Author Question: What Kind of Car Accident Matches these Injuries?

Mary Asks:

I have a couple questions. My young adult characters (a total of six— four of them intoxicated) were involved in a car accident. The two sober ones were in the first vehicle. My plan was to have the driver suffer from a broken wrist, maybe a bump on the head, nothing too serious (this can change if it needs to). If he is that okay would it be unrealistic to have his passenger hit her head hard enough to lose consciousness and suffer memory loss when she wakes up? I was thinking of including pretty severe amnesia, but as for the other four characters, would their level of intoxication let them walk away with little to no injuries, or would they still arrive in the ER with at least the unconscious passenger?

Jordyn Says:

There are so many variables in car accidents that you could basically do whatever you wanted, but I’ll give you some guidelines.

If you want the injuries to be less severe, I would not have a very serious car accident. For instance, your two sober characters in the first car should not be traveling probably over 45mph. Are there air bags in the car? Did they deploy? Typically they’ll deploy in a front end collision. Now air bags are not like soft little pillows when they inflate so facial injuries are not uncommon with air bag deployment so your driver breaking his wrist (if he were bracing the steering wheel in anticipation of the accident upon impact) with a bump on his head would be reasonable if he were seat belted into the car.

The sober passenger— I’ve never really seen “pretty severe amnesia” in head injuries unless the brain injury was very significant (like brain swelling, bleeding requiring intubation, medical coma, etc). This could be achieved if this passenger was not wearing a seat belt and maybe came up over the top of the air bag into the windshield. Or, for some reason, the air bag failed to deploy and they hit the dash board or they’re driving an older car without air bags.

Generally people with amnesia related to a “simple” concussion will remember what happened to them in a few hours— generally after sleeping so everything can “reset” itself. Most often, in the ER, we observe them until they are at their “neurological baseline” which means they basically have to be the same way they were before the accident as far as knowing who they are, where they are, and what time it is, and somewhat remember what happened. Also, their physical symptoms will have to be improved (little to no headache, no repetitive vomiting or nausea, good motor function, and can walk with little to no dizziness).

So to have “pretty severe amnesia” which I think you mean to have the amnesia to persist over days or weeks then I think this character would need a more severe head injury— which could probably be achieved if the passenger went through the windshield because she wasn’t wearing a seat belt.

The drunk kids— with an offset front end collision of around 45 mph and they were all seat belted into the car with air bag deployment then I could see them walking away with little to no injures. Likely, EMS would transport them to the ER for a medical exam because 1) they are minors (I’m assuming under 18) and 2) they’re drunk and could be responsible for an accident. The police might be interested in a legal blood alcohol levels which can be very tricky (for instance, our ER doesn’t do them. We’ll do a medical one, but this isn’t released to the police). Now, could a prosecutor later obtain those medical records through the courts? Probably with a warrant.

Hope this helps and best of luck with your story.

Treatment of Car Accident Victim with a Brain Injury

Leslie Asks:

My character has been in a car accident and sustained head damage (swelling to the brain)— is there a medical term for that? Also, the swelling becomes so bad the doctors have to remove part of her skull— is there a name for that? How long does that swelling usually take before it goes down so they can replace the skull? Does the character regain consciousness? I have her in an induced coma which I want her in for a while.

Jordyn Says:

Upon further clarification of this question from the author, she says there is not a significant description of the motor vehicle collision in the manuscript and the scene is being told from the POV of a nurse.

The brain swelling is called cerebral edema. Usually, if it’s a significant car accident then there is usually bleeding as well. This is why I ask about the car accident. It should be pretty serious.

A nurse will use language that a family can understand. So, I might actually avoid a lot of medical terminology when speaking to the family unless I also clarify what the words mean.

I might say something like, “Your mother (or whatever relation) has a lot of swelling in her brain as a result of the car accident. We call this cerebral edema.”

A craniectomy is where they remove a portion of the skull.

Peak brain swelling is generally 48-72 from the time of injury and diminishes from there. Induced coma is a reasonable medical scenario here.

Whether or not this patient regains consciousness is up to you as the writer. Statically, the odds are pretty low for her to be the same person she was before. If she does wake up, she’ll have extensive rehab needs for sure– but you could write it either way.

Best of luck with your story!

Author Question: What Happens to the Child of an ER Patient?

Susan Asks:

I am wondering what happens when a mother is injured and her seven-year-old child is with her. The unconscious woman is discovered by a passer by who calls 911. She wakes up, an ambulance arrives and she is taken to the ER.

I assume the child who is fine would go with them if the police haven’t been called. The woman is from out of town and knows no one in the city so the child can’t be picked up by anyone. The mother has a concussion and is kept overnight for observation. I am most interested in learning what would happen with the child at the point that they arrive at the ER while the mother is being examined.

Jordyn Says:

From the EMS standpoint— yes, they would bring the child with the parent.  As far as in the ER, if the mother is awake, the child would be in the room with her. The ED staff can assist with care of the child until the mother is feeling like she can manage. A child this age could be given activities to keep them entertained (coloring, snacks, a movie, etc).

If the child needs more than that then a member of the staff (like an ED tech or volunteer) could provide some assistance until the mother is feeling better and able to care for the child on her own.

Also, a concussion is not a reason for admission to the hospital. Not even overnight observation. Concussion patients are generally not admitted— even with a loss of consciousness at the scene. Even a minor car accident with loss of consciousness does not require admission if everything else is okay.

You don’t specify her mechanism of injury in your question. For concussion we want to see them alert and oriented and that their concussion symptoms (headache, dizziness, nausea) improve or resolve. CT scanning is more common in the adult population for head injury so if that shows no bleeding then there’s really no reason for her to stay in the hospital. If you need her admitted, I can help you have the character meet admission criteria.

Hope this helps and happy writing!

Medical Review of The Shack

There’s nothing like a Christian movie to create a firestorm of controversy. I am a Christian and saw the film and I thought the biggest failure of the film was actually medical in nature.

That’s right . . . medical.

There have been plenty of articles written on The Shack’s theology, but I doubt anyone has touched on the medical inaccuracies which I’ll do here. If you haven’t seen the movie and don’t want any spoiler alerts then stop reading . . . like right now.

The story revolves around a man named Mack who early in the film narrowly misses a major collision with a semi. At the end of the movie, it’s revealed that he’s been in a coma (he’s been unresponsive) for approximately 2-3 days. Our first glimpses of Mack post accident are in a regular patient room. He has an IV, IV fluids and is on a monitor.

Problem One: If you’re broadsided by a semi, you should actually look injured. Mack is relatively uninjured as a result of this accident. He has but a few scrapes (not even stitches) on his face and none of his bones are broken.

Problem Two: The IV pump is not running. If you watch the film, the IV pump is off. If it were on, you’d see numbers lit up on the screen.

Problem Three: If a patient is unresponsive, you have to provide a way for things to come out. Think about it, do you ever go three days without peeing? Neither does a comatose patient. Plus, we need to ensure kidneys are functioning properly which means we need to monitor urine output. This is the type of patient where the phrase “a tube in every orifice” means exactly what it means. Also, there is a significant amount of literature that patients should be nourished with tube feedings much earlier. In real life, Mack would likely be in the ICU, perhaps even on a ventilator, until he woke up. His only medical support would not just be IV fluids.

Next time Shack, call me.

Author Question: Family Notification of Death

Themelina Asks:

I have read some of your posts and I am wondering if I could please have some help regarding a book I am writing. I have three scenes in my book that are in a hospital. The background story is that a girl gets notified that her mom and sister have been in a car crash. Her mom has died and her sister is currently in surgery. Is it right that a police officer comes to her house and lets her know or does something else happen?

After she finds out she faints, and hits her head. I don’t want to make this part sound too serious. However, I still want her to go to the hospital. So what floor would she go to? How long would she stay?

Lastly, the third scene is where the sisters see each other after surgery for the first time. She is paralyzed. How could she communicate with her?

Jordyn Says:

Thanks, Themelina, for sending me your questions.

Question #1: Who would notify the family of the death? I could see this happening a couple of ways. If the mother was declared dead at the scene of the car accident then the police would notify the family. If the mother is transported to the hospital and the hospital team declares her dead then it probably falls on the hospital team to notify the family.

We don’t generally like to give death notifications over the phone. I’m not saying it’s not ever done, but not preferred. We would likely call the family and ask them to proceed quickly, but safely, to the hospital. This might also be preferred because the sister is requiring surgery and except in the most extreme cases surgeons generally like consent before they operate. If there is not a parent to give consent (you don’t mention a father in your scenario) it could fall to the sister, if she is eighteen or over, to give consent for her sister’s surgery.

Question #2: People who pass out and hit their heads are rarely admitted to the hospital. I’m assuming you want this sister to suffer some form of concussion. She gets the awful news about her family, passes out, hitting her head in the process. If she wakes up rather quickly (a few minutes or less), is oriented to person, time and place, and doesn’t show neurological signs of a brain injury that might require surgery then she would get a physician evaluation, a few hours of monitoring to be sure her symptoms are improving, and then she would be discharged home. There would also be no need to wake her up through the night. This is a myth.

Question #3: You don’t specify in your question the level of the sister’s paralysis. Her ability to talk will depend on the level of paralysis. Patients paralyzed from the neck down are, at least for a while, on a ventilator. When a person has a trach, there are special adapters for the trach that allows people to talk. However, a trach is not placed at the beginning and it takes time for a person to learn to talk with the special valve. If she is on a breathing machine and can’t write (because her arms are paralyzed), but is awake and can understand questions then we use a system of eye blinking for responses. One blink for “yes”. Two blinks for “no”. And obviously more simply phrased questions.

Hope this helps and good luck with your story!

Medical Scene Diagnosis: Part 2/2

Today, I’m continuing my analysis of this medical scene. You can read the Part I here. Last post we learned this patient has been in a terrible car accident. We’ll resume with the physician entering the room to give the patient the low down. My comments will be in parentheses in red. I’m just focusing on the medical aspects, not grammar.

doctor-840127_1920-1The door opened, and an older gentleman in a lab coat walked briskly into the room. He checked the clipboard hanging from the end of the bed, noted the numbers on the monitors beside the bed that were tracking Tony’s vitals, and nodded, apparently pleased with what he saw. (Patient information is not kept in plain view. Clipboards hung on the end of the pateint’s bed with medical information is a HIPAA violation. HIPAA is the law that protects patient information.)

“I’m Dr McGregor, your attending physician. Arnold says you remember the accident?”

“Just parts of it.”

“Do you know what day it is?”

Tony squinted his eyes as he concentrated. “Well, I was driving home from San Jose late Saturday night or early Sunday morning. Other than that, I couldn’t say for sure.”

The doctor made some notes on the chart. (Many hospitals have gone to computer charting.)

Tony forced a grin. “Is that a good nod or a bad nod?”

Dr McGregor smiled at him, peering over the frames of his bifocals that perched on the end of his nose. “That’s good. It’s Sunday, actually. You haven’t lost much time. Considering the shape you were in when they brought you in here, that’s a miracle.”

Tony nodded gently. “Yes, sir.  God is in the business of miracles.”

The doctor peered intently at Tony, then smiled. “Apparently so. You should have died.”

Tony tried to shift, then winced at the waves of pain and nausea that threatened to engulf him.

The doctor moved closer to him and laid a restraining hand on his shoulder. “Take it easy. If you want to move, ask your nurse for help.”

“I’d like to have my head up.”

“I think we can arrange that.”

Dr. McGregor beckoned to Arnold, who came around to the head of the bed. Using his forearm, he propped Tony in the bed, adjusted the pillows, and nodded to the doctor, who stood at the end of the bed. Dr. McGregor pushed a button that raised the head of the bed. Arnold eased Tony back to the pillows and adjusted the sheet covering the lower half of his body. (I like that it’s a male nurse because it’s unusual. However, the doctor is coming across as very stereotypical. He’s older, long lab coat, bifocals on the end of his nose. What are some ways to vary this character to make him more unique?)

Tony gripped the handrails as another wave of nausea passed over him.

Dr McGregor patted his shoulder. “It’s normal to have some dizziness after a head injury, and you got a pretty nasty bang on the head.”

Tony held up one bandaged hand. “What else is wrong with me, Doc?”

Dr McGregor cleared his throat before proceeding. “Well, some lacerations on your hands from broken glass.” He flipped another page on the chart. “Same on your legs and back. A couple of broken ribs. The most serious injury is to your liver.” (Remember in the first part of this scene, the writer noted his legs and feet were unscathed. Maintain consistency with the patient’s injuries.)

“My liver?”

“Yes. You sustained a fairly serious tear in the accident. We were able to stop the internal bleeding, but right now your liver is not working well. In fact, the most recent blood panel we did shows it is deteriorating quickly.  I’m sorry, Tony.”

Instinctively Tony’s hand moved to his right side. He felt the edge of a bulky bandage that covered his flank, the incision still tender.

“A person can’t live without a liver, can they, doctor?”

“Your only option at this point is a liver transplant.” (I liked this a lot because I learned something new. As a confessed medical nerd, the first thing I thought was really? Went and looked and transplant can be used in cases of severe traumatic injury to the liver. Check it out here if interested.)

“A transplant?” Tony felt sweat running down the back of his neck and realized his face was wet, too. He ran a hand across his forehead.

“Yes. We’ll enter your name and statistics on the national database for liver transplants. To be honest, although your need is critical, your physical condition at this point in time would place you near the bottom of the list. In the meantime, you will have to stay in hospital so we can monitor your liver function.”

“Come on, Doc. Don’t beat around the bush with me. Not everyone who needs a liver transplant gets one, do they?”

“That’s true.”

“So, what other alternatives do we have?”

The doctor squinted. “I’m going to be honest. Your best bet at this point is to have a close family relative donate part of their liver. That will be the best match and can be accomplished a lot more quickly than a regular transplant.” (This is a place to be careful with your statements. After all, a stranger can come up as a perfect match. It may be better to say, “Your best hope for a new liver is to test a close biological relative like your mother, father and any siblings. If they prove to be a match, this process will be faster than waiting on the transplant list.”)

Tony’s heart sank. This didn’t sound good. “So what exactly are you saying?”

Dr. McGregor blinked at him myopically. “I don’t think you would survive the waiting. If you have any close relatives, you should call them.”

“My parents are dead and I’m an only child.”

“I’m so sorry, Tony. I wish I had better news. There’s not much more we can do at this point. Except pray.”

This writer deserves a lot of credit for setting up some nasty odds and conflict for this character. Strong work!! Do you have any other medical suggestions? 

Medical Scene Diagnosis: Part 1/2

This medical scene was submitted by a fellow writer who wanted some critique and agreed to allow me to post my suggestions leaving her name off the piece. The scene begins with a victim of a motor vehicle collision coming into the ER. His car rolled several times during the accident. What follows is her scene. My thoughts will be in parentheses at the end of the sentence in red. I’m only going to comment on the medical accuracy. Grammar editing is not the focus.

crash-1308575_1920Tony screamed out to God, and flung his hands over his face. Rough hands grabbed his hands as he tried to pry off whatever was smothering him. (This is good as patients often feel like an oxygen mask is smothering. Kids particularly aren’t fond of them.)

“Hey, take it easy. You’re all right. You need that oxygen.”

Tony opened his eyes, blinking rapidly in the bright lights. As his blurred vision came into focus, he tried to see who was holding his hands.

Blue scrubs. Dark face. The whitest of teeth. Name tag. Arnold.

Tony tried to speak, but his throat was dry. Arnold reached over, raised the mask on Tony’s face, and placed something cold and hard in his mouth. Making sure the mask was securely replaced, he sat back in his chair. (In the initial evaluation of a trauma patient in the ER, a patient is never given anything by mouth until it is ruled out whether or not they need surgery. The more the stomach is empty, the less likely the risk of aspiration during intubation. In this situation, aspiration would refer to inhaling vomit into your lungs while the endotracheal tube is placed. Aspiration can mean different things in the medical arena. And I also don’t know too many nurses who actually sit vigilant at a patient’s bedside.)

“It’s an ice chip. It’s all you can have right now.” (I know, we’re mean. But not even ice chips.)

Tony nodded his gratitude and slowly savored the small chip. It may have just been ice, but at that moment, it was like ambrosia to his parched throat.

Swallowing carefully past the pain in his throat, Tony lifted the mask and tried again. “Where am I?”

“You keep that mask in place. You can talk through it just fine.”

He waited until Tony complied before continuing. “You’re in the Regional Medical Center in San Jose.”

“Accident?”

Arnold’s smile faded. “Yes. Doctor said you’re lucky to be alive.”

Tony nodded towards the container of ice. Arnold placed another chip in Tony’s mouth, replaced the mask, then set the cup where he could reach it on the bedside table.

“Where is the doctor?”

“I’ll go have him paged.” Arnold rose and left the room. (This is a situation where it is reasonable for a nurse to give the patient an update on his status and condition without needing to page the doctor. I may say something like, “Your leg is broken, but your other tests looks good. I’ll let the doctor know you’re awake and he’ll come in and talk things over with you in more detail.” Also, in the ER, doctors are generally present, and there may not be a need to have them paged. This can be very unit specific so you’d have some latitude as a writer.)

Tony surveyed his situation, beginning with his toes, and moving up to his hands. While he was achy all over, his feet and legs seemed to be unscathed. His chest and abdomen hurt, burning all the way through to his spine, and were heavily bandaged. (Saying his feet and legs are unscathed may be reaching a little. Remember, he rolled his car several times. At a minimum, there should be some bruising, cuts, or abrasions.)

His hands were bandaged but usable, and he took this opportunity to pop several chips into his mouth, crunching them to make them go down faster. Feeling with his hands, he knew his head was bandaged. Vaguely he remembered blood running into his eyes.

We’ll resume the analysis of this medical scene next post. Any other medical aspects you would change?