Author Question: Amputations and Infections

Kariss Asks:

A Navy SEAL team is on a mission in Ukraine. One of the guys gets shot in the leg by a sniper and then gets debris in his leg when the boat explodes. They dive into the Black Sea to get away before getting to the getaway boat. He is sent to a military hospital in Germany and then sent back stateside to make decisions with his wife. In the story, I need him to have his leg amputated but also be a potential candidate for a bionic leg/prosthetic down the road.

A few questions in that regard…where would he need to get shot in the leg for that to be an issue? I thought a major artery. But I'm not sure that is accurate. Would infection be a problem from the dirty water and wound? If so, how long would that take to set in? Since I need amputation to be the final outcome, how long would doctors deliberate and monitor issues before choosing to amputate? I think my timeline may be too long in the book and I want this to be accurate.

Also, I have one of the SEALs call the wounded warrior's wife to let her know there is a problem and they are coming home. Because of mission sensitivity, he can't tell her what happened, especially over the phone. My editor thinks a doctor would be the one to contact the wife instead of someone on the team. But I'm not sure that would be true in the case of classified special forces ops. Any input on this?

Jordyn Says:

Thanks for your question. It's an excellent one and I've pulled in several people to help so thanks Tim (who serves as a military chaplain) and Angelique (a physician co-worker) for your insights.

Question #1: There are many indications for amputation-- only one being lack of blood flow to the extremity. So damage to a major artery doesn't necessarily have to be your mechanism of injury. Top three reasons would be trauma (the extremity has lost too much muscle, bone, etc), infection, and vascular insufficiency (damage to the blood supply that keeps the tissue alive.)

Question #2: Is infection a concern because he was swimming in gross swamp water? Yes, this will be a concern. Infection could show up in as little as 12 hours. More commonly is 48 hours. Of course, there are always outliers. What you could research is common skin infections, microorganisms, and such in the geographical area your incident happens. You might find something better that fits your time frame.

Question #3: How long would the doctors take to make a decision? Here, you could basically make the medical scenario fit your timeline. If you want them to amputate right away-- go with major loss of tissue from the extremity. It's basically not salvageable. Or-- longer (days to weeks) then you could use a scenario where infection sets in, he doesn't initially respond to the antibiotics, they try a different antibiotic-- maybe surgical debridement, etc. That process could take a week or more.

Question #4: Notification. This is directly from the chaplain's e-mail to my query.

I can only speak based on my experience in the Navy, and please recognize that the various military branches handle casualty notifications in different manners. That being said, a doctor would not be the one to call giving the nature of the incident. A command representative in addition to a chaplain would generally make an in person visit to the primary next of kin, in this case, the spouse. Also, if this is really a soldier, then he's Army, whereas, the other branches would refer to themselves as Airmen, Sailors, or Marines. 

As a side note, in discussing your question with the physician, she said below the knee amputations are easier to fit with a prosthetic versus an above the knee amputation so consider this as well for your story.

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Kariss Lynch began her writing career in third grade when she created a story about a magical world for a class assignment. Chasing her dream into college, she received a degree in English at Texas Tech University and fell in love with writing faith-based fiction about characters with big dreams, adventurous spirits, and bold hearts. Her first novel, Shaken, book one in the Heart of a Warrior series, released in February 2014, with the second book, Shadowed, scheduled to release in Winter 2015. Kariss is a diehard Texan, born and bred in Dallas, where she now works as a writer for a local communications ministry.