16 Aug 04 9:24 PM
Reply To: 30255
Again, sorry to be so late!
Some of this is technical stuff that non-medical people are unlikely to spot as a problem, so take what's useful and don't worry about the rest.
Is it plausible that Theodred would remain unconcious due to pretty severe blood loss that long?
The problem you run into here is a common one for authors. If the blood loss is so severe that he is unconscious a long time, he's really in bad trouble, and his chances of dying are much higher. It's surpising how many people with devasting injuries are conscious. Also, it will take him a lot longer to recover if the blood loss is so severe. I see a few alternatives: either he is awake for this, or he sustains a head injury to knock him out, or someone gives him something - in a preanesthetic era alcohol or laudanum (from the opium poppy) are the only choices.
Is my description of shock reasonable?
The pallor and cold and damp is perfect.
Is it reasonable that he would not bleed to death in the time before Grimbold gets the tourniquet on him? (I could have him fall in such a way that his leg is compressed under either him or the dead orc, if neccessary.)
How much blood he has lost can vary, especially since it is not a complete amputation. Where the axe hit can help define this. You want the bone to be broken and muscles cut, but this can happen without hitting the big blood vessels. If it was only attached as you describe, it would mean the several large blood vessels were cut through. You might consider setting it up differently. If the bone is shattered, and the muscle is cut up by the axe and the bone shrards, that's a reason to amputate but Haelan can cut the blood vessels in a controlled situation. He'd still bleed a fair amount from the cut muscle of the injury, but you would have more time to take action.
Are Haelan's actions believable? I wrote this before reading your articles in Research here; now I think perhaps I should have her strip him before she operates, and check the rest of him over for other wounds as well.
You did very well with the flap and repeated flushing. An experienced healer would check him over, to make sure she wasn't treating one thing while an unnoticed stab wound was killing him. It doesn't have to take long.
I added having her sterilize her instruments because I wanted something she could have learned from the Elves. Would that have a significant effect in lowering the chances of infection? The Civil War site said that if the amputation was done within 24 hours of the injury, in conditions a lot less sanitary that what I've written, that the amputee would have about a 50% chance of survival (which is plenty for me, makes it quite believable that he could survive it).
Very well done; the sterilization would help greatly to reduce the risks. I'd also suggest that you specify the thigh injury as towards the lower end, as the survival rate is much higher.
I looked for websites for amputees, trying to find people talking about their feelings and experiences with amputation, but couldn't find much (mostly lots of talk about the latest and greatest technological advances in prosthetics - very interesting, but not very useful to my story - though any information about historical prosthetics would be useful, because he's going to have a wooden leg eventually, and I've been trying to figure out exactly how it would be constructed and attached).
There are some good articles about the psychological aspects here:
and a few bits on historical prostheses
here, here, and here.
How long after such an injury would he be able to be up and around?
This depends somewhat on his blood loss. With severe loss, it's going to take him about 10 days to start making new blood, and about a month before he's back to normal in terms of blood.
For the story I need him awake and aware about 4 days later, enough to have a confrontation, which could be physical if needed for him to be re-injured, because then he has to be out of commission, either unconcious or feverish or heavily drugged, for about a week. How soon would he be able to be up and around, learning to walk with a wooden leg and crutch? That part of the story is very flexible; I can work with whatever is realistic.
He would be conscious fairly fast as there's really no reason for him to be unconscious. In RL they start physical therapy for amputees pretty early, like a few days. He could be drugged or just very weak from blood loss.
Anything else that catches your eye as wrong or unbeleivable? This is the major plot point that the whole story turns around, so it's got to work.
A few other comments.
Haelan would only be experienced in amputations if she'd been around battle - I wouldn't think it that common otherwise. She might have seen occasional amputations if, for example, a horse fell on someone and caused a shattered femur. You mention that she spent some time in the Houses of Healing; that should give her some battle medicine. You might consider Hamm mentioning that, or I doubt he'd convince them to take Theodred to her.
You also mention that a surgeon in Minas Tirith gave her his own instrument set. That seemed unlikely to me unless he was retiring as he'd then have no instruments to use. He could retire, of course, or he could give her the instruments of some previous healer he admired.
If you want to mention everything she'll need, I'd add a forceps and possibly a retractor. It's almost impossible to sew without something to hold the tissue in place while the healer is sewing, which is where the forceps come in.
Finally, this has nothing to do with the medical parts, but would Elfhelm and Grimbold accompany Theoden? I don't think both commanders would go and leave their men to less experienced captains. More likely they'd detail a trusted aide or lieutenant and some men to accompany him. At most, one of them would go, leaving the other in charge.
Anyway, hope this helps.