Tag Archives: Starke is not a real doctor

Hey there. Went through some of your old asks to see if you’d talked about this before, but couldn’t find anything. My question is this: I’ve got a character who’s arm has been cut clean off at the shoulder (through some kind of magical, incredibly sharp sword). He’s got access to essentially modern-day medicine. How long will it take for him to bleed out/reach the point where doctors can’t save him?

At a wild guess, I’d think somewhere south of five minutes. The way you would calculate a concrete number is to divide ~2.25 liters by the volume of blood lost per second. That should give you the answer of roughly how many seconds your character can survive. Again, if it’s over 300, I’d be surprised.

There’s a minor issue in that calculation; the blood loss wouldn’t be completely
linear, and if you really wanted to do the math and get it just right,
you could use their blood pressure, and use that to get the volume of
the first couple spurts. Remembering that blood pressure drops as you spray blood all over the place like a broken lawn sprinkler; but even at low pressure, a wound like that is going to loose blood fast.

This is also why I can’t tell you exactly how fast your character will be losing blood. The answer there is “very,” but that doesn’t really help for a calculator.

That 2.25l value is actually an average. The real target is the victim losing ~40% of their total blood. For an average adult male, that’s going to be 2.24l. But, because all of these values are relative to the size of the victim, the time to bleed out shouldn’t be affected by this. There are a lot of medical conditions that can affect bleed times, and recovery. But, I’m willing to go out on a limb and say, at these volumes, none of them will really matter much.

The Wikipedia article on Bleeding should cover you for identifying the symptoms. It has (at the time of writing this), a copy of the four hemorrhage stages. The very short version is that the victim will become cold and clammy, disoriented and confused, unconscious, and dead, in roughly that order.


I’ve been having ideas about a story that involves widespread transhumanism, but when I think about it, there’s stuff about the concept I’ve never understood. What happens to your augments as you age or your body shape changes? How are the augments maintained? Do you clean them? What powers them? What happens when technology advances and your augments are obsolete? If your job requires augs that are weapons, what happens when you’re off duty? I know it’s MY story, but I’m stuck for answers.

We had a professor in college who used to say, “when you encounter a word you don’t know, look it up.” It’s good advice, and might have helped you here. I’m going to assume you first ran into transhumanism in association with Deus Ex: Human Revolution. So, let’s look at all three pieces of this, transhumanism, cybernetics, and the philosophy at play in Deus Ex.

Transhumanism is a philosophy that advocates the use of technology to transcend the human condition. I’m being a little reductive here, and this isn’t a philosophical strand I’m well versed in, but, the entire goal is to use technology to make life better.

For someone who views cybernetic augmentation as the path to take, the answer is fairly simple; if a body part is failing, you repair or replace it. But, that’s not the full extent of the philosophy. In fact, at this moment, as you’re reading this sentence, you’re engaging in another strand.

Remember, the basic idea is to use technology to fundamentally improve the human condition. Welcome to the internet: giving you free access to information that, thirty years ago, would have taken months of research going from library to library, fishing through the stacks for that one thing you needed.

At a fundamental level, the internet is, already, a major piece of transhumanist technology. It brings us together and opens up exchanges of ideas that wouldn’t have been possible in the past. It changes the nature of the world, and they way you can interact with humanity as a whole. Using technology to make us more than we were.

It’s really hard to explain to someone born after ~1995, just how massively the internet has changed the world.

While I’m not very familiar with his work, another major proponent of transhumanism, and a separate strand of it was Timothy Leary. In his case, he was advocating higher human consciousness through pharmaceuticals. That is to say; LSD. Using, drugs to achieve some kind of spiritual enlightenment isn’t what comes to mind, when I hear the term. But, there it is.

That said, pharmaceutical transhumanism can also include things like anti-agapics (immortality serums), and any superhero that got their powers from drugs. Retroviral engineering might also count, depending on how loosely you define “pharmaceuticals.”

The term itself originates in the 1960s, but there’s actually elements of the philosophy far earlier. The health science craze of late 19th century is probably an example. Finding a way to be more than human through the wonders of science and technology is not a new idea.

Now, that’s the philosophy in very broad strokes. I’m not well versed in the political strands. The two political outlooks I know of are ones that take a libertarian free-market approach, and one that takes a self deterministic approach. But, again, I have a bachelors in political science, and this is the first time I’ve ever run across a formal write up on Transhumanism as a political ideology.

For cybernetics, it really varies based on what the piece of hardware actually is. Pacemakers and other powered implants require some power source. So that requires either an external accessible port, or they require surgery every-time the battery needs service.

Internal prosthetics, like hip or knee replacements, have a shelf life of 10-15 years. They’ll decay over time and from use, and eventually need to be replaced. That does involve surgery. The implant gets pulled, tossed, and replaced. The old one might be refurbished, but it’s not user serviceable.
I’m less familiar with external, removable, prosthetics. I suspect the overall lifespan is lower, with some user serviceable parts.

As for full on powered augmentations? I don’t know. Anything with that many moving parts is going to need to be serviceable. Especially if it’s going to get shot at. Exactly how modular they are, or if the pieces use proprietary tech is a world building question. It will depend on what you’re saying in your work.

It is probably worth dragging out the old observation. If you replace someone’s arm with a cybernetic one, it won’t let them toss cars around. The arm itself may be superhumanly strong, but that just means it will be able to tear itself from its owner. So, if you’re wanting to give a character super strength, they actually need to have their shoulders, spine, and legs also reinforced, or replaced. I have no idea what those would do to someone as they age, but I suspect that they would interfere with any changes to the body from aging. Actually, I know that’s the case, to some extent, because it’s a real concern for people who suffer serious injuries in childhood.

So, Deus Ex is about transhumanism. All three games are, actually. But, the original game, and it’s title, come from the transhumanist apotheosis in the plot. The title derives from the phrase, deus ex machina, or literally, “god from the machine.”

As writers, we usually use deus ex machina in reference to an author pulling a resolution out of their ass. To an extent, that’s the meaning of the original Greek. In some Greek plays, an actor playing a god, would descend on a crane or ascend using a levered platform, to resolve the story.

With the original Deus Ex, the title is oddly literal. A major chunk of the original game, after you get past the whole Illuminati versus Majestic 12 storyline, is the use of artificial intelligences to function as all knowing, all seeing, gods in the machine and, in one ending, merging a human consciousness with an AI and giving it full control over all human communication.

In spite of that, the philosophical core of Deus Ex is an information age state of nature debate.

I usually break the state of nature debate down into the Superman/Batman dichotomy. That’s probably disrespectful to the historical discussion, but, it is a very good abstract. The basic question is, how will humans behave without a civil society or government? And, it has direct implications for how you govern.

The Superman side of things is that humans are fundamentally good. Laws and society are necessary to protect people from their worst impulses. But, those impulses are an aberration, not the norm.

The Batman side is that people are fundamentally self interested and dangerous to the whole. “Life is nasty, brutish, and short,” to misquote Hobbes’ Leviathan. Laws and government are necessary to coerce people into line.

Most of the state of nature debate happened in the 17th and 18th century. It’s not “resolved,” but, modern philosophy has moved elsewhere. Deus Ex revisits this basic question, and frames it in the context of global conspiracies and a counterterrorism plot that was, honestly, a couple years ahead of its time.

The original game is the one most relevant to your question about obsolesce. The main character in Deus Ex is a nanotech augmented agent, working alongside, now, obsolete cyberaugmented agents. The game presents this with a mix of fairly solid character moments. Some of this runs as a basic analogy for aging soldiers, but the residual prejudices regarding cybernetic augmentation make for some interesting texture. Especially given that nano augmentation is much less invasive, and difficult to detect at a glance.

The second game, Deus Ex: Invisible War is mostly a rehash of the first game, and as a result, probably the weakest Deus Ex title (ignoring the spin-offs). This does have some of the most disturbing endings in the series, however. Including two different endings where the entirety of humanity is forcibly augmented.

Deus Ex: Human Revolution is the game you’re probably familiar with. As with the original game, it’s more interested in letting you participate in the conversation then explaining three-hundred years of state of nature thinking. This is probably the best one for looking at how normal people would look at cybernetic augmentation. This generally gets used as an analogy for racism, which is probably useful, if you remember that’s what they’re doing.


Q&A: Vampire Feeding Symptoms

If a vampire drains a victim completely of blood, would they show any bruises? If not, what other trauma would they show?

Given that a bruise is, literally, a sub-dermal hemorrhage… I’d be willing to go out on a limb and say, probably not. Actually, if you want something sufficiently messed up; a vampire that preferentially goes after bruises is a possibility.

That said, corpses don’t generally bruise. So, if they were killed, then exsanguinated, there wouldn’t be any bruising. Depending on how fast the vampire was draining them, I’m not even sure if bruises would form.

Now, what would happen if you hooked a vacuum cleaner up to someone’s vascular system? Yeah, I don’t know, and I really don’t want to research that. (Mostly, because I know it’s been done, and will return valid information.) But, depending on the specifics of how vampires work in your setting, they could actually rip apart the victim’s circulatory system, resulting in massive hemorrhaging, or collapsed veins and arteries.

Of course, if your vampires are messy eaters, and literally rip their victims apart… you’d see that on the victim.

This kind of illustrates the problem with vampire questions in general. There isn’t much consistency. Either in fiction or folklore. Most societies have some kind of vampire myth. It builds out of cultural anxieties, usually in reference to death and handling the dead. Though, it’s probably worth pointing out that Dracula, and the modern vampire mythos spawned from him has a lot more to do with sex, sexuality, and xenophobia, than anything to do with funerary rituals being botched.

The result is that vampires are as varied as the human cultures that created them. So, asking, “how would they work?” Is going to result in a fair bit of guess work. The other side of this is, in using them, you have a lot of freedom to decide how the rules work for your vampires.

In the past I’ve identified Ravenous (1999) as a pretty fantastic vampire movie. I stand by that. But, there aren’t any vampires in it. Not explicitly, anyway. It’s about cannibals who are empowered by feeding on human flesh, rejuvenating them and granting superpowers. The movie calls them Wendigo, but, they’re vampires.

For modern settings, I strongly recommend the parasitic variety. In the modern world, dead bodies drained of blood turning up is a clear sign that something has gone horribly wrong, and in a setting where vampires exist, you’re going to have people who hunt them. Meaning an exsanguinated victim is just one undead fashion reject signing themselves up for a world of hurt.

Although it’s a pain to find, I do still strongly recommend the British Ultraviolet TV series. It was a smart look at vampires hiding in the modern world. It’s also a very intelligent, and rational, handling of the pre-millenial anxieties of the late 90s.

White Wolf’s Vampire: The Masquerade is somewhat similar to Ultraviolet. They’re both working towards building vampires that could exist in the modern day. Though, V:TM is a lot less shy about insinuating vampires into social systems like the Police and government, while Ultraviolet is more interested in the vampire hunters. I did a full article on White Wolf’s World of Darkness setting last year. So, that might be worth skimming before jumping after them. But, for writing horror, it is a very good reference to look at and think about.


Q&A: Honeyed Wounds

I watched The Equalizer recently. Is it really possible, in your opinion, to seal up a gunshot wound with boiling hot honey? McCall does this as a quick patch up so can keep fighting later on. Wouldn’t it just hurt more when he tries to take off the honey to treat the wound?

I’m honestly not sure. I know honey is bacteriostatic, so you can use it as an antibacterial salve on minor wounds. As for actually sealing a wound? Especially one with deep trauma. I’m skeptical. This would be (almost exactly) like trying to treat a gunshot wound with Neosporin. Yeah, it’s great for minor cuts or mild burns, but against a bullet, not so much.

If this is after field surgery to keep the wound from getting infected, it’s a lot more plausible, but not just, “boil and pour it in there.”

My recollection is that boiling honey breaks down the enzymes that make honey bacteriostatic, which is vital to preparing it for fermentation into mead. …but, the internet says I’m wrong, that you can get honey to ferment at room temperature if you cut it with enough water, and that there’s no enzyme function involved.

I suspect that, as with a lot of organic mater, your body can pretty safely absorb it during the healing process. So, getting it out of the wound is a lot less important than you might think. That said, if you do need it out of the wound, you can wash it off, which you need to do when cleaning most wounds.


Q&A: Stab Wounds

Hi in my fanfic I’ve just been writing my character dies after having a thrown knife stab her in her side and then ripping it out to kill the other person. Is it feasible that my character dies quickly or will she need help?

Yeah, so, basic first aid. If you’ve been stabbed or impaled, do not remove the foreign object. The exception is if the object is causing more damage by staying there.

This even extends to situations where a character’s been run through on a piece of rebar. They’re better off being cut down and taking the pole with them to the hospital than pulling it out.

Pulling out a knife (or any impaling object) will result in more immediate trauma. It got in there, but pulling it out won’t reliably follow exactly the same path. This is especially true of things like serrated or hooked blades.

So long as the object remains it will still obstruct the bleeding… some. This isn’t going to be enough to save their life, but pulling it out can tip the balance the other way. This is especially true if you end up with a blade nicking an artery, or a blood rich internal organ like the kidneys or liver. You’ll lose some blood, but pulling the blade out can turn things to life threatening very quickly.


Q&A: Starke is not a Real Doctor

Starke, as you have reminded us on 24 occasions, you are not a doctor. How then did you manage to build up such a large amount of medical knowledge?

Scouts, family, and research.

I’ll snark on the subject occasionally, but the Boy Scouts do actually force you to learn some intermediate first aid procedures. It never gets into the range of full field surgery, but there’s actually a lot of training that goes into reaching Eagle. Medical, and otherwise. Some basic stuff comes straight from that.

Second, there’s a stupid number of medical professionals in my immediate family. My mother taught pharmacology and substance abuse (diagnosis and treatment) for most of my life growing up, and a lot of that rubbed off. It’s also part of why I have a more solid grasp of drug interactions and effects than basic A&P.

My father was a certified EMT for a few years, and, while less of that rubbed off, he was also one of the people responsible for handling the first aid classes in Scouts, which meant it ended up more advanced than was probably strictly necessary, by the book. My oldest brother is an actual doctor, and, while I’ve never lived with him, I did have the misfortune of being stuck at the table during extensive discussions about his work. Forensic radiology, and later emergency radiology, if anyone’s wondering. Also, as with my father, he’s an Eagle Scout as well, which gets towards the slightly skewed perspective I have of thinking, that the rank, and associated skills aren’t that unusual. Even when they are.

Finally? Research. This is one that’s, technically, open to anyone. It depends on exactly what the question is, but with some stuff, like the intracardiac injection question yesterday, or the malnourished teenager question a while back, I just need to look it up and check. There’s a couple decent medical resources online. WebMD comes to mind, though honestly I use google on the term, and then sort through the responses based on where it’s coming from. The other thing about researching basic medical information is, this stuff is really well documented. It’s not always as accessible as medical professionals think it is. But, it is out there.

Part of the reason for the disclaimer is, since I’ve never had the full range of training, I want that out there. I’m doing the best I can, but it’s not technically my area of expertise, even though I’ve had to learn a lot on the subject.


Q&A: No Such Thing as a Safe Gunshot Wound

dogmatix said:

I think what they’re asking is ‘how do I shoot someone without killing them?’ Yes, there is no safe way, but you’re not really explaining WHY. Probably something to do with the possibility of hitting veins/arteries, organs, etc, I’d guess?

That’s the basic gist of it. Also, we have talked about gunshot wounds before; here, and here. We even have a tag on the subject. (It actually manages to make the tag cloud with 12 entries… I should probably switch that to alphabetic sorting for everyone’s convenience.) The short version is that bullets have a nasty habit of doing unexpected things. It’s not exactly random, but there’s way too many variables to predict in the field, meaning any bullet could turn your internal organs into goulash. Even under the best circumstances, any untreated gunshot wound can result in death.

This is before you even get into weirdness like hydrostatic shock, which might not be an actual thing. Though, I do need to expand that tag, and might need to do a more detailed post on it, because I know I’ve talked about it more than once.


Q&A: Introcardiac Injection

Can regular needles be used to get a shot to the heart?

You mean an intracardiac injection? No. It requires a longer needle than a normal injection would. It’s also an obsolete technique because there are better, faster, and safer, ways to get medications into someone, that don’t involve stabbing them in the heart and hoping you don’t cause a hemorrhage.

Anyway, as always, I’m not a doctor, and this is something that was certainly never covered in Scouts. So, I could be wrong here.


Q&A: Arrow to the Leg

I read somewhere that an arrow to the thigh can kill someone. Is that true? How?

If it severs the femoral artery? That can kill in minutes. Combine that with the fact that arrows excel at cutting tissue apart, and the risk of severing something important is pretty good.

Even if it misses anything major; you’re still pumping a lot of blood through your legs, so without medical attention, bleeding to death is still a real possibility, even if the arrow doesn’t hit anything vital.


Q&A: Fourth Degree Burns

My MC’s arm got brunt to the bone in her hand/wrist, to the muscle (and a bit further) to the elbow and to the muscle from her elbow to her shoulder. She lost her nerves from her elbow to her fingers and the feeling comes back from her elbow up. She gets some treatment, mainly just ointments/herbs. She has 2 years until she joins the military. Would that be enough healing time? How would this affect her fighting? She fights in a style similar to tai chi, ninjato and teakowndo, does this matter?

Oh god, I can already tell this would be a nightmare to fully research. What you’re describing is a fourth degree burn… well, technically at least three fourth degree burns, requiring surgery, and possibly, in this case, amputation.

If your character has had enough of their arm burned away to destroy the nerves running down the arm, then everything “south” of the burn will be paralyzed, including her hand. If the burn also destroyed the artery in the arm, which is possible, then the tissue beyond the burn will die and proceed to rot. Technically this is called “tissue necrosis,” or gangrene, but, the reality is far less clinical and more horrifying.

Even if that’s not the case, third and fourth degree burns both carry a pretty serious risk of infection. For someone in a pre-modern setting, without an understanding of bacterial infection, and without access to a sterile operating environment? This is probably a death sentence.

Long term survival for burns like this, usually involve grafting tissue from elsewhere on the body. In that case, arterial grafting is possible today, though I don’t know how old that particular technique is. Muscle and skin grafts have been around for awhile. From what I can tell, nerve grafts are still semi-experimental, the technology is getting there, but it’s still tricky.

But, for a character limited to herbs and ointments? Unless they’re explicitly magical, and you’re in a setting where magic can repair egregious injuries like this? No, that’s how your character died, not a thing that happened to her before she started serving in her military.