I’m working on a book and sometimes it is necessary to yell, so here’s a side blog. also subject to talk about assorted dnd campaigns and occasionally poetry!
I actually hate writing, I always end up writing something that has no way to Segway into the next scene naturally and it’s actually so fucking annoying
Ive definitely felt that there is no natural segue into the next bit of dialogue or into the next scene, but that oftentimes is because people in real life don't segue.
One tool I like to use is "character observes physical object nearby and then unexpectedly dives into tangent."
So, for example, I have two knights arguing about who is their Lady's favorite. One argues that they have more tenure, the other argues they have more skill as evidenced by their many claims to fame. The first points out that paying for fame is not the same as earning it. The second protests that--
The argument goes from there, the two knights listing their own pros and brutally pointing out the other's cons. As they begin to struggle to come up with new pros ("the Lady likes red and I wear a red cape." "We both do, idiot.") the silence grows lengthier between each statement.
The older knight frowns and looks huffily at a nearby tree. After a beat they say, "I don't think that Lord Minnegan's impenetrable fortress is impenetrable."
And the second knight goes, "our Lady released the informant yesterday."
By having the knight look at the tree, I've effectively created space between the dying argument and this new line of conversation. Is it because both are tired of the conversation? Probably. Is it because they are professionals who should've been discussing the mission from the get go rather than childishly arguing about favorites? Undoubtedly.
But I didn't need a line of dialogue like "we shouldn't be arguing like this. It doesn't matter. We should talk about the mission" to get there. I just went there and hoped the audience would be able to understand the how of it. The action of looking at the tree is the only deescalation I needed to pivot in a new direction
I hope you don't mind me jumping on your post! I just love this type of roadblock because it's like a puzzle. How do you move forward? How can you make the pieces fit when writing a multifaceted story? It's super fun and frustrating in equal measure
Because someone asked me, a million billion years ago: some information, reference, and explanation of things that might be around when you're writing/drawing someone in the hospital. And if you just,,, have seen some of these things in hospitals and would like to understand them better. It's good for that too I guess lol. Under the cut, because this is long and image-heavy
(Disclaimer--this is mostly for characters hospitalized for traumatic injury, broken bones, etc--I don't work ICU so my advice is less applicable there)
((Double Disclaimer: I've tried to keep this applicable to the general concept of hospitals, but apologies if over-generalization has slipped through!))
IVs
Item one! Because it's very visible and often misunderstood: our friend the IV. Shown below, a pretty bog-standard hand IV, a dressing with a clear window to show the insertion site, and technically-optional but very commonly-used J-loop tubing
(You can also just screw the long infusion tubing directly onto the IV itself, but it's a pain in the ass to do and often pinches the patient when you take it on or off.)
Common Misconception: If we are "taking you off the IV" we are not removing the IV! We're unhooking the tubing from that hub you can see at the end of the J-loop.
Common Misconception: The actual “IV” is the very thin plastic tube that goes into the vein itself, and the plastic hub that rests on the skin outside. The needle used to guide the IV is retracted once the catheter is into the vein. There’s no needle in there. Irritation to the inside of the vein may feel sharp, but it's not because you're being literally stabbed.
Artists: Note that the IV is inserted pointed up the arm, toward the heart! I've seen it drawn the other way once or twice. Nope!
Artists: most likely areas to see an IV placed ^^^
Writers: IVs in the elbow-bend/antecubital vein/"AC" tend to kink when the arm bends, which causes the pump to beep. Perhaps to the annoyance of Blorbo, who would like to be able to use their arms for things.
Somebody more critical could be getting medications and fluids through several IVs at once, and will often have at least one that's not currently in use as well--the most IVs I've seen in one patient is five, with three of those all running infusions at once, but generally I'd expect one or two IVs in a routine surgical patient, and probably two to three in a trauma patient.
Patients who have had surgery or a traumatic injury, or who aren't able to eat/drink like normal, will often be getting a slow drip from a big bag of fluid (i.e. saline! laypeople know saline, I think right?)
Artists: these bigger hydration infusions are compatible with most other medications, so when someone gets an IV medication--an IV antibiotic, an electrolyte, etc--they'll often be hung "piggyback" or as a "secondary infusion" (see below). If blorbo has two bags hanging on connected tubing, one should be notably lower than the other.
If Blorbo has medications running, and/or is anywhere but the emergency room, the tubing will also run through an IV pump, to moderate how fast it goes. (reference: IV pump).
There are other types of venous access, and also arterial lines, but we don't have a million words to do a primer on access types unfortunately.
RE: IVs being dramatically yanked out so Blorbo can run off to do Drama: should stop bleeding with a minute or two of light pressure, and bleed in a dark, welling trickle, not a bright red gush or spurt. Unless Blorbo got an IV accidentally placed in their artery, which is *LOUD INCORRECT BUZZER*.
Dressings/Bandages
There are approximately eight billion types of dressing, but this is specifically a PSA that there are a lot of options that aren't the classic White Wrapped Bandage.
Dressings of the Wrapped Bandage genre are used, especially on things like a hand or foot wound, or to (try to) wrap a head wound. (Bandaging somebody's face/head, my beloathed. it does NOT stay on.)
BUT injuries not on a part of the body with fiddly surfaces like toes/fingers or facial orifices are often covered by what I'd broadly call an "island dressing"--essentially a big bandaid sealed on all sides, or gauze pads laid down and taped to fit the wound. Looking up "surgical dressing" has provided me with a lot of the ones I was thinking of, and minimal gore, so I recommend it! Things of this general species:
Those dressings ARE sometimes paired with essentially a wide ACE bandage--in my field, I often see a smaller dressing on the hip/knee/ankle surgery site, and then an elasticated wrap around a large part of the leg, to gently compress the limb.
Oxygen (reference:nasal cannula or hospital oxygen mask)
Writers: Oxygen flow is measured in "liters per minute" which is confusing but true. You'll hear medical people shorten it to "they're on two liters nasal cannula" or "they're on ten liters nonrebreather", etc--or if Blorbo isn't on oxygen at all, they're on "room air".
The nasal cannula is a tube to deliver extra oxygen through the patient’s nose; the tubing goes back over the top of the ears, loops forward and meets under the chin. The other end is usually hooked to a wall port if the patient’s in bed.
This is one of the biggest ones I see people draw funky. The versions people come up with are very funny but also that's probably not what you're going for so pls. Take this reference I am gently handing to you.
A CLOSED LOOP: two small tubes in the nose, then the tubing goes back over the ears, then down onto the chest where the loop joins back up into one length of tubing.
It’s not actually as common to wear an O2 mask--masks deliver a higher concentration of oxygen than the cannula does, and if someone is struggling enough on a regular nursing floor that they need a mask to get their oxygen up, that's something their nurse is most likely keeping a close eye on. The Intensive Care Unit/ICU, the Emergency Room after a trauma, or in the hour or two after surgery are the places I'd expect to see a lot of O2 masks.
Artists: If you're looking up reference for oxygen masks, note that the kind shown on the left, with the bag (a nonrebreather) is a further step past the simple face mask shown on the right and delivers a pretty hefty dose of oxygen. Things have gotten pretty serious breathing-wise if Blorbo needs a nonrebreather.
Many people in the hospital don't actually need oxygen. Some common reasons people DO: lung injuries/diseases, a sleepy/sedated/unconscious patient, or something like broken ribs, where breathing is painful/hard. (looking at u, hurt/comfort writers).
We check oxygen on the finger the majority of the time (reference: pulse oximeter clip, pulse oximeter sticker)--if the patient’s unstable/sedated or has problems with their oxygen levels, the sticker is made to stay on continuously while the clip is easier to apply for occasional checks and then take off.
A little guy of this general variety, although you can honestly freestyle the shape. Note the norm is that the cord comes out on top. These can actually be used on any finger, or even the toes, although the fingers tend to read better.
Fun fact: the little finger doodad, whichever kind you choose, simultaneously reads oxygen and heart rate. If Blorbo has a little clip on their finger, their monitor should probably be showing both!
Drains (Careful looking up ref of these--they’re usually used for wounds, and the image searches can sometimes be unexpectedly graphic)
Inserted into somewhere there’s going to be drainage (because of infection or after some kinds of surgery/injury)
There are a million kinds of these, but I most commonly see the JP/Jackson-Pratt. The little hand grenade guy. He shouldn't be round unless he's full and needs emptied; the suction comes from compressing the bulb and corking it that way.
On a non traumatic-injury-related topic: to my knowledge, this is commonly what you'll see placed after top surgery! Congratulations to Blorbo on the top surgery.
Another useful friend for more traumatic art/writing is the humble chest tube, inserted for injuries around the lungs; severely broken ribs, blunt or penetrating trauma, etc.
Injuries around the lungs can cause air or blood to pool in the space the lungs are supposed to take up, and a tube can be inserted so the lungs can do their thing again. They drain into a weird flat tall little box that collects the drainage and can be hooked up to suction to help the drainage along. (reference: chest tube dressing, pleur evac)
There are a million pieces and parts to a pleur-evac and I could explain them all but to be frank you do not need to know. Face it away from the illustration and I will still be applauding, impressed that someone drew a chest tube.
Heart monitors
Most people who are hospitalized for a run-of-the-mill fanfic-style traumatic injury (and who don’t have heart problems/symptoms) don’t necessarily need their heart monitored, but if they’re critical/have heart issues, a telemetry box is a common piece of hospital equipment.
It’s hooked up by five wires to five stickers that go on the patient’s chest--if you want to get the placement right and make a nurse quietly impressed, look up five-lead telemetry
Incredible. A whole eight pixels of telemetry setup. >:Ic To simplify it down: one on either side a little below the collarbones, one on either side of the ribs, and one about in the middle. That's close enough for horseshoes or hand grenades, at least!
I've talked about this on the blog before, but the formula for a passable heart rhythm is a little rounded bump up from the base line, then a narrow spike up, down below baseline, and back to center, then another rounded bump. That makes one total heartbeat. Keep those clustered pretty close; if it’s a slower heartbeat, they space out slightly more but most of the space comes BETWEEN those clusters, not separating the parts themselves.
This is another one I see artists freehanding often, to often very humorous effect! Remember y'all, BUMP SPIKE BUMP.
Feeding Tubes
Unless the character’s going to need tubefeed long-term, hospital feeding tubes mostly go through the nose rather than in through the abdominal wall. They can be taped onto the nose (reference: NG tube tape) or we can loop something up one nostril and down the other to hold it in if it’s staying for a while/it keeps getting pulled out (reference: bridled corpak).
If your character had a gut injury/surgery, or is very malnourished from some form of illness and needs concentrated nutrition but can’t tolerate a lot of food, a hospital might give them tubefeed.
(we can also give nutrition through an IV! Sometimes tubefeed and TPN or PPN (IV nutrition) are given at the same time, especially for very malnourished patients or ones we're weaning off of the IV nutrition)
Vital Signs
This one's mostly for the writers lol. A very simplified rundown:
Vital signs are usually taken at regular intervals, often every 4-8 hours on a regular nursing floor, or more frequently in ICU/ER, where they often leave the machine hooked to the patient and can set it to automatically cycle at an ordered frequency
TEMPERATURE:
often in celsius, yes even in America
PULSE:
Patients who have lost blood and are stressed and in pain--aka most trauma patients--will often run faster heart-rates. Some young traumas especially will sometimes just maintain 100s-120s even at rest.
BREATHS PER MINUTE:
Pretty self-explanatory. I often hear respirations shortened to "respers". Counting them is not often noticeable but might include glancing from the patient to the clock/a watch and/or having a hand on their shoulder or back.
Narcotic pain medications are a notorious reducer of respiratory rate/depth, especially when somebody has had enough to make them drowsy.
OXYGEN SATURATION:
(AKA "pulse ox"/"sats"/"O2")
100% is obviously the best
95-ish on a young person who's been sedentary or sleeping heavily wouldn't surprise me too greatly but I would expect it to come up with deep breaths and coughing.
If young previously-healthy Blorbo is needing oxygen to get above the 93-94% range or below, especially all of a sudden, I'm looking for why! Sometimes "why" is obvious--rib fractures, sedation from anesthesia or pain medication, pneumonia, etc--but if it's not, we might be getting a chest x-ray.
Older patients who smoke and/or have long-term respiratory diseases can sometimes just run around 88-90%, but it's sure the fuck not a sign of good health. :T
BLOOD PRESSURE:
Hoo boy there's a lot here. In case this is new information: "blood pressure" is TWO numbers, written as X/Y and usually spoken as "X over Y". "120 over 80" being the old textbook "normal" number.
The patient's BASELINE blood pressure and how it's TRENDING (is it going up, down, has it dropped or spiked suddenly) are very important parts of assessing a blood pressure, so trying to assign meaning to specific numbers gets tricky!
High blood pressures are not usually going to be the problem in Blorbo-torment situations, which tend toward blood loss etc, so to broadly cover the opposite:
100s/60s is what I'd generally call a "soft" blood pressure; on the low side but not necessarily concerning in isolation.
90s/50s is eyebrow-raising. We're looking closely at other vital signs, assessing the patient, seeing if they've had a lot of medication that can lower blood pressure (pain medication/narcotics a common suspect). We're likely calling doctors for blood work (to look for signs of bleeding) and/or asking for a "bolus" (a half or whole liter bag of fluid run very quickly). Some people just exist in the 90s/50s! But if Blorbo doesn't, or if they're having other symptoms (dizzy, sleepy, lethargic, pale, heart-rate rising from their baseline rate). CONCERNING.
80s/40s is "if a doctor doesn't come up here ASAP and/or order some stuff right now, I'm activating my hospital's rapid response team" territory.
70s/30s is "I'm going straight to the rapid response team and calling a doctor once that's called because I'm worried this is going to turn into a full-blown Code Blue" territory.
Either the top or bottom number (systolic and diastolic, to their friends) being low to the degree above is of note--they don't exactly go up and down in lock-step. Unfortunately to get into the minutiae of "well if the systolic is THIS but the diastolic is THAT, I'm less concerned than--" would take a million years lol.
ARTISTS: there are about a million formats for vital machine readouts, so the exact design isn't important! But I do note that having several different colors is a very common feature. Here the heart-related vital signs are all red, the oxygen is blue, and the temperature is green.
"THEIR VITALS ARE DROPPING"--@ hospital drama TV what are you doing. that's nothing. it's nothing. Stop it. if I've heard any phrase used to a similar effect it's "they're crashing" but also like. If there's a team of medical professionals in the room we don't need someone to announce generally that things are going bad. We can tell. Calling out a specific vital sign--"blood pressure's tanking, 64 over 30"--"I'm getting 76% O2, I need a nonrebreather"--is way more specific and lets us know exactly how bad and in what way. 😤
CODES
Big bad! Blorbo has 1. stopped breathing, 2. abruptly stopped responding to stimuli, 3. stopped having a pulse, or some combination!
This does not just happen, so if you're going to write a code being run you might have to do some extracurricular looking around to find a story-compatible reason WHY blorbo tanked. Extreme electrolyte imbalance caused a dangerous heart arrhythmia? Very severe blood loss->hypovolemic shock? Vomited and choked on it? Vasovagal response when they were trying to poop made them pass out and it's a false alarm?
If someone's found unresponsive, you might see a "sternal rub"--a quick and dirty way to figure out if someone is just really drowsy and lethargic vs completely unresponsive, scrubbing your knuckles down hard against their breastbone. It hurts! And if someone doesn't react to it you can pretty decisively say "shit this person's unresponsive" and get help.
The phrases "CALL A CODE" and a coworker's voice yelling "I NEED SOME HELP IN HERE!" down the hallway galvanize me into an immediate adrenaline response at this point.
In a hospital, there will also be some kind of alert or alarm to immediately summon everybody. On my unit it's a little lever on the wall that immediately turns the call light system a bright flashing blue and has a very urgent and distinct alarm, but tbh most variations on "easy to activate and makes a loud distinctive alert" would be believable to me as a nurse.
The defibrillator will be brought in and hooked up (modern defibs use stick-on pads, not the paddles), but not all codes involve the classic "CLEAR!" and a shock; the defibrillator scans the heart rhythm and determines if the heart's in one of the two (2) shockable rhythms. Even when the code IS heart-related, which not all codes are, the heart rhythm is not always going to be shockable, in which case it will be a matter of CPR and IV medications for heart rhythms, and potentially intubation for breathing problems.
OF NOTE: 'no heartbeat at all' is not actually one of the shockable rhythms! People tend to treat shocking someone as a "restart the heart" thing but it's a "jolt it back into the right rhythm" thing, actually!
Just whacking somebody on the chest, AKA "precordial thump" or slapping them and telling them to Fight It are not accepted medical treatments lol. The first one has SOME very limited utility as a last-ditch thing with no other equipment available but if somebody did either one in the hospital they would look fully unhinged.
This has turned out very meandering, but hopefully also helpful in some regard! Obligatory disclaimer again that my experiences are not universal, although I've tried to keep this generally applicable. UoU
big fan of characters who look cool and tough and stoic but only because theyre internally thinking "fuckkk what do i say. how do i make friends. they didnt teach me how to do that in sword school."
the thing that bothers me with 7 deadly sin based characters is when they cant decide if they embody the sin by suffering from it or by drawing it out of others. ie. if your gluttony demon is a guy who loves eating then your lust demon should be a gooner sex pest. and if your lust demon is a seductive girlboss then your gluttony demon should be a 5 star chef. does this make sense.
Just woke up and can’t explain further but a witch who lives in a very Peculiar and Particular house who through some series of events feels so bad for a group of college kids that she invited them to live with her (possible after feeding them a few times, that’s how you get attached)
And she carefully instructs them on the house’s very peculiar and particular upkeep (if you take a book from the book shelf, you must put away the dishes first or if you walk upstairs with shoes then everyone downstairs must take their shoes off, etc)
She kind of expects everything to go to shit because she once had a lover who didn’t listen and got eaten by the house (which doesn’t always happen! It was an egregious violation done to the Particular and Peculiar House) but the college kids follow the rules to the letter. Flawlessly. They even inform her when the house makes new rules
“We added it to the list.”
“The list?”
“Yeah, absolutely feral behavior to not have a list.”
“I have a good memory.”
“Well now you also have a list guests can read before they switch the chairs around at the table.”
most of a bottle of wine in and thinking about how the family regret plot is just so juicy because you get to deal with the family member who didn't realize it was happening, the family member who did it because it ingratiated them with the instigator of the family, the one who did it because it was easy, and the one who did it from jealousy
AND the MC who was ostracized and bullied and now gets to move on and flourish under new conditions
Violence: A Writer’s Guide: This is not about writing technique. It is an introduction to the world of violence. To the parts that people don’t understand. The parts that books and movies get wrong. Not just the mechanics, but how people who live in a violent world think and feel about what they do and what they see done.
Hurting Your Characters: HURTING YOUR CHARACTERS discusses the immediate effect of trauma on the body, its physiologic response, including the types of nerve fibers and the sensations they convey, and how injuries feel to the character. This book also presents a simplified overview of the expected recovery times for the injuries discussed in young, otherwise healthy individuals.
Body Trauma: A writer’s guide to wounds and injuries. Body Trauma explains what happens to body organs and bones maimed by accident or intent and the small window of opportunity for emergency treatment. Research what happens in a hospital operating room and the personnel who initiate treatment. Use these facts to bring added realism to your stories and novels.
10 B.S. Medical Tropes that Need to Die TODAY…and What to Do Instead: Written by a paramedic and writer with a decade of experience, 10 BS Medical Tropes covers exactly that: clichéd and inaccurate tropes that not only ruin books, they have the potential to hurt real people in the real world.
Maim Your Characters: How Injuries Work in Fiction: Increase Realism. Raise the Stakes. Tell Better Stories. Maim Your Characters is the definitive guide to using wounds and injuries to their greatest effect in your story. Learn not only the six critical parts of an injury plot, but more importantly, how to make sure that the injury you’re inflicting matters.
Blood on the Page: This handy resource is a must-have guide for writers whose characters live on the edge of danger. If you like easy-to-follow tools, expert opinions from someone with firsthand knowledge, and you don’t mind a bit of fictional bodily harm, then you’ll love Samantha Keel’s invaluable handbook
I made some weird little watercolor and gouache paintings for a sci-fi-themed exhibition. I was miles out of my comfort zone and some of my paintings were Quite Bad but I had fun
the human-faced bear principle of storytelling: the amount of people who will remember the exposition about the rules of magic or the history of elf culture inherently pales in comparison to the amount of people who will remember the scene where someone gets mauled by a bear with a human face
this isn't a call to necessarily include a literal bear with a human face (though you should at least consider it. obviously.) but pointing out that, while a lot of sf/f writing advice places heavy emphasis on fleshing out the small details of a fictional world as much as possible, there's often little attention given to the value of including effective "bear attack scenes", for lack of a better term; tense, scary, shocking, weird, or otherwise visceral scenes or concepts (the pale man, the chestburster, the sunken place, the raptors in the kitchen, artax in the swamp, the annihilation bear, the basement in parasite, the blood test in the thing, etc) despite those having a significantly higher hit rate of making a story striking and memorable to people
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