Surviving a Shipwreck Post Hurricane

Jocelyn Asks:

I’ve written a hurricane scene, and I don’t think I got the medical details right, so I thought I should check with you.

I have characters abandon their ship as it goes down. They stay afloat using planks of wood, but just holding on to them in the water, not lying on top of them. This takes place in the Gulf of Mexico in September.

When they are rescued several hours later, what will their condition be? Will they be fully conscious? Would they be cold? My heroine’s brother dies in the water, so is that enough to put her into shock, along with the ordeal of surviving the hurricane?

While one character is floating in the water, a piece of bowsprit breaks off from another ship and flies through the air, hitting him. I want to injure him enough for him to lose his grip on the plank he’d been holding onto, but I don’t want him to die from this injury. I was thinking if the wood hits him in the arm or shoulder, either breaking his arm or dislocating his shoulder, that would be good enough. Is that realistic though? Or does it just depend on the angle and the velocity?

Jordyn Says:

First thing to determine is the temperature of the water in the Gulf of Mexico in September. I found a table from the National Oceanic and Atmospheric Administration with water temperature tables for the Gulf of Mexico  that lists temperatures for September in the mid to upper 80s.

The next question is how long does it take hypothermia to set in when you’re submerged in water at this temperature?

This table gives an "indefinite" time frame where as it lists time limits for cooler water temperatures. For instance, in water that is 32.5 degrees, it gives a time of under fifteen minutes for exhaustion or unconsciousness to set in.

Considering this information, your characters should be conscious when they are rescued. Just because they don't die from hypothermia doesn't mean there aren't other risk factors like getting eaten by ocean creatures, sheer exhaustion, or dehydration and malnourishment from not eating or drinking.

If the rescue is under twelve hours, I'd imagine they would be in pretty good shape. An adult can probably survive three days without water but it would also depend on what environmental factors are present. You'll dehydrate faster in sunny weather than a cool, overcast day. I would imagine they would still feel cold. Your normal body temperature is 98.6. Hot bath water ranges from 99-104 degrees. Bathwater temperatures vary depending on the source and hot tubs are around 104 degrees. So, being immersed in 80 degree water will still feel cool. Patients getting room temperature IV fluids always get chilly.

Emotional traumas like the death of a loved one AND surviving a cataclysmic weather event can put someone into shock.

I think it's reasonable to give your character a fracture after being hit by the bowsprint. But then he'd be unlikely to use that arm at all to hold onto things but it should be a survivable injury if a closed fracture and the rescue is fairly soon. I would think an open fracture, where the bone comes through the skin, would put him more at risk for complications and lower his survivability if the rescue is delayed by a few days or more. 

Author Question: Delayed Death by Crossbow

Ben Asks:

Here's my scenario that I would appreciate some advice on:

I've got a 25 year old woman that is shot through the left calf and the upper torso (I was thinking, maybe having the upper body shot piercing her shoulder) by crossbow bolts made of wood in my fantasy novel. The weapons that shoot her are each one-hand-held, meaning that they can be aimed and fired with only one hand.

What I need to know is this:

1. Would this outright kill the character?

2. If yes, where on the average human female body can I have two crossbow bolts made of wood puncture that body in such a way as to negate instant death, but still leave months of recovery time for that character, if she gets the proper medical help fast enough?

For background information, the science level of the world I am writing is roughly the same level we have today in America and Europe, the same with this world's medical tech and knowledge.

Jordyn Says:

Thanks for sending me your questions.

1. A wound to the calf is unlikely to outright kill someone immediately. Any bleeding that's not controlled if brisk enough can lead to death. Infection is a risk with any wound-- particularly those that are caused from things (like arrows) that penetrate the body deep into its tissues leaving bacteria and other microorganisms behind.

The shot to the torso has more likelihood to cause death if it hits the right structure. On the left side of your chest are your heart, great blood vessels, and lungs. If the shot was more to the shoulder then an outright kill would be less likely and the risks above would be more prominent (bleeding and infection).

2. A shot to the calf and the shoulder have the potential to set your character back several months. If you don't want the character to die-- I would avoid having a shot to the torso. A projectile to any extremity can cause the bone underneath to fracture. Fractures typically take 6-8 weeks to heal.

If you didn't want to go with a fracture of the bone from the projectile-- you could have onset of infection (depending on how sick you'd want her to be for those months). Systemic infection can easily cause death. Local infection to the wounds can be problematic as well. You could also go with tendon damage to the arm or leg which would inhibit movement of the extremity. Healing and rehab of tendon and/or ligament damage can take months as well. Whenever an extremity isn't used because it's immobilized you always get muscle atrophy (muscle wasting) which causes weakness of the arm/leg, etc. It takes time to rehab that as well.

Good luck with your novel!

Author Question: When Were Casts Invented?

Ann asks:

I have a question about treatment of a leg fracture in the late 1860's. My character has broken his tibia (? --the bone at the front of the calf). It's not a compound break. Can you tell me if it would have been splinted or casted at that time, and how long before a determined person with such a break could walk using crutches? How long do such breaks take to heal?

Jordyn says:

Here is a great source that talks about the invention of plaster of paris. It looks like it would have been used for casting during your time frame. http://www.ehow.com/about_5134930_plaster-paris-history.html

This link says specifically:

Plaster Casts

• The invention of the plaster bandage can be attributed to an Arabic doctor and is noted in the Al-Tasrif, an Arabic medical encyclopedia dated from around 1000 C.E. This earlier adaptation of plaster for orthopedic cast making was unknown by European and American doctors. The use of plaster of Paris in the modern medical field began in earnest during the 1800s. By the 1850s bandages were rubbed with a plaster of Paris powder and then dampened and applied around the injury. During the 1970s this type of cast making began to wane. Most of today's orthopedic casts are made of synthetic materials.

With a cast in place-- he should be able to walk with crutches but NOT bear weight right away. That would be very painful. People are usually in casts, depending on the break, for four to six weeks. Today, we usually splint people for a week to allow for swelling before the cast is put in place to prevent compression syndrome but I can't say whether or not that would have been common practice at the time. He will have muscle atrophy of the leg during that time from non-use/limited use.

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Ann Shorey has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Medical Question: Can my Rocker Perform?

Stacy Asks:

I have a couple of questions for you about a broken foot. In my WIP, my main male character broke his foot. About how long would it be before he could be up on stage in a rock concert? He's the lead guitarist of a Christian rock band and is quite active during the show (running around, etc).

Jordyn Says:

First, I'm assuming you mean a bone in the foot is actually broken and not the toe itself.

I was actually able to run this by an ortho doc and these are his thoughts. Splint/crutches for one week with limited mobility. Then a walking boot for 4-6 weeks. He thought it would be hard for him to bear weight for the first two weeks so I think jumping around on stage would be problematic during that time frame.

After the first two weeks, he should be able to walk and bear weight but jumping around may still be difficult. Probably could go either way. If he does choose to do a concert-- at least have the foot be painful during/after the performance.

Western Medicine Circa 1890: Part 4/4

Lacy concludes her four-part Friday series today on western medicine during the 1890's. It's been a pleasure to have her and I hope you'll check out her novel. Lacy, best of luck and many blessings on your writing career. I hope you'll stop in again.

I hope you’ve enjoyed the excerpts from Marrying Miss Marshal that I’ve shared the last three weeks. This week, I thought I’d talk a little bit about my current project, which is now on my editor’s desk (hopefully soon to be bought!).

The story is set in the same time period and area as Marrying Miss Marshal but with different characters. In it, the hero has several adopted children and one of them falls off a ladder in the barn and breaks his leg. Because of this, the hero has to rely on the heroine’s help or he risks losing the hay he needs to put up to make it through the winter.

FRACTURES

In the reference Family Physician: A manual of domestic medicine, it is recommended that only medical doctors be allowed to treat fractures, otherwise the results could be lost of use of the affected area (finger, limb, etc.).

However, according to Bleed, Blister and Purge, if there was no doctor available, the only choice was for the homesteader or whoever it was to do their best to repair the broken bone. Treatment included splinting and then wrapping with surgeon’s plaster to put the limb in a cast. I would assume that sometimes in this case, the fracture would not be set exactly right and probably resulted in loss of some functionality of the arm or leg. However, in my story, I did choose to make a doctor available to help.

Here’s an unedited excerpt from my current project. Enjoy!

Penny found the house dark, and a bent-shouldered Jonas sitting on the porch steps. The lightening sky provided enough light to see his head was between his hands. Was he sleeping?

“Jonas?” she called softly and his head jerked up. Not sleeping, then. “Everyone all right?”

He stood and raised a hand to the back of his neck, half-turning from her so she couldn’t see his face.

“Yes. The doctor arrived just after you left—”

“After you made me leave.”

“—and set Maxwell’s leg. It’s splinted now with a plaster cast. He’s supposed to stay off it for a few days—or as long as I can keep him down.”

“Did he get any sleep last night?”

“Doc gave him some pain medication, knocked him right out.”

She couldn’t resist reaching out to touch his arm. He jumped at the contact but didn’t pull away.

“And you?”

He shook his head, ran his other hand down his face. “Couldn’t get my mind to quiet. We’re already behind on the haying, and with the Sumners’ fields to cut, too—without a driver—without Maxwell, I don’t see how we’ll finish.”

“Can you hire someone else?”

He was shaking his head by the time she’d finished her question. “Everyone’s hired out for the season. It’s not likely.”

“Well, what about Poppy?” As she said the words, she thought about her grandfather’s continuing exhaustion, though he’d been trying to hide it from her. “No, he probably shouldn’t be out in the sun all day.”

“There’s no one…”

She’d never heard Jonas so disheartened before. She knew part of his defeated attitude was because of his worry for Maxwell and loss of sleep. Maybe that’s why he’d overlooked the last obvious answer.

“What about me?”

Copyright © 2011 by Lacy Williams.

REFERENCES:

Family Physician: A manual of domestic medicine (1886) is available in the public domain on Googlebooks:

(Treatment of fractures begins page 717)

http://books.google.com/books?id=C1IpAAAAYAAJ&source=gbs_navlinks_s

Bleed, Blister and Purge by Volney Steele, M.D. (2005)

CONTEST REMINDER

Don’t forget to leave a comment to be entered to win a copy of Marrying Miss Marshal and three other Love Inspired Historical books. You’ve have until 11:59pm EST to comment and I’ll be drawing a winner tomorrow! Full contest details were posted June 30th.

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As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 

A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).

Fractures: General Guidelines

Fiction, particularly the thriller genres, generally require a character to sustain an injury. These can run the gamut from minor to life-threatening.

Today, I'm going to focus on a couple of general guidelines if you injure a character with some type of fracture.

Remember, if you leave a comment this month, you'll be eligible to win a copy of Brandilyn Collins novel, Over the Edge.

Though it may be hard to break a bone, sometimes it seems the most minor accidents can cause a fracture. My mother once slipped off a small rock onto the side of her foot. Her foot was bruised and mildly swollen and in my nursing wisdom (I was only in nursing school at the time), I said, "There's no way you broke it slipping sideways off a rock." Needless to say I was wrong. Yes, broken foot.

Guideline #1: The amount of swelling is not indicative of fracture. Ankle injuries are classic for this. Patients come in with a horribly swollen ankle, convinced they broke it. My guess in the pediatric realm (up to age 21), the ankle is 95% of the time sprained and not broken. Arms that have an obvious deformity and you can see the limb is broken before you get an x-ray, have little swelling in comparison.

Guideline #2: If something is broken, generally the joint above and below will need to be immobilized (or very close to the next joint). Someone asked me once if a person broke one bone in their lower leg, could they drive? There are two bones in the lower leg: the tibula and the fibula. Depending on how close the fracture is to the knee, the ankle and knee will have to be immobilized. I don't know how many people can drive with a straight leg.

Guideline #3: Splints are placed first. It is rare to put a cast on in the emergency department. The reason splints are placed first is to allow for swelling to come and go. A splint is generally fiberglass sheets secured in place with an ace wrap. This allows for expansion during swelling. Then in 7-10 days, the patient is referred to an orthopedic doctor for cast placement.

Guideline #4: A good rule is that a cast will be in place for 6-8 weeks. Now, this is highly variable and if an author said the cast needed to stay in place for nine weeks, it probably wouldn't drive me nuts enough to go check it out. However, a cast on for two weeks is unlikely. You should consider this guideline because it will effect your character for that length of time and inhibit their mobility. Maybe, this is something you want as the author.

Guideline #5: My observation: these bones/joints have a higher incidence of requiring surgery: ankle, elbow, and femur. Now, you can make any fracture bad enough to require surgery but these ones can be more common to require the OR.

What other guidelines would you like to see?