David W. Page - Body Trauma: A Writers Guide to Wounds and Injuries (Get It Write)

Table of Contents

Introduction

Part I: An Overview of Trauma

1 Concepts and Terminology in Trauma Care

Why Do Accidents Occur? Emergency Management Levels of Trauma Care Destructive Impacts Wounds in a Trauma Victim

Care of the Trauma Victim in the Field

Managing the Airway in the Field A Breath of Life Maintain Circulation

Disability: Can the Victim Talk and Move? Expose the Victim

Special Problems in the Field

The Trauma Center

The Dynamics of Trauma Care

The Level I Trauma Center

The Trauma Room

The Four First Steps in Trauma Care

Care of the Trauma Patient in the Operating Room

The Operating Room The OR Personnel

How Cases are Listed: The "Bumping" Scenario

When Things Go Wrong in the OR

OR Atmosphere

PACU: The Recovery Area

The Intensive Care Unit

The Surgical Floor

Rehabilitation and Going Home

Part II: Specific Traumatic Injuries By Organ System

Head Trauma: From Concussion to the Persistent Vegetative State

Diffuse Brain Injury Focal Brain Injury Scalp Injury Facial Injuries Lower Jaw Injuries

Neck and Spinal Cord Injuries: Snapped, Stabbed and Strangled

Direct Trauma to the Neck Indirect Trauma to the Neck The Treatment of Neck Fractures

Chest Trauma: The Dirty Dozen Maiming Injuries

The Dirty Dozen

Injuries That May Kill Within Minutes Injuries That May Kill Within Hours

Abdominal Trauma: Beware of Hidden Damage

Patterns of Intra-Abdominal Injury Blunt Trauma to the Abdomen Penetrating Trauma to the Abdomen Diagnosing a Major Abdominal Injury The Outcome of Abdominal Injury

Extremity Trauma: Crunched Arms and Legs

The Upper Extremity The Lower Extremity

Part III: Unique Traumatic Injuries

Bites: Animal Assaults

Dog Bites Human Bites Snake Bites Shark Bites Horse Bites Stings

Sea Life "Bites" Animal Defenses

11 Impalement Injuries and Mutilation: From Fencing to Fences

Features of an Impalement Injury Mutilation and Torture

Traumatic Amputations and Replantation: Don't Lose the Missing Part!

How a Finger Is Replanted Are Kids' Injuries Different? A Warning!

13 Burns and Frostbite: The Scars of Temperature Extremes

Burns

House Fire Smoke Inhalation Electrical Burns Lightning

Environmental Temperature Damage

Heat Stroke (Sun Stroke)

Heat Prostration (Heat Exhaustion)

Frostbite

Hypothermia

Other Cold Injuries

Diving Accidents and Altitude Illness

Diving Accidents and Their Consequences Decompression Sickness ("The Bends") Barotrauma

Nitrogen Narcosis ("Rapture of the Deep")

Altitude Sickness

Acute Mountain Sickness (AMS)

High Altitude Pulmonary Edema (HAPE)

High Altitude Cerebral Edema (HACE)

Assaulted Eiders, Battered Women and Injured Kids: The Defenseless

Battered, Bruised and Abused Kids Battered Women Abused Elders

16 Sexual Assault: Unspeakable Trauma

What Is Rape?

Why Do Men Rape Women?

Myths About Rape

The Initial Examination of the Victim

Sexual Assault Against Children

The Sexually Abused Adolescent

Organ Donation: Who Makes the Ultimate Gift?

Who Becomes an Organ Donor?

The Process of Obtaining Organs for Donation

The Process of Performing an Organ Transplant

Bibliography Glossary

Introduction

In literature, as in life, sooner or later everyone becomes injuredaccidentally or as a consequence of malicesomewhere in the story. The writer must force characters to face conflict. And that includes creating injuries. Every writer needs to understand how to create authentic traumatic injuries as well as how to deal with their consequences.

The focus of this book is on violent injuries that do not result in death.

Every writer confronted with the dilemma of how severely to hurt a character must understand the consequences of the physical havoc created. Injuries should be realistic, reflect the character of the person inflicting the insult and be tailored to the needs of the plot. More sophisticated than in the past, today's readers have become avid, critical consumers of media violence. Hence, your story's accidents and injuries and the convalescence they cause must ring true.

As you write what is referred to in this book as an "injury scenario," you must hold the tuning fork of authenticity to your ear. You'll learn to review pertinent anatomy, assess the world of your storywhat's there to serve as a weapon and who's present in the scene to use itand decide what mayhem your tale needs. These are the elements of a trauma prescription.

Whether the genre is mystery-murder, horror, romance or any of the varieties of mainstream thrillers, the writer's art hinges on accurately depicting human suffering. Ernest Hemingway insisted it is what the writer leaves out that counts most. The late Gary Provost in a similar vein taught his writing students: Less is more. Richard Cohen, in Writer's Mind, instructs: Fiction writing should imply there is a great deal more than what has been written.

If using less material is the goal of good writing, why learn so much about inflicting injuries?

In "The Snows of Kilimanjaro," Hemingway never describes the gangrenous leg that plays a central role in the story. He alludes to the offensive smell and the progression of gangrene and even reflects on how it began with an element of neglect on Harry's part. At no point is there an explicit description of the rotting leg.

In Ian Hamilton's biography entitled In Search of J.D. Salinger, he describes the author of The Catcher in the Rye as he becomes progressively urbane, increasingly accomplished at his craft. Following the

publication of Salinger's "A Perfect Day for Bananafish," Hamilton states, "Thanks to The New Yorker he was beginning to learn the pleasures of reader manipulation, of having a sophisticated readership that had been trained in the enjoyment of inconsequential sorrow. He was learning how to leave things out, to flatter and deceive."

Herein lies the paradox of fiction writing: You must understand what to include and what to leave out. In order to leave something out of a scene, you need to understand all of the elements that could (but shouldn't) be included.

Authenticity emerges from personal experience, struggle and then understanding. Certainly, Hemingway had seen his share of war wounds. But most writers have little experience with traumatic injuries. This book describes in detail what you must learn about body impact and the spectrum of potential injuries in order to select what details to include in your scene. Once you understand what's there and how it gets maimed, you'll feel the pain and know what aspects of the injury to describe. The reader's visual imagery is enhanced by the inclusion of the right details. By learning a lot about a particular injury, you may select the most visual elements and write a sparse, fast-paced action scene.

Rather than being anecdotal, this book describes the process of how to create a dramatic injury scene. Included are suggestions on how to incorporate the more complicated material into your story.

No writer can describe, allude to or choose to ignore something that she doesn't understand. And you can bet the treasury that before the chubby cherub chortles, someone in your story is going to get hurt. If it's your traumatic scene, you'd better know exactly how it happens.

Body Trauma provides an organized menu of injuries and a suggested method of approach to guide you through the process of creating authentic misery. Using the various examples presented in conjunction with master injury lists (a menu of specific injuries) for each body system, you may construct innovative insults and terrible wounds to fit the specific demands of your plot. Not just a mere laundry list of clinical mutilations, this book describes how to create novel impacts, bodily disruptions and agonizing tissue trauma. By identifying where the impact occurs and what it does to the body, you can properly weave the length of the disability into the drama. This is called the time line of the injury.