1. Stephen Gazzard
    Offline

    Stephen Gazzard Member

    Joined:
    Jun 21, 2014
    Messages:
    58
    Likes Received:
    9

    Good sources for medical considerations

    Discussion in 'Plot Development' started by Stephen Gazzard, Oct 14, 2014.

    I am not a medical expert. I have a character who suffers a wound that needs to appear fatal at the time it happens but I won't him to survive. Right now it's the whole "bullet didn't hit any major organs but you still got shot" shtick.

    What I'm getting stuck on is how long he's down for. I don't want him to be down for too long because there are other characters in my book doing other stuff and I don't want him out of the action for too long. But I have no medical background on the complications / recovery time for such injuries, or if there are similar injuries I could use instead to serve the timeline / need of this scene.

    What resources do you other writers use to determine was is a feasible injury for a character to take in your book?
     
  2. Shadowfax
    Offline

    Shadowfax Contributing Member Contributor

    Joined:
    Aug 27, 2014
    Messages:
    2,504
    Likes Received:
    1,337
    Well, I can't help with how long your MC should stay down, just longer than Jack Bauer...!

    Bear in mind that a bullet doesn't just go straight through (often what kills you is the infection caused by a bullet that stays inside) but will impart a LOT of its inertia to the body parts that get in its way...it will 1/ knock you backwards and 2/ cause some bruising, etc. to the areas near where it impacts.

    You might like to google Phineas Gage...had a steel rod blown clean through his skull and out the other side...after-effects of character alteration.
     
  3. Jakv6
    Offline

    Jakv6 Member

    Joined:
    May 9, 2014
    Messages:
    44
    Likes Received:
    7
    Does he receive aid? Is he able to give himself some first aid? Where did the bullet hit? Centre mass? Limb? Skull? You could blow off a portion of the skull and he would look pretty damn dead, but wouldn't necessarily die. He would in any case almost certainly need to go to a hospital, unless you can think of a VERY good reason that he could shrug off a fatal-looking injury.
    From where does he need to appear dead? Close up or far away? As the previous post says, he would be knocked backwards - perhaps he could be knocked into a wall and could strike his head, rendering him unconscious. The bullet could hit, say, his shoulder, resulting in a non-fatal wound - but also resulting in a scene that nevertheless closely resembles a dead body, i.e. motionless, with blood seeping out from under it.
    There are many possibilities, I think. Too many variables for me to give a really helpful answer. My advice would be to pare down these variables yourself in order to let the solution become visible.
     
  4. Stephen Gazzard
    Offline

    Stephen Gazzard Member

    Joined:
    Jun 21, 2014
    Messages:
    58
    Likes Received:
    9
    All excellent questions and exactly my point - there are a lot of things to consider. To narrow it down a bit, this takes place approximately 200 years ago, the character gets help almost immediately. It does not need to appear fatal on close inspection - it happens in the middle of a chaotic scene and serves to remove the character from the story for a short while to heighten drama and give a couple of characters a chance to shine, while also shining a negative light on the character that shoots him. As such the specifics of what the injury are can be changed easily enough to serve these needs if (for example) research reveals that gunshot wounds 200 years ago were 100% fatal regardless where the person is shot. I just don't know a good place to research this kind of stuff :)

    I do think the shoulder wound is close to what I have in mind for this scene and what I have written already. I'll try and do some further research on that for a starter.

    Thanks for the comments!
     
  5. Shadowfax
    Offline

    Shadowfax Contributing Member Contributor

    Joined:
    Aug 27, 2014
    Messages:
    2,504
    Likes Received:
    1,337
    2
    200 years ago is a time when gentlemen duelled to settle their differences, and did not necessarily die (Andrew Jackson, later US president, fought a number of duels, sustaining a chest wound that gave him lifelong pain in one, the Earl of Cardigan - of charge of the light brigade fame - creased the hairline of one of his opponents) BUT why would somebody be carrying a handgun? They weren't that commonplace, they weren't the six-gun of western fame, they were muzzle-loaders, so you wouldn't just pop off at somebody.

    If you still think that the gun wound is plausible, bear in mind that gunpowder at the time was nowhere near as powerful as, say, during WWI, and the ball (almost certainly roundshot in that era) would have been quite a large bore - very heavy, but not very fast...more damage going in, but also more chance of not having the inertia to get out again.
     
  6. jannert
    Offline

    jannert Contributing Member Supporter Contributor

    Joined:
    Mar 7, 2013
    Messages:
    7,780
    Likes Received:
    7,292
    Location:
    Scotland
    Yes, once you said 200 years ago, my mind immediately said "1814." Have you done any research as to exactly what kind of weapon was used to inflict the gunshot wound? That will be important as to what kind of injury actually would be caused. And of course, whether it was inflicted close-up or at a distance. (And check distance, as many weapons of that period were pretty short-range and/or very innacurate. Rifles had been invented, but only elite sharpshooters used them in battle, etc.

    Also, obviously if it was that long ago, there would not only have been no antibiotics to fight infection, but the whole idea of infection was completely skewed. It wasn't until after the American Civil War period that any kind of attempt was made to sterilise wounds, etc. So that also comes into play. Maggots were sometimes used to clear dead tissue from a wound, and there were other remedies less effective to treat other aspects of injury. But to keep infection at bay was pretty much a hit and miss affair. It would be very unusual for a wound to remain uninfected, so fighting infection would definitely be a factor—and would certainly impact on healing time, never mind basic survival.

    While I was writing my story (which takes place in 1886 and also involves a gunshot wound) I ran across this book which might be of use to you, although the treatments etc are modern. However, the effects of trauma are well explained. Body Trauma: a writer's guide to wounds and injuries, by David W Page, MD, 1996, Writer's Digest Books.

    One of the best things to happen to me was running my scenario past a friend of mine who is a doctor. She very kindly pointed out the mistakes I was making, and gave me a lot of pointers about how she would have treated a wound during that period of time, where knowledge was still pretty basic and the opportunities and tools were limited as well. If you've got somebody you know with medical training, I'd certainly ask. Tell them exactly what you want to do—not I want him to get shot and recover quickly, but be very very specific. Exactly where on his body do you need the wound to be? What exact kind of weapon made the wound? What is the victim's basic physical conditon beforehand? What are the conditions like where he is injured ...battlefield, his front parlour, etc? What are the resources available to the person who treats him, etc? Hopefully your medical mentor can keep you right.
     
    Catrin Lewis likes this.
  7. Stephen Gazzard
    Offline

    Stephen Gazzard Member

    Joined:
    Jun 21, 2014
    Messages:
    58
    Likes Received:
    9
    ^ Thank you for the tip on that book ... it sounds along the lines of what I'm looking for. Any knowledge of any similar references for historical periods? Been trying to do some hunting on google but thinking it might be worth visiting my local library.
     
  8. Shadowfax
    Offline

    Shadowfax Contributing Member Contributor

    Joined:
    Aug 27, 2014
    Messages:
    2,504
    Likes Received:
    1,337
    Stephen, "about 200 years ago" is somewhat vague. However, 1815 was the battle of Waterloo, and the twenty years before that was the Napoleonic wars in Europe, and that came pretty soon after the French and American revolutions. Google any of those and you should get some guidance towards more specific sites.
     
  9. CGB
    Offline

    CGB Active Member

    Joined:
    May 15, 2014
    Messages:
    141
    Likes Received:
    45
    Gun shots were not 100% fatal 200 years ago. In fact, the ballistics of that time period were such that people often did survive the getting shot part.

    Now what I would guess most often killed victims of GSWs was a secondary bacterial or fungal infection. Specifically, the complications of such an infection. Of course, the location of the wound would be be important. Any GSW to the abdomen in that time had an extremely high fatality rate due in large part to perforation and spillage of bacteria from the GI tract into the peritoneal cavity. One result of such an event is bacterial contamination of the bloodstream (called septicemia), which even today in modern level 1 trauma centers is extraordinarily difficult to treat. An individual in the 1800s would have been screwed.

    But even wounds elsewhere are problem. If they hit a major artery, they could rapidly exsanguinate. Even if this wasn't the case, infections were still quite common. Remember, they didn't have a tetanus toxoid vaccine back then nor did they have antibiotics. I can tell you with 100% certainty that Clostridium tetani infections will ruin your whole day. Soil/dirt-contaminated wounds are a problem, as these bacterial are ubiquitous in soil, as is C. perfringens (the causative agent of gas gangrene).

    200 years ago was 1814, so that was still ~5 decades away from the experiments of Louis Pasteur which more firmly established germ theory, and ~5.5 decades away from Joseph Lister's popularization of aseptic surgical technique/carbolic acid use.

    Still, even before that doctors and surgeons (not necessarily the same at the time like they are today), may have used wine spirits (a light antiseptic, unbeknownst to them) as a part of a tincture which would be applied to wounds. I'm sure there were other antiseptics in use at the time (I would guess mostly by field surgeons who dealt with a lot of gun shots woulds and had plenty of subjects with which to experiment, but this is just a guess). You may have to do some more research on specific things they may have used for wound care.

    Source: 2nd year M.D. student
     
  10. GingerCoffee
    Offline

    GingerCoffee Web Surfer Girl Contributor

    Joined:
    Mar 3, 2013
    Messages:
    17,602
    Likes Received:
    5,877
    Location:
    Ralph's side of the island.
    History of Infections Associated With Combat-Related Injuries

    There are a lot of stats on fatality rates in the civil war at the top of page 2223. As long as some people survive, your character can survive.
     
  11. Jack Asher
    Offline

    Jack Asher Wildly experimental Contributor

    Joined:
    Sep 4, 2013
    Messages:
    3,571
    Likes Received:
    2,053
    Location:
    Denver
    3 things that no one else has touched on:
    1.) A modern bullet leaves the gun at around 250 C. Shot from 200 years ago would probably be cooler but not by much. This means that bullets are usually sterile when they enter the body.

    2.) Removing a bullet on the other hand is a great recipe for infection, in fact it's what killed President McKinley and scores of others. (This is the reason that President Teddy Roosevelt refused to let doctors remove the bullet when he was shot.)

    3.) Without the concept of recovery therapy, recovery time is going to very arduous. There will definitely be nerve damage and even if the bullet hit nothing of consequence there will be inhibited organ function. Surprisingly the human body has very few "useless" organs in which to take a bullet.

    All that being said I would suggest the bullet hit his liver. It has the fastest organ healing time, and regenerates better then anything else. Downside: Liver's have a hell of a lot of blood in them and internal bleeding is not something they would be equiped to deal with 200 years ago. Best have him jam something clean deep into the wound (modern soldiers keep a tampon in their medkits for this purpose).
     
  12. GingerCoffee
    Offline

    GingerCoffee Web Surfer Girl Contributor

    Joined:
    Mar 3, 2013
    Messages:
    17,602
    Likes Received:
    5,877
    Location:
    Ralph's side of the island.
    All good points, mostly. If the bullet rips the intestine or bowel, infection will almost certainly be fatal. And a ruptured spleen or liver almost certainly would end in fatal hemorrhaging, as would hitting any large blood vessel in the chest and abdomen. Though the liver is divided into lobes so it is possible to survive a hit in the liver if only a single lobe is hit and the bleeding can be stopped.

    Another source of infection is the open wound days after the trauma.
     
  13. AlannaHart
    Offline

    AlannaHart Contributing Member

    Joined:
    Jan 18, 2014
    Messages:
    367
    Likes Received:
    201
    Location:
    Australia
    Have a bullet ricochet off of something else and hit him in the head? It could give him a nasty looking head wound but on closer inspection, it mightn't have breached his skull.
     

Share This Page