soundcloud.com/authorsontheair/gswtochest

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/18-gunshot-to-the-chest.html

Gunshot wounds (GSWs) come in many flavors and those to the chest can be particularly dicey. Yet, a chest GSW can be a minor flesh wound, a major traumatic event with significant damage, or deadly. If you have a character who suffers such an injury, this podcast is for you.

Here are a few interesting questions about chest GSWs:

Could a Person Survive a Gunshot to the Chest in the 1880s?

Q: My scenario is set in 1880. A man in his early 20s is shot in the back by a rifle. He loses a lot of blood and is found a couple of hours later unconscious. Could he survive and if so how long would it take him it recuperate? Also, would it be possible to bring him to consciousness long enough for another man to get him into a buggy. Is any part of this scenario possible?

A: Everything about your scenario works. A gunshot wound (GSW) to the chest can kill in minutes, hours, days, or not at all. The victim would be in pain and may cough and sputter and may even cough up some blood. He could probably walk or crawl and maybe even fight and run if necessary. Painful, but possible. He would likely be consciousness so could even help get himself into the wagon.

If all goes well, he should be better and gingerly up and around in a week or two. He would be fully recovered in 6 to 8 weeks.

After surviving the initial GSW, the greatest risk to his life would a secondary wound infection. Since no antibiotics were available at that time, the death rate was very high—40 to 80 percent—for wound infections. But, if he did not develop an infection, he would heal up completely.

How Is A Gunshot To The Chest Treated?

Q: I have a few questions regarding a gunshot wound that my poor character will be sustaining later on in my story. Supposing it’s a fairly small caliber bullet (typical handgun fare, not buckshot or anything) and it hits near the heart without puncturing anything important, how long might his recovery time be? He’s a strong, kinda-healthy guy in his thirties, although he drinks a fair amount and used to smoke. He’ll be rushed to a high-quality hospital immediately and receive the best care throughout recovery…what’s his outlook? When will he be allowed to go home, if all goes well? How long before he’s healed to normal?  When will it be safe for him to walk around, drive, have sex, etc.?

A: In your story, what happens to your shooting victim depends upon what injuries he received. A gunshot wound (GSW to docs and cops) can be a minor flesh wound or can be immediately deadly or anywhere in between. It all depends on the caliber and speed of the bullet and the exact structures it hits. A shot to the heart may kill instantly or not. The victim could die in a few minutes or survive for days or could recover completely with proper medical care and surgery. It’s highly variable but ask any surgeon or ER doctor and they will tell you that it’s hard to kill someone with a gun. Even with a shot or two to the chest.

A small caliber and slow speed bullet—such as those fired by .22 and .25 caliber weapons—are less likely to kill than are heavier loads and higher velocity bullets such as .38, .357, or .45 caliber bullets, particularly if they are propelled by a magnum load—such as a .357 magnum or a .44 magnum. Also, the type of bullet makes a difference. Jacketed or coated bullets penetrate more while hollow point or soft lead bullets penetrate less but do more wide-spread damage as the bullet deforms on impact.

All that is nice but the bottom line is that whatever happens, happens. That is, a small, slow bullet may kill and a large, fast one may not. Any bullet may simply embed in the chest wall or strike a rib and never enter the chest. Or it could enter the heart and kill quickly. Or it could puncture a lung. The victim here would cough some blood, be very short of breath, and could die from bleeding into the lungs—basically drowning in their own blood. Or the lung could collapse and again cause pain and shortness of breath. But we have two lungs and unless the GSWs are to both lungs and both lungs collapse the person would be able to breathe, speak, even run away, call for help, or fight off the attacker. Whatever happens, happens.

This is good for fiction writers. It means you can craft your scene any way you want and it will work. He could suffer a simple flesh wound and have pain, shortness or breathe, and be very angry. He could have a lung injury and have the above symptoms plus be very short of breathe and cough blood.  If the bleeding was severe or if both lungs were injured he could become very weak, dizzy, and slip into shock. Here his blood pressure would be very low and with the injury to his lungs the oxygen content of his blood would dip to very low levels and he would lose consciousness as you want. This could happen in a very few minutes or an hour later, depending upon the rapidity of blood loss and the degree of injury to the lungs.

Once rescued, the paramedics would probably place an endotracheal (ET) tube into his lungs to help with breathing, start an IV to giver IV fluids, and transport him to the hospital immediately. He would then be seen by a trauma surgeon or chest surgeon and immediately undergo surgery to remove the bullets (if possible) and to repair the damaged lung or whatever else was injured. He could recover quickly without complications and go home in a week, rest there for a couple of weeks, return to part-time work for a few weeks and be full speed by 3 to 4 months. Or he could have one of any number of complications and die. Or be permanently disabled, etc. It all depends upon the nature of Injuries, the treatment, and luck.

What Does a Close-range Gun Shot to the Chest Look Like?

Q: I have a question regarding gunshot wounds. In my latest mystery, a man and a woman, my heroine, struggle for a gun. It goes off, hitting the man in the chest. I want the man to live, but be temporarily incapacitated and need hospital care, so if the chest isn’t the best location, other suggestions are welcome. What would the gunshot wound likely look like before and after the man’s shirt was removed? Would there be a lot of bleeding where my heroine would take his shirt off and stuff it over the wound?

A: A gunshot wound (GSW) to the chest would work well. For it to be quickly fatal, the bullet would have to damage the heart or the aorta or another major blood vessel, such as the main pulmonary (lung) arteries. Under these circumstances, bleeding into the chest, the lungs,  and around the heart would likely be extensive and death could be almost instantaneous or in a very few minutes. He could survive even these injuries, but this would require quick and aggressive treatment, including emergent surgery, and a pile of luck.

If the bullet entered the lung, the victim could die from severe bleeding into the lung and basically drowning in his own blood. Or not. He could survive such an injury and would then require surgery to remove the bullet, control the bleeding within the lung, and repair the lung itself. This would require a couple of hours of surgery, a week in the hospital, and a couple of months to recover fully.

The bullet could simply embed in the chest wall and never enter the chest cavity. It could bounce off the sternum (breast bone) or a rib and deflect out of the chest, into the soft tissues of the chest wall, or downward into the abdomen. Once a bullet strikes bone, it can be deflected in almost any direction. Sometimes full-body X-rays are required to find the bullet. If the bullet simply embedded beneath his skin or against a rib or the sternum, he would require a minor surgical procedure to remove the bullet and debride (clean-up) the wound. He would be hospitalized for only 2 to 3 days and would go home on antibiotics and basic wound care.

Close-range, but not direct muzzle contact, wounds typically have a small central entry wound, a black halo called an abrasion collar, and often an area of charring around the wound. The charring comes from the hot gases that exit the barrel with the bullet. In addition, there is often tattooing, which is a speckled pattern around the entry wound. This is from the soot and unburned powder that follows the bullet out of the muzzle and embeds (tattoos) into the skin. The spread of this pattern depends upon how close the muzzle is to the entry point, If it over about 3 feet, then no tattooing or charring will occur.

In your scenario, the victim’s shirt would likely collect the soot and heat so that it would be charred and “tattooed,” rather than the victim’s skin. So, the shirt would show an entry hole, charring, and blood. Once the victim’s shirt was removed, the entry wound likely be a simple hole without any charring or tattooing, since the shirt would have collected this material and absorbed most of the heat. The wound could bleed a lot, a little, or almost none. It depends upon how many of the blood vessels that course through the skin and muscles are damaged.

Yes, her initial efforts should be the application of pressure over the wound to control bleeding until the paramedics arrive.

For more fun questions check out my Q&A books:

F&F200X302

FORENSICS and FICTION: http://www.dplylemd.com/book-details/forensics–fiction.html

MF&F 200X320

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

M&M 200X300

MURDER AND MAYHEM: http://www.dplylemd.com/book-details/murder-and-mayhem.html

 

Criminal Mischief: Episode 05: Making Characters Compliant

AOTA Graphic

Criminal Mischief: The Art and Science of Crime Fiction: Episode 05: Making Characters Compliant

LISTEN: https://soundcloud.com/authorsontheair/character-compliance

PREVIOUS EPISODES: http://www.dplylemd.com/criminal-mischief.html

Making Characters Compliant Show Notes:

Coercion and Threat

Leverage

Trauma:

Trauma is time limited

Unconscious vs Pain/Fear of death

Drugs:

Drugs have variable timelines

Drugs don’t have timers

Alcohol and Mickey Finn

Narcotics and sedatives

Date Rape Drugs

Rohypnol

GHB—Gamma Hydroxybutyrate

E, Ecstasy, MDMA—3.4-Methylenedioxy Methamphetamine

Ketamine

Links:

Date Rape Drugs: http://www.dplylemd.com/articles/date-rape-drugs.html

ROHYPNOL: https://www.drugs.com/illicit/rohypnol.html

GHB: https://www.drugs.com/illicit/ghb.html

ECSTASY: https://www.drugabuse.gov/publications/drugfacts/mdma-ecstasymolly

KETAMINE: https://www.medicalnewstoday.com/articles/302663.php

Andrew Luster: https://en.wikipedia.org/wiki/Andrew_Luster

Dr. Grant Robicheaux: http://www.newser.com/story/264806/calif-surgeon-girlfriend-may-have-raped-hundreds.html

 

FFD 300X378

 

Burking Still Lives After 200 Years

Asphyxia is the interruption of oxygen (O2) supply to the body, particularly the brain. Normally, air contains O2 and, when breathed in, it passes into the blood, using hemoglobin as a transport molecule, where it is distributed to the tissues. Any interruption of this delivery chain can lead to death from asphyxia.

The air might be deficient in oxygen such as at high altitude or when another gas such as carbon dioxide (CO2) accumulates, depressing the O2 content to dangerous levels. Or flow into the mouth and nose could be restricted by smothering, choking, or strangulation, or by anything that restricts the expansion of the chest. Or the inhaled air could contain a toxin such as carbon monoxide (CO) or cyanide (CN), and these, in turn, interfere with O2 delivery to the tissues.

Burking is the term applied to asphyxial deaths that result from someone sitting on another in a fashion that restricts breathing. The victim dies from asphyxia. This is a form of Mechanical Asphyxia, where the movement of the chest wall is restricted to the point that breathing isn’t possible. Burking refers to the famous case of Burke and Hare.

 

4261a8eda2c13a9c70713c2e0ffcf2d6

 

From FORENSICS FOR DUMMIES:

Applying Pressure: Mechanical Asphyxia

Mechanical asphyxia results when some external force applied to the body prevents the expansion of the chest and leaves the victim unable to breathe. A person trapped beneath a heavy object, such as a car or a collapsed wall or ceiling, can die because the force of the external pressure prevents the victim from taking in a breath.

A boa constrictor kills in exactly this way. This muscular species of snake wraps itself around its prey. Each time the prey exhales, the snake coils a little tighter. So, each successive breath becomes increasingly shallower until the prey can’t take another breath. Death follows quickly.

 

FFD 500X629

 

Suffocation by “Burking” 

Experts have come to know a particular form of mechanical suffocation as Burking. William Burke was a merchant of sorts around Edinburgh, Scotland, in the early 1800s. In 1827, he hooked up with William Hare, who ran a beggars hotel in the village of Tanners Close. In December of that year, a resident of the hotel died, and Burke arranged to sell the body to a Dr. Knox, who needed corpses for his dissection demonstrations. Burke and Hare loaded a coffin with bark and buried it in front of many witnesses. They then delivered the body to Dr. Knox and received seven pounds and ten shillings. The men struck an arrangement whereby Burke and Hare would deliver the doctor more bodies for eight pounds in summer and ten in winter. (Apparently grave robbing was more difficult when the ground was cold.)

Burke and Hare began digging up fresh corpses for their new enterprise, but the local populace refused to die fast enough for the greedy men. They began kidnapping and killing people who were not likely to be missed. Burke sat on his victims, holding their mouths and noses closed until they suffocated, after which Burke and Hare delivered the corpse and collected their fee.

A lodger at the hotel notified authorities when she discovered the sixteenth and last victim beneath a bed. Police arrested the two men. Hare then cut a deal and testified against Burke. Burke was convicted and experienced asphyxia for himself when he was hanged on January 28, 1829, an event attended by as many as 40,000 people.

 

Burking is alive nearly 200 years later. It seems that 325-pound woman sat on her 9-year-old cousin to punish her for some indiscretion. Unfortunately, the child died from mechanical asphyxia—-“Burking.”

 

DNA Solves the 80-Year-Old Death of Belgium’s King Albert I

Belgium-Albert-King-of

 

Belgium’s King Albert I was found dead on February 17, 1934. The experienced rock climber was found at the base of a large formation with a gash to his head. Speculation that he was murdered ran rampant. During World War I, he had resisted Germany and attempted to block German troops from entering his country. They eventually did, but he fought them every step of the way. Was Germany somehow complicit in his untimely death?

Many felt that he had been killed elsewhere and his body dumped where it was found. The evidence suggested otherwise. His glasses were found nearly 40 feet above him – – he was very far-sighted – – and his climbing rope was still attached to his body. But, the most important evidence that suggested a fall rather than a murder was blood on the leaves near the King. If this blood was indeed Albert’s, then he must have shed it at that location, meaning he was at least briefly alive when he reached the ground at the base of the rock formation. If he had been killed elsewhere and dumped, there would have been no blood around the body. Dead folks don’t bleed. The leaves were apparently collected and preserved.

Flash forward to 2014. The blood of the leaves was tested. Not only was it human blood and but also it was matched against two relatives of the King. These results suggested that the blood was indeed the King’s blood and it had likely been shed from a head injury he received from his fall. This 80-year-old “murder” case seems to be a tragic accident.

 

In the 1800s, Wagon Train Travel Could Be Deadly

Wagon Train

Many brave souls headed West during the 1800’s, often by wagon train. They fought weather, disease, starvation, hostile folks of all types, and potentially deadly injuries. Medicine was crude, basically non-existent, and many died along the way.

Check out my latest Q&A on the Suspense Magazine Blog:

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

Read the answer and listen to the expanded audio information here:

http://suspensemagazine.com/blog2/2017/07/01/could-death-from-bleeding-be-delayed-for-several-days-after-a-frontier-wagon-wheel-accident/

This was one of the many clever questions included in my first Q&A book—MURDER & MAYHEM

M&M 200X300

 

The World’s First Homicide?

No one knows for sure when the world’s first homicide took place – – other than Cain and Abel, that is. But it just might have happened 43,000 years ago in northern Spain. A skull retrieved from the Sima de los Huesos (Pit of Bones) in the Atapuerca Mountains showed two circular puncture wounds in the forehead of the skull. The skull had been found shattered into 52 fragments but miraculously was nearly complete. Once it had been reassembled the two wounds were easily identified. Researchers believe they were made by the same instrument and that they were not consistent with a simple fall into the cave shaft.

When you examine the skull it definitely looks as though some pointed instrument, most likely a stone tool or weapon, had delivered the blows. Of course, the assailant could claim self-defense, but this looks like a homicide.

 
 
%d bloggers like this: