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Multiple real injuries from a supernatural event
quelquescoeurs wrote in little_details
I'm trying to write a story where one character goes through a supernatural experience and ends up with some serious medical issues.  Basically, his entire body is put through the wringer.  I want the character to be physically compromised, even disabled, but have his mental faculties more or less intact.  Here's what I've come up with so far.  I won't go into this much detail in the story, but I want to have a clear picture in my mind.

  • Subdural hematoma from brain swelling/injury, which addressed either with surgery, an induced coma, or both.

  • Pulmonary edema that is a cause of concern for a while but resolves relatively quickly

  • Dilated cardiomyopathy as a result of the pulmonary edema and/or myocarditis

So far, I figure the effects from these (besides increased risk of sudden death) would be:

  • Extreme fatigue, loss of concentration, short-term memory loss, and increased anxiety as a result of the brain injury

  • Risk of edema, embolism, and arrhythmia.  The character would have to wear a life vest to defibrillate his heart, or have an ICD surgically inserted.  Would compression socks be used for edema in the legs in this case?

  • Won't be able to physically exert himself for some time, and then will have to be careful

  • Will need physical and occupational therapy

  • Will have to eliminate sodium, fat and caffeine from his diet

Does all of this make sense? What would tell the police or doctors if you brought someone in like this and they were unaware of the supernatural?  If anyone has any tips or advice about accurately depicting these kinds of injuries and the fallout from them, I'd greatly appreciate it. Thanks for your time!

You do realize that both sodium and fat are essential for life so he would have to reduce rather than remove them?

Yes, you're right. I should have said reduce, not eliminate. That was a poor word choice.

when you're talking fat - which kind of fat?I have a slightly elevated blood cholesterol, so I was advised not to eat certain kinds of fats(i.e. beef) but actively encouraged by my dietitian to eat others(i.e. Salmon)

Probably saturated fat, because of the strain it would put on the heart. Monounsaturated and polyunsaturated would probably be okay in moderation.

Your character may even have compression socks for the coma / after waking but before he is allowed to move much. He will almost definitely have painful shots (in the stomach) to improve/maintain circulation during this time, regardless of the socks. What timeline do you have in mind for recovery from the effects of the brain trauma? Does it happen during the story?

He will probably also need speech and occupational therapy.

What kind of shots will he need in his stomach? Do you know the name of the drug or exactly what it's supposed to do? That might be an interesting detail to add.

His recovery does happen during the story. For his arc, he will struggle with his new medical conditions and with finding meaning in activities other than those he's been used to.

As for a timeline for the brain trauma, I was thinking the first couple of months would be worse--I like your suggestion of speech therapy as well as occupational--then he would mostly suffer from fatigue, anxiety, and trouble concentrating. Does that sound about right? Does he need more time?

Disagree about stomach shots, I've never heard of anything like this...?

I speak from experience. =)

haha okay. I was misled by the words "stomach shots" and "improve circulation" and the fact that you were associating it with compression stockings.

Well that's what they were from my perspective, what I thought the nurses told me they would do and what they told me an alternative might be. *shrug* =)

The "shots in the stomach" would be a low-molecular weight heparin, like enoxaparin - I.e., an injected anticoagulant. They're for prophylaxis against clots (like deep vein thrombosis), which is a serious risk if you're immobile and especially if you have an arrhythmia. Patients would have them every day, same time each day, in the flesh (well, subcutaneous tissue) of the abdomen - although not everyone finds them painful, depends on who gives it as much as anything. They do tend to bruise around the injection site, though. They also don't HAVE to go in the abdomen, we sometimes get asked at my place of work if it can go in the thigh or arm - answer is yes, but it'll probably hurt more as there's less area to inject it into.

NB: I work in the NHS so the nitty-gritty might be slightly different where your story's set, but the basics should be the same.

Interesting. My story is set in the US, but I'll look more into that. Thanks.

Glad to know this! Thanks =)

ETA: I should have checked the new comments before replying. Sorry for the less informative repetition!

No idea on the drug, sorry, only that it stings and is to prevent blood clots, etc., from lack of movement. Assuming he can eventually walk he will get (I think) one a day until he is up and moving around regularly with no walking frame (at least 2 weeks if his coma is a week+ and his recovery is considered extremely fast.)

The timeframe sounds right-ish. Lights and/or noise may also be a bother and he is highly at risk for depression. (Even if he doesn't have it, doctors will expect it.) The side effects will vary depending on the location of the injury to the brain. Memory may be a big one too. It is highly likely he will not consciously remember any of the event that led to the trauma (though may have related dreams), and he may not remember hours, days, weeks or even up to a year or so before the incident (though he also might remember it okay but with a few gaps.) Any difference in functioning will be very frustrating and as time goes on he will begin to really understand the new limitations he has to face. The apparently tiniest thing (to others) can be heartbreaking to the one experiencing it.

Don't forget to account for post-traumatic amnesia (probably a day but certainly not a week if you want him to regain/retain high brain functioning).

How long is he in a coma for? This will have a huge bearing on his physical strength. If it lasts a week, then he likely won't even be able to lift a cup of water for about a week. I imagine that if it goes longer, the effects will be worse.

Happy to answer any more questions you may have in a pm =)

Edited at 2014-07-30 12:01 pm (UTC)

Very helpful, thank you! I was thinking the coma would last about a week, so this works great. I'll pm you if I think of any other questions. :)

Some anonymouse evidently thinks that a discussion of recovery from a monster-mauling is a suitable place to pimp their auto-racing video game.

Got it.

Dilated cardiomyopathy is a very chronic process, and wouldn't be caused by short-term pulmonary edema or myocarditis. Normally dilated cardiomyopathy is the result of chronic heart failure or it's genetic.
Compression stockings are usually not used for peripheral edema because it's painful (usually pts are screaming when you press down even a little). Typically patients tend to take water pills (lasix) that basically makes them urinate to get rid of the extra fluid in their body, thus reducing the edema.
The case you described isn't really a case where an ICD is indicated unless pt showed signs of atrial fibrillation (in which case they should also be on blood thinners indefinitely) or some other sort of arrhythmia.

The issue I would have here is that these are very chronic injuries (perhaps minus the brain hemorrhage). I don't know how long your person was exposed to this supernatural environment but unless it's months to years, it's unlikely to happen.

Yes to diet restrictions, also fluid restriction.
Unless your character's heart failure was caused by unhealthy lifestyle, there is probably also no reason for you to restric their fat intake.

(Last concern for you: I find chronic heart failure/dilated cardiomyopathy an extremely unsexy disease because the pts tend to be old and unhealthy... but this is extremely personal, your readers probably won't think the same way :P)

Edited at 2014-07-29 03:04 am (UTC)

Thanks for the clarifications. This is very helpful.

My character has been exposed to this supernatural environment for the better part of a year, and it almost kills him. Since it is supernatural, I'm not too worried about the likeliness, though I appreciate your point. I agree that none of it is possible, really, as the supernatural does not exist. But I want to set this in the real world, so the medical treatments and conditions need to be as close to real life as possible.

I agree that this is an extremely unsexy disease. My character is in his thirties and was perfectly healthy before he got sick. I've always been drawn to the less sexy parts of life, I guess. :)

Ah okay. I was contending with your description that the dilated cardiomyopathy would be caused by pulmonary edema and myocarditis. If you just told me his heart somehow became floppy and dilated due to a supernatural event, I'd support that :)

Good, I'm glad that my explanation makes some sort of sense. Thanks for your help. :)