Tag Archives: Starke is not a real doctor

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

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

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

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

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


Q&A: Kockouts

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

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

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

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

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


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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Q&A: Vampire Feeding Symptoms

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

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

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

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

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

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

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

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

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

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

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


Q&A: Honeyed Wounds

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

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

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

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

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


Q&A: Stab Wounds

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

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

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

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

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