Series Post: Ask Dr. Dina - Breaking Stuff

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. This is the third post in a series 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.

Today we're going to talk about trips and falls.

We've all done it. We've all tripped over our own feet, the cat, shoelaces, curbs, anything. We've all fallen – out of bed, off a chair, off the bottom step.

While most trips and falls result in nothing more than bumps or bruises, some are more than they appear. The body is amazingly resilient and can handle a great deal, but it is also amazingly fragile, and things you wouldn't think hurt actually break bones.

I speak from personal experience here. About seven years ago I tripped and fell in a parking lot when I stepped on a piece of gravel. Everything at that moment combined – my boot/ankle turned inward, I was off-balance mid-step, there wasn't any way to regain my balance despite years of kickboxing and gymnastics training. I was going down and I knew it. Amazing how quickly you process these things. Fortunately, thanks to the above mentioned training, I know how to take a fall. (Yes, there are "ways" to properly fall.) I hit the pavement hard, face first. Talk about a faceplant. Also fortunately, I'm a Goth and it was early spring, so I was wearing my full-length black leather trenchcoat. I'm also a small person, so said coat reaches my ankles and wrists. This was, as stated previously, fortunate, as when I went down, my arms that came up to protect my head were both cushioned by and protected from injury by the leather. My head was in turn protected by my arms.

Not so fortunate were my knees. They took the brunt of the force when I hit the ground, and I tore the left leg of my jeans.

All of this took place in less than five seconds. One second I was upright, the next I was face first on the ground.

It's instinctive of me with my background and training to do an immediate "self-diagnostic" to determine injury before moving if something has occurred. Having done that, I waved off my husband's offer of help (he was quite horrified and very chivalrous) and got up myself. Once upright I checked myself over for changes in status – sometimes it takes a few minutes to several hours or even days for injury to become apparent – and found nothing injured but my pride (fortunately it was dark in the parking lot and we were alone and no one but him saw me kiss the dirt) and carried on into the theater. I noticed the torn knee of my jeans as we took our seats, but shrugged it off as it was a small hole, and naturally asphalt is rough, so meh. Shit happens.

As we watched the play, I did note that the small hollow on the outside of my left knee throbbed a little, but hey – trauma. Hurts gonna hurt. Plus, I have a high tolerance to pain. So, meh. After the play I went home, cleaned up the tiny little scrape under the torn material, took an ibuprofen and promptly forgot about it.

Occasionally it would throb and I'd notice it, but I'd also ignore it. Meh. Of course it hurt. Asphalt is hard, la la la. I noticed it would hurt more when I did things like walking my dog or climbing up stairs. Again, I ignored it.

I ignored it for 10 months.

After a long trip in which my knee throbbed insanely annoyingly for a good bit of it, I was at my doctor for something completely unrelated (I think it was an ear infection, which I don't mess around with – another post on infection a different day), he asked me if anything else was bothering me. I mentioned my knee. He poked and prodded and scowled and said, "let's get that x-rayed." 

Ohhhhh, joy.

So down to radiology I trundled, orders in hand. La la la, pics taken, xray read, report to doctor and…

"Looks like you have an old healed fracture there," he said, pointing to the offending spot on the film. "Right there at the head of the fibula. Looks like the tibia took a nice crack, too. How did you say this happened?"

(For those who aren't familiar with anatomy, the fibula is the thinner leg bone on the outside of your leg, and the tibia is the bigger one, often referred to as your "shin bone.")

What the doc was saying was that I'd broken my leg and walked around on it for 10 months. 

It was hurting all the time because it was trying to heal itself without proper care/being splinted/me being on crutches to give it a rest. Had I gone to the doctor/ER when the fall happened, they could have splinted or casted the leg and given me crutches to get around on while it healed. The leg is fine now, of course. I mean, there wasn't really anything to be done about it at that point. It was already healed. It had only been a small fracture ("Fracture" is the proper medical term for "break." There's no difference whatsoever between a "fracture" and a "break." Fracture = break. A lot of people mistakenly believe that a fracture is a type of break, but it's not. There are degrees of breakage, from hairline to compound fracture, but they all mean the very same thing – if you fractured a bone, you've broken it. The degree is what matters.) and while it should have been treated/set, it wasn't as bad as it could have been. Hell, some strains and sprains are a lot worse (these are soft tissue injuries I'll discuss in another post) and hurt more.

My point is, severity of the trauma doesn't necessarily indicate severity of the injury. You can go through a horrific car accident and emerge completely unscathed. You can break a glass in the sink and sever your radial artery. It just depends.

In my case, it was a tiny little fall. Honestly. I've fallen harder in the gym. But it wasn't about how hard I fell. It was about how I did. I fell, I hit my knees, I fractured my left fibula and tibia. The patella was fine (kneecap). That thing can take massive amounts of pressure (it's designed to), but can still fracture, and that's obvious from the moment it happens. You generally aren't able to stand/walk with a fractured patella. I could stand and walk, so naturally I figured I was fine. I wasn't. I'd broken my leg. I should have gone to the ER/doctor ASAP. I should have had it treated and set.

But I didn't.

In your writing, keep this in mind. Even something you think isn't at all serious can have an effect, even days later. Swelling, inflammation, pain – keep all these in mind, especially if you do a series. Ilona Andrews is awesome about this in her Kate Daniels series. Kate suffered a serious injury to her knee in one of the books, and it pops up as problematic every now and then because it's damaged and will take years to heal, if ever. Some things will always have issues, and keep in mind that a broken bone, while generally stronger in the area that's been healed over, will never be as whole or functional as it was before it was broken.

You'll hear older people talk about how they know a change in the weather is coming because something on their body is "acting up," or of how certain body parts hurt years later because of an old injury. You see this a lot in sports medicine/athletes. If your character has been injured in any way, keep that in mind and don't just make everything fine in the next chapter or even the next book. If you're going to put your characters through hell, they should at least suffer the consequences.

Literally.

There's a certain character I will not deign to name that I despise (hint: it rhymes with "hella.") who has what is supposed to be a "charming little quirk" of clumsiness. If you're going to give your character a "quirk" like this, remember that there are results.

Cause. Effect. Easy peasy. You can't have something happen to your character - medically or otherwise - without a result. Everything results in something.

For instance, writing this blog post has made me desire more tea. I shall now go fulfill that desire.



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.)

Series Post: Ask Dr. Dina - Altered States

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.

This is the second post in a series 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.

Last post I talked about loss of consciousness, or LOC as it's abbreviated in medical charts. Today I want to talk about another aspect of consciousness called "altered level of consciousness." This is abbreviated "ALOC" or "alt. LOC" in medical charts (it's also called "altered mental status/AMS" in some places) , but I don't claim to be an expert in medical terminology. Plus, charting notes change all the time and every place has its own system, and it's been awhile since I worked in a medical setting. Google "medical charting abbreviations" if you're intensely curious about this. (Some of them are made up and deliberately dark humor/not supposed to be taken seriously even when they get used, so be warned. Medical people have to have a sense of humor like this because working in the field is very grim and it's our way of talking about assholes/communicating with staff when someone is clearly just taking up space in my emergency room because they're lonely or drug-seeking. "FFF" and "GOMER" come to mind readily. Also, if you're ever prescribed or know someone taking "Obecalp," just read it backwards. You get my point.).

In this post I'm talking about the condition, not how it's noted in your chart.

Now, your LOC can be altered in a variety of ways. Some of these are interesting, some aren't.

Interesting ways include intoxication and euphorics. Non-interesting ways include trauma and health issues. For example:

A diabetic whose blood glucose ("blood sugar") level has spiked into the 250-300mg/dl+ range – called "hyperglycemia" (the current "normal" for diabetics is generally below 180mg/dl after meals) – can result in confusion, drowsiness, unconsciousness/coma. The same can happen if the blood glucose level drops below 40mg/dl. Everyone is different and some people experience symptoms of low blood sugar (hypoglycemia) at 70mg/dl. There's even a non-diabetic condition called "hypoglycemia" that screws mightily with blood sugar levels.

Most non-diabetics have experienced the jittery, shaky, weak feeling you get when you haven't eaten all day and need something NOW at least once in their life. Some people call it "hangry" - you're grouchy and pissed off and really hungry and a sandwich makes everything all right again. There's a reason for that. Your blood sugar was low. Just because you aren't diabetic doesn't mean you can't suffer temporarily from either high or low blood sugar, and this can affect your LOC.

The same applies to your character. If your book takes place over three days and not once has your character had anything to eat, there's going to be problems. Just because you write fiction doesn't mean your human character doesn't need something to fuel their body every now and again. (You can even make this a thing, like Harry Dresden and his Burger King addiction or Woody Harrelson in Zombieland and his search for Twinkies.)

If your character has a condition like diabetes, this is especially important. Glucose levels are critical to maintain and monitor for diabetics and hypoglycemics. Any swing one way or the other and their LOC can change in seconds. I'm not just talking about mood swings here (though they're common with immediate changes in blood glucose levels). I'm talking about one minute they're talking to you just fine, and the next they ask you where they are or don't know who you are. This is why many diabetic patients wear medical alert bracelets or necklaces, because if they're found unconscious, a simple check of their blood sugar level can alert responders and caregivers what the possible cause might be and they can get immediate treatment. It's amazing how quickly a shot of insulin or glucagon (medication used to decrease glucose levels in hyperglycemia faster than insulin - used when immediate treatment is needed) can "bring someone around."

You'll hear a term thrown around hospitals – "stable." This means a patient's condition, no matter what it may be, is leveled out for the moment. You might not think of a coma patient as being stable, but in the medical profession, it can be. Why? Because they're not declining (getting worse). Stable is better than decline. It's a hell of a lot better than "decompensating," which is nice, safe medical speak for "dying." Stable is a good thing, no matter how it's used in a hospital setting. It might not be the best, but it's better than the alternative(s).

You want to stabilize a diabetic's blood sugar level when their LOC is altered. Stable can also mean "under control."

An example of intoxicants altering your LOC is that lovely familiar term "DUI." (This is different from "DWI," because DUI is "Driving Under the Influence" and DWI is "Driving While Intoxicated." DWI is generally reserved for alcohol ["drunk driving"], while DUI covers alcohol, drugs [legally prescribed or not], and other substances like gas fumes or anything else that "influences" your level of consciousness.)

Ever read those little labels on your prescription bottles that say "do not operate machinery, may cause drowsiness" and so on? They're not there just for fun. They're warning you that that medication is capable of altering level of consciousness in some people. Some drugs are designed for just this purpose (anti-depressants, anti-anxiety medication and so on) and say RIGHT ON THE LABEL – "do not do these things until you know how this medication affects you." Why? Because some people pass out or can't function normally when they take them.

Cold medicines. Read the label on a few of those bad boys sometime. Nyquil says right on it – "may cause drowsiness." (That's kind of the point with that one, really, but some people don't get that.)

Which brings me to the point of this post. If your character is a drinker, different kinds of booze are going to affect them differently. Some characters can knock back a fifth of scotch and be utterly fine. Others touch a wine cooler and hit the floor. Know how things work for both your character and the situation. If you've already established that your character faints at the sight of blood (ALTERED LOC! FAINTING!), you can't have them happily wading through the bloody corpses of fallen comrades in your post-apocalyptic dystopian novel.

If your character is on any kind of medication, know the effects of it (and for fuck's sake, GET THE NAME AND EFFECT RIGHT – I've thrown books across the room from supposed "professionals" who didn't get this basic concept) and how it affects your character. You can even make this a quirk, like how ADHD pills actually have the opposite effect on adults versus kids (I'm not making this up! This is why Mommy steals little Johnny's Ritalin. I'm serious! This happens! So you can have a character that does this.).

This is why it helps to know the side effects in addition to the intended effect. A lot of side effects include drowsiness/altered LOC. Just because they don't affect EVERYONE that way doesn't mean they don't have that affect on some people.

In your writing, keep your character's LOC in mind. If they've just been in a fight and taken a knock upside the head, they're likely to experience mild to severe ALOC, especially if they've been knocked out.

If they've been given or have taken drugs, keep the effect in mind. Alcohol, health issues, trauma. Anything. Trauma can be emotional as well as physical. If Joan just saw her best friend/husband/roommate/dog/other she cares about get eaten by zombies or whatever, she can (and likely is) "emotionally compromised" as the Starfleet Regulation says. (Shut up, I'm a geek.) Some people shut down completely – and literally – when they're emotionally compromised. You know, like the fainting at the sight of blood thing.

So keep LOC in mind when writing your story. Know your character and how their environment and actions affect them. Not only will it add more realism, but you won't be in danger of using an animal medication on a human.

(Seriously…I read (okay, didn't finish) a book that had this in it. AND IT WAS PUBLISHED LIKE THAT. Hello! A five minute Google search would have told the author that this medication was not used in that way, by anyone, EVER. Or maybe they did Google it and used the first drug name that popped up in the search engine and didn't bother to read the link. This is why it's important to do your research on things.)


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.)

P.S. Today is the last day to participate in the Evil Auction, so get over there and bid!