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  Introduction

  I. Doctors, Hospitals, Illnesses, and Injuries

  1. Traumatic Injuries and Their Treatment

  How Would Death Occur from Blunt Head Trauma?

  Can My Heroine Survive an Auto Accident and

  Ruptured Spleen?

  Where Can My Hero Be Shot and Survive?

  Can a Person with Broken Ribs Swim?

  What Is the Mechanism of Death in a Suicide by Hanging?

  What Wounds Would Result from an Attempted

  Suicide with a Gun Placed Under the Chin?

  Can a Traumatic Miscarriage Prevent Future Pregnancies?

  What Are the Symptoms of a Concussion?

  What Happens When You Get the "Wind Knocked

  Out of You"?

  What Injuries Occur When Someone Is Thrown

  Down a Stairway?

  What Injuries Occur in a Fall onto Rocks?

  What Is the Likely Cause of Death in a Fall Downstairs?

  What Happens When Someone's Nose Is Broken?

  How Long Will a Black Eye Persist?

  Where Would the Spinal Cord Have to Be Injured to Cause Quadriplegia?

  Could My Pregnant Character and Her Unborn Child

  Survive a Severe Concussion and Near Drowning?

  Could Death from Bleeding Be Delayed for Several Days?

  What Was the Technique for Limb Amputation in the

  Nineteenth Century?

  What Are the Physical Limitations of Someone with a

  Shoulder Dislocation?

  What Are the Symptoms and Treatment of a "Sucking

  Chest Wound"?

  2. Environmental Injuries and Their Treatment

  What Happens When Someone Dies from Exposure?

  What Happens When Someone Dies from Dehydration?

  What Is the Treatment for Dehydration?

  How Long Can Someone Survive in a Freezer?

  Does Alcohol Intake Prevent Death from Freezing?

  Could Someone Survive in a Roadway Tunnel Where a Forest Fire Raged at Both Ends?

  What Happens When Someone Is Struck by Lightning?

  Can a Person Stranded at Sea Survive by Drinking His Own Urine?

  3. Doctors, Hospitals, and Paramedical Personnel

  Can X-Ray Films Be Copied?

  How Do Doctors Handle Emergencies and Concussions?

  How Do Hospitals Ration the Blood Supply in Major Natural Disasters?

  What Is Artificial Blood?

  What Is Blood Doping, and How Does It Work?

  What Is the Basic Procedure for Blood Donation?

  What Medical Emergency That Required Quick Action Would Likely Occur in a Gunshot Victim in a Hospital ICU?

  What Information Would Emergency Department Personnel Give Out Regarding a "John Doe"?

  What Medical Expertise Would a Seasoned Commando Possess?

  Can Firefighters Estimate the Survival Time of a Victim Trapped in an Airtight Enclosure?

  Can Paramedics Determine If an Accident Victim Is Alive by Measuring Liver Temperature?

  What Is the Difference Between a Psychologist and a Psychiatrist?

  4. Medications and Drugs

  What Are the Effects of the So-Called Date Rape Drugs?

  How Do Drugs Alter the Size of the User's Pupils?

  How Safe Is It to Handle Cyanide?

  Will Food Intake Prevent Alcohol Intoxication?

  How Dangerous Is It to Transport Heroin in a Swallowed Condom?

  Can Opium Addiction Make Someone Violent?

  Is Ritalin Useful in the Treatment of Attention Deficit Disorder, and How Can It Be Abused?

  What Is Seasickness?

  5. Diseases and Their Treatment

  How Do Heart Disease and Angina Limit My Hero's Activities?

  How Would an Allergy to Bee Stings Affect My Character's Lifestyle?

  What Types of Malaria Exist?

  What Exotic Diseases Are Prevalent in the Caribbean?

  What Are the Symptoms and Signs of Spinal Muscular Atrophy?

  What Type of Bacterial Meningitis Is Most Likely to Infect Adolescents?

  Is Shock Therapy Effective Treatment for Severe Depression?

  What Are the Symptoms of a Miscarriage?

  What Complications of Pregnancy Would Lead to Hospital or Bed Confinement?

  What Medical Emergency Would Expose a Young Woman's Secret Pregnancy?

  What Is the Gulf War Syndrome?

  II. Methods of Murder and Mayhem

  6. The Effects of Guns, Knives, Explosives, and

  Other Weapons of Death

  Can a Stun Gun Serve as a Murder Weapon?

  What Happens to the Victim of a Stun Gun Attack?

  Will a Stun Gun Shock Others Who Are in Contact with the Victim?

  What Would a "Bang Stick" Wound Look Like?

  Is a Blow to the Head More Deadly in a Heart Patient?

  Will Ground Glass in Food Kill a Person?

  How Long Does It Take to Smother Someone with a Pillow?

  How Does an Ice Pick to the Back of the Neck Kill?

  What Are the Most Lethal Wounds That Can Be Made with a Knife?

  What Structures Must Be Injured to Make a Stab Wound to the Back Lethal?

  What Noises Are Made by Victims of Stabbings or Gunshots to the Neck?

  Can Someone Who Has Been Stabbed in the Neck Speak?

  Where Would an Intoxicated Person Have to Be Shot to Put Him in a Coma for Two Days?

  How Did David Kill Goliath?

  7. Poisons and Drugs

  Is There a Drug or Poison That Mimics Death but Allows the Victim to Survive?

  What Poison That Can Be Secreted in a Glass Will Kill Instantly When Swallowed?

  Can Ingested Cocaine Kill?

  What Happens in Carbon Monoxide Poisoning?

  What Duration of Exposure to Natural Gas Would Be Required to Kill a Person?

  What Substance Could Be Added to Water to Hasten Death in Someone Stranded in a Desert?

  Is There a Drug That Not Only Subdues a Victim but Also Erases Her Memory?

  Is There a Toxic Pesticide That Can Be Disseminated by Fire or an Explosion?

  Are Some Poisons Absorbed Through the Skin?

  Does Jimsonweed Make an Effective Poison?

  How Does the "Posture" of Strychnine Poisoning Work?

  What Is the Lethal Dose of Strychnine in Humans and in Various Animals?

  Is There a Poison That Causes Stomach Distention and Death?

  How Deadly Are Death Cap Mushrooms, and What Do They Do to the Victim?

  What Drug Available in the Nineteenth Century Could Be Used to Make a Victim Pliant but Awake?

  What Were Some Common Poisons Available in Medieval Europe?

  What Are the Effects of Rhubarb Ingestion?

  Does Selenium Make an Effective Poison?

  How Quickly Would Someone Die After Drinking Alcohol Laced with Xanax?

  What Substance Can Be Added to a Fire-Eater's "Fuel" to Cause a Sudden and Dramatic Death?

  8. Medical Murder

  How Can Someone Who Is Undergoing Heart Surgery Be Murdered?

  What Dose of Morphine Would Kill a Man Undergoing Cancer Treatment?

  Can a Transfusion Reaction Be Used for Murder?

  Can a Bee Sting Kit Be Altered to Result in the Death of the User?

  Can Insulin Be Used for Murder? How?

  Would Denying a Diabetic Insulin Cause Death or Just Illness?

  Is There a Lethal Substance That When Given to a Patient Might Appear to Be a Hospital Blunder Rather than a Homicide?

  What Drugs or Medicines Will Become Deadly When C
ombined with a MAO Inhibitor?

  How Does a Physician Distinguish Between a Drug-Induced Fever and One from an Infectious Process?

  Can a Patient Be Killed by the Rapid Injection of Potassium Intravenously?

  If Someone with Tuberculosis Is Smothered, Would There Be Blood on the Pillow?

  III. Tracking the Perp

  9. The Police and the Crime Scene

  What Does the Wound from a Close-Range Gunshot Look Like?

  Will a Bullet Fired at Close Range Exit the Skull, and If So, Will the M.E, Be Able to Use It for Ballistic Analysis?

  Can Stored Blood Be Used to Stage a Death?

  Would Glycerol Used as a Blood Preservative Likely Be Found in Blood Used to Stage a Crime Scene?

  How So on Do Strangulation Bruises Appear?

  When Does a Decomposing Body Begin to Smell?

  Do the M.E. and Police Use Vicks VapoRub to Mask the Odor of Decomposing Bodies?

  Does a Cold Room Delay Detection of the Odor of Body Decomposition?

  How Long Does It Take for an Unburied Body to Skeletonize?

  What Is Calor Mortis?

  Under What Circumstances Is Body Mummification Likely to Occur?

  Is It Possible to Obtain Fingerprints from a Mummified Corpse?

  Does a Body Mummify If It Has Been Bricked into a Wall for Several Years?

  Will a Body Encased in Concrete Mummify?

  Is It Possible to Trick a Lie Detector?

  Can an Intoxicated Person Fake a Field Sobriety Test?

  Can Fingerprints Be Lifted from Human Skin?

  10. The Coroner, the Crime Lab, and the Autopsy

  Who Can Serve as Coroner?

  When Are Autopsies Done, and Who Can Request Them?

  How Detailed Are Routine Autopsies?

  What Information Does an Autopsy Report Contain?

  What Information Is Placed in a Death Certificate, and Who Can Sign It?

  How Is the Time of Death Determined?

  Would Storing a Body in a Cold Room Hinder the Determination of Cause of Death?

  Can the Coroner Distinguish Between Electrocution and a Heart Attack as the Cause of Death?

  Can the M.E. Distinguish Between Blunt Trauma and Stab Wounds as the Cause of Death?

  Can the Coroner Distinguish Between Drug Overdose and Gunshot as the Cause of Death?

  Can the Coroner Determine the Cause of Death a Month Later?

  Is It Possible to Detect Morphine in a Body Two Months After Death?

  Can a Blood Alcohol Level Be Determined in a "Floater" After Two Weeks?

  How Long Does the Foam Around a Drowning Victim's Mouth Persist?

  From How Small a Sample Can DNA Be Obtained?

  Does the M.E. Use Tattoos and Body Marks for Corpse Identification?

  Can the Age of Surgical Scars Aid in Victim Identification?

  Will Stomach Contents Reveal When and What the Victim Ingested?

  Can the Type of Alcohol Found in Stomach Contents Be Determined?

  Can an Autopsy Reveal a History of Pregnancy or Childbirth?

  Can the Coroner Determine the Caliber of a Bullet by Simple Inspection?

  In Slashing Wounds, Can the M.E. Determine What Weapon Was Used?

  Can the Coroner Distinguish Between Freshwater and

  Saltwater Drowning? Will an Autopsy Determine If Chlorine Is Present in the Lungs?

  Do Skin and Nail Changes Occur with Some Poisons? Is There a Poison That Can't Be Detected or That Can Be

  Masked By Venom? Do Postmortem Wounds Bleed? What Do "Mood" Cosmetics Look Like on a Corpse? How Was Death Determined in the Seventeenth Century?

  Odds and Ends, Mostly Odds

  Do the Pupils Enlarge or Shrink with Death?

  Do Bodies Move During Cremation?

  How Is Body Weight Determined in a Quad Amputee?

  What Drug Is Used for Animal Euthansia?

  Will Oleander Poison a Cat?

  What "Hot" Substance Can Be Used to Sabotage Someone's

  Diaphragm? Do Blind Persons Have "Visual" Dreams?

  A Few Final Words

  Figure 1a The Intracranial Spaces

  Figure 1b The Three Basic Types of Intracranial Bleeds

  Figure 1c Mechanism of Brain Stem Herniation

  Figure 2 The Spleen

  Figure 3 Tension Pneumothorax

  Figure 4 The Dermatomes of the Body

  Figure 5 A Sucking Chest Wound

  Figure 6 Lichtenberg Figures

  Figure 7 Pupillary Reactions to Drugs

  Figure 8 Coronary Artery Disease and Its Complications

  Figure 9 The Life Cycle of Schistosomiasis

  Figure 10 Ectopic Pregnancy

  Figure 11 Cardiac Pacemaker

  Figure 12 The Cervical Spinal Cord

  Figure 13 The Anatomy of Throat Slashing

  Figure 14 The Circulation of the Blood

  Figure 15 The Blood Supply to the Lungs

  Figure 16 Anatomy of a Severed Trachea

  Figure 17 Materials Expelled from a Gun Muzzle

  Figure 18 The Anatomy of a Gunshot Wound

  Figure 19 Osmosis and Drowning

  INTRODUCTION

  Regardless of genre, every story must possess character and plot. These are the sine qua non of storytelling. Without plot, nothing happens; without character, no one cares what happens. The other story elements—setting, theme, mood, voice, subplots—are solely to support this relationship between protagonist and plot. Thus, a good story is a believable character with which the reader empathizes caught in some life-altering situation.

  To reveal character and progress plot, we often place our heroes in stressful situations. Why? Stress brings out the best and the worst in people and makes for interesting and exciting plot elements. There is no better way to stress your protagonist than to apply physical, emotional, and/or psychological pressure.

  This is particularly true in the mystery and thriller genres where readers demand to be enthralled, dazzled, informed, and kept awake at night. For this reason mystery and thriller writers often use illness, injury, and psychological stresses such as fear, anxiety, panic, anger, envy, jealousy, remorse, and guilt to thrill and mystify the reader.

  In some genres, such as fantasy, allegory, and comedy, the writer can create a world that has no basis in fact or reality. He must, of course, remain true to the rules he has established for that particular world. Short of that restriction, anything is possible.

  For mystery and thriller writers the world of their stories is typically "the real world," and therefore "real world" rules must apply.

  This places a heavy burden on the writer to get it right. Meticulous research, attention to the smallest detail, and avoidance of a "fast and loose" approach to the facts are essential to building a believable story. Inconsistent motives, convenient resolutions, and errors of fact can undermine even the most likable characters and clever plots.

  A major obstacle for many writers is obtaining the specialized knowledge needed to bring their story to life. This is especially true when scientific or medical issues arise. Whether these are the procedures or inner workings of hospitals, emergency departments, or operating rooms; the functioning of doctors, nurses, paramedics, and other paramedical personnel; the mental and physical repercussions of acute or chronic illnesses or injuries such as auto accidents, gunshot wounds, or lightning strikes; the effects of both prescribed and illicit drugs; the impact of acute and chronic psychiatric disorders on victims and their loved ones; or issues in determining the cause and time of death or other forensic procedures, a valid understanding of the complex issues adds depth and drama to any manuscript and lends it the ring of truth.

  Where do writers obtain this information? Too often from rehashing the stories of others or echoing what they see on television. Even the promise of the Internet as a source of unlimited information has proven to be false. One can find an overwhelming amount of data on almost every imaginable subject but be ill equipped to se
parate the truth from the flotsam and jetsam of cyberspace. The old medical adage that "bad data is worse than no data" holds for mystery writing as well.

  What This Book Is

  This book is intended to inform and entertain not only writers of mysteries and thrillers but also writers in all genres. In addition, lovers of books and movies and anyone with an inquisitive mind will find items of interest within these pages.

  This project began at the suggestion of Jan Burke, past president of the Southern California chapter of Mystery Writers of America. She asked if I would write a medical Q and A column for the Southern California chapter's newsletter, The March of Crime. My column, "The Doctor Is In," now appears in that publication every month as well as in the newsletter of the Southwestern chapter, The Sleuth Sayer.

  Since this project began, I have received and attempted to answer hundreds of questions from writers of all genres, including many well-known novelists and screenwriters. Some of the best, most interesting, and most informative are included in this book.

  My thanks to each and every writer who submitted a question, for your curiosity, your amazing imagination, and your dedication to "getting it right." I have learned as much from researching and answering your questions as I hope you have from the answers given.

  My hope is that all the readers of these pages will find that this material answers some of their questions, raises their level of understanding of medical and forensics issues, causes new questions to germinate, and, most of all, stirs their creative literary juices.

  This book is a compilation of some of the medical and forensic questions I have received from writers over the past several years. In the answers I have striven to give writers enough medical and scientific background to provide depth and breadth to their understanding as well as address the nuances of their particular scenario. The goal is to allow writers to use this newly gained understanding to craft more believable scenes or stories. I have attempted to make each question and answer stand alone while minimizing unnecessary repetition of information contained in other questions.

  What This Book Is Not

  In no way should the material contained in this publication be used for diagnosis or treatment of any medical disorder. Even the simplest question and answer would require decades of education and experience before it could be applied in a real-life situation.

  Medicine is an exacting discipline; it is both a science and an art whose mysteries are revealed only after years of practice.

  Although I have endeavored to make the information accurate and scientifically correct, many subjects are too complex to explain in detail while addressing the nuances and controversies of modern medical knowledge. Such is the art of medicine. The answers are provided for use in the context of fiction writing and storytelling, and should be used only for such purposes.