Ten Popular Misconceptions About Injuries in Fiction

A Guest Post by M.J. Carlson

You’ve all experienced it—reading a thriller or watching a movie or TV show when a character is injured, sometimes severely, until the next scene, when they’re all back to normal and on with the chase.

In all fairness, the author may have never experienced that particular injury. Information about symptoms of injuries can be hard to find and difficult for the average person to interpret. So, to compensate, writers often talk to other writers about injury symptoms, paraphrase descriptions from other texts, or “just write whatever the plot needs to happen.”

To make matters worse, Hollywood has perpetuated a “hero as superhero” myth. Accordingly, Americans have come to expect their heroes to be bigger than life.

So, let’s take a realistic look at the ten most used (and misused) injuries in fiction.

Probably the most used, and misused, injury in fiction is head trauma. It seems every time a character needs to be silenced, subdued, or moved, or if one character needs to gain entrance past guards or escape captors, someone gets whacked on the head, rendering them unconscious for exactly the necessary time. The injured characters almost universally awaken with minimal symptoms, usually treated by simply wrapping gauze around their heads.

If you’re writing a story involving real humans, though, some things to keep in mind are: any head injury resulting in loss of consciousness for more than a few seconds will probably result in:
– sharp, stinging pain at the point of contact (usually the scalp or face) with bruising
– headache
– dizziness
– nausea/vomiting
– confusion
– blurred vision
– ringing in the ears
– decreased coordination
– light/noise sensitivity

Concussion with loss of consciousness <5 minutes may take days to weeks for complete recovery.

A moderate or severe head injury of loss of consciousness >5 minutes may also result in excruciating headache, repeated vomiting or nausea, seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and confusion, restlessness, or agitation and may take months to fully recover from.

Blunt trauma (probably fiction’s second most common injury) includes almost all transportation injuries, like motor vehicle collisions, pedestrians struck by vehicles, airplane crashes, and boating incidents, as well as jumping or falling from heights, blast injuries, and being struck by a firm object, such as a fist, crowbar, bat, or ball. In medical terminology, blunt trauma, blunt injury, non-penetrating trauma, and blunt force trauma are usually synonymous. In legal terminology, blunt force trauma implies intent. Blunt trauma can often lead to other types of injuries, including abrasions (road rash), contusions (bruises), lacerations, fractures, concussions, burns, and internal organ injuries.

Strangulation involves lack of blood flow or oxygen to the brain. The three types of strangulation are: hanging (suspension from a stationary object by a cord wound around the neck), ligature strangulation (strangulation without suspension using some form of cord called a garrote—usually from behind), and manual strangulation (throttling—strangulation using the fingers, legs, or crook of the elbow, AKA the “sleeper hold” popular on TV and in police departments).

Your character will probably experience panic (they will panic), rapid heart beat, tunnel vision, weakness, euphoria, hallucinations, slowed heart rate, and unconsciousness, all in fifteen seconds to a minute. On awakening, they may have a sore throat, headache, dizziness, or nausea and vomiting lasting minutes to hours.

A laceration is a tearing of the skin, not a clean cut (incision). The amount of pain involved is roughly proportional to wound size and edge irregularity. Skin wounds hurt because nerve endings are exposed to air, changing the pH. Depending on the severity, typical recovery time with stitches is 2-4 weeks, or months without stitches.

A puncture wound (penetrating trauma) is any wound deeper than it is wide. A puncture wound can be Low energy (spears, knives), Medium energy (arrows, crossbow bolts, handguns, shotguns) wounds result in a sharp, “jolting pain” and typically need 1-3 months recovery time, or High energy (high-powered rifles). These injuries usually require 3-6 months recovery time, often with permanent residuals.
– Arrow or crossbow bolt – often a sharp, ‘searing,’ ‘jolting’, or ‘stinging’ pain
– Bullet—small caliber wounds are often described as “a mild to moderate stinging” sensation, may not be immediately noticed by the victim unless a bone is broken or a lung is punctured. This is more common on battlefields, where adrenaline is high. Oh, Hollywood? There’s no safe place to shoot a human being. Any puncture wound, even a shoulder or leg injury, can result in massive blood loss and death within a few minutes.

Blood loss & shock: After more than about 1 liter of blood loss your character will start to experience:
– Confusion
– Rapid heart rate
– Rapid, shallow breathing
– Weakness and chills, starting in the extremities, moving toward the heart
Typical recovery time with intravenous volume replacement is 1-2 days, and without is 2-4 weeks, Hemoglobin replacement without transfusion for 1 liter is approximately 3-6 months.

Sprains and fractures are extremely common injuries in fiction. A sprain is stretching a joint’s tendon past its limit and a fracture is any disruption of a bone’s structure. The pain from either can be immediately incapacitating, sometimes resulting in shock and loss of consciousness. Typical recovery time for sprains and simple fractures is 4-6 weeks.

Sprains can be Grade 1 (a stretched tendon with no tearing), Grade 2 (some tearing of the tendon), or Grade 3 (complete tearing, resulting in an unstable/unusable joint).

A simple fractures is a broken bone, while a compound fracture involves a bone fragment poking out through the skin. As you can imagine, this is usually an incapacitating injury.

– Sharp, sudden, nauseating pain with a sickening “snap” or “crack” as the bone breaks
– Deep, aching or burning pain in the area of the injury
– Probable inability to move the extremity
– Possible numbness if nerves are involved
– Lightheaded or dizzy from shock (the character may pass out)

Burns can be radiation, thermal, chemical, or electrical. Burns are categorized according to the depth. A first degree burn is a superficial, painful burn, often resulting in reddening of the skin and little or no lasting damage. A second degree burn results in partial thickness damage to the skin in the form of blisters or killing skin cells at the top of the dermal layer (a dry, white look to the skin).

A third degree burn is painless, because the skin and nerve endings are dead. However, the surrounding skin is very painful because it’s at the second degree stage. These injuries always result in scarring, and usually contractures (inability to move the extremity in certain directions). Third degree burns usually require hospitalization and greater than 60% are often fatal. Rehabilitation from third degree burns is slow and painful, and usually involves rehabilitation hospitals, physical therapy, and removal of dead tissue.

Cold injury is also graded according to damage and depth. First degree is initially cold, then numb, with mild superficial pain on warming. Second degree is usually painless because of the numbing effect of cold. It’s a deeper injury, associated with blisters and peeling skin. Pain starts with warming of the area. Third degree is almost painless, because the skin and the nerve endings are dead. As in burns, third degree cold injury always results in extensive, deep scarring and contractures and probably the loss of fingers/toes, etc. Greater than approximately 10% of the surface area almost always requires hospitalization for dehydration and pain control, and may involve amputations of the affected body parts. Greater than 30% third degree cold injury is usually fatal.

Chilblains is a phenomenon where the extremities are exposed to hours or days of constant wetness and temperatures above freezing. Chilblains sometimes results in nerve/blood vessel damage.

In decompression injury (AKA “leaky spaceship syndrome”), symptoms of air hunger, shortness of breath, confusion, panic, blurred vision, and rapid heart rate start as air pressure drops below 8 lbs/sq in. Exposure to a vacuum does NOT instantly freeze skin. Heat loss through convection actually slows due to lack of a medium to absorb the heat (it’s a vacuum). Exposure to a vacuum doesn’t cause the body to explode. The surface blood vessels will rupture (most noticeably in the whites of the eyes). Gas expansion in the lungs is a problem, though. As blood vessels in the lungs explode, the lungs fill with blood.

Going the other direction, at ocean depths more of than a hundred feet, nitrogen from the air is forced into the blood by higher pressures. When the pressure is reduced back to sea level too rapidly, the stored nitrogen returns to gas and can cause bubbles in the blood, resulting in severe joint pain (gas trapped in joints, AKA the bends), heart attack, or stroke.
In conclusion, Super Hero Syndrome and Hollywood Healing are a fantasy. If you’re writing a superhero character (John McClane, Jack Reacher, etc.), this information probably won’t directly apply to your main character, but the characters they interact with will still be subject to normal human frailties. If used judiciously, this information can serve to enhance your storytelling and more fully engage your readers, thus providing them a richer, more enjoyable experience.

The story you choose to write is entirely within your control, as is your character’s (and ultimately, your reader’s) adventure. This concept is only one of many to consider when providing your reader with a fulfilling vicarious experience. If, by the end of the story, you and your reader are satisfied, you’ve been successful.

M.J. Carlson:

M.J. Carlson is an American science fiction author of numerous novels and short stories. He also maintains an active speaking schedule, giving workshops on writing software, story structure, and accurately writing injures from the character’s point of view. He lives in Melbourne, Florida, with his Wise Reader and Muse, Sparkle, and more computers than any sane person should have. For more information, check out mjcarlson.com or M.J. Carlson, writer at Facebook.

Two to Three Novels per Year…Yeah, Right.

empty handedI didn’t think I had anything to write about for Misconceptions, but then i realized that I had a common misconception staring me in the face. I’d planned on putting three books out in 2016. I’ll be lucky to get one. I think that’s due, in part, to a common misconception by writers and readers; for some insane reason, we believe that life will go as planned. Even though it’s proven to us again and again, that life will NOT go as planned, we still seem to believe that it will.

Take my story for instance. I already had Moon Shadows written, the first in a series of six, and so I was sure it would go out in 2016. Nope. Taking a closer look, I realized this is a series that needs a publisher. It has great potential as a YA novel, but changes need to be made and it needs the marketing and backing that a pubolisher, even a small one, can give it. So nope, not coming in 2016.

I was partway done with two other novels, but medical issues within my family and extended family took time as well as money. I needed to get a consistent income which meant getting a regular job. Now, most authors work and write so what’s the big deal? Most aren”t the mother of five, active in their church and community, and spending 3-6 hours a week with dr. appointments. Is that an excuse? Yes! I should manage my time better, get less discouraged, and I should make writing more of a priority. I watch TV to escape the stress, I worry about things I can’t change then can’t focus on my stories, and my priorities occasionally get completely screwed up.

I’ve gone off on a tangent a little bit here, but I think the point is valid. Life happens. Excuses happen. Recognize it, deal with it, and keep writing. Let your readers know that you’re still working. Change timelines. It’s okay. And if you can only get a book out every other year for a while, or even longer, that’s okay. After a couple of those, you may be able to get four out in one year. Will missing self-imposed deadlines affect your career and your fan base? Maybe, but not detrimentally. Don’t believe the hype that you HAVE to have X number of books out per year. Believe in your fans, believe in your art, and believe in yourself.

Cryonics, or Death Swallowed Up

O’ Death,
Won’t you spare me over til’ another year
But what is this, that I can’t see,
With ice cold hands taking hold of me.
– traditional American folk song

Take the nihilistic assumption that humans are in the process of dying the moment they are conceived. Everything our bodies do is to maintain the process of surviving through creating, maintaining, and eliminating. Start messing with the supply chain, the fuel,the equipment, or the director, and the body has a problem.

If you can get it back up and running, good. If you can’t…things don’t shut down right away. Death is a process.

But how what exactly IS death? What does that look like?

The line between “alive” and “dead” is getting more and more blurred as we advance in technology. At this moment, different countries and different people define death differently. Ultimately, if the person in your story isn’t moving, breathing, and has no pulse, they’re probably going to go in the ground after a few minutes of being like that, since the brain damage sustained and the medical technology available is probably not going to get them to any livable state.

But what if you could? What would that look like?

“Not breathing.”
I can hold my breath; Am I dead? I can be choking or in laryngospasm when drowning; Am I dead yet? No? I can still have a pulse even if I’m not breathing, right?

“No pulse!”
Through chest compressions I can pump your heart for you and give you a pulse. I can run it through a machine and pump it indefinitely.

“No…self-initiated pulse?”
No pulse doesn’t mean the heart isn’t working at all, and you need an EKG (electrocardiogram, or a “heart strip”) read by a trained person to tell the difference between “ineffective pumping” (therefore not producing a palpable pulse) and “heart isn’t showing any electrical activity at all” (asystole, or ‘flat line’). 

You could be in atrial fibrillation, which is basically the heart jiggling itself like jello. It could be persuaded to pump again, given a good shock to reset it. Why do you think they call those chest-paddles “DE-fibrillation”?

Note: You cannot use a defibrillator on someone who is “flat-lined”, or in “asystole”, where there is no electrical activity in the heart. You can’t de-fib when there’s no fib. You can’t reset a rhythm that doesn’t exist. You start CPR when you hear that flat-drone, or don’t get a pulse. Put the paddles down your doctors would know better.

In some countries, death is defined as no self-initiated pulse. Even in the US, if you can’t get the pulse back after CPR (if the patient didn’t have an Advanced Directive against it and weren’t considered “DNR: Do Not Resuscitate”), the doctor will generally call it (and the doctor has to call it, not the nurse).

There’s some wiggle room though. Even in asystole, the brain may still have electrical activity.
…Remember how I said that everything is breaking down, and that this is guaranteed?

Well you can slow it. You can delay it. You can even potentially reverse it (for the most part).

Since all things are made of cells, and cells are made of parts, and those parts are made of chemicals, and those chemicals are made of atoms, and those atoms are made of….well, they’re always moving. Even solids, like a table, are always constantly shaking. In place, but, moving. Everything is in motion in some way. If you slow that down, reactions don’t happen.

If you heat up a body, things start to break down faster. Fever can be dangerous because it can “denaturate proteins”, which means, it’s so hot, hot means moving fast, moving fast means shaking apart, breaking down.

So what happens if you cool a body, such as in cryogenics?

Yes, the ‘freeze them in time’ for future revival’ thing but that’s more cryonics.

Things slow down. Do it too slow, such as hypothermia, the damage won’t be stopped. The body is mostly water, so ice crystals can form and burst cells, circulation is cut off, essentially leaving the limbs for necrosis (and gangrene to set in).

But in people who have been cooled quickly, instantly almost, the process the body goes throu-…

Okay let me back up even more. Oxygen is required for a lot of the body’s processes. There is such a thing as a “reperfusion injury”, where oxygen is introduced to an area deprived, and suddenly it has all this…currency with which to pay the men to start destroying things.

“But it has oxygen! I thought that was a good thing! Shouldn’t it be happy?”

Yeah, but remember, the body is a jerk, and runs more like a bureaucracy. The paperwork had already gone through, they just ran out of ‘money’ on the project. So no oxygen, no currency, no processes. This can cause damage.

But if the body is cooled properly, it’s too slowed to actually do anything even if it has the currency of oxygen. It’s stuck in a stasis.

Some success has been made with patients who were quickly frozen by the environment or strategically frozen when in critical condition. We pull them back with slow warming and controlling and staying ahead of the destruction. One step back, two steps forward.

Imagine this for your story:

“Red” triaged patients who would normally be tagged ‘black’ (“don’t bother”) frozen to halt the death process until an appropriate level of care can be arranged.

A hospital that is overrun with casualties that can’t reasonably stabilize everyone without putting a few ‘on hold’. 

A cryogenic chamber that flash-freezes and slowly warms the patient up to bring them back after space-travel or ‘until we have the technology to treat your condition’. 

So here’s the million dollar question:

If we can pull them back, if CPR, cryogenics, and just…act of god for all we know, can make them alive again, were they really dead? And where is that line?


Squishy Humans: The Weak Link

This month’s topic is almost too good to be true. For an engineer, popular culture is like an endless fountain of improper physics to pedantically complain about. Seriously, it’s like crack to us. The best examples of physics in stories get most things right or are well-written enough to make us forget to look too closely. The worst examples are Armageddon.

Before I get into more specifics and insight a flame war, please view this post as seeking to educate, not ruin anyone’s fun. I’m willing to forgive quite a lot of bad physics provided the story itself isn’t cringe-worthy. That being said, there’s stuff we see in movies, shows or books that, given our current understanding of technology and physics, just wouldn’t work in real life. I’ll be focusing primarily on human beings’ tendency to go squish when confronted with sudden acceleration.

One of the questions I get a lot from non-engineers is why we don’t have flying cars. Over the years, I’ve come up with an only slightly snarky standard answer to this question. “Imagine if every car accident was fatal.” It generally gets the message across.

With that in mind, if someone asks why we can’t have an suit like the one Tony Stark wears, one problem (of many) is the number of high-speed impacts Iron Man sustains in that suit. If we assume the suit is made of super-light advanced alloys that could sustain high speed impacts without damage, that’s great news … for the suit. But if the suit is staying pristine, that means that it’s not absorbing the energy of the impact, it’s merely transmitting it. Sooner or later that energy must be absorbed, and if the suit isn’t doing it, the squishy human body wearing the suit is.

A great example of this phenomenon is with cars. Did you know that cars didn’t used to get all crumpled up in accidents? The invention of crumple zones, parts of the car intended to dramatically deform, was implemented as a safety feature. Again, something has to absorb and dissipate the energy of an impact. Crumple zones represent the car absorbing it and directing it around the driver. Even then, seat belts and airbags are required to keep the driver from getting slammed into something hard and unyielding. There’s no such thing as a free lunch. Either the car is getting wrecked, or the driver is. If Tony falls from two hundred feet up and is brought to a sudden stop by the ground, the suit (aside from some scratched paint) might well be fine, but poor Tony … not so much.

This problem of machinery dealing with sudden acceleration better than us squishy humans extends to dogfight sequences as well, be they in the air or space. In movies you’ll often see a manned aircraft or spacecraft evading missiles. It’s a great testament to the skill of the pilot hero! Trouble is, that wouldn’t really work. A missile is all machinery, electronics, explosive, and rocket or jet fuel. All of those things are more capable of surviving sudden, violent changes in direction than squishy humans. In the best case, our fearless pilot will just black out as acceleration forces all the blood from their brain. The worst case a big mess. Aircraft are specifically designed not to be able to do that to pilots. What that means is that they can’t just outfly a missile with no such soft tissue constraints. Missiles can be tricked or decoyed away, but as long as they are properly functioning, they will never be outmaneuvered by a human pilot.

Which brings us to the reason that all of this is forgivable. I’ve just spent six hundred-odd words telling you all the ways your favorite movies, shows and books are screwing up physics for the sake of excitement. But stories need characters, and most of them need human characters, or else they’ll suffer problems with relatability. While a real-life dogfight of the future would likely be fought at speeds too fast for humans to perceive, much less participate in (see Surface Detail by Iain M. Banks for a great example), most of the time such a battle would result in a story without any real stakes.

So what’s a science-discerning author to do when reality gets in the way of story? When possible, acknowledge the issues and try to make overcoming them integral to the worldbuilding or plot. James S.A. Corey’s series The Expanse does a great job with this, placing its human pilots in “crash couches” designed to absorb the energy that would crush their bodies and injecting them with “the juice,” a fictitious cocktail of drugs to prevent them succumbing to sudden, massive acceleration. These are great details that really enrich the setting and trigger enough of my engineering reward centers (presenting a problem and offering up a plausible-ish solution) that I’m willing to forgive them their stretching the laws of physics.

Above all, do the research. Treat your audience–and their intelligence–with respect. Always try to be aware of the rules you are breaking, and understand why you need to break them. Better yet, treat the rule as a storytelling constraint and try to use it to find a better way to tell your story. Many of your readers might not care, but you’ll make some future engineer reader very happy.

About the Author: Gregory D. LittleHeadshot

Rocket scientist by day, fantasy and science fiction author by night, Gregory D. Little began his writing career in high school when he and his friend wrote Star Wars fanfic before it was cool, passing a notebook around between (sometimes during) classes. His first novel, Unwilling Souls, is available now from ebook retailers and trade paperback through Amazon.com. His short fiction can be found in The Colored Lens, A Game of Horns: A Red Unicorn Anthology, and the upcoming Dragon Writers Anthology. He lives in Virginia with his wife and their yellow lab.

You can reach him at his website (www.gregorydlittle.com), his Twitter handle (@litgreg) or at his Author Page on Facebook.