Tag Archives: Starke is not a real doctor

In Marvel, Captain America has incredibly fast healing/general recovery (he can’t get drunk) and it’s explained by an increased metabolism. This means he has to eat more. I’m wondering if A) the explanation of ‘his body runs faster’ is actually valid and B) assuming that it’s real (enough), what would that even look like?

I think so. Or at least, I’ve known people who described themselves this way, and did have a phenomenal ability to process through alcohol.

I’ve literally watched a friend put away a fifth of Bailey’s in one sitting without any outward signs of intoxication. Granted, Irish Cream only runs around 34 proof, and some people are very good at concealing intoxication, but he was always rather annoyed by how much he had to drink in order to get buzzed.

What I can’t say with certainty is, if that was actually his metabolism, some other genetic resistance to alcohol, or a resistance to poisons in general.

Either way, this results in someone who needs more alcohol to get drunk, and sobers up faster. It’s also worth pointing out, this can just as easily be bravado, and a talent for hiding intoxication.

So, in short? I don’t know, but that is what I’ve been told.

With Captain America, the healing factor alone is enough to mean he can’t get drunk. Wolverine and Nick Fury have the same resistance, when the writers remember it’s there.


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I don’t know if you guys are the right people to ask, but I thought I’d chance it. What are places on the body that can get “non-lethally” shot? Like places where a bullet can hypothetically go through (completely) and not kill you, assuming you had medical aid nearby?

So, this is one of those things. There is no such thing as a safe gunshot wound. If you get shot, without medical attention, there’s a real probability it will kill you.

With immediate medical attention, gunshots are very survivable. Life threatening, don’t mess around with it, it can still kill you, but you’re odds of living are much better than your odds of dying.

A study conducted on Philadelphia first responders (police, and EMTs) pegs the survival rate for gunshot wounds that make it to the emergency room at around 67%. The mortality rate during transport was in the high 20% range (I don’t have the data set in front of me, so I’m working off an abstract.)

So, if you get shot, and someone can get you to the hospital, you have a pretty decent chance of living. In the past, I’ve pointed out that getting shot in the head is surprisingly survivable (the odds of dying are somewhere around 95-98%). I can’t recommend it as a career path, but people can and do survive those.

In cases where the bullet results in serious internal damage, like a collapsed lung, there is a real chance you can survive. There’s also a chance you’ll never fully recover from your injuries, depending on what got shot. And, even if you do survive, you’re going to be out of commission for a long time while you recover.

One bullet is an immediate threat to your life, but it’s not an automatic death sentence.

Getting shot ten or twenty times? Then you’re probably screwed. Again, this is survivable, but the more holes bullets make in you, the faster you’ll bleed to death. So, getting hit repeatedly is a much more dangerous situation.


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How many times do you have to have a minor concussion to really need to see a doctor?

Once. I’ll keep saying this, but: concussions are one of those injuries you really should not screw around with. When you’re talking about your characters, things are a bit more flexible, but it’s still an injury that would need to get checked out as soon as possible.


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Remember in the movie “The Princess Bride” where Wesley says the iocane didn’t kill him because he built up an immunity to it? Is that a real thing, and if it is, can someone can resistance to multiple poisons at once by focusing on one, or do you need to build resistance to each poison individually?

Yes and no. Iocaine itself is fictional, so we can scratch that off the list quickly.

Fair warning: I don’t have access to any of my toxicology and forensics texts at the moment, so I’m a little sketchier on the poison side of things.

That said, drug tolerance is quite real. It’s a state where someone acquires resistance or full immunity to a specific drug through repeated use. Usually this refers to the use of things like antidepressants, painkillers, sedatives, or other drugs, not poisons per say.

Cross-tolerance occurs when tolerance to one drug also provides tolerance to another, or accelerate the onset of tolerance for another drug. Usually these are drugs with similar neurological effects, or drugs within a family. Such as stimulants, opiates, antidepressant, and so on.

There are also stray drugs that result in almost arbitrary cross-tolerances developing. Such as amphetamines and pseudoephedrine (a nasal decongestant). Usually this is because of the drugs’ mode-of-action (literally how it affects the chemicals in your brain) are similar or almost identical, though it isn’t always the case.

Now, note that I’ve been talking about drugs all this time. (Partially, because my Book of Poisons reference is in another timezone.)

As I recall, this is true for some poisons, but it’s vanishingly rare. If you have a character who tries to kill someone via a heroin overdose, it’s entirely possible the victim would have acquired a tolerance to the drug (even if they’ve never used heroin, but do have a history of abusing other opiates) to the point that the killer wouldn’t deliver a lethal dose.

It’s also distinctly not the case with some poisons. Either because the lethal dosage is so low it is impossible to introduce into your body safely (ricin), or because chronic use of the poison at low doses will still kill you or at least cause permanent physiological harm, it’s just the symptoms will be slightly different.

For example, it’s actually impossible to develop a tolerance to arsenic this way because chronic arsenic poisoning will lead to death. The symptoms are different, but the end result isn’t.

The short version is, not really. You may be able to find a few poisons that you actually can legitimately acquire a tolerance to (though I can’t remember any off hand), but like so many things in The Princess Bride, this isn’t about objective reality, it’s about painting a storybook fairytale with a very fine brush for the texture.


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As part of the whole killing-versus-incapacitation conversation, I’ve noticed an abundance of the us me of tranquilizer darts in movies and especially covert-op video games. What are the concerns there? I know it can’t be just, “bang,” bad guy goes to sleep for a bit. Or at least not as simple as people portray it, anyway.

It’s not. Actual tranquilizer guns are used when dealing with animals, not people. You dart the animal and wait up to half an hour for it to kick in. When we’re talking about a bear wandering around a subdivision and knocking over dumpsters, that’s fine. You keep people out of the way, and give the animal time to keel over, then you take steps to maintain its safety while you transport it elsewhere.

Tranqing people isn’t that different. If you dart someone, you can be looking at up to thirty minutes before they’re actually under. That’s thirty minutes for them to realize they have a dart in their neck, freak out, and alert the entire base, and start a manhunt, or start shooting hostages, whatever applies.

Also, tranquilizers aren’t safe, not really. Overdosing will kill the victim. Dosage is calculated based on a lot of factors, including weight, age, metabolism. When you’re dealing with wildlife, you can make sure the animal gets proper medical attention if you overestimate, but that’s not an option in combat.

You can’t really speed up the rate that the tranquilizer works, safely. Because, if you miscalculated the dose, then it will go lethal that much faster. With a slower onset, if something does go wrong, you’ve got time to get medical help to the victim. Except, none of this works, if the entire point is to remove someone quietly while infiltrating a facility.


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Hey! Uh with your most recent post about concussions… while concussions are very serious, I think you mixed up brain oxygen-deprivation and concussions. Depriving the brain of oxygen for even a very short period of time will cause irreparable brain damage and can result in turning someone into a vegetable.

Physical trauma to the brain, including concussions can also lead to irreparable brain damage and put the victim in a persistent vegetative state. The list of things that can break your brain in horrific ways is, sadly, not a short one. That said, cerebral hypoxia (depriving the brain of oxygen) is high on the list, and one of the reasons “just choking someone until they pass out” is not any safer than pounding their skull into a wall until they stop twitching.

Now, it’s probably worth pointing out, I was talking about grade 3 concussions. Since the question was about the character loosing consciousness, and lower grade concussions stipulate no loss of consciousness. As far as I know, more mild concussions are less likely to produce that kind of brain damage, at least on the first injury, but they also won’t knock someone out.

In deference to you; there are a lot of shared symptoms between cerebral hypoxia and concussions. There are differences, these are different medical conditions, with distinct causes and long term consequences. I honestly don’t know how much can (or should) be read into the overlap.

As always, I’m not a medical professional, though identifying concussions was covered in Scouts. Also, in fairness to you, a lot of the symptoms I think of for concussions are shared with cerebral hypoxia. The diagnostic training from first aid would distinguish them, but when I think of a concussion, the symptoms that come to mind are ones that occur with both (IE headaches, confusion, impaired cognitive function, impaired fine motor function.)


Q&A: Kockouts

How plausible is it to knock someone unconscious without killing them? I have a monster character that, when people annoy him, picks them up and slams to either knock them out or kill them. One of my characters has to have this happen to them and they survive it, but I’ve heard it’s actually really rare to knock someone out and not kill them. Is it true that this isn’t plausible, and if it’s not is there anything else, like smothering, that they *could* survive? I love your blog by the way.

I know we’ve answered this one in the past, but it doesn’t seem to be properly tagged, so I can’t find it. The very short version is, “It’s entirely plausible, but your character will probably end up a vegetable after the fact.”

Being knocked unconscious is actually a concussion. It’s a life threatening injury. Being knocked out for more than a few seconds (of the top of my head, the number is somewhere around 30) will result in permanent brain damage for the victim. Being unconscious for more than a few minutes will result in either a coma or death. (For what it’s worth: I’m phrasing it like the symptom is the cause. The concussion’s severity determines both how long the victim is out, and the extent of other neurological damage.)

So, while it’s entirely possible to be knocked out by being body slammed into a wall, freeway support column or ‘57 Chevy, undertaking complex tasks like walking, talking, or remembering your own name, will probably be out of reach afterwards. Depending on the severity of the concussion these symptoms could last for minutes to permanent.

It’s also worth pointing out that concussions are cumulative. They’re literally bruising on the brain itself, from bouncing against the inside of the skull. These do stack up, meaning future concussions occur more easily, and are more severe. Knocking characters out repeatedly will kill them, quickly.


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hi, i was just wondering, is there anything super important in your arm that would kill you if you got shot there? like upper arm near your shoulder but a little below

Well, there’s an artery near the armpit. In the shoulder it’s the Axillary, below the shoulder it becomes the Brachial. It’s the same artery, only the names were changed to confuse pre-med students. As I’ve said before, I’m not a doctor, but my advice would be, “don’t get shot there.”

I don’t know what bleed out times look like if that’s severed, but at a guess I’d say, “not long.” Probably under 120 seconds.


I have a character who is a champion track star (high jump) but also fairly rigorously studies muay thai. Bc of how the story goes, she ends up getting in some serious fights. I was just wondering if you could give me some understanding of the disadvantages or weaknesses of muay thai so that I can add more jeopardy to the fight scenes?

Well, there’s the part where any injury will end her track career. Bruises will slow you down, to say nothing of broken bones. This is before you consider the risk of stress fractures down the line. If she breaks any bone she’s actually using, which is to say, “all of them,” her track career is over.

She can come back after she’s healed, but, that’s lost time she’ll never get back. As a teen, coming back later is too late, she’ll have missed the windows for advancing to higher levels of competition. As an adult, coming back later means her body is already in decline, so she’ll never be back to where she was.

We’ve talked about this in passing before, but anyone who engages in violence pays a severe opportunity cost. You cannot be a champion athlete and get into frequent fights off the field/court/whatever. There’s no such thing as, “so good you don’t even get hurt.” That’s a fantasy. If you fight, you will get hurt. That may be at the hands of your opponent, but there is a decent chance you’ll do it to yourself.

A lot of the time, your most painful combat injuries will come from pulling muscles. This is actually preventable, if you do your stretches reliably. The problem is, these won’t be the same stretches a track runner would need to engage in. I don’t know if the stretches are somehow incompatible, but it is something that can, and will, mess you up.

For a character who’s career is violence (or includes violence), injuries are an accepted part of the job, and something that they can work around (though there are always other costs), but for someone like a track star? That opportunity cost will be the end of her career.

From what I know of Muay Thai, it actually makes this more likely. The style is very aggressive. It originated as a pit fighting style, and that still shows. I don’t know if the American schools that market Muay Thai as self defense have rectified this, but at least in it’s original form, this was a style that protected the martial artist by reducing their opponent to meat pudding before their foe could do the same to the practitioner. It’s brutal to both the victim and the attacker.

This is also exactly why no reputable martial arts school would leave your character’s violent impulses unchecked. It’s a huge liability issue for the school. So, as a martial arts student, getting into fights will get you expelled. Actual martial artists are not going to be going in and solving their issues with violence. Again, “violence as a last resort.” This is non-optional, because it’s a necessary component of the training. It depends on the type of training they’re engaging in, but violence outside the school will eventually get noticed. This can lead to legal liabilities for them and damage them financially. This character can only get into so many “self-defense” fights before it becomes a pattern. Generally, street level violence is something they’ll attempt to ward her off of.

Of course, her martial arts school isn’t the only one that would get rid of her over violence. If we’re talking about a teenager, she’ll get cut from Track the instant these fights start. Which may have been her goal all along. If she has someone in her life that’s pushing her towards sports, then violence may be her means of lashing out. Training in Muay Thai exacerbates the situation by making her more dangerous, and it’s worth remembering that this isn’t considered “evening the playing field”. As an adult, then serious fights will result in criminal charges, another level is added based on her martial training. Even if she can demonstrate self defense, that’s still time lost due to legal entanglements which will interfere with her ability to train (I’ll come back to this in a minute), and of course, a conviction could easily end up being a couple years in prison, which would end all of her athletic aspirations on the spot.

When we’re talking about a track star, we’re looking at someone who is dedicating a lot of time and energy into being good. This may be their only way into a good college or their ticket ride to a great one, they may have their sights set on the Olympics. All those are in danger of being dashed by an injury pulled from a street fight or a criminal charge. This means a pattern that might be considered slightly irregular in someone else increases into genuinely self-sabotaging/self-destructive behavior. They are setting out to destroy their future on all fronts and I’d think long and hard about the psychological reasoning behind why.

If we were talking about a sport, where violence is an acceptable part of the game, and it makes the school serious money, like concussionball football, then the administration has incentives for turning a blind eye, but, for someone in track and field? Not so much.

There’s also a “not enough hours in the day” question. While training to actual combat proficiency in Muay Thai is possible, that’s not really compatible with someone who’s committing enough time to competitive grade track and field training. Competitive, high level sports are all day every day. They take priority. She’s getting into her Muay Thai school, maybe, three times a week for an hour. It’s recreational and she’ll be skipping days to focus on track when competitions come up. She could be more regular during the off season, but a lot of Track and Field members do double up for Cross-Country in order to stay competitive. So, that’s where her Track and Field teammates are.

If your character is training for any higher level track competition, that’s going to be their life. All of their free time is going to go right back into training. As an adult, that’s all of her time. Failing to do so will put her at a disadvantage against anyone who’s getting those extra four hours of training and conditioning in, that your character is spending learning Muay Thai.

This is long before we get into other life aspects like social pressure. Her coach will notice if she’s routinely showing up to practice with a split lip or a black eye. If she’s limping because someone connected with her thigh. If her knuckles are cut up. She will be bruised and she will be bloody from her fights and the adults will notice. If she tries to pawn it off on the Muay Thai, her coach will either talk to her parents about it interfering or go to them directly to have a discussion on the subject. By working together, they’ll figure out about her extracurricular fights even if they didn’t immediately jump to that conclusion.

It’s not as easy as it is in Hollywood to hide the fact that you’ve been fighting. The more in the spotlight a character is, then the quicker it outs.


Is it possible for someone to be biologically modified to be more adept at fighting? If so, what would need to be altered?

Not with current technology, but, with sufficient technological advancement? Yes, or at least it should be. Warhammer 40k’s Adeptus Astartes comes to mind as an immediate example. Also, XCOM: Enemy Within’s gene modded soldiers, so far as that goes.

At that point, the question isn’t so much “what needs to be altered?” as, “what do you want to change?”

Some of the classic examples that come to mind are increasing bone density, accelerating healing and clotting, or neural modifications. A lot of these would actually result in medical complications. Though, the complications will vary based on exactly what you’re modifying.

For example: Mast Cell production will, or at least should, accelerate clotting and wound healing. But, at the same time, that is a real medical condition, called Systemic Mastocytosis, which manifests as an increased histamine (read: allergic) response. Specifically rashes, abdominal pain, and difficulty breathing are all possibilities. So your character can’t bleed to death, but the same system means they can have a sudden fatal anaphylactic response to pet dander. (I wish I could remember where I saw someone using mast cell
overproduction to justify giving their characters near instant healing,
but this isn’t just a random example.)

So, the general plan of, “well if X is good, let’s just engineer someone to make more of it,” isn’t really a legitimate solution.

As part of a larger program, and with a lot of specific engineering, there is a real potential that you could build a better combatant. Tougher, more resilient, faster reflexes. But, as to what you’d need to change? I don’t know. It also depends on what you want out of your combatants, and just how inhuman you’re willing to make them.

Now, that’s just the medicine and science. There’s also a legal and ethical question.

The legal one is fairly simple, sort of. There’s a very real chance that biomodified supersoldiers are illegal under international law. I’ve seen this presented as flat fact in the past, but there are actually a lot of pieces to the interpretation. If you really want to dig into the legalities and bioethics of this, there’s a very detailed article from California Polytechnic on the subject.

So even if your characters can enhance their soldiers through bioengineering, it’s distinctly possible they might not be able to because of legal obligations.