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Tuesday, February 24, 2009

Your Medical Fiction Questions Answered

Got a burning medical question to give your novel authenticity? I asked our readers for questions to discuss here on the QueryTracker.net blog and, as promised, I'll be answering a couple of medical writing questions today.

Disclaimer: The information provided in this post is intended for writing purposes only and does not represent medical advice. (Sorry, my lawyer-boy husband made me say that.)

First, we have the following series of questions from Diana (some details removed):

I'm working on a narrative non-fiction piece about a real murder that happened in Burlington, Kansas in 1925. The husband allegedly comes home to find his wife, a 31-year-old farm woman, dead on the floor. Pretty gruesome.

Because of some rumors that surfaced, the woman's body was exhumed three days after she was buried (and five days after she died, which was on May 30). They were verifying whether or not she had been sexually assaulted, and whether or not she had ever had an abortion.

Here are my questions, from the perspective of 1925 medicine:

1. What would the doctor doing an autopsy on an exhumed body look for to determine if a woman had been raped?

2. What condition would the body be in at this point?

3. What signs would a doctor doing an autopsy look for to determine if an abortion was performed?

I'm afraid I can't tell you too much about the 1925 perspective, as my grandparents were all less than 6 years old in 1925. And of course, forensics is not my area of expertise, but I will do my best to answer.

I'm not sure how the fact you're writing narrative non-fiction plays into things, as I would assume that the evidence you describe would have to be accurate to what was actually found during the investigation. But taking these questions as for a fictional scenario:

1. The evidence they'd be looking for would be evidence of sexual activity, which would include checking for pubic hairs not belonging to the victim, and at 5 days, given the fact the woman had died (and therefore was not upright, moving, bathing etc.) they might still find living sperm (although 5 days is pushing that limit). They might also test for acid phosphatase, which can be used as a screening test for semen. As far as evidence of rape, specifically, they'd be looking for evidence of trauma, bruising, tears, etc. Often times, it can be hard to tell the difference between rape and consensual sex on the basis of forensic evidence alone. Aside from the fact they'd have no DNA analysis available, I'm not sure how much the 1925 angle would affect the available investigations.

2. The condition of the body would be somewhat dependent on the weather conditions to which it was exposed. Typically, over the first 2 - 3 days, the body appears grossly intact, but by the time in question decomposing would have reached the putrification stage. The body's bacteria starts breaking it down, causing green discolorations and bloating of the tissue. The green color comes from partially digested hemoglobin (blood protein). The bloating is caused by gases released by the bacteria.

3. Regarding evidence of a prior abortion, the doctor would be looking for evidence of instrumentation, such scars or marks from a clamp on the cervix.

Our second question comes from Susie:

My MC is a thirteen year-old girl. She 's on a ladder, standing about four feet off the ground, when she looses her footing and falls, landing with the full weight of her body on one shoulder. Would this impact be enough to snap her collar bone? Would she be able to get up by herself after this had happened? Would she still be able to walk around and act semi-normal, hiding the fact that she'd broken the bone? Would it hurt if someone hugged her? What would treatment for this type of injury be?

A fall of four feet, at the right angle, could certainly fracture her collar bone. While painful, a fractured clavicle doesn't really impair activity as much as you might expect.

After a clavicle fracture, the shoulder typically sags forward and down. She would have trouble lifting the arm due to the pain, and may feel grinding in the shoulder if she tried.

She probably wouldn't be able to push herself up with the injured arm, but she should be able to get up by herself. She definitely would be able to walk around, and if motivated, could probably hide the fact that she'd been injured, depending on what she was wearing (the displaced bone can often be seen as a lump under the skin.) and her pain tolerance.

It would, indeed, probably hurt her if someone hugged her.

Treatment for a fractured clavicle consists of pain control and immobilization (for comfort, mostly) with a sling or figure-of-eight strap. Right after the injury, ice would help as well. After 4 - 6 weeks, she would have to start working on range of motion exercises for her shoulder to regain normal strength and movement in the joint.

So, BIG thanks to Diana and Susie for submitting your questions for discussion. I hope my answers will be helpful for your writing projects.

I will continue to accept medical fiction questions for future blog discussions. You'll find my email address in the links listed on the right. Or you can reach me through my personal blog, Trying to Do the Write Thing.

H. L. Dyer, M.D. writes women's fiction and works as the Clinical and Academic Director for the Hospitalist Program at a pediatric teaching hospital near Chicago. In addition to all things literary, she enjoys experimental cooking and composing impromptu parodies to annoy close friends and family. Click to visit her personal blog, Trying to Do the Write Thing.


Archetype said...

Great questions, and great answers! I'm so glad we're doing this! :-D

Mary Lindsey said...

Me too!

'Shroom said...

This answered alot of my Q's about that, my story wasn't very accurate on the part where my character gets mauled by a mountain lion...

Diana said...

Thanks so much for answering my questions! I haven't been able to find any primary source details. Your answers gave me a much better sense of what the doctors were likely looking for.

H. L. Dyer said...

I'm so glad it was helpful, Diana. Thanks for contributing a great question!