Head Injuries: Jason Joyner

There was that time when the editor saved the medical professional.

As a physician assistant, I enjoy having medical aspects in my story. But even medical folks can slip up and have errors in our fiction.

I have a scene where my heroine gets head trauma and wakes up later in the clutches of the villain. The freelance editor, Ben Wolf, wondered about that. He had read that if there was significant time of loss of consciousness (LOC), then it suggested a serious injury that would be hard for the victim to bounce right back from to be active.

One of my pet peeves is when characters are injured and recover too fast, so I had to look into this again.

Basically, my heroine suffered a concussion, also known as a Traumatic Brain Injury (TBI). Symptoms of a concussion can include headache, confusion, dizziness, visual changes, a blunted affect, and may or may not include LOC. (People always flash lights in pupils to check for concussion. If the pupils are affected, it is a serious sign and they won’t be up and active soon.)

LOC usually is only for a few minutes, and as my editor noted, will mean a much more severe injury if it lasts for hours.

Blast. Foiled by the editor.

Except, you can use the amnesia angle.

A concussion with LOC may have retrograde (before the incident) or antegrade (after the incident) amnesia. According to one research article, the antegrade amnesia can last for a few hours after the incident. I can attest – I had a concussion in 5th grade and couldn’t remember a couple hours afterwards.

So if you need your protagonist to be out of it for a while, keep the actual LOC on the short side and use the amnesia angle to get you where you need to be. The victim may be incoherent, unsteady, with a blank expression during this time. Use these symptoms to add drama to the situation.

When your protagonist comes to, it is actually the end of antegrade amnesia. I remember with my concussion it was like I “woke up” after lunch during our quiet reading time at school. I was confused, unsure of what happened. I could remember part of the morning, but about two hours was blank. I even found a goose egg on my head later, but I didn’t know how it got there.

So that was my work around. My heroine didn’t have LOC the whole time. But there was enough injury to cause confusion and amnesia, keeping her from attempting escape. There you go Ben. A few minor tweaks, and all is well. Except for my heroine, who’s tied up and threatened. But that’s another story.

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Jason loves good stories and wants to use words to make a difference. When he’s not writing, playing soccer, or losing in fantasy football, he works as a physician assistant in southeast Idaho. He also tries to keep up with his awesome wife, three high-energy boys, and his little princess. He writes suspense and YA supernatural, and likes to use his medical experience to punch up the stories. You can find him on Twitter @JasonCJoyner or his blog at www.jasoncjoyner.com/blog.

Broken Heart Syndrome

I was watching TV at the gym (can’t remember exactly which tabloid show it was– you know, I’ve got the earphones in blaring music and I’m trying to read subtitles while running!) when a story comes on about a woman who can’t remember her wedding day.

Ok– well that’s a teeny bit unusual. I’m surmising she must have been in a horrible car accident later that day or something.

No, nothing like that.

They go on to explain that this woman suffered from Broken Heart Syndrome for which my eyes roll several times around my skull as I’m sure this can’t be a real medical thing. I mean, tabloid TV, she can’t remember her wedding day, Broken Heart Syndrome— they have totally made this up.

Evidently, they did not.

According to the Mayo Clinic, Broken Heart Syndrome is a “temporary heart condition brought on by stressful situations.” Anyone who has been through planning and actually wedding someone knows how stressful that can be. Because of the release of all these stress (adrenaline) hormones, “the heart temporarily enlarges and doesn’t pump well.” What differentiates this from a normal heart attack is that the coronary arteries aren’t blocked though the symptoms might be similar– sudden onset of chest pain, difficulty breathing and weakness.

Other names it goes by:

  • Takotsubo Cardiomyopahy
  • Stress Cardiomyopathy
  • Stress-induced Cardiomyopathy
  • Apical Ballooning Syndrome 

It is treatable and symptoms reverse in a couple of weeks. In this woman’s case, however, she suffered cardiac arrest. Her husband was able to revive her but she was comatose for approximately four days– hence losing all her wedding memories.

Be careful next time you throw someone a surprise birthday party. Make sure their heart can take it.

Remember Me: Use of Amnesia in Fiction

Heidi asks:

My question is, if I have a character that drowns but is revived, could they have temporary amnesia, especially if they hit their head? If so, how long might it last?  A few days? I know Goldie Hawn’s character in Overboard gets amnesia after falling off a boat into the water, but I’m not sure how accurate that really is.

Dianna says:
The definition of drowning: A submersion event where a patient is pronounced dead within 24 hours of the event.
 If a patient dies 24 hours post the event, it’s called a drowning-related death.
That said, your character did not drown and was then resuscitated. Instead, your character suffered a near-drowning event. In order for it to be referred to as a near-drowning event, the patient must be treated for at least one submersion-related complication. You say your character was resuscitated, so I’m assuming the patient was in cardiac arrest, which would definitely be considered a submersion-related complication.
Detail to consider: How long was the patient in cardiac arrest? In cold water, the mammalian diving reflex can prevent death, even after prolonged submersion (a patient in cardiac arrest can be resuscitated after 30 minutes or even longer).
I’d definitely write in that the character hit their head somehow and then suffered a prolonged cardiac arrest due to the submersion post hitting their head. (Basic background information: If the human body loses its oxygen supply, the heart stops. Since we can’t breathe under water, we’re unable to in-take oxygen.) If cold water isn’t fitting for your story, then lower the cardiac arrest time to 5-10 minutes, which is still long. The amnesia could occur simply from the trauma to the head only. The near-drowning event and long cardiac arrest time could worsen the amnesia.         
Anterograde amnesia: Memory disorder only affecting the retention of new information and events. Example: Patient Jim can only identify his friends, recall their names, retell stories about them ONLY if he knew them BEFORE the amnesia. So, when Patient Jim meets anyone after suffering with amnesia, it doesn’t matter how much time he spends with them, next time he sees that person he won’t remember them at all.   
Retrograde amnesia — Memory loss of the past or segments of the past.
Some patients can suffer with both anterograde and retrograde.
Some patients fully recover from amnesia, some don’t.
Every patient is truly unique with every medical situation — how one patient’s body responds medically, another patient responds completely different. So, you could write whatever you want (within reason) with amnesia and it would be realistic. Again, every patient is very different.
In Overboard, that character’s memory returned in a very realistic manner. What happened was she had a strong visual (her husband) of her past, which triggered her brain to remember her past, and pop her memory returned. Sometimes memory return is gradual, other times it comes all at once. However, the situation with her simply falling into the water and losing consciousness then coming to in the hospital with amnesia is over the top Hollywood. If I remember correctly, the storyline was that the cold water and the experience itself (floating in the ocean for hours), was the cause of amnesia.
Sure, it’s possible (again, everyone is different) but not a solid storyline. To me, what that storyline says is the amnesia is an emotional issue (the floating experience, plus not being happy in her life), not a medical issue, which is definitely possible, but they should’ve highlighted that point. Or, adding in head trauma would’ve made it an even better story.   
The tricky thing about amnesia (but it’s good for writers) is it deals with the brain, an organ us humans will never be able to truly understand like we do all other organs and systems, so we have little knowledge on how or why some things occur or don’t occur with: memory, personality, personality disorders, mental illness, etc.