Tips for Writing Injuries! (AGAIN)
Your action hero just got shot in the shoulder, stitched it up in a motel bathroom, and is now running through a forest. I need you to know that a shoulder wound severs muscle, nerves, and sometimes bone, and the human body's response to that is not "mild wincing followed by full range of motion." here is what injuries actually do to peoplee...
⊹ Adrenaline is REAL and it does allow people to do extraordinary things immediately after injury, BUT it is a loan, not a gift. you borrow the function and you pay it back later with interest. Your character might genuinely be able to run for twenty minutes after being stabbed. and then the adrenaline drops and everything the body was delaying arrives all at once. the collapse is NOT weakness. it's biology collecting its debt. write the debt collection. it's more interesting than the heroic sprint anyway.
⊹ Blood loss changes cognition before it drops you. you don't go from "fine" to "unconscious." you go through a whole middle stage of confusion, poor decision-making, emotional dysregulation, a strange calm, tunnel vision, difficulty forming sentences. Your injured character making a bad call, saying something they normally wouldn't, becoming suddenly and inexplicably gentle--that's blood loss. use the middle stage. it's dramatically rich and almost nobody writes it.
⊹ Recovery has a timeline and the timeline is long and boring and inconvenient to plot. a broken rib takes six weeks and during those six weeks sneezing is a genuine emergency. a concussion means no screens, no reading, no bright lights, and symptoms can persist for months. a stab wound to the abdomen means weeks of infection risk, limited mobility, and a specific kind of exhaustion that has nothing to do with sleep. Your character being sidelined and frustrated and useless for a long time is not a narrative problem. it's the story.
⊹ Pain also affects personality in ways writers skip. chronic pain makes people short-tempered and then guilty about being short-tempered. it makes concentration difficult. it makes intimacy complicated, both emotional and physical. a character who was patient and warm before their injury and is now snappy and withdrawn is not a character regression. they're in pain. pain is exhausting in ways that don't show on the outside. the people around them noticing and not knowing how to help is a whole story in itself.
Oooh ooh I have things to add!
- Re: the shoulder injury above - if someone sewed up the skin but didn't reattach nerves, tendons, etc. that were (fully) severed those things still will not work! Look up the anatomy of the area you're injuring and what the things there do
- Even if things aren't fully severed the pain and swelling in an area can make healthy muscles unable to contract as a protective mechanism (ask anyone you know who's had an ACL tear about their quads post injury/surgery). That's why an injured leg "gives out". If the situation is important enough (like your character is running for their life) their brain miiight override that but not necessarily
- Most nerves carry both sensation and motor signals so if you damage a nerve you will likely have numbness/tingling/maybe pain (in specific distributions that you can look up) and also weakness or paralysis of specific muscles depending on the severity of the injury
- Nerves take for freaking ever to heal (axons regenerate at ~1mm per day or ~1 inch per month) and sometimes they just don't (especially if they're fully severed and not surgically reattached)
- For most common injuries you can look up healing timelines but be careful with what endpoint you're looking at - for example you might be back to ADLs (activities of daily living like walking, dressing, maybe cooking and cleaning) in as little as a week but that doesn't mean you're back to running or sports or fighting bad guys
- Also with timelines there's a limit to how much you can push them. Like yes a pro athlete (or spy or superhero or whatever) might be pushed to go back "too soon" but if you're cutting 3 months off of a 4 month recovery timeline either they're 100% going to get reinjured because the tissue isn't healed yet or they're straight up like not even walking yet
- Pain, especially chronic pain, is super complex and interesting, and so often misunderstood or misrepresented (in medicine, not just in writing). If your source for how chronic pain works is more than ~5 years old it's probably wrong. There almost always BOTH physiological/biological factors and psychosocial factors in chronic pain and reducing it to just one or the other is both probably wrong and also likely not as interesting to your story - for a while we kind of thought it was all biological and then the pendulum swung to it being all psychological but it probably is both for most people
- A note / expansion on the above point about adrenaline: the phenomenon described is totally accurate but it's not just because of adrenaline. Pain is at its core an alarm system that your brain/nervous system uses to protect you. So if the most dangerous thing for you right now is the bear chasing you, it might not produce a pain experience to alert you about your broken leg, but once the bear is gone the broken leg is now the most important thing and your brain will make sure you're in enough pain that it's your top priority
- Bigger picture, your brain also isn't always correct in its danger assessment and it can both over- and under-react to the situation, which has the potential to be really narratively interesting (although it's kind of problematic for real people unfortunately). For example someone with chronic pain might find the sensation of a scarf or necklace painful because their nervous system overreacts. Conversely, if someone is always getting in fights and coming off totally fine their nervous system might underreact to a more major injury sustained in that familiar setting and they might not feel the pain of a broken bone until 2-3 days later when the inflammatory process gets bad enough that the brain realizes it judged wrong (seriously. ik that sounds fake but it literally happened to my professor who fell off a horse and was not in pain from a literal broken spine until 2 days later)
Lots of good stuff here. One thing abt shoulder injuries I haven't seen mentioned anywhere in the reblogs is that, aside from having your arm permanently messed up from nerve damage etc, you can literally die from them. There's a big-ass artery in there, you can easily bleed out if it's hit. Look up subclavian arterial rupture/trauma.
All that being said! People get lucky. Just because an injury is potentially fatal doesn't mean your character can't walk away from it with nothing but a cool scar and some juicy mental trauma. As a writer, I think it's fine to do whatever serves the story you want to tell. I personally prefer a modicum of realism, meaning I will at least try to acknowledge in the text when someone does get lucky.
I'd also add:
"I got stabbed in the abdomen but LUCKILY it didn't hit anything important!" drives me completely fucking insane as someone who knows anatomy, just saying. You've got your intestines in there; try stabbing a sausage and sewing the skin back on, go on. Sausage skins are literally intestines. Look how thin they are. That shit is DELICATE!
Along those lines if you get stabbed in "the side"... your large intestines are there. That's where all the poop is. You get poop in your open wound you are dying in agony without surgery because it's poop and it's riddled with bacteria. Because yeah your bowels will have to be stitched up.
Abdomen wounds are agonising because if your bowels don't open up and drown your wounds in poop, it's your intestines or stomach drowning your wounds in acid. Also you need your abs to sit up. You need your side to twist the around. Nothing in your body is redundant.
A lot more wounds need surgery than you think. A lot of broken bones need surgery. Pre-modern medicine this meant disability. Pre-modern medicine a compound fracture was a death sentence.
Sometimes pain takes a few days to REALLY kick in. My dad broke seventeen bones in a car accident and kept declining pain relief because he was totally fine. He eventually gave in because different doctors kept suggesting it. Four days later, even with that pain relief, he could barely talk, he was in so much pain.
Which reminds me, what's with the sheer amount of fantasy stories with no pain relief??? Everyone focuses on healing the wound but nobody acknowledges pain exists except for the, like, first five minutes, and then after they get medical attention it's just a bit sore at most. A lot of stuff people treat like bruises will actually drop your character for weeks.
Your character doesn't just have to worry about broken bones if they get tossed against a wall, their organs might get hurt as well. And if they have benign cysts on their organs, those could burst. I've seen a lot of kidney cysts in ultrasounds, if you wind up in a bad enough car accident those are bursting. Have fun!
Stuff often hurts either more or less than you'd think. I met a guy a few weeks ago who didn't know he broke his fucking NECK for thirty years because it was just sore now and again. Meanwhile my dad - most of his breaks were ribs, which authors tend to treat as a mild inconvenience. He had spine breaks too (and a burst kidney cyst, see above) but he said the ribs were worse. That's because just breathing moves them and you can't just stop breathing... and even if you could, your ribs will heal wrong because they'd heal too rigidly.
Someone further up talks about how pain is an alarm system and adrenaline is only part of the reason why pain signals are suppressed. Well, that is, in fact, how adrenaline works. Your unconscious mind isn't going "wait until the bear goes away THEN we'll hit her with pain signals!" because your brain is not that smart. What's actually happening is that the adrenaline is suppressing the alarm system. That's literally how it works. It's not separate, it's part of it. Different neurotransmitters and hormones can enhance or suppress pain. Adrenaline is one of the more powerful ones.
Minor injuries can be more deadly or disabling than you think. You can fall over, hit your head and die. Major injuries can also be more survivable than you think. People have shot themselves in the head with a shotgun, blown off their jaw and face, and lived. There's a lot of myths about which parts of the body are the most and least valuable. As pointed out above, a shoulder wound is a lot more deadly than you think.
"My character got a horrible injury but LUCKILY it didn't hit anything important so they are back up and running around like nothing happened after a short rest!" just give your character a stubbed toe. a stubbed toe is what you want. just give them a stubbed toe. George R R Martin was such a breath of fresh air because he never chickened out of disabling his characters, killing them, or giving them extended recoveries, and he didn't treat prosthetics as 1:1 replacements for the limbs they're standing in for. the tendency of authors to chicken out of hurting their characters has completely destroyed the drama of characters getting hurt for me because every time I read a story and a character gets hurt I KNOW the truth is author is going to cop out because they ALWAYS cop out and just pay lip service to pain like they just had a fucking stubbed toe. just give them a stubbed toe istg.
(I know as prev said that sometimes you just want to write a particular story and they're absolutely right, but this will never not drive me insane. if you're writing hurt/comfort fanfic then yeah I'm expecting a full recovery like nothing bad happened because that's the convention, but authors who play up the drama and pretend they're going to take it seriously only to wind up yanking my chain AGAIN is a particular pet peeve of mine)
