Tag Archives: Starke is not a real doctor

Q&A: Hypothermia and Alcohol Intoxication

Any tips on writing dialogue featuring a character suffering/recovering from hypothermia? At a glance it seems like hypothermia makes you act kind of like you’re drunk, is that accurate?

transquad

I’m not completely sure. I’ve never seen severe hypothermia first hand, so I’m going off diagnosis guides and making a guess. That said, I have seen a few warnings about potentially misdiagnosing hypothermia as alcohol intoxication, which makes me suspect these are very similar.

This is a little more complex than that, because, from my limited research, alcohol intoxication seems to exacerbate hypothermia. Your body temperature crashes faster, and you stay intoxicated for longer. This is because hypoglycemia (low blood sugar) interacts viciously with hypothermia, and excessive drinking can result in (temporary) hypoglycemia.

If you’re wondering, “if it’s that dangerous, why would anyone drink in the cold?” The answer is fairly simple, alcohol makes you feel warm. This is why there are traditions about consuming hard liquor to endure or recover from the cold. The biological reality is that warmth is an illusion, but the experience led people to believe that alcohol helped dealing with the cold.

To your question about dialog; Hypothermia’s slurred speech and impaired cognitive function could look a lot like alcohol intoxication. However, when it comes to, “acting drunk,” not so much. There’s a number of specific physical symptoms beyond the slurred speech and confusion associated with hypothermia. Hypothermia will result in drowsiness, so no matter what kind of a drunk you normally are, hypothermia will look like a sleepy drunk. Beyond that, there’s shallow breathing, a weak pulse, and of course shivering.

So, hypothermia doesn’t look like alcohol intoxication, however, the slurred speech, mumbling, impaired coordination and cognitive function do. It’s close enough that hypothermia can be mistaken for alcohol intoxication in a cold environment by someone without medical training, but not so close as to say that it’s just drunk in the snow.

-Starke

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Q&A: Adrenaline

hello! so, i’ve been reading your posts for some time and i was wondering about how the adrenaline really works in a fight. i read an article saying that adrenaline, specially when “normal” people fight (not pro fighters), works like an advice to run for your life. not like something that inspires you to fight. but, i can’t confirm this information, because i can’t find another person talking about it. so, may u write something about how adrenaline works in real situations? thank u so much!

hwfflepff

The short answer is that adrenaline is a hormone. When threatened, your adrenal gland secretes epinephrine (adrenaline.) Like most hormones, it affects a many organs uniquely.

I’m going to be a little reductive here, the major effect is that adrenaline increases the conversion of sugar into energy, and reduces the production of insulin, meaning you’ll keep that energy longer. It also increases your respiration rate, hyper-oxygenating your blood, and your heart rate, getting that hyper-oxygenated blood to your brain.

Adrenaline increases your pain tolerance significantly. Though, I’m not sure what the mode of action is for this effect. It also increases your apparent strength, though this is a little misleading. Humans are, in general, much stronger than most people realize. However, we moderate to prevent self-injury. Because adrenaline reduces pain, in combination with the other changes, this results in a significant strength increase. The reason you wouldn’t normally do this is that you’ll pull, wrench, and sprain muscles. This is still true during an adrenaline rush. You just don’t feel the pain, but it doesn’t make you more resistant to damage.

The entire result is vaguely analogous to, “overclocking,” your body. It will function more effectively for the duration, but the process is very stressful for your body overall. It’s a biological function that prioritizes immediate survival over general health.

After the immediate threat passes, the individual will be left with a lot of nervous energy from the rush. They’ll be jittery. This leads to a comment I’ve made before; I deeply dislike adrenaline rushes. It’s useful in the moment, but in my experience it always outlasts the provoking incident. Though, I’m fully aware my experiences are not universal. While it’s not going to be true for everyone, figure your adrenaline will crash roughly an hour after the initial rush. (The exception would be if you’re under constant stress. In those cases, the heightened adrenaline levels can persist for the duration.)

When your adrenaline crashes, you’re going to feel exhausted (and potentially nauseous.) This is the normal consequences of what you just put your body through. You will become aware of injuries you sustained during the rush, including some of the muscles you overtaxed.

If heightened adrenaline levels are maintained for long periods of time, this can have disastrous effects on the heart. You really cannot safely sustain the elevated heart rate, and eventually it will fail. Because adrenaline rushes are triggered by stress, they can be caused in situations where they’re neither useful nor helpful. This can include constant adrenaline production because of stress. PTSD is one situation where adrenaline rushes can be triggered by an inappropriate stimuli. This can pose a real health threat. This can kill you.

Adrenaline will not grant you insights into fighting. The fight or flight response is a biological response to danger. It’s important to understand, “fight or flight,” is a single response. It’s not like you have a, “fight,” response, and, a separate “flight,” response, it is a single biological response for either course of action.

Adrenaline is not “blind instinct.” While it will affect your brain, it’s not going to shut you down into a feral fugue. You’re still (theoretically), a rational, sapient being. Adrenaline doesn’t change that. You will be thinking faster, but not smarter, so if you’re prone to making dumb decisions you can now expedite that process.

In two words, “not fun.” Adrenaline is a useful survival tool. It can be the difference of living and dying, however, it is just a chemical your body keeps around in case things go horribly wrong.

-Starke

Q&A: This Will not be on the Test

I was wondering what are the standard teachings that comes with fighting? I mean, what else do you learn? You seem knowledgeable about medical stuff. Is it your merit or do people get taught about those along with their education etc.

There isn’t a single, “standard,” here. Martial arts classes will teach you whatever the instructor feels is relevant to your training. If they think you need anatomical knowledge, they’ll teach you that. If they think you’ll need to learn about human behavior and psychology, they’ll cover that instead.

So, with that said, I didn’t learn this in martial arts. My medical training, such as it is, comes from two sources.

First, I’m an Eagle Scout, including some limited medical training. I don’t remember how many medically related badges I have. At least two, probably more.

The second source is more informal. I was raised by a clinical pharmacologist, and a Methodist Minister who decided he wanted to become an EMT after a midlife crisis. While we’re not close, I also have a brother who’s an MD. The short version is, I grew up with an unusual amount of medical information getting thrown around, and picked up some more along the way..

My exposure to medical ethics came from psychology classes I took in college. It’s the only field where I maintained a perfect 4.0.

So, as I say in the tags on every medical post, I’m not a doctor. I can render first aid and that’s close to the end what I’m willing to do to another person. However, I have enough knowledge that I can offer advice from a writing perspective. Also, because of the informal background, I rarely have issues understanding online resources.

My formal education is, I have an associates in Computer Programming, and a Bachelors in Political Science, along the way I ended up 3 or 6 credits short of a minor in Psychology. Yes, that’s a weird educational path, and no it’s not a medical background.

Scouts included some medical training. Now, anyone who sticks with scouts will get some basic first aid training, however I also went back for merit badges on the subject, so my medical training was more extensive.

If anyone’s wondering, “how could you have forgotten which badges you earned?” I have over 40, I could not give you a list from memory if you put a gun to my head. I can’t even remember the names for all of them looking at my sash.

One of my self defense classes, the one in the late 90s, was explicitly from the Boy Scouts. The Scout Master was a Captain in the Air Force, he grabbed a Sheriff’s Deputy he knew and put the entire Troop through a couple weeks of training. Ironically, this was the least responsible round of training, as it prioritized the hand to hand component rather than focusing on situational awareness, threat assessment, creating an opening and extracting.

If you want to learn medicine, go to school for it. There’s certainly a need for medical professionals in the world. Just, be aware that it’s a very unglamorous profession.

If you want to learn martial arts, take a course. You can do both, unless you’re in your residency.

In general, a well run class (of any kind) will include the information you need to understand the material presented. (Or, in academia, will have published prerequisites.) There are definitely martial arts classes out there where you’ll learn a bit of A&P along the way. I probably learned some anatomy from martial arts and simply didn’t realize it. However, you’re not going to get medical training from enrolling in a martial arts class.

-Starke

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Q&A: Shot in the Leg

So I read your post on gunshot wounds to the leg and it was very helpful, but what I’m looking for is a little more specific. My character gets shot in the leg, clean, nothing major hit. The wound is bandaged. But immediately after she gets shot, she passes out and isnt aware of anything. Is that believable? If the wound was bandaged right away, would she survive being carried for an hour before even reaching the hospital?

So, what caused her to pass out?

There’s nothing wrong with being able to survive for hours after taking a bullet if it didn’t hit anything vital. Some gunshot wounds can take a long time to kill you. Bandaging it is a good idea, because it will slow the blood loss.

Blood loss can result in losing consciousness. You lose a lot of blood, go into hypovolemic shock, lose consciousness, and bleed to death. If a patient loses consciousness shortly after suffering a gunshot wound, that tells you to look for serious blood loss. You may want to double check and make sure you didn’t miss any internal hemorrhaging.

You know will not cause you to pass out? The pain from getting shot. I feel like I’ve written this recently, but pain does not make you lose consciousness. Pain will keep you awake. While I’m a little less confident of this, I’m pretty sure getting shot will keep you awake. Even if the pain doesn’t, the adrenaline will.

If someone gets shot and passes out, they’re losing blood fast. You lose consciousness when you’re down ~20% of the blood in your body. You die when you lose between 30% and 40%. Napkin math says, if someone gets shot, and it takes 30 minutes for them pass out from blood loss, you’ve got a bit less than 15 to 30 minutes before they’re dead.

So, you have a character who gets shot. Their leg gets bandaged, but they lose consciousness within five minutes of the wound, they’re not going to survive for an hour without medical attention. Even if it takes two hours for them to lose consciousness, taking another hour to get them to a hospital would be an extremely risky decision.

Now, if they’re semi-conscious for most of the ride. Say, the first 50 minutes, and lose consciousness about 10 minutes out, it’s going to be touch and go, they’ve still lost a lot of blood, but that is survivable. If they pass out ten minutes earlier, it’s distinctly possible they’ll be dead on arrival.

If she’s being carried by hand, that carries extra risks because it could aggravate the wound and accelerate blood loss. Especially if they’re carrying her with the gunshot wound at a lower elevation than the heart. The ideal situation would be to lay her out on a vehicle’s bench or a stretcher, with the injured leg elevated above the heart. If you’re bleeding to death, don’t let gravity help finish the job, make your heart work to kill you. It will buy you time.

Also, hand carrying another human being for that long will be exhausting. It’s not impossible, but unless someone’s in excellent physical condition, they might not be able to carry her the distance, and shuffling her between carriers runs the risk of aggravating her wound, making things worse. This is less of an issue if they’ve got her on a stretcher or some other kind of stable platform.

Now, it’s possible she lost consciousness due to some other factor, but I can’t think of any off-hand, that would improve her odds for her survival.

If she lost consciousness shortly after getting shot in the leg, it’s a very bad sign. She’s probably losing blood much faster than anyone realized and would be dead in minutes. My suspicion would be an arterial bleed, which can be managed to a degree by keeping pressure on the artery to reduce blood loss. However, we’re talking about a character having to shove their finger into her wound to stop the bleeding (which requires some fairly specific anatomical knowledge.) Given how fast she lost consciousness, I’m pessimistic about it buying more than a few minutes without serious medical attention.

So, is it believable? No. It’s entirely believable she’d remain conscious, going into shock. It’s entirely believable she’d lose consciousness shortly after the injury, and die a few minutes later. Unfortunately, it’s one or the other.

If she’s bleeding out, her initial symptoms would include a headache, vertigo, nausea, and increased perspiration. These aren’t particularly worrying. She’s loosing blood, but she’ll probably live. However, over time, she’d start manifesting more serious symptoms. These include losing body temperature (and feeling cold), starting to suffer from impaired cognitive function, particularly confusion. Her skin would become cold and clammy, and would get paler as blood pressure dropped. Her pulse would get faster and weaker, also as her pressure dropped. It would become harder for her to remain conscious. Eventually, she would lose consciousness. The faster these symptoms manifest, particularly the more severe ones, the more dire the situation. If she’s going straight to passing out, and help is an hour away, she’s already dead.

I’m sorry, but if she drops after the firefight, you just killed your character.

-Starke

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Q&A: Dextrocardia

I’m not sure if you could help as this may be more medical but someone in a fight gets stabbed in the heart with the weapon left in the body and left for dead. Thing is, that’s not the heart because the victim has dextrocardia, in other words the heart is on the other side of the body. Can the victim survive this? Or would the attacker know they missed the heart. Or do most attackers want to miss the heart because they don’t want arterial spray all over?

That’s not how dextrocardia works. That’s not where your heart is.

Your heart is in the center of your chest, between, and behind, your lungs. The organ is asymmetrical, and the left side is responsible for pumping blood, meaning it is larger on that side. However, if you’re trying to stab someone in the heart, that’s going to be center mass. Dextrocardia or no, you’re going to hit their heart.

If, for some reason, you decided to skewer their pericardium, and could find that in battle, but they had dextrocardia, you’d still collapse their lung. It’s not like, “oh, yeah, that’s not where I keep my heart, I’m fine.” You would still seriously mess them up.

Incidentally, impaired cilia functionality is sometimes associated with dextrocardia. The lung’s cilia are “hair-like” tissues that assist with respiration, and help protect the lungs from infection. This means that the sufferer may experience reduced resistance to airborne bacterial and viral infection, and they may have difficulty getting sufficient oxygen. These have serious developmental implications.

Something I’m not entirely clear on is whether dextrocardia is merely associated with heterotaxy, or if it is a form of heterotaxy.

Heterotaxy is a catch all of genetic mutations where the subject’s internal organs either aren’t where they’re supposed to be, or are oriented differently from normal. This can be benign in rare cases, but those internal organs don’t, usually, function properly. Additionally, some organs can appear as multiple smaller variants (which don’t function properly), or an organ can be outright missing (with severe consequences.)

In the case of dextrocardia, a common form of heterotaxy is a missing spleen. You need that for your immune system, and it’s absence is a pretty big deal. This will often require the subject to supplement their immune system with antibiotics.

Additionally, dextrocardia is frequently associated with other heart defects. It makes sense that the heart might not be in working order, but this can get wild, including the ventricles being reversed, a perforated intraventricular septum (this is the tissue that separates the ventricles), failure of the heart’s walls to develop properly (or at all), the complete absence of a ventricle, (meaning the subject has a single ventricle heart), or having both the pulmonary artery and aorta connected to the right ventricle, with the left ventricle being basically unused.) All of these can result in poor circulation (at least), and saying, “what if they get stabbed there,” comes after a host of other symptoms.

Worse, with already poor circulation, a collapsed lung is significantly more dangerous, before we remember they’re probably immunocompromised. Yeah, that would still kill them. If both ports are on the right ventricle, this also means they’ll have abnormally high blood pressure in their lungs. That place they’re now bleeding from.

There is one, slightly less dire diagnosis, though it’s not dextrocardia. Situs inversus is a rare condition where all of the subject’s internal organs are “mirrored” from normal. The heart leans to the right, the right lung is smaller, the liver is left(ish), the spleen is on the right (and functional.) This is usually benign. It occurs in ~1:10,000 people, and can be the result of a recessive genetic mutation, or it can be a non-genetic result of an embryo splitting during gestation creating “mirror twins.” One of the twins may have reversed internal organs. Worth noting, most mirror twins do not exhibit situs inversus, it’s still a rare condition there. (Most mirror twins will have normal internal organ configurations.) Because it’s benign, it’s rarely diagnosed directly, and usually comes up when the subject is seeking medical attention for something else.

Basically medical trivia, but someone with situs inversus cannot have dextrocardia (as a disorder), and instead would have levocardia. This because the name, “dextrocardia,” includes the direction the heart is leaning. Situs inversus with levocardia is exceptionally rare. Though there are a few documented cases.

So, can it save your character? Even with situs inversus, your heart is in basically the same place. Getting stabbed on the “wrong” side would still collapse your larger lung, and either hit your heart (if they’re close to center mass), or (if they were a little low) your liver. So, no, it would never be, “oh I left my internal organs in my other chest,” it’d still be a lethal, or near lethal, chest wound.

-Starke

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Q&A: Asphyxiation

i’m writing a story and in one scene, a character is being suffocated. i don’t really know how to write about it but i want to be realistic! would the body twitch or just go limp? would they go into a coma or die? sorry if this is too weird!!

If we’re skipping straight to asphyxiation, without any obvious cause, you’re looking at hypoxia. The victim may become tired, disoriented, or confused, and then pass out, slip into a coma and die.

However, if there’s a perceptible cause, such as someone strangling them, that’s going to provoke a violent response. With a major caveat, choking someone is not as easy as it looks. The import detail is that there are two kinds of chokes. Both rely on cutting off oxygen to the victim’s brain. You can do that either by preventing respiration, or by directly obstructing the flow of blood to the brain. The latter is far faster and more effective, but it’s not what you’d usually call “asphyxiation.”

Choking someone by preventing respiration it time consuming. We’re talking about having to continue to choke them, uninterrupted, for over a minute, while they fight back, and for several more minutes after they lose consciousness, “to make sure.” They will start to fade, and fighting back will hasten the process some, but in combat terms it’s still a small eternity. Just because they’ve gone limp doesn’t mean they’re going to die. Your body is remarkably skilled at breathing, especially when you don’t think about it, meaning there’s a real risk that they’ll begin breathing again after you stop choking them, conscious or not.

As for your other suggestion, they’re probably not going to be twitching. There’s a lot of things that can cause twitching, including messing with their nervous system directly, but the only thing I can think of associated with choking is in erotic asphyxiation. If that’s your thing, have fun, but I don’t think that’s what you were asking about. That’s also a byproduct, not a symptom. Maybe some kind of nerve agent could produce that result while also killing the victim, but I’m unsure.

Also, I usually reserve this for the tags, but I’ll remind you, I’m not a medical professional. I got my my First Aid and Medicine badges over twenty years ago, so this is outside my area of expertise. With that warning in place: You might also see twitching leading to asphyxia if the victim suffered a stroke or seizure. For example, a muscular spasm could close or collapse the trachea. However in that case, the spasm would be the cause of the asphyxia, not a symptom of it.

If it’s just something obstructing the airway that’s going to provoke the victim’s gag reflex, or get them coughing. This can also occur with some gases that will also interfere with breathing. The victim will respond, trying to clear the airway however they can. How well they can offset panic, and think their way through the situation will determine how well they respond. I’m aware a few anecdotal examples where people performed impromptu Heimlich Maneuvers on themselves using furniture, or other convenient objects.

Speaking from my personal, and somewhat distorted, experiences: Someone going for your throat is fucking scary. I’ve never reacted well to someone going there in a fight. You want to see a human being go into a frenzy? Go for their throat. You’re going to get hurt.

So, some unsorted technical information to work with.

Choking with two hands is, ironically, harder than with a single one. Your hands will get in each other’s way. A single handed choke has the disadvantage of being dependent one point of failure, but it is easier.

People do not react well to strikes that go towards the neck or face, (this is isn’t just me.) Or, perhaps, I should say, “they react too well.” Going for choke at arm’s length will give them a lot of time to respond. You’re getting very close to the center of their vision, so they will have an easier time tracking, and reacting to, this movement.

For someone with training, lifting their opponent off the ground with a single handed Darth Vader style choke is significantly easier than it looks, if their foe is against a wall. Downside is the victim will have all their limbs free. I guess if you’re a Dark Lord of the Sith it doesn’t really matter, but this kind of a move is better suited for theatrics and intimidation, not combat. It looks cool, and I wouldn’t be surprised to learn David Prowse could actually dead lift someone with one hand. Buit, you don’t want to do this.

For those times when you need to fake a death with a willing partner, it’s remarkably easy to “fake” a choke in front of witnesses. Just make sure you’re not actually applying too much pressure, play the role, and make sure no one gets a chance to examine the, “corpse.” The major risk here is if you’re trying to fool someone who knows what to look for.

“Safely” choking someone out usually involves coming from behind and wrapping your arm around their neck. Depending on how you do this it could either be simple asphyxiation or a blood choke. One benefit is that you can do this with something in your main hand. Your off hand can be used to fend off their attempts to retaliate.

Preemptively defending against this is actually really simple: Tilt your head forward until your chin is flush with your chest. Any attempt to choke you from behind will now require getting through your jaw. This will defend against both arm bar, and triangle chokes. It even offers some protection against being garroted, and chokes from the front. The key is, it has to be done before the choke gets under the chin, after that it’s too late.

I hope this helps, and please don’t try any of this stuff at home.

-Starke

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Q&A: Anemia

i’ve looked around and haven’t really found much on the topic, so i was hoping you guys would have a better idea. i have a fighter character who has anemia (as well as chronic pain). they definitely aren’t zipping around, but I’d be curious to what specific limitations these would give for someone who uses hand to hand and blades? thank you either way for your time!

Chronic pain is a problem, but anemia is a showstopper. The pop culture frame of reference is that anemia impairs or prevents clotting. If that was the extent of the condition, it would be serious enough to make combat exceptionally dangerous. If you can, literally, bleed to death from minor bruises, that’s going to make hand to hand exceptionally dangerous. However, that’s not what anemia is, and the reality is so much worse.

Anemia itself is a general condition where you lack sufficient red blood cells. The inability to clot is related to this, because the blood isn’t thick enough, however, this is only one of the symptoms, and while it can be life threatening, it’s not the biggest problem for a fighter.

Common symptoms for anemia include weakness, fatigue, and dizziness (among other things.) The simple version is that the body uses red blood cells to transport oxygen through to where it’s needed. In an anemic, there simply isn’t enough blood to transport enough oxygen. I can’t find concrete confirmation, but based on the cause, I’m almost certain that strenuous physical activity will aggravate the symptoms. This means an anemic fighter will exhaust very quickly, and is at particular risk for tachycardia (in addition to injury.)

Worth noting that anemia doesn’t, necessarily, prevent exercise, and in some cases it’s probably still a good idea, but the patient needs to be very mindful of their condition.

Also, not all forms of anemia are as dire as I’m making it out to be. I probably experienced mild anemia as a result of my excessive use of aspirin when I was younger. Seeing the symptom list now, I can say some of that was there, but at the time, it wasn’t severe enough for me to realize anything was wrong. The tipping point was when I was looking at watery blood from a nose bleed, and attributed that to aspirin being an anti-coagulant.

Additionally, anemia can be caused by a number non-self-sustaining causes. Aspirin is one (I suspect, the chronic use of any anti-coagulant will have similar results), heavy blood loss, and iron deficiency are also possible. In the case of blood loss, this is something your body will recover from with time. With iron deficiency, your body simply doesn’t have the materials it needs to make red blood cells, but if you adjust your diet, or take supplements you can manage this.

There are other causes, For example: I’ve been ignoring sickle cell anemia. In this case the blood cells exist, but they’re deformed, and can’t interact with the body properly. The resulting symptoms are similar, though the cause is distinct. I probably should point out that “pain crises” are a symptom of sickle cell anemia, if that’s the specific form of anemia you’re talking about, there’s a lot of literature on the subject, and some of the details vary significantly.

So, if your character has any condition which impairs the production of red blood cells, they may have very mild symptoms. They’re anemic, but might not even realize it, until they start losing blood. The problem comes in when their body can’t replenish lost blood fast enough. Initially their clotting factor may be close to normal. They won’t be impaired in combat. However, their injuries will stack up and over time their ability to recover, and even their ability to heal from prior wounds will go off a cliff.

Thing is, that can happen to anyone. An anemic condition will further aggravate, or jump start it, but if you’re losing a lot of blood, that will have knock on effects until you can fully heal. Again, serious blood loss will result in a form of anemia. It’s not a chronic condition, but your body simply doesn’t have enough blood, and it’s working to get back to where it should be.

If your melee fighter is anemic, it’s going to be a downward spiral. This is a condition where your body really cannot take a lot of abuse, and hand-to-hand combat places a harsh toll on your body. It’s even worse with blades, because you will bleed. That’s blood that you cannot afford to lose, and you won’t be able to stop bleeding.

-Starke

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Q&A: Stabbed in the Neck

What are the chances of survival if you get stabbed in the neck? For instance, by a six-inch knife? Where is the worst spot to take a wound like that, and where does it offer the highest chance of survival?

candelantern

The chances of survival are not great.

So, normally, the rule of thumb is: Three inches of penetration anywhere on the body is enough to kill. The thought process is that, if you’re going that deep, you’re going to hit something that’s either necessary, or that will cause the victim to bleed to death. When we’re talking about the neck, everything is a lot closer to the surface.

You need your spinal column. That’s pretty well armored, but it’s still vulnerable. Hit it with enough force, and you can knock the third or fourth vertebra out of position, severing the spinal chord, and killing them on the spot. Run a blade horizontally between those two, and you should be able to do the same with slightly more finesse (for whatever that’s worth.)

You need your arteries. That’s the carotid which is mirrored on each side. Sever either, and your life will be over in minutes.

There’s the trachea and larynx. You need those to breathe. They’re protected by a layer of cartilage, but that’s it. If it gets carved up, you’ll asphyxiate. This is survivable with immediate medical attention. But, this is well beyond normal first aid training. You someone with actual medical training on site.

There’s the upper esophagus which is important, though not immediately life threatening, but that’s shielded between the trachea and vertebrae.

There’s no place to get stabbed in the neck that isn’t immediately life threatening, everything’s either muscle or vitally important to your survival. Six inches of penetration will go all the way through, probably damaging multiple vitals.

Stabbing someone in the neck is a fantastic way to kill them. You’re almost guaranteed to hit something that will quickly end their life.

The most survivable neck injuries would be superficial slashes that don’t actually get deep enough to damage anything important.

Damage to the trachea is survivable if they can get immediate medical attention. But, again, you need a paramedic or doctor right there. This isn’t a case where, “I passed my first aid cert,” will cut it.

The worst, is a toss up. Anything that severs the carotid will kill them. Someone who knows what they’re doing could execute this pretty efficiently. They just need to drive a blade through the artery and open it up.

Running a blade into the spinal chord will also get the job done. That requires more precision, but this isn’t better. And if they’re striking from behind, aiming for the base of the skull is going to be easier and more reliable.

These are both really lethal outcomes, but realistically, if you’re running a six inch blade through someone’s neck, they’re dead.

-Starke

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Q&A: Resident Evil

I always wanted to know if Ada Wong could really have survived after the tyrant threw her at the control panel in the original RE2, and how could someone survive the type of fall she suffered in the remake RE2, could you answer the doubt of an Ada enthusiast?

Going in reverse order, the remake is on my to do list. It’s installed on my PC right now, but I haven’t had the time. I’ve seen Ada do a lot of things over the years that are, flat out, not survivable. So, without seeing the fall your talking about, if you’re asking? Probably not. Or at least, not without serious injuries. That’s never stopped her before, but Resident Evil has always had a “tangential” relationship with realism.

The console in the original game? No. Mr. X chucks her into that with enough force to put a huge dent in it. The thing appears to be steel, and she goes in directly against her head and spine, so no, Ada should not be able to survive that.

When you slow down the animation, (for example: Because you’re watching it in a blurry .avi to analyze exactly what happened) it starts to look even less survivable, as the first point of impact is pretty clearly, her skull.

We do find out that, as an adult, Sherry can survive those kinds of injuries in RE6. Something about the specific G-Virus strain she’s infected with (I do understand the lore explanation, but, it’s not relevant), so she should be resilient and recover from injuries like those seen. (When she’s under player control, her health mechanics are consistent with the other characters in that game.)

I’m bringing this up, because I’m not 100% sure that Ada isn’t modified to some degree. To the best of my knowledge, the games have never tipped their hand to say that she might also be a carrier for some unique viral strain. I don’t think that’s the intended read, simply because it would have become a plot point by now, but it’s one of the only ways to justify Ada’s resilience, aside from just shrugging and saying, “action movie rules.”

That is the real answer here, by the way. Ada, Leon, and Claire all run on action movie logic. They take ridiculous amounts of punishment and keep going. I do like it when a setting has justifications for that kind of durability, (again, Sherry comes to mind in RE2 & 6), but it’s genre acceptable behavior. And, as much as they are horror games, even going to the original Resident Evil, there’s action movie DNA mixed in.

Also, having kinda trashed the original game over the console damage, it is worth remembering that Resident Evil 2 came out on the original Playstation, 21 years ago. At that point in time, the technology available was limited. The game used prerendered backgrounds, because the PS1 couldn’t handle rendering the entire image in 3d. That would have been over the hardware budget. The damage we see to the console is over the top and cartoonish, because the actual game hardware had a very limited polygon budget, and needed to convey to the audience that Mr X had damaged it when he threw Ada into it. Within that context, if we assume the damage to the console is grossly exaggerated for visual clarity, not to indicate the amount of force used. It’s possible Ada could survive that. Travel distance and speed are both pretty low in the cutscene, so the force shouldn’t be extreme enough to mangle the console like that. By extension, Ada hitting it like that drifts into the territory a potential for serious injury, but, one you could walk away from with superficial damage, if you got lucky on the impact.

There’s a weird bit of trivia here, and this could be an issue with watching the .avi at 60hz, when it was originally designed to be viewed at 24hz, but there’s a frame where Ada does not render when she’s being thrown. I suspect the version held by Mr X is swapped out for the normal Ada model roughly at the moment when you get the blood spray on impact, and the console swapping out. Someone who has more familiarity with the PS1’s architecture might be better able to better explain this, and it is possible I’m simply misreading the .avi compression blur. I’m only bringing this up, because I have been digging through that video while working on this post, and saw some weird things.

So, to the original question, “Yeah, maybe?” Looking at Resident Evil and asking about realism kinda misses the point. Ignoring RE6, the games usually start from a fairly grounded point, and gradually escalate into insane antics. This is a pretty common narrative structure, but when Resident Evil goes big, it gets really crazy. I’m not mocking either, because, to the series credit, it usually manages that escalation very well, to the point that you don’t realize just how insane its gotten until you’re punching boulders in a volcano.

-Starke

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Q&A: Amnesia

re: concussion types: you mentioned global amnesia being incredibly rare as a side effect of head trauma, so i was wondering, how bad would the trauma have to be to induce “i can’t remember anything” amnesia? most info i found relates to memory loss around the time of the trauma, not on total memory loss which really speaks to uncommon it is, but if you have any insight i would love to know! (also from what i gather, you’d lose not only memories but physical skills as well, reading, walking etc)

So, the correct term for what we’re talking about is Retrograde Amnesia. This is the loss of previously created memories. There’s a lot of potential causes, but as with concussions, it’s not about how hard you’re hit, it’s what your brain is doing.

In a lot of cases, it’s not even about an injury; simply, something in your brain doesn’t work right. Your brain stores and recovers a lot of information on a regular bases, and whenever something goes wrong, whether that’s due injury, illness, chemicals, electroshock “therapy,” or psychological factors, it’s amnesia.

The term itself, is a bit misleading, because it’s describing a wide range of similar symptoms under a single header. The term itself is basically just, “can’t remember.” So, technically, if you forgot where you left your keys, and wanted to be overly dramatic, you could call that amnesia. No one else would be likely to agree, but you wouldn’t be completely wrong.

Complete Retrograde Amnesia is incredibly rare. I don’t have a number for this, the rate of incidence is that low. It’s a bit confused, because things like dementia are forms of retrograde amnesia. So, this can become a question of severity.

The one I do have numbers for is Transient Global Amnesia. I’ve actually had the privilege of watching an entire TGA event from start to finish. The rate of incidence there is about 5:100,000, and events usually last for less than a day.

TGA is complete anterograde amnesia, with mild retrograde amnesia. In this case, the patient was unable to form new long term memories for about six to eight hours, and while the event persisted they were unable to recall events in the previous nine months to a year. This lead to some remarkably repetitive conversations. After the event completed they were unable to recall events from roughly six hours before the event started until after it’s conclusion, and my understanding is they never recovered those memories.

During initial onset, the immediate fear was that the patient was experiencing a stroke. Given the symptoms, that was a reasonable concern.

Lit says that the patient should be able to remember, roughly, the last five minutes during the event. That sounds consistent with what I saw, but I didn’t time it.

So, there’s a term up there, “anterograde.” Let’s describe these. Retrograde simply means, “moving backwards.” Outside of amnesia, you’ll most often encounter this regarding the movement of celestial bodies. Under the geocentric model of the solar system, planets which appeared to reverse course were a serious puzzle, and the phenomena was described as, “retrograde motion.” When you add the fact that planets orbit around the sun, and not the earth, it makes perfect sense. They’re not reversing course, it’s simply a function of the planets’ orbits creating the illusion of reverse motion. Planets are still described as being “in retrograde,” to indicate that their apparent motion has reversed from the perspective of earth, even though we now understand why this happens.

Similarly, anterograde simply means “moving forward.” (Worth knowing that, while retrograde derives from Latin, and has been around since, at least, Middle English, anterograde is a modern word.) When dealing with amnesia, anterograde is the inability to form new memories. IE: “Without memories moving forward.”

As with any other form, anterograde amnesia can be there result of a number of different causes, including some illnesses, chemical reactions, brain tumors, injuries, and stroke.

Anterograde amnesia can also be experienced as a result of being put under general anesthesia. This means, I’ve probably experienced this first hand, but have no recollection of it.

A concussion can result in either anterograde, retrograde, or a combination of both forms of amnesia. Usually associated with damage to the medial temporal lobe. Note: this part of your brain does a bit more than just store memories. It’s also responsible for spacial cognition. If I remember correctly, but I can’d find reference to verify right now, damage to the medial temporal lobe also result in epileptic seizures, and loss (or at least impairment) of emotional control.

Since we’re talking about neural structure, and way out of my depth already, let’s talk a little more about memory. You have at least two distinct types of memories. Episodic memories are things you experience. If you stop and think back to something that happened, that’s an Episodic memory. Semantic memories are skills, and abstract knowledge. While knowledge derives from episodic experiences, you actually store this stuff differently. (I’m not clear on the exact, chemical or biological distinction here.) This is important to understand when talking about amnesia, because what you have seen and what you know are different kinds of memories. So, the idea that someone can’t remember who they are, but still has all their knowledge and skills, isn’t that far fetched. Except for the part where they can’t remember anything about who they are.

I’m going to stick a note in here: You asked about walking, that’s not a memory. Your brain is pretty well hardwired to do that. There’s actually a number of basic actions and functions of fine motor control, that have nothing to do with memory. Some of this stuff will atrophy if you don’t use it, but you’re not going to forget it. One of the more interesting ones is swimming, as infants are born with a reflexive ability to (attempt to) swim. This atrophies pretty quickly, but, it’s interesting.

One form of amnesia we’ve all experienced is infantile amnesia. This just discusses the phenomena where people do not (generally) remember the first three to five years of their lives. (There are exceptions, but those are rare.) This is simply a function of neural development, and may be tied to development of language skills.

There is one last variety you should familiarize yourself with: Dissociative amnesia. This a psychologically derived. It includes things like repressed memories and fugue states. The patient decides (at a sub-conscious level) not to remember something. This can be because the event is so traumatic they refuse to acknowledged it, or any number of other factors. In some extreme cases, the patient rejects themselves. They forget everything. Technically the memories are still intact, it’s not they put their brain on a bulk eraser and nuked it. They simply will not interface with those memories. In some ways can be pretty, “laser guided,” because the patient is trying to protect themselves, and are the best suited to know if something’s going to cause problems.

As a therapist, there a fairly decent argument not to probe someone with dissociative amnesia too deeply, unless they really are asking you to. We don’t talk about this much, but when it comes to psychology and the Hippocratic oath, if the patient is not being harmed by their issues, or harming others, you don’t mess with them. A patient with a dissociative amnesia who is happy with who they are, is not someone who “needs to be dragged back to face themselves.” Chances are, there were really good reasons their mind went, “nope,” duct taped the whole thing in a box, and chucked in the back of a closet. If the patient comes to you distressed because they can’t remember who they were, that’s different. If the patient simply can’t remember who they were, but is fine who they are, do no harm.

Okay, that’s amnesia, let’s talk about why you should never use this stuff in your writing.

The amnesiac point of view character is a very, very, useful trope. It’s too useful. This is why it has become cliche.

When you create a new world, you as the writer, know the rules, you know players, you know all the moving pieces. Your audience knows nothing. At this point, you have to decide how to introduce your audience to your world. What better way than picking a PoV character who remembers nothing and needs to be spoon fed the backstory as they go along? The audience, and the character, will acquire information at the same rate as they progress through the story.

Amnesiac characters can also justify a lot of exposition. If they know nothing, then they’ll have to have all of this explained to them. But, you might have just noticed a problem, that’s not how amnesia works (in most cases.)

Someone might not remember that the person they’re talking to killed their sister, but they are going to remember the factions and other political considerations that govern the other character’s motivations. Some details will be missing, but the abstract knowledge should be intact.

Many amnesiac PoV characters aren’t really amnesiac, they’re simply audience proxies who are unfamiliar with the backstory, blundering around, as the world is gradually filled in.

Now, having just picked at this a bit, it works very well. Especially if you, (as the writer) are not yet comfortable with the setting. The problem, and the reason I said, “don’t use this,” is because it has become cliche, due to overuse. You can’t pick a fantasy novel off the shelf without accidentally knocking over eighteen more about edgy amnesiac heroes wandering around someone’s home brew D&D campaign. It gets worse when you get into other media.

There are some other good uses. One is an amnesiac character investigating themselves. There’s a lot of this in the thriller genre. Much like the case above, this is a bit cliche, but is also a situation with some unique options. Robert Ludlum’s The Bourne Identity comes to mind as an interesting variant of this. Though the amnesiac spy has been done to death since.

Amnesia is a very useful, very potent, tool for a writer. It’s one you do not want to abuse, because, when misused, it will deprive your story of its uniqueness. If you have to chose between an amnesiac PoV, or committing to a PoV character that’s up to speed, pick the latter. It may not seem as easy, but it gives you more control than your realize.

-Starke

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