How does a broken rib feel? Can a character really walk on a broken ankle? What are the symptoms of asphyxiation, and how long will your character remain conscious? What really happens to a character in the vacuum of space?
The answers may surprise you. Most writers (thankfully) have no experience to the very wounds, injuries, and trauma they must describe from their character's perspective. Many writers, especially beginning writers, have difficulty describing the acute physical injuries their fictional characters experience, using subjective terms.
Now, you can finally separate facts from fiction. This book explores the most common injuries writers inflict on their characters from the character's point of view using common terms and examples focusing on the writer's needs. Stop searching obscure medical texts or lurking outside emergency departments to interview trauma victims.
"As an author who is pretty hard on her characters, this book is essential to my research. A valuable and useful resource"– D.T. Reed
"A detailed, well-organized book written by an MD who is also a science fiction writer. I whole-heartedly recommend it"– Anne Larson
"A great resource!"– Cat Lee
"I bought this yesterday and it's AWESOME– Amy M. Hughes
Welcome to the jungle
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.
―Introduction to Body Trauma, by David W. Page
What this book is, and isn't―and its reason d'être
What this text isn't
This text is not and should not be considered a medical text (although some superficial medical terms and concepts will be discussed at a laymen's level to help with understanding). It isn't a medical reference or a substitute for consultation with a medical professional regarding any personal questions or issues that involve the symptom commonly referred to as pain. This text is not and should not be used as a reference while discussing personal issues or any symptoms with any medical professional, for any reason. Finally, this text is not and should not be considered a substitute for good judgment and common sense. If you are looking for answers to any personal issues regarding the symptom commonly known as pain in this text, you are looking in the wrong place. While those are important issues, they are well beyond the scope of this text. This text is also not an introduction to the external description of trauma and its effect on the body, nor is it an overview of the American medical system or what happens in an emergency room (where I spent a good deal of my youth and later, my career, albeit on different sides of the suture needle). There are already excellent books available on this subject. What we will be covering here is the subjective side of trauma and the resultant pain―the symptoms your character will experience over the course of their relentless torture at your hands as you write their stories.
What this text is
This is a reference work for writers. This book is a reference for writers to facilitate causing harm to their fictional characters for fictional purposes and is intentionally written in a humorous tone to make the information more palatable and encourage the more realistic depiction of trauma in fiction. Why, you might ask, do writers need a reference book on human physiology, especially the physiology of injuries and pain? Good question. Many writers, even experienced writers, have a poor understanding of how to describe acute pain from the character's point of view. There are many good reasons for this.
How often have you read a novel where a main character suffers a significant injury, only get up and shrug it off for the remainder of the story. Did that engage you emotionally, or did it pull you away from the story, at least for a few minutes, while you wondered how the character could recover up from being tortured and still have enough strength to save the day? Does a character in a novel or a movie climbing a cliff with a broken arm bother you? How about a character knocked unconscious for an hour, only to wake up good as new and run around as if nothing happened?
As a child, I loved comic books. I invariably used my entire weekly allowance to buy the latest offering from DC or Marvel. My first crush was on Jean Gray and I wanted to attend Professor Xavier's School. Many of you may have had the same addiction. Some of you may have been introduced to literature in this manner, as I was. If you're writing a superhero tale, you may not need the information contained within this book. After all, Clark Kent has gotten along nicely for seventy years without so much as a stubbed toe. But even the Man of Steel had to interact with Lois and Jimmy. At this point, I'm reminded to mention Man of Steel, Woman of Kleenex (copyright 1971), an essay by Larry Niven covering the physical logistics of a Superman/Lois Lane courtship and mating. Not to be read with a mouthful of any liquid.
People read fiction for two reasons: for entertainment and escape. Entertainment removes us from the usual mundane trivialities or chronic anxieties of day-to-day life. However, I believe fiction not only allows us an avenue of escape but a method of coping with and putting reality into perspective at the same time.
Story concept and writing craft aside, there are two very basic requirements for a fiction story to be engaging: First, there must be conflict. Without conflict, there is no story. At least one that will hold the reader's attention. Second, the reader must either identify with or root for a main character. There are probably exceptions to this rule, but I can't think of any.
Beginning writers are told the mantra, which they repeat faithfully: Hurt your characters, hurt your characters, hurt your characters. But, fortunately for most writers, they've never experienced the kind of trauma that they expect their characters to not only survive but ignore, soldiering on to the eventual confrontation and overcoming of the antagonist. More often than not, in these cases the scene rings false to the reader, deflating the writer's credibility. The connection is broken and the chimera is dispelled, even if only temporarily, revealing the emperor's underpants.
Something writers too often forget is that in the course of hurting their characters, their characters have been injured, sometimes significantly. While inflicting injuries on their characters, the writer may not realize how seriously her characters will be affected by the damage she's dispensed. Those details must be dealt with, same as the clouds above their characters' heads or the grass below their feet. The only way for a writer to convey any of these experiences is by describing them, clearly and effectively. Only then, will the scene ring true for the reader, engaging him or her emotionally and viscerally and pulling them more fully into the story through the character.
Often, writers have difficulty with this area of description because he or she has no direct knowledge of the true extent of the injuries they've inflicted on their characters. How many writers have had broken arms or ribs, or sprained ankles, or concussions? Before you ask, I'm certainly not advocating writers go out and jump off the garage roof in order to understand a broken leg, although it might narrow the field somewhat of competition for my own work. Nor am I offering a weekend S&M getaway for writers, although that might also be fun.
Raising the Stakes
At last count, I've been reading for the better part of six decades, and I've noticed a shift in storytelling over the past thirty or forty years. Before that time, or in the dark ages, as my younger friends like to say, a story was related to the reader much as it would be if told by a narrator, with the characters kept safely on the other side of the narration (the "fourth wall" in movie terms). Fiction stories were geared toward creating a relationship between the story and the narrator, with the reader being assigned a voyeuristic role.
Now readers are exposed to the characters on a much more intimate level. The reader is "pulled into" the story, and sympathizes with the characters. This is the proverbial two-edged sword―while the stories are more exciting (we hope) and a more efficient avenue of escape, writers are pushed to new levels of description to fully convey what their characters are experiencing, and are often presented with the task of describing injuries from their characters' point of view.
Readers of fiction want one thing―a powerful emotional experience. They want and expect to be someone else temporarily. They want to feel something for the characters in whom they are investing their time and attention. Emotion is the common element of all fiction. This is an important concept for the beginning author to understand completely. Readers have no interest in simply reading about someone else having powerful emotions. For a few hours, readers want to live an exciting life facing down international terrorists and solving impossible puzzles. They want the adrenaline rush of living someone else's thrilling, exhilarating life. Without that element, modern readers will become bored.
Imagine if you can, the tedium of spending hours your life watching someone you don't know crying or kissing someone you've never heard of. That's lifeless and insipid. No one has never bought a novel in hopes that would deliver a mediocre emotional experience. Powerful emotions make stories more enjoyable and memorable.
If in the course of engaging your readers at this visceral emotional level, you can (and indeed, should) transport them to a place real enough and introduce them to characters compelling enough that they convince your reader to view their own world through new eyes, you can move mountains. The old saying about the might of the pen is as true today as it ever was. And when we wield that pen, eventually, whether in fiction or in real life someone always gets hurt.
For the unfortunate characters who people our stories, the natural outcome of this particularly dangerous recipe is, as my grandmother used to say, that someone's going to get hurt.
It's true. Writers everywhere are encouraged to hurt, maim, and kill their characters in ever more gruesome and exciting ways and we try, lord knows.
Until now, the only avenues of information writers have had to assist in this challenge are personal experience (ouch), interviewing others who have had the injury (sometimes impossible), or scouring medical texts, that, while accurate, are about as interesting as watching mud dry. Even relying on fellow writers is hit and miss. How are we to know if our favorite thriller or romance author has any idea what a broken arm or a concussion really feels like? Or, more importantly, do they really understand the extent and implications of these injuries? With very few exceptions (and I'm a science fiction fan), a character who jumps out of a helicopter from a hundred feet, lands in a river, swims to shore and walks away as if nothing happened stretches my suspension of disbelief to the point of snapping me entirely out of the story. I believe getting the details right is worth the effort and can often lead to story possibilities I hadn't thought of before.
As you read this text, you'll notice words like "probably" and "usually" and "more likely than not" used repeatedly. Those aren't typos, nor are they writing tics. There really is a tremendous variability built into biological systems. The incapacitating pain one character's broken toe causes may allow another character to hobble to safety (or their next injury). This is also a good thing as it allows writers to tailor the injuries they'll inflict on their characters to the character's nature and the needs of the story to some degree.
So, who am I to proclaim expertise on the subject? I'm a medical expert. I graduated from a U.S. Medical school, finished my residency in family medicine, and maintained board certification for sixteen years. Besides practicing family medicine, I worked in emergency departments in both a large, urban hospital and a smaller, rural setting, and literally did thousands of minor procedures in the course of my career. I've also studied the art and craft of writing for the last ten years and have written nonfiction articles, novels, short stories, and have spoken at several writing conventions on this topic.
I also trained and taught martial arts for a decade (I still work out, but I lost interest in tournaments years ago), and have ridden motorcycles for over forty years, so I've had and seen my fair share of injuries.
As with most nonfiction, the suggestions and guidelines in this text are based on the work of some very smart, dedicated, people. If you want to know who most of them are, please check out the References section at the end.