Tag Archives: Starke is not a real doctor

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

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

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

Q&A: Concussion Types

in my story, for plot reasons, my character is in recovery for three weeks from a concussion. there’s no memory loss, but she passes out for 10 seconds and when she wakes up she’s nauseous and has slurred speech + ringing ears. how hard would she have to get hit in the head to have a concussion that is that severe?

This is going to be a bit nitpicky, and it’s not going to give you the answer you’re looking for, so, before we start, sorry about that.

Being knocked unconscious is a Type 3 Concussion (minimum). Nausea, slurred speech, and ringing in the ears are consistent with a concussion. For a Type 3, a recovery time between a week and a month is reasonable.

The rating for types work as follows:

Type 1 Concussions do not result in a loss of consciousness, and symptoms (or, at least, most symptoms) subside within ~15 minutes of the injury.

Type 2 Concussions do not result in a loss of consciousness, and symptoms persist beyond 15 minutes. Recovery usually occurs within 10 days of the injury.

Before we keep going, the symptom list is a bit longer than what you listed above. It can include: Confusion, impaired fine motor control, headache, nausea, vomiting, vertigo, sensitivity to light and/or sound (I think the other senses too, but I’m not 100% certain), difficulty with concentration and thinking, irritability, amnesia. (Also missing a few. This is brain damage we’re talking about, and it can scramble a lot.) (Also note, Type 1 Concussions usually only have mild symptoms, such as headaches and mild nausea. The more severe symptoms will, usually, push it into a Type 2 because they don’t go away.)

Also, before we keep going, worth singling out amnesia for a second. This one gets seriously misrepresented in pop culture. Realistically we’re talking about someone losing some time around the concussion. They may not remember what lead up to the injury, or missing a couple hours after it, and never will. Global, “I can’t remember anything,” amnesia is incredibly rare.

Type 3 Concussions get to pick off the full symptom list above (it won’t have everything, but it’s not limited the way a Type 1 is.) It also comes with less than 60 seconds of unconsciousness. Full recovery usually takes between 10 and 30 days. This is what you’re describing.

Type 4 Concussions involve being unconscious for more than 60 seconds, and recovery time can range from a couple weeks to more than a month.

With all of that said, what you’re asking is, “how hard does she have to be hit in the head?” The answer is, “hard enough.”

Concussions, and most brain injuries, aren’t about how hard you’re hit, it’s about what happens to your brain after you’re struck. A concussion is a bruise on the brain itself. Usually, the head is jostled, and the brain bounces off the interior of the skull, causing injury. This is just like any other bruise except the tissue being damaged is responsible for regulating the rest of your body. A relatively light hit to the head can cause a Type 4 Concussion and kill you. Conversely, you can take some horrific abuse to the head, and not suffer a concussion at all.

If you’ve been digging through medical write ups on websites and trying to figure out how hard someone needs to be hit, the answer is there’s no concrete rule. From a medical standpoint, concussions are about where you ended up, not how you got there.

Finally, recovery times are directly related to how well someone follows medical advice on recovering. There’s a lot of things that are personal to the individual and their concussion. Ex: you may not have trouble watching TV, but others will, and with a future concussion, you might.

Also, further muddying things, multiple concussions are cumulative, even over a long period of time. So, if you’ve suffered a concussion, you’re at greater risk of suffering future concussions from head trauma. Something to keep in mind if your character’s recovering from one.

Concussions are very serious injuries. If you suffer one, even a Type 1, you really should see a doctor, and follow their advice while your brain heals.

-Starke

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

Q&A: Psychic Pain

Is pain easier or harder to deal with if you know when & what kind, or does the answer vary depending on the person & degree of pain? Two characters’ (enemies) bodies are connected in that if one character is hurt, the other will feel it. I thought A could threaten to torment B (as coercion) by inflicting pain on herself out of B’s sight so that B can’t predict when/what the pain will be, but this only works if being unable to anticipate pain makes it worse (or at least B thinks it does).

ree-fireparrot

Technically, the question, without qualifications, is a yes. The source and kind of pain experienced will affect how severe it is, or how difficult it is to manage. Further, individuals have distinct pain thresholds, so, what you can endure may be unbearable to someone else. This is a non-answer in this case, because that’s not what you’re asking; but that’s the question.

Somewhat obviously, there’s not a lot of (reputable) studies on psychically inflicting pain on people, so the question you’re asking is significantly more speculative than it looks.

Specifically, how does psychically inflicting pain on someone relate to actually experiencing pain?

I dunno.

There’s no empirical data on this.

So, let’s split this up into three separate problems to consider.

First, psychic research is a thing. A lot of money has been thrown at researching ESP and other weird, neurological phenomena, but, there’s no smoking gun. A big problem with ESP research is, you can’t really create reproducible results. “With this person, I can have this result,” isn’t proof of anything.

To be clear, I don’t care if you believe in psychic powers or not, I’m just saying, “there’s nothing here to definitively help your question.” If parapsychology is your jam, there’s some fun stuff there, but always remember that this isn’t, really, science. It’s people taking their science toolkit and playing with ghosts.

Also, it doesn’t really matter if this is done with technobabble or magic powers, either way, there’s no real world data to work from.

The second problem is more complicated: sensory data is personal, language is communal. So, when I call something blue, you know what I’m talking about, but are we actually talking about the same experience of a color? Or, do we “see” different colors, but our understanding of language says, “it’s blue?” This gets a little trickier because we know there are some minor discrepancies in what we see, smell, hear, taste, and touch. Because of synesthesia, we do know, that your brain is doing a lot of work processing sensory data. Thanks to EEGs we know there’s some similarities, so it’s not like, “I see green and you see blue,” (assuming you don’t have tritanopia color blindness, in which case green is cyan for you), but pinning down exactly what’s experienced by the individual, without being able to externally audit that data, is frustratingly difficult.

In case anyone’s wondering, color blindness is a physical defect in the eye, leaving it unable to perceive specific (primary) colors (red, blue, and green, because we’re talking about light, not pigment), so everything they see is a mixture of the colors they can perceive.

The reason this is a problem is, you’re trying to psychically inflict pain on another person. Now, is the pain experienced by one person going to have the desired effect on another? I don’t know. It should be painful, but will it be more painful? Less painful? Will the pain be something they can filter out? Will it be impossible to filter? Could you outright kill them from the process?

I dunno.

Normally, this isn’t a problem, but when we’re talking about directly transplanting the experiences from one person to another, it all becomes relevant.

The third problem may be more of a boon. There’s a psychological factor to knowing someone else is being harmed. Your character isn’t being injured, a third party is. Depending on the nature of their relationship, that can carry a lot of psychological weight. Hell, if the person their linked to is someone they despise, feeling that person suffering could empower them with a sense of schadenfreude.

So, as I said, for the basic question, yes. People experience pain differently. People are different. Unfortunately that feeds into a larger issue where, people are different, and what they experience is different. The value in a scene like this isn’t the pain your character experiences, it’s the psychological factor of knowing someone else is being hurt, and having no control over that.

-Starke

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

Q&A: Broken Wrist

Hei, I just have a realistic question on fighting whilst injured sort of question, My MC has a broken wrist in a solid cast but is forced to fight for her life in a small corridor to snowy outdoors. She’s a highly trained agent but does get injured further by her assailant who is also highly trained t and much bigger, Would it be realist that her injuries (the wrist, a stab wound to the thigh, stunning blows to her head) would render her ability to fight useless in the long run?

So, three things.

First: Size is completely irrelevant. The faster you come to grips with that, the better off you’ll be. If you don’t know anything about combat, size can be intimidating. Being bigger does not mean your punches hit harder. It doesn’t mean you can take more hits. It doesn’t make you’re more resistant to throw. Your character has been trained; she would know all of this. At that point, dwelling on the size difference is just generating false drama.

If you’re trained, a large foe is just a bigger target.

A character who is in better physical condition is a serious threat. That’s not a function of size. Someone who’s 6’3″ can easily be laid out by a scrappy 5’nothing who exercises regularly, and keeps their training sharp.

When it comes to condition, your character is at a huge disadvantage, and it has nothing to do with size; it’s their wrist. Usually we think of “condition,” in the context of if they’re physically fit, but injuries, illness, and other impairments are relevant. Your character could be a top grade fighter, but if they’re drunk, that’s going to seriously impact their ability to fight.

Broken bones are a huge liability in a live fight. If it’s on a limb (including the wrist) you can’t use that limb at all. If it’s a broken rib, there’s a real danger that any blow to your core could force it into your internal organs resulting in some nasty hemorrhaging.

In the case of your wrist, a broken forearm means you really cannot use that limb for anything. Even in the cast. Abusing it by trying to block or parry is a good way to permanently lose the use of that hand. Best case, she may only need surgery to repair the additional damage inflicted.

Second: The first rule of self defense is avoiding situations where you’ll need to use your training. Violence is a bit chaotic, and even if you really know what you’re doing, you’re still at risk of suffering serious harm. The best way to avoid that happening is not putting yourself in that situation to begin with.

It isn’t possible to avoid all potential threats. The entire reason self-defense training exists is an acknowledgement that, sometimes, things happen outside your control. Sometimes an assailant will attack in a, “safe,” area. Sometimes you simply need to traverse spaces that aren’t secure.

When you’re writing a character who’s been trained, it’s worth remembering that this will influence their behavior. For example: If your character is going someplace unfamiliar, they’re not going to do it alone, and wounded, unless they really have no other option. In a situation like this, it would be better to bring allies, or not go at all and send others. Your character is wounded, if she has option to, she should avoid fieldwork until she’s fully healed.

Third: Let’s reconstruct this for a second. Your character is attacked by a highly trained assailant. He has a knife. His goal is to harm your character. Why doesn’t he simply shank her, confirm the kill, and move on with his day?

If the expectation is that she’ll have her head bounced off the wall (or something else) resulting in a minor concussion, why didn’t he simply kill her.

Again, one of the wounds was a stab into the thigh. Ignoring for the moment that taking a blade to the upper leg can be very dangerous, depending on where it connects, if he’s in possession of the weapon and willing to use it on her, there is no way your character walks away from this fight at all.

Even in the most generous situations, he’s stabbing her, she knows who he is (or could potentially ID him), there’s no reason to let her live. And, of course, if he’s willing to stab her in the leg, and bouncing her head off of something solid enough to inflict a concussion, he’s certainly willing to kill her.

This gets back to the reason behind the second point; you don’t put yourself in dangerous situations without cause, because it can turn nasty, fast.

If the male character is the attacker, tracking her down and initiating the fight, then there really is no reason for him to let her live. His goal is to neutralize her, and the safest way to do that is to kill her.

As a writer, you need to look at violence as a tool in your story. Your characters will resort to violence based on who they are. A well-written character needs concrete goals. These don’t always need to be communicated to the reader, some can inferred, but, they need goals. At that point, their decision to engage in violence needs to be compatible.

If your assailant is highly trained, and bringing a knife to the fight, they’re planning to kill your character. At that point, it’s not going to be much a fight scene. A chase maybe, but if he catches up and puts a blade in her leg, she’s toast.

Now, maybe there’s justification for all of this, which doesn’t show up in the ask, but, it is something to be very careful of. Injuries to your characters aren’t simply damage tracking. They’re persistent effects that should influence future sections of your story. In fairness, that’s sort of here, but at that point you do need to keep track of how severe these injuries would be, and how debilitating it would be to stack them up. Part of the reason why you rarely see writers stacking more than one or two injuries on a character, it becomes a lot of work to keep track of how badly hurt they are.

-Starke

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.

Q&A: Practical Torture Goals

I would implore you to do actual research on torture and how torturers behave. A lot of the information you present as fact is dangerously misinformed. Torturers are not ‘professionals’ and does not yield accurate information. You shouldn’t be answering any questions on torture if you haven’t read O’Mara. This isn’t about torture being bad. It’s about torture not working at all. I apologize if I seem harsh, but this needs to be said.

I have read Shane O’Mara’s work. Not all of it, and not recently. I skimmed through years ago. Though, judging by your question, I’m not entirely sure you are familiar with his work.

The irony is, there’s not a lot of difference between O’Mara’s position and ours, when it comes to torture. The biggest discrepancy is perspective. He’s a neurologist who had a focus on the specific effects of stress and pain on the brain. My background is political science, so my interest grew out of examining coercive methods used by nation states. As a result, my specialization is more focused on what it does at a policy level. And we both come to, nearly the same point:

People forget the reality of what torture was used for, and has been used for through the generations, a quite different purpose: To spread fear, extract confessions, all of those kinds of things. But, the royal road to gathering reliable information? No.

Shane O’Mara – “Your Welcome” (Podcast Interview)

This gets into a fundamental misunderstanding about what torture is, and why you use it. Many people who’ve never looked at torture in depth, including the interviewer in that podcast, and the person who sent this ask, believe it’s about extracting information.

No.

The perception of torture as intelligence gathering is pervasive. It’s honestly difficult to point to uses of torture in popular media that get at the real point behind its use. The ur-example of this misconception would have to be 24, and it’s ends-justify-the-means embrace of torture.

The problem is, as the US Military’s Enhanced Interrogation Program learned in Iraq, torturing someone only makes them tell you what they think you want to hear. This was not new information. Nearly every organization in history that’s employed torture has understood this.

Most civilians do not. Many organizations have exploited this fact to further their agendas.

Torture excels at extracting false confessions. To make the suffering stop, you put a narrative in front of someone, and they will crack and sign off on it. This is the true power of torture. It doesn’t tell you what’s real, it coerces the victim to agree with your version of the truth.

Confessions are not reliable, in any sense. Someone may admit they committed an act for any number of reasons unrelated to the truth. Social norms put faith in the idea of a confession as, “the truth,” but that is just words; like everything else, it shouldn’t be taken at face value. As mentioned above, torture exploits this norm, and relies on that general acceptance of confessions to glaze over all the incongruities. Even when those confessions are patently absurd or downright impossible, people will still say, “but they confessed.”

I remember an example of this a couple years ago, from another person bringing their favorite academic into a discussion. In that case it was James Wasserman, an author who wrote a history of the Knights Templar. The end of that order came from confessions extracted under torture by one of the Inquisitions. (I don’t remember which one.) Even knowing that the confessions were coerced, Wasserman sees nothing wrong with taking them at face value. (Also the reason he comes to conclusions that radically differ from every rational academic that looks at the subject.)

That said, unlike Wasserman, O’Mara does something interesting. We’ve always known you can’t get good information from torture, and O’Mara decided to take neurology and look at why. The answer has to do with how memories work.

The brain stores memories as chemical chains. Under the best of circumstances, this is not a good, robust, long-term storage system. In some ways it’s surprising it works as well as it does. Stress and trauma both adversely affect your ability to form new memories and retain them. This has nothing to do with torture per se. If you’re put through six kinds of hell, you’re going to forget things.

Again, this isn’t exactly new information. It’s something that most therapists and investigators are well aware of. If you’ve been a victim of violence, even if it wasn’t perpetrated by a human, you may have experienced this. You might not realize it. I’m sitting here, thinking about my first dog attack and realizing, I don’t really remember that day. I remember that it happened, (and I can still find the scars on my left hand), but if I’m being completely honest with myself: a lot of the details are just gone. I do remember the sounds. Unfortunately, and if pressed, I could present a partial chronology of that day, but it would be reconstructed from information I have about when it was, what I was doing, things that happened before and after the attack.

Even without resorting to extreme events like that, your memory of traumatic or highly stressful experiences isn’t going to be completely clear. Ironically, this can also screw you over. If you get stressed out over a test in school, that will impair your ability to study, and even your ability to recover information during the exam.

Within this context, sleep deprivation has a significant effect on your cognitive abilities. This puts a fair amount of stress on your system for no real value. So, pulling an all-nighter before a test is not recommended.

Caffeine, and other stimulants don’t, really, help here. They’ll help you stay awake, they’ll help you feel more alert, but they won’t make up for the lost sleep, so the cognitive impairment will still be there, you’ll just look sober.

So, stating the obvious here but, having bunch of armed men attack and capture you, being dragged off to a dark room somewhere, isolated from any support network, being yelled at, and being threatened… That’s all kinda stressful.

In fact, many interrogators will seek to prolong the stress of capture as long as possible. They’ll use loud music, bright lights, keep the room cold, prevent them from sleeping (with all of the associated sleep deprivation considerations coming into effect) in an attempt to keep their captive off balance, to prevent them from settling into a new norm. While they’re in this state, they’re more susceptible to suggestion.

There is a continuum to all of this. It’s part of why studying for tests in an academic situation is such a good example: In the entirety of your life, it’s a pretty minor stress, but it is stressful, and the details you’re being asked to retrieve are trivial. So that’s some of the first information your brain will dump when things start fraying. When you put someone in real danger, the stress will start dumping much more important things. It’s not like you’ll forget your name, or where you were born, but it could easily dump information an interrogator would be interested in; like the names of people you met at a party last week.

All of this information also applies to witness testimony. Even when the investigators aren’t leaning on you, the stress from the original event can easily play havoc with your memory. This is one of the reasons why investigators need to be careful when they’re interviewing victims, because they can easily corrupt the victim’s memories simply by asking the wrong questions, and getting the victim to reconstruct their memory on the spot, which won’t necessarily match what happened. Of course, an unscrupulous investigator can push a victim to remember things that didn’t happen, simply by asking leading questions. If you’re suddenly feeling a little uncomfortable with the idea eyewitness testimony right now, good. You should. As with confessions, as a culture, we put way too much faith in them.

When you put this together, it explains why torture doesn’t yield accurate information. Again, this was known, but the neurology wasn’t. So, in this sense, O’Mara does make an interesting and useful contribution to the lit. He’s connecting stuff we already knew in different fields and saying, “this is how it works together.” He’s also getting into the neurochemistry, which is interesting to a degree, but not particularly accessible. The exact reasons that your brain has issues with sleep deprivation make for a fascinating discussion, but if I start talking about neurotransmitter reuptake again, people are going to glaze over.

You should start to see why torture excels at getting people to confess to things they didn’t do. Even confessing to things that aren’t possible or are patently absurd.

In most cases, someone will do anything they can just to end the suffering. Being tortured sucks, and if you just need to sign on the line to make it stop, a surprising number of people will do so. Even if it’s not the truth. Even if they’re signing their lives away.

On the other end of the spectrum, torture someone for long enough, and the lines between the real world and fantasy start to blur, or come apart entirely. You’ll get confessions about how they summoned up The Devil for an orgy and bake-off, or how they were plotting to mount laser cannons on frogs to assault New York. It sounds bonkers, but the victim may be so broken, they can’t tell the difference anymore.

I’m honestly unsure where this line about, “no professional torturers,” comes from. Especially given O’Mara has talked about the NKVD, CIA, Enhanced Interrogation Program, and many other intelligence agencies. That is to say, groups that do employ professional interrogators. I’ve seen this line come up several times, and the only way I could possibly attribute it to O’Mara is by deliberately misreading his methodology. The idea that no one gets paid to lean on others is patently absurd. Even the Mafia and Cartels have professional torturers. How well they do their job is a different question, but I’ve seen some genuinely disconnected comments about torturers being nothing but unhinged psychopaths, and that’s not supported by any reputable source.

I get the appeal of being able to say that, “a rational person couldn’t do this,” because it makes the world feel safer, but the truth is, there are people out there who come across as normal and are paid to do horrific things to other human beings.

The other side of this is that some of the EIP interrogators did end up with PTSD. It takes a pretty specific mindset to be able to do this to someone without suffering psychological harm in the process. That said, it’s not that different from other careers where you deal with horrific experiences on a regular basis, such as EMS, LEOs or soldiers.

The horrible thing about the real world is, torture works. It doesn’t gather usable intelligence, and if you thought that was the point, you fell for the big lie. Torture is about making someone confess to things they never did. It’s about making them agree with your version of the world, irrespective of the truth. It’s about scaring people. Convincing them to never oppose your organization. It does all of those things, and if you’re stepping back and saying, “no, it can’t possibly be that bad,” it worked on you.

Torture is scary; it shows how horrible the world, and the people in it, can be. There’s no shame in looking away and saying, “I can’t deal with this.” I don’t blame you. But there’s no virtue in lying to yourself and saying, “no, it doesn’t do anything. It can’t. I need the people who do this to be cartoonish super-villains.” I don’t blame you for the instinct, that’s better world, but not the one we live in.

-Starke

This blog is supported through Patreon. If you enjoy our content, please consider becoming a Patron. Every contribution helps keep us online, and writing. If you already are a Patron, thank you.