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  • Wound Healing in Stories

    Posted . Older posts

    This is a "need-to-know only" article about wounds and wound healing, for writers with little or no medical training.

    Topics Covered

    1. Why Healing Matters
    2. Consequences of Injury
    3. Table of Injuries: Healing time and handicaps for common injuries
    4. Physical Therapy
    5. Elderly, Juvenile, or Immuno-Compromised Individuals
    6. For Fantasy and Historical Authors Only: Injuries in a pre-antibiotic world

    Why Healing Matters

    Any book whose conflicts involve physical violence are going to have injured protagonists. (If they don't, then you've got another problem, an insidious form of Mary Sue-ism that saps the conflict of any real tension.) If you're going to hurt your characters, you're going to have to heal them again.

    Like everything else in your story, you should do this with thought and research, making a deliberate decision as to how to portray the injury and healing in your story. You can choose not to show the healing process if you want, but it should be an educated choice, not an accident.

    Consequences of Injury

    You can bring more tension into your stories by making injuries and healing have real consequences, ones that ring true. After your reader sees that injuries are serious in your story, they'll be biting their nails during every fight and they will really wince when your character gets hurt!

    Physical Handicaps While Injured

    While healing, your wounded character will have specific problems and handicaps to worry about, or require specific care. In the table below, I've provided notes and suggestions for ways to incorporate that into your story in interesting ways. Of course, everything must serve the story, so feel free to pick and choose. I see these as opportunities, not restrictions.

    The Timetable

    If your character gets hurt, ey will heal on a schedule, and it will be eir schedule, not yours. The most common mistake storytellers make when injuring their characters is to fast-forward this schedule unrealistically.

    Sometimes, this is simply not knowing how long injuries take to heal. That's what this article is for. But other times, authors fast-forward the schedule because they don't feel like dealing with it. If you are tempted to ignore real-time healing schedules for the convenience of your story, then I invite you to ask yourself why. Does it really make your story better to ignore the realities of injury?

    Table of Injuries: Healing time and potentially story-relevant notes for common injuries

    Here's a handy list of how long it will take your dudes and dudettes to heal from a given injury. Partial healing means the injury is no longer critical, but the character is weakened and risks re-injury if ey isn't careful. Full healing means ey is back to full strength.

    Following each entry are notes on aspects of the injury that are most likely to be relevant to a story's plot. In other words, it's what I think you need to know.

    Injury Partial healing Full healing
    Broken bone: Simple Fracture 3 to 4 weeks (in a cast) 6 to 8 weeks
    A character with a broken bone in a cast can do many normal activities but cannot put weight on the bone. Excess weight will set healing back to square one.
    *Broken bone: Compound or Open Fracture 4 weeks (in a cast) 8 to 12 weeks or more
    Open fractures are debilitating and carry serious risk of deadly infection. They require surgery to set. They must be considered a life-threatening injury, even in a world with antibiotics.
    *Sprain 2 weeks 6 weeks
    Highly variable. Ankles heal more slowly than wrists. Bad sprains require an x-ray as they may be complicated. Many sprains involve avulsion fractures, which extends the length of time they must be splinted.
    Mild concussion 1 month 3 months or more
    I'm not even listing serious or repeated concussion here because it is such a big deal, you would have to be writing a book that is ALL ABOUT head injuries. Cognitive symptoms of brain injury are significant, noticeable, and difficult to portray accurately; research is a good idea even for mild concussions. In general, I strongly suggest you do not knock your characters unconscious without making it an important part of the plot.
    *Dislocated joint 2 to 3 weeks until movable 4 to 10 weeks
    Heals faster if reduced (put back into joint) immediately. Shoulders are easier than "hinge" joints like elbows and knees. Simple dislocations heal like a soft tissue injury. Complex dislocations, however, involve damage to bones/ligaments, and may damage blood vessels or nerves; they have a healing schedule like a fracture. Once dislocated, the joint forever remains vulnerable to getting dislocated again. Your character now has a permanent weakness.
    Broken rib Immediately 6 weeks
    Simple broken ribs don't need treatment. The character can walk around, drive, use the computer, etc. but cannot lift heavy things, bend or twist, or throw punches without severe pain and possible worsening of the injury. While healing, the rib can be easily re-broken by careless actions or even by coughing. Broken ribs make it very difficult to breathe deeply and thus negatively impact your character's endurance. They carry a risk of chest infection (pneumonia).
    Gunshot to torso (or getting run through by a sword or arrow) A few days to a few weeks 4 weeks or more
    Spend some time thinking about where, exactly, your character got shot. If bones in the shoulder are broken, that arm is unusable until the bones heal. There may be organ damage. My point is, be careful. Don't shoot your character and then have em kicking ass a few hours later. (Hollywood action heroes, I'm looking at you.) At the very least, give em a couple days in bed. Serious risk of deadly infection, even with antibiotics.
    Blood loss 1 to 48 hours 24 hours to 5 days
    Dehydration is the first problem, and can be dealt quickly. Low blood pressure may make your character dizzy and weak. Blood regenerates itself in 24 hours. However, your body must rebuild its reserves and your character will be fatigued and hungry for some time. Add extra recovery time if your character does not get a transfusion.
    *Simple cut 1 (small cut) to 8 (bigger cut) days 2 to 4 weeks
    Cuts requiring stitches will tear open, worse than before, if the character overuses them. Severe cuts will make your character fatigued, possibly severely. Don't ignore that or it looks silly. Pain is also significant. Deep cuts near mobile body parts (like hands) involve weakness and internal scarring that may require physical therapy, and may be permanent.
    Burn or scrape involving lost skin Depends 4+ weeks
    Patches of lost skin must be regenerated, involving "granulation tissue" which is very delicate. Bumping or rubbing it will set healing back. Your character must not do anything that might damage it. That's why I put "depends" on the healing schedule; if the injury's on eir chest, the character can get back to business soon, but if it's on eir leg, ey must be more careful. Burns especially carry serious risk of infection, because of the dead tissue. Large burns cause potentially fatal dehydration. There will be scarring.
    *Prolonged unconsciousness or coma 1 week 1 to 12 months
    If you intend your character to awaken from unconsciousness lasting more than a day, I strongly encourage you to research what this will do to your character. People waking up from a year asleep and going right back to normal is ridiculous but, sadly, very common in stories. Don't be one of those guys! Research!

    * Means the injury will require significant physical therapy.

    Physical Therapy

    If you've never had the pleasure of an injury requiring physical therapy, it's easy to forget such a thing can happen. But injuries that make structural changes to the body will require physical therapy to restore the individual to optimal functioning.

    You don't have to introduce a physical therapist character. Characters who are good at listening to their bodies can do their own physical therapy. It's boring, so I'm not saying it needs tons of screen time. Just a couple quick mentions of things your character is doing to improve strength and flexibility in the damaged area will do.

    Remember that some injuries never heal. A battle-scarred veteran will have aches and pains that never leave em.

    Elderly, Juvenile, and Immuno-Compromised Individuals

    If you've got an immuno-compromised character, my hat is off to you: you're portraying a minority and if you're researching it by reading articles like this, then you're doing it right. However, that's beyond the scope of this article and my own understanding. Sorry! But, generally speaking, you will want to extend healing time, pay more attention to hygiene, and dramatically ramp up the risk of infection, both primary and secondary.

    Elderly characters are more prone to complications, particularly involving fractures, particularly women. Sprains and dislocations will almost certainly involve some bone damage. They also heal more slowly in general and are more vulnerable to secondary skin injuries and infections.

    Youngsters are lucky. They bounce when they land and they heal fast, especially their bones, which aren't fully ossified (made rigid by calcium) yet. But injuries to delicate areas like hands, feet, and spine can have lasting effects on their growth. Physical therapy is important.

    For High Fantasy and Historical Authors: Infection in a pre-antibiotic world

    You guys have a tough row to hoe. You're writing about a time when folk die from tiny cuts, let alone serious injury.

    Now, you don't have to have your character get infections from eir injury. But if someone ELSE does, and maybe a bit player or a bad guy dies of sepsis, that will lend a lot of tension to your main character's plight. It's a good opportunity! Let us feel their helplessness and fear. Like Katniss fretting over Peeta's leg wound, we know medicine exists... but it's not available, and its absence is felt keenly.

    Your characters, meanwhile, know their lives depend on not getting an infection. Depending on the time period, they may or may not really get the point of hygiene, but we readers seem to generally accept that everyone in High Fantasy understands the concept of clean, dry bandages. Keep those bad boys clean and dry, change them every day, and let us feel the characters' worry as they check on their wounds for signs of sickness.

    Signs of infection include localized fever or (worse) general fever, localized or (worse) radiating redness, excessive oozing or weeping especially of "goopy" stuff, wounds that are taking too long to heal, malaise, and unpleasant smells.

    Why haven't I cited sources?

    I gathered the information for this article off the hivemind of the internet, not a single source. Definitely I tapped Wikipedia a lot, but I never read just one place. As a result, the facts listed are consensus facts, and often represent a compromise between several conflicting accounts, or an attempt to put together information most relevant to the "average" people (not elderly or juvenile or immuno-compromised) who star in the majority of stories, especially the kind involving violent conflict.

    Special thanks to my RN friend Elana Kahn for pointing out some things I missed :)

    Disagree? Have questions? Email me!

    I love to be proven wrong, almost as much as I love answering health questions. You can reach me at melanie at weisberg dot ws.

    Posted