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Tuesday, April 7, 2009

More Medical Fiction Questions Answered

Okay, gang... the Doctor is IN! More medical fiction questions...

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, a question from Cole:

My MC has lacerations across her neck and shoulder, presumably from a shark. These lacerations, while deep, only exposed her collarbone, but did not damage to the bone. What treatment would she be given in the hospital, and what would her at home care instructions be? Ointments? Oral antibiotics? (I’m assuming she can’t get her wounds wet?)

I must confess that, as a pediatrician in the Midwest, I don't see too many shark bites. But with any bite, there would be concern for infection. The interesting point to consider here would be that the victim would presumably be immersed in sea water during and after the injury, which puts some other unusual organisms into the mix. Most certainly, the wound would be flushed with sterile fluid. She would also receive antibiotics. If the wound was concerning enough, they might give the antibiotics by IV or by a shot (IM).

Depending on how the wound looked, they might decide to close the wound (if the wound looked very clean and they had good access into the wound to clean it out). If they were concerned about infection, though, they might choose to let it close on its own. In that case, they might pack the wound.

Packing a wound involves stuffing a length of thin (like a shoelace), medicated gauze into the wound with the end trailing outside the wound to provide a wick for the infection to drain out of the body. The packing is removed and replaced periodically until the wound is healed enough that there's nowhere left to pack.

And, yes, she'd be told to the wound out of water. And away from sharks. =)

Next, we have a question from Robyn:

In my MG novel I have a story about two thirteen year old girls lost with their horses in the Blue Ridge Mountains.

Now towards the end of the book they meet up with a rabid bobcat. The animal attacks the protag and bites her, cuts her all up, etc. you get the picture.

My question is, how long before the affects from rabies will kill her? I don't want to kill her so I need a time frame here in which to get her rescued. And what physical problems will she have from the rabies? She is also a type one diabetic,(Poor girl). Does she have days? Just hours? Will she be nauseous? Things like that.

Rabies is a strange virus, and I'm not sure it will work well for your story, since it seems you want her to have symptoms, but you also want her to recover.

Rabies is a virus. It has an incubation period that can range from a few days to years, but the average incubation period is somewhere in the neighborhood of a few weeks (20 to 90 days). During the incubation period, the victim has no symptoms of rabies.

To cause symptoms, the virus has to travel through the nerves to the spinal cord and then begins to affect the rest of the central nervous system. The more wounds there are and the closer they are to the brain and spinal cord, the faster symptoms will show up. Since your protagonist suffered multiple bites, she would probably show symptoms within a month.

But here's the catch... by the time someone shows symptoms of rabies, it's too late. If they don't receive the prophylaxis meds during the incubation period, they will die from the disease with rare exception. There have been a handful of cases where a patient has survived, but they are extremely rare and the patients have serious long term consequences.

The first case documented of someone surviving rabies without prophylaxis was in 2004. You can read about that girl's progress and disabilities here.

That said, the progression of rabies goes like this:

  • Incubation period (days to years)- No symptoms
  • Prodrome period (2 to 10 days)- vague symptoms including fatigue, headache, sore throat, decreased appetite, and fever. They might also have pain or parasthesia (tickling or pins-and-needles sensation, etc.) around the wound.
  • Neurologic period (2 to 7 days)- speech problems, incoordination, paralysis, twitching or jerking movements, altered mental status.
  • Late stage: coma, low blood pressure, irregular heart rhythm, heart attack, DIC (diffuse bleeding problem), and death.
And, wow! Lost in the wilderness with juvenile diabetes and bobcat wounds... you have certainly given your protagonist plenty of challenges!

Thanks to both Cole and Robyn for contributing some great questions!

If YOU have a medical fiction question you'd like answered, please email me. My email address is in the sidebar.

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.


Stina said...

This is one of my fav QT posts. It shows how important it is to get the medical facts straight when we write novels, because someone with a medical background will notice our mistakes and we'll lose all credibility.

Thanks Heather for the informative answers. Now I'm all set for when my mc is attacked by a shark in Lake Bemidji and then ravaged by a bobcat with rapies. Of course this is after she is released for the hospital once she has recovered from that bout of intrauterine bleeding (which fortunately she doesn't go unconscious from anymore). Whew! Can't wait to see what the next medical questions are. :D

Cole Gibsen said...

Thanks so much!!!

Suzette Saxton said...

This is one of my favorites too. Always a fascinating read.