Series Post: Ask Dr. Dina - Loss of Consciousness

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance! That being said, let us continue.

Today I begin a series of ELEW blog posts inspired by our lovely Bitchstress Dreamkiller called "Ask Dr. Dina."

As the above disclaimer states, I'm not really a doctor, nor have I ever been. I have worked in the medical field in various settings and have an extensive and varied medical background. These posts will all focus on how medicine applies to your writing.

We’re going to start this series off talking about fainting. In the medical field, this is called "syncope" or "sudden loss of consciousness" (not to be confused with "altered level of consciousness" which is a separate issue I will address in another post). Both are written as LOC in medical charts.

Writer Andrew Jack has done an excellent series of posts involving fighting, and he addresses some fantastic points about what it's actually like to lose consciousness and the repercussions involved.

Let's bring up some of the names people call LOC, shall we? "Fainting," "passing out," "blacking out," "knocked out," "unconscious," etc. They all mean the same thing. They might not all have the same cause (because there are a lot of reasons LOC happens), but they all mean the same thing. Your character is non-responsive.

As Andrew up there says, LOC isn't a quick thing to recover from. You don’t just pass out, then when you "come to" get up and are your old self again. Depending on the cause of the LOC, there are going to be problems – disorientation at the very least. If you've ever been knocked out – and I have – you're going to have a headache. How long and how bad it is depends on what happened. Even something as simple as a sudden change in blood pressure can cause LOC, and when consciousness is restored, your head will pound.

There are various stages of consciousness (the altered states I'll talk about in another post), ranging from mild WTFery to coma. "Coma" or "comatose" means you're not able to be roused by any means (and there are lots of ways to try and bring someone around, and most of them aren't pleasant). You're unconscious. This can last minutes, hours, days, or longer. Sometimes you never regain consciousness, but that's another post.

If you've ever called an ambulance or been in the emergency room and been asked what you thought were silly questions, there's a reason for it. They're trying to determine your mental status. If you don't know your name or what day of the week it is or who the President is or how you got where you are (or don't know where you are at all), it tells the health care professional a lot of things. Your answers determine your LOC and by proxy what needs to be done to help you/what part of your brain is affected.

When they shine a light in your eyes one at a time or put their hand in front of your eye and pull it away again, they're looking for a reaction in your pupils. Your pupils can tell a lot about your LOC (which is why a policeman will shine his flashlight in your eyes at night when he pulls you over – if you're stoned, your pupils won't constrict like they're supposed to. They'll remain dilated thanks to the high you're riding). It's called PERRLA – "pupils equal, round, react to light, accommodation." If any one of those things is off, there's a problem. If you ever see someone with one pupil bigger than the other (and believe me, this is noticeable), it's called a "blown pupil" (mydriasis) and generally (but not always) indicates stroke or other intracranial pressure issues.

As I said, a lot of things can cause LOC, and those things have consequences. If your character is knocked unconscious by a boot to the head, how long they're out and how they behave when (if) they regain their senses depends on you.

And therein lies the problem.

You need to know, as a writer, if their reaction to their change in LOC is realistic enough FOR YOUR WORLD. If your charrie is superhuman or not human at all or has special abilities and can take a blow to the head and be fine, all right. Great. But justify that. If they're just a regular person, be sure and add consequences to being knocked out or even just beaten up.

If possible somewhere in your story, have them checked out by a medical professional. It's the least you can do.

 Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)