WRITERS: Ask Me Your Medical Questions!

Lordy I have no idea how old this ask is because I been dang negligent.

Without seeing the wound myself I’m not sure. If it’s purple sounds like there’s some deep bruising/hematoma going on there.

Also BRO this is not a medical advice blog and I am not a doctor. If you can’t feel your foot and your tissue looks weird YEAH go get seen. Please! You’re foot will thank you.

This is more a space for writers to come ask someone who actually works in health care whether or not their medical scenes are gonna break suspension of disbelief. Or like. Go through medical details or something.

Hi, I'm an aspiring fantasy author! I don't know if you'd know the answer to this question, but I thought id ask anyways. I have a woman whos death I'm writing that is very tragic and sad, long story short, there is a war, she is poisoned by a villain, as the poison is slowly coursing through her veins, she knows she will die. She is pregnant , so she decides to cut her baby out of her stomach in hopes that it will survive and not be poisoned. No one else is around to help her in the middle of a battlefield. ( the child is supposed to survive in the story) How far along would she have to be for the baby to survive? How much blood loss would occur? and how quickly would she die, or how long could she live before dying? What would be symptoms of cutting a baby out of your body? (for example would you cough up blood or pass out or something)? I know its crazy but I'm trying to keep it as realistic as possible. any info would help :) 

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Oof that’s a doozy!

So my first thought upon reading this is…. She better we performing that cesarean very very quickly. Mom and baby share a blood supply so if she has a poison in her blood stream that’s going to kill her, it’s going to kill baby that much faster.

So then that leads to: how was she poisoned exactly? If it’s entering her system via blood stream, or even intramuscularly, she has very little time before she’s just straight up poisoned. When it comes to anything “coursing through veins” there’s really no “slowly” about it y’know what I mean?

If it’s something she ingested, she has more time as then she needs to absorb it through her stomach or intestines, but then you also have to ask why she wouldn’t just make herself vomit (not that that will be 100% protective, but it will certainly help).

To get down to your actual questions:

Fetuses are considered viable at 24 weeks. That is, their lungs are juuust developed enough that they can actually use them. There have been cases of babies even more premie than that surviving, but that’s a baby that is gonna have a loooot of problems. Even at 24 weeks you’re really pushing it. If you’re talking about a battlefield, blood and grit type of situation where you’re really not going to have access to supportive devices, pulmonary support, temperature control, resuscitative measures, etc. 24 weeks is pretty unrealistic. 24 weeks is going to be a pretty sick baby that’s going to require a lot of medical support.

So that’s a thing that possible I guess. Is in necessary to the story that the baby MUST be preterm? Viability and infant health decrease, and complications increase with every week you fall short of full gestation. I would assume in the type of situation that you’re talking about, in order for the infant to survive, they would need to be pretty close to full term. So while OB and peds are definitely not my specialty, based on what education I do have, I’d say you probably couldn’t go much lower than 34 weeks and have it be realistic.

A lot of blood loss would occur. The uterus is highly vascular, it’s under a lot of pressure (as you could imagine), there’s gonna be bleeding; and that doesn’t even get into shit that can happen with the placenta. C-sections have been performed outside of a hospital setting and people have lived through them… but there’s a lot that can go wrong, particularly if you’re doing it to yourself fueled by necessity and panic. She’s not gonna be careful. She’s not expected to survive either way right? That’s all pretty straight forward. She’s gonna bleed to death either way, but she’ll have at least enough time to get it done. It’s not like we’re talking about an aortic rupture, this is not a situation that she’s going to bleed out in seconds. As long as she’s not just hanging bleeding out of her uterus for a prolonged period of time, I’ll buy it. Everyone’s different, there’s no universal rule on how long it’s going to take someone to bleed out, or to start getting symptomatic from blood loss, etc. so just be reasonable. She’s not going to be high functioning for thirty minutes, however, she might be with it enough to perform complex tasks for 10-15.

I’m more concerned, actually, with what’s gonna happen with the kid. There is a blood-placenta barrier and MAYBE you could make an argument that whatever the poison is can’t cross the barrier…. But idk that’s a stretch. I think shit like arsenic and lead exposure to mom are able to affect the fetus. So I would think that cutting that umbilical cord (the source of poison) is going to be the number one priority. Make sure she has something to clamp that sucker with or else baby’s gonna hemorrhage and die too.

SYMPTOMS: nah you’re not gonna cough up blood since your uterus is not connected to either your stomach or your lungs.

But- she’s going to be in excruciating pain. I’m not sure what kind of poison you’re using in this case, so can’t speak to that. But if we’re just talking blood loss here: she’s going to start getting dizzy, nauseated, sweaty, and shaky. She could be vomiting. Her heart rate is gonna sky rocket. As things progress she’s going to start having mental changes, confusion, anxiety, and eventually unconsciousness. That progresses to death obviously. Again depending on the type of poison, it’s debatable whether the poisoning would like, shut down her respiratory system, or she’d die of blood loss first.

So I was wondering, If someone were to wake up in the hospital, high on adrenaline, would this lessen the affects of sedatives until he calms down? I’m sorry if it’s a stupid question I was just really curious about it.

Thank you for your time :)

Woo buddy I’ve used a lot of sedatives. Literally everyday at work I’m giving moderate sedation at least 4-5 times. I’ve also frequently received ICU and ED patients who are intubated and on the heavy drips (propofol, precedex). And I’ll say it all just depends?

Typically, we’ll start to see signs that someone needs heavier sedation and then adjust accordingly to keep someone nice and calm, so it usually doesn’t get that far. However, the short answer is yes, because of a variety of reasons (pain and fear being chief among them), patients can often become agitated and combative even while sedated. I’ve seen people basically levitate off my procedure table even with lots of sedation on board. Again I will say it’s a stretch because sedatives work really well for most people, and literally the point of many of them (versed) is that even if they would normally be panicked (you mentioned adrenaline?) they aren’t experiencing that fear. Signs of agitation will start appearing well before when we’d technically consider someone conscious, abs if they have a good and attentive nurse, and their blood pressure can tolerate it, whatever IV drip they’re on will get titrated up really fast, before it ever gets to that point.

So the long and the short is that sure, it’s possible and happens, but it’s not super likely. Especially if someone is intubated on a super heavy drip (like propofol).

Just like with everything else it depends. What is she landing on? Rocks? Dirt? Mulch? Someone’s thatch roof cottage? How is she landing? Shoulder first? With her arm out? Hip first? With her weight evenly distributed? Did she try to catch herself with her hand when she hit the ground?

Disclaimer here: trauma and ortho aren’t my specialties, but with the knowledge I do have, and depending on the variables, I’d say you could make a case from anywhere from just some nasty bruising all up her side to more severe injuries: dislocated shoulder, broken arm bones/wrist, fractured pelvis, broken ribs and the complications that go along with that (punctured lung, pneumothorax, internal bleeding, etc.). This is one of those scenarios where it wouldn’t be too hard to convince me either way that she walked away with just a few scrapes or that she had more serious injuries. It depends on how she lands, what she lands on, and really just how lucky she is. What outcome do you need narratively? Adjust your variables accordingly.

So this is really gonna depend.

1 cm razor blades are enough to do plenty of damage depending on where on the body the wound is. I have seen people bleed out from a 2mm puncture site in an artery. But this happened BECAUSE it was an artery. This isn’t a hard and fast rule obviously. So let’s dig into this a bit.

The body has two vascular systems basically. There’s arteries and veins. Arteries are incredibly high pressure and all it takes is a tiny hole in certain large arteries (think femoral artery) in order for someone to bleed out fairly quickly. The arterial system is very high pressure as it’s the system that delivers oxygen/nutrients/etc. to all of your body tissues. So in order to do that it needs to be under pressure and move along a pressure gradient from high to low (heart generates pressure when it contracts and is the source of the pressure gradient. high pressure/arterial—> low pressure/venous, and then blood returns to the heart and the cycle restarts). Obviously this mechanism works great for that, but the side effect of that is when the structural integrity of the artery is compromised it can be really hard to control the bleeding, and holes in the arteries don’t close up like more superficial/venous wounds as the pressure from the blood gushing out of the hole maintains the patency of the opening.

On the other hand, more superficial, non-arterial wounds typically don’t have the bleeding powder for someone to lose so much blood that they pass out. They bleed for a bit and then close up on their own. There are some exceptions, like with the great veins of the body, but those are usually pretty deep and inaccessible (vena cava), or are located fairly close to arteries (example: the femoral artery and vein are right next to each other) so at the point that large veins would be compromised, it would probably be the least of your characters problems because either they’d have organ damage, or their arteries would also be gushing blood (probably). In order for someone to pass out from these kinds of more superficial wounds, it would have to be pretty darn extreme - probably superficial full body wounds. (Side note: with that extensive kind of damage to the skin they’d be a massive infection risk after this)

Anyway, there’s another issue here that I can see and it’s that once you’re at the point of passing out from blood loss, you’re already deep in hemorrhagic shock. Brain perfusion is the body’s priority, and as such it will receive blood at the expense of basically the rest of the body. If you’re passing out from blood loss, you’re in pretty critical shape. Losing enough blood for brain perfusion to be decreased (leading to unconsciousness) in ten minutes is a pretty significant gush that isn’t going to fix itself, and things are going to start going downhill really fast at the point that they’ve passed out. This would not be a gentle loss of consciousness for this character. This would be a massive crash, and the situation would continue to escalate. They would be in major peril and would require some kind of medical intervention in order to survive this.

Assuming they survive that kind of rapid blood loss, recovery and resuscitation will be necessary. Whoever is on the receiving end of this narrative treatment is probably going to have a rough go of things after this. People who lose that amount of blood are usually going to deal with complications, organ damage (especially the kidneys and intestines!), and limb ischemia at various levels. They may have issues with clotting and stroke. Depending on the severity, they may have brain damage. Etc. what I’m saying is that they’re gonna be in bad shape.

Without knowing all the context here (idk, maybe you really need this character to ACTUALLY lose enough blood to pass out), if the narrative goal is JUST for them to lose consciousness: an alternative is that rather than passing out from blood loss the character could have whats called a vasovagal response. This is a fairly common phenomenon. You know those people who faint when they get stuck with needles or when they donate blood? They’re vagaling. This is where there is a very sudden drop in heart rate and blood pressure that causes unconsciousness in some people. A lot of things can trigger it - anything from bearing down to poop, to the sight of blood, to fear responses. You’d be shocked how many people I’ve found down in the bathroom because they were constipated but especially determined to get one out. It’s also not uncommon to have people vagal when we’re holding pressure in sensitive areas (like if we’re holding pressure in the groin because there’s an arterial puncture). The unconsciousness is usually brief and fairly harmless, and unlike passing out from blood loss you don’t have to deal with the long term side effects and complications that occur as a result of major blood loss, e.g. injured cleanie-beanies.

So, to recap - if you really need them to pass out from legit blood loss in 10 minutes:

From superficial wounds, it would have to be pretty excessive/all over the body and they’d probably pass out from pain before they got to that level of severity wrt blood loss.

From arterial, you just need one good puncture in the right place - most accessible arteries would be radial or ulnar arteries (in the arm and wrist) or the femoral/popliteal (in the groin or behind the knee) but the caveat there is that if you don’t want your character to die, that arterial wound absolutely needs to be dealt with quickly as it won’t close up on its own and if your character is down and out, they’re realistically about to die. You also should probably take into consideration the potential complications and the recovery from hemorrhagic shock.

Does it need to be blood loss? Or is the goal just unconsciousness? Because if that’s the case: have them vagal. It can still be the result of them being wounded/blood loss but the mechanism and severity would be different. They could look down and see one decent sized gash that looks much worse than it is and pass the fuck out. Some of their symptoms leading up to that would be similar - shakiness, dizziness, nausea/vomiting, etc. but there won’t be any long term consequences for their internal organs.

@studio-hatter

I love reading fic. It used to get me through fucking longass nightshifts and it still gets me through slow days when no one is having a heart attack. I love and appreciate those of you who write them for keeping me sane at 3am/when the shift is dragging. But as an RN who’s spent years at the bedside and in emergency procedural areas, NOTHING takes me out of the moment like a poorly written hospital/medical scene. Please let this be my service to all y’all.

I’ve been a nurse for years. I have my own specialties that I’m most comfortable with but enough general knowledge to cover most medical topics. I know how the floor works, I know how the ICU works, I know how procedural/OR works. And barring that, I have hella resources to tap into at work.

Are you not 100% sure who should be filling in what role? Please ask me. No I promise the MD ain’t programming that IV pump and that nurse is about to lose their job by forcibly taking your characters possession away without a really good reason. Them ‘needing their rest’ is not a reason. Not sure how long it’s gonna take the IM injection to sedate your character (or how that sedation will look)? Hello. I am here 4 u. Do you think that massive impaling wound is going to be accommodated at a tiny community hospital in rural Maine? Think again, bucko! That’s a rapid transfusion and and an expensive chopper ride to a trauma center near you. Probably! Are you trying to make your medical scene work a specific way but don’t really know how it would look? I can contrive the fuck out of some cause for you.

Hospitals can be overwhelming, nebulous, frustrating, and confusing. Even to those who spend most of their lives there. The way things run, or how certain processes work is not always readily apparent.

SO! I’d love to fill y’all in on the nitty gritties of hospital flow and culture, answer your medical questions, or even glance over your scene for you. I get that you all have done exhaustive research to get things just right (and trust me when I say I am thankful!!!) but let me help lighten the load. Please let me give back to the community by making sure your hospital scene doesn’t suck!