.hine (hineas_estel) wrote in little_details,

Abdominal GSW & Peritonitis; Christian/Hindu marriage & gotra/kuli; UK&US medical residencies

I have three completely unrelated questions for fanfiction purposes that I hope someone can give me an answer to :)

1.) Set in the UK around 2006:

One of the main characters, a physically fit male in his late 20s, is shot in the abdominal area (lower left quadrant) from a distance. We aren't given details on what type of gun is used except that it might have been an automatic, so I plan to not go into detail and simply stick to whatever would work best for the scene.

After being shot, the main character is then abducted by the shooters, so he doesn't receive immediate medical treatment. Or any treatment, really, for about 24 hours or longer. He was also infected with an invented-for-tv strain of the pneumonic plague at about the same time he got shot, and starts showing symptoms after about 18 hours.

In canon, he survives all of this, only to be tortured to death at a later point, so I do have quite a bit of creative license. Nevertheless, I'd like to at least try to make things somewhat plausible. So, fact-checking!

First off, a gunshot wound to the lower left quadrant would likely cause injury to the intestines (colon or small intestine); but while this would cause some bleeding, it wouldn't kill the victim in a matter of minutes. The injury would, however, lead to peritonitis. According to the internet, this takes about 12 hours. Is this an accurate timeframe? And if not, what would be? How much bleeding would there actually be?

Due to the infection of the abdominal cavity by bacteria and the slow blood loss, the character would then go into septic and hemorrhagic shock. Online research has given me a time frame of 2 to 3 days of agony and in and out of consciousness before the body starts shutting down completely. As stated above, the character is rescued about 25 to 30 hours after getting shot. (He is given a mystery vaccine for the plague at that point, so I'm not sure if there are any symptoms / complication I should watch out for. Could it interfere with mechanical ventilation later?) But is it even likely for him to still be alive at this point? And what would his condition be like? I'm guessing he would be barely conscious, with high fever, severe pain and rigidity of the abdomen, racing pulse and shallow breathing. Does this seem accurate, or am I missing something?

Assuming the character does make it to a hospital, by means of tv magic or otherwise, what's the treatment, prognosis, and recovery like?

According to the internet, there will be ATLS procedures, followed by surgery (laparotomy to explore and repair, as well as intravenous broad-spectrum antibiotics. Anything I'm missing here?) Would it be possible to have only the one surgery or would it be more likely to have several over a matter of days? If it's the former, would the wound be closed immediately? Or would wound closure be delayed to ensure there is no infection. If the latter is the case, how long (or short) could that delay be?

If I understand correctly, after the surgery, the patient will remain intubated, given a paralytic agent to prevent movement, and be closely monitored to make sure the infection is cleared. The internet gave me a timeline of about 9 days in the ICU, 5 of those on a ventilator, with about 30 days of staying in the hospital in total. Does that sound about right? Also, I’m not sure what would actually happen during that time. Any insights? Additionally, what complications could arise?

Finally, I read that the recuperation period usually takes 6 to 8 weeks, after which the surgical incisions have healed about 90% and pain medication is no longer necessary, but that full recovery may take longer. What would be the recovery time for best and worst case scenarios? And what possible side-effects could there be during recovery? What about PT?

Ideally, I’d like the character to make a full recovery, while making the injury and following illness as dramatic as possible, obviously. I’m perfectly okay with the recovery process taking several months, however.

Searches done include the gsw tag of this comm, as well as variations of gsw to the abdomen / gut-shot + injuries / complications / recovery time / etc. as well as (penetrating / secondary) peritonitis + treatment / recovery / etc. I also looked into laparotomy + recovery. Basically, I have a rough idea of what is going to happen, but a lot of info floating around is either based on hear-say or what people saw on tv, so I'm not sure how accurate the above is. And did I mention timeframes? ;)

2.) Set in the US, circa 1980

If a white American man and a Hindu (Marathi) woman marry and have a child, and that child chooses to to follow the Hindu faith, what gotra (kuli?) – or caste, for that matter – would the child have? From what I understand, both systems are usually strictly patrilineal. Would that mean the child just wouldn’t have one? Or could he take that of the mother, or maybe of the maternal grandfather?

The parents of the child in question end up getting divorced, in case that makes any difference.

Searches done include variations and combinations of child + interracial/interfaith marriage / christian father & hindu mother + gotra / kuli / caste.

3.) Los Angeles, around 2007

I have a main character who, after finishing med school and his general surgery training in Britain (CCT), decides to go to America and become an ER doctor. This obviously requires him to jump through a number of hoops before then starting an ER residency. His fellow residents have gone to med school in the US (and according to tv canon, spend one year interning before starting their actual residency).

As I understand it, some of the duties of an ER resident in the US coincide with MC’s training duties in the UK (ward rounds, clinic duty, acute patient assessment & on-call duties in A&E). I’ve also read that because of the longer training and having to deal with a lot of minor things that aren’t related to one’s specialty, UK doctors tend to be much better generalists. On the other hand, intubations etc. seem to be something that is almost exclusively handled by anesthetists in the UK (Correct me if I’m wrong, please!).

My question is how experienced/competent, or inexperienced, the main character would be compared to the other residents. Is the MC so specialized after completing his surgical training that he’d be unused to perform certain procedures, therefore doing worse than his peers? Or would his experience mean he’d be able to react and deal with things more efficiently and calmly? Both? I’d be grateful for any insight. Into differences in attitude as well.

Research: I’ve read up on duties and jobs of residents/SHOs & registrars in the US/UK, and sifted through various documentaries available, so I have a decent knowledge of how things work. I just haven’t been able to find anything about this particular issue.
Tags: india (misc), uk: health care and hospitals, usa: health care and hospitals, ~marriage, ~medicine: illnesses (misc), ~medicine: injuries to order, ~medicine: injuries: gunshot wounds, ~medicine: medical education, ~religion: hinduism

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