cade_bertezim (cadebertezim) wrote in little_details,
cade_bertezim
cadebertezim
little_details

Lifethreatening infection/septicaemia/MRSA/something nasty after shrapnel injuries.

Setting: A roughly modern fantasy world. If it makes a difference, these events are taking place in a hot, dry climate, though the character is near a major river delta when he's first wounded.

I’ve searched:  “blood poisoning, shrapnel” “septicaemia, shrapnel” “MRSA wound” “infected wounds” and every variation I can think of, and I’ve consulted Little Details before. My research has helped, but I just want to be sure I'm getting this right.

This is a follow-up to this post,on giving a character a potentially fatal infection from a wound, while still keeping him functional for a time.   Back then, when this part of the story was still in the planning stages, I thought I wanted the situation to play out over a much longer period of time; now, it’s more like ten days or so.  And while I always meant the kitteh character’s life to be in danger, I used to think there was no need to have him actually at death’s door when I  swooped in with the healing phlebotinum. I now cannot fathom this: of COURSE he should be at death’s door!

I think the contracted time-scale actually helps with plausibility.  But another change may be more of a problem - back then, I imagined that the kitteh character, who is a fugitive, would receive no professional medical attention at all. Now he  actually has two rounds of access to medical treatment – once when he’s just been injured, and later, in another country, when he’s very ill indeed. Despite this, I need him to not get better.

So I thought “Well, I’ll just write what I want to happen, using the information I have (from the last post), and finish the story, and polish it up later.” and polishing it up is the stage I’m at now.

The character is a fugitive in his early 30s, This may be relevant in that we may assume their bugs are at different stages of resistance to antibiotics, or something – but I’d prefer to have this feel like something that could happen in the real world.  I described him as otherwise healthy before, but if necessary he could be physically run down – he’s been living a gruelling sort of life.

1)    He is hit by flying shrapnel during an air raid and receives lacerations to his back.  He’s not in too much pain at first, and hoping he may be able to get by with only amateur medical treatment, he picks himself up and stumbles off to a friend.
2)    Friend says, “You’re an idiot, this looks a total mess, let’s take you to hospital.”
3)    Hospital is overwhelmed and dirty and in some way botches things –e.g leaves some fragments of something nasty in the wound? But he is stitched up, given antibiotics and sent home. 
4)    Antibiotics evidently aren’t strong enough/the right kind, because a few days later his temperature is rising and the wounds aren’t healing properly.
5)    He does not dare to go to a hospital again for plot-related reasons. His friends get him black market antibiotics and he seems to improve rapidly, finds he needs more rest than usual but otherwise can cope with travel, making decisions, etc.
6)    About 8 days or so friend takes his stitches out. I wrote this as painful enough to upset said friend, but not unbearable, with him bleeding a little. But everything mostly holds together and looks okay.
7)    The next day (presumably he’s run out of the black-market antibiotics?) he starts getting feverish and becomes more and more unwell. Receives some antipyretics which improve his symptoms for a few hours, but nothing else. Nauseated, can’t eat. Nevertheless, like the sensible character he is,  he travels to a (fictional) war-torn third world country.
8)    “I’m okay I’ll lie down in a minute yeah everything hurts and the room’s spinning but I just need to do this one thing” BOOM COLLAPSE DYING NOW ANGST FOR EVERYONE.
9)    There’s no longer any problem about taking to him to a hospital – he can have the best medical attention the war-torn country can provide. (...hopefully not that great?) I have them cutting some shrapnel/diseased tissue out of his back and sticking him on a ventilator. But alas, he is still dying, dying, dying. Well, I need them to be extremely pessimistic about his chances.


 What I need to know:

    Obviously the primary question is “Is this plausible and if it’s not, how can I make it so?”   and the secondary question is “what would the wound look like and feel like,” especially at stages 5, 6, and 7?

More specifically:

a)    I like the idea the doctors miss some bit of shrapnel that’s gone deeper than the rest, and by the time it’s found and removed, it’s “too late”. But I fear it may actually be unlikely that the shrapnel would cause infection in itself, and a iatrogenic infection might be more plausible.  If so, is there anything specific that might have gone wrong?
b)    Would there be something obviously wrong at stage 6? (Can there not be anything obviously wrong?) And either way, would taking out the stitches (I’ve implied that there are lots) be more or lesss painful than the “distressing but bearable with gritted teeth” level I’ve written it at?
c)    After stage 6, I’ve  focused much more on the fever/ultimate organ failure etc than on the wound itself. What would be going on with the wound?
d)    Is there anything obvious I've missed?
 

Tags: ~medicine: injuries to order, ~medicine: septic shock
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