Writing injuries in your fiction
Updated: May 13, 2021
The human body (along with weapons, martial artists, and horses) is one of the most frequently abused and misunderstood objects in popular media. Hollywood has us nodding sagely as human bodies take obscene amounts of punishment, people slip unconscious just to wake up a couple of hours later totally fine, and swords pass through necks without a hitch. Characters who get shot in the arm shrug off the wound and fatal injuries are healed by a bandage and a lie down.
Hollywood can get away with this because it knows that everyone’s there for the million-dollar explosions and hyper-stylised violence, but you can’t quite offer the same level of visual polish in your fiction. As such, ridiculous injuries (and ridiculous reactions to them) can wreak havoc and result in much readerly eye-rolling.
But fear not! It’s time to clear up some myths about the human body and what exactly it can be expected to endure. Of course, it’s also important to think about the healing process—something that is almost always ignored in movies—and other important questions, like just how many times would you need to hit someone in the neck with a sword to reliably sever their spinal column?
We’ve all seen it: James Bond, having been knocked out by the lethal Oddjob, wakes up next to his open minifridge hours later with a bad headache and a temper. It’s one of the oldest action movie tropes: hero is ambushed, knocked out, and locked away somewhere. He wakes up and must stage a daring escape.
Except, no. Hollywood and TV would have you think that being knocked out by a blow to the head is merely an inconvenience—after all, we see boxers go down only to hop back up a few moments later—but it turns out that, if you’re out for more than about five minutes, chances are you’re dealing with either severe concussion (concussions are cumulative by the way—that is, the more you’re knocked out, the worse your concussion is next time), trauma of the brain, or internal bleeding (which is where blood pools slowly inside your skull). And that’s in minutes.
Speaking of knockouts, let’s not forget knockout gas and tranquilliser darts, two more staples of spy and action movies everywhere. Knockout gas and tranquillisers turn up in everything from James Bond to X-Men, and they tend to work in a similar way to a good old-fashioned whack on the head: clean, tidy, and never lethal.
However, in the real world, turns out you have to be incredibly exact with just how much tranquilliser/incapacitating gas you’re pumping into someone. Too little and you shrug it off completely, but a smidgeon too much and boom—death. Real-life anaesthesiologists have to carefully regulate the amount of sedative in a patient’s blood even while they’re already unconscious! To sombrely turn to a real-life example of Hollywood thinking gone wrong, consider the 2002 Moscow theatre hostage crisis: authorities pumped an unidentified incapacitating agent into a hostage situation, hoping to knock everyone out, and killed hostages and hostage-takers alike.
Of course, fiction is fiction and you’re not bound by the rules of reality, but the reader only has so much suspension of disbelief. Even those readers who don’t know much about actual injuries still know how the world works, and falling back on simplistic ideas can accidentally change the tone of a piece. Including a perfect tranquilliser dart, an impeccable truth serum, or a secret agent who can knock guards out and leave them tied up for hours with no ill effects moves your work closer to cliché. If you’re happy with that trade-off, fine, but it’s one you should know you’re making.
You’re also not bound to full measures. If your story had a no-risk tranquilliser and you’re only now learning that’s comically unrealistic, you could scrap the idea, or you could just play up how rare and hard to make this tranquilliser was. Or maybe your gadget specialist is a genius who has measured out the exact correct dose. Or maybe the protagonists all know it’s risky, but their mission is worth that risk. There are thousands of ways to hew closer to reality in a way that suits your story, and they’ll generally improve the narrative.
As anyone who’s broken a bone will tell you, it’s not all chuckles and ice cream. Once you’re past the initial stab of intense agony, you’ve got a long, long time to wait for that bone to heal—and that’s with modern medical science. If you’re writing a fantasy novel and your character breaks a leg, chances are they’ll be relying on a splint and hoping that the bone sets in the right way.
A broken arm will typically be out of action for a month or two, depending on the severity of the break. It might need a splint or a cast (these are almost always preferable) and at the very least you’ll want a sling. Sometimes, the bones will be so poorly aligned that the doctor (or medic, sister-in-arms, friend, etc) will have to realign the bones with their hands. Sounds like a good time.
Legs, on the other hand (foot?), can take a lot longer to heal. A small fracture might take only six to eight weeks, but serious breaks (with more lovely realignment and maybe even some surgery and metal rods) can take up to six months to heal. The leg will be more or less entirely useless during this time, and you can expect to be in a cast, on crutches, or in a wheelchair.
Even minor breaks—toes or ribs for example—can’t necessarily just be shrugged off. First of all, a rib may very well, in its breaking, damage the rather vital organs cowering behind it. But, even if you avoid a punctured or collapsed lung, a broken rib can restrict the space your lungs have to expand into, meaning breathing can be painful for weeks after the break. The good news is a broken rib typically takes only about six weeks (at least) to heal.
Again, that’s not to say that your badass character can’t shrug off injuries, but a sense of realism helps redefine what shrugging something off actually means. Writing realistic injuries helps behaviour to scale—that is, if the rib feels broken (and that feeling is adequately communicated in your fiction), the character seems like even more of a hero for pressing on, even if the healing time and restrictions on their movement take longer. The clichéd action hero ignores serious breaks and the reader shrugs because the hero’s reaction limits how serious the injury seems. Depict realistic injuries and you get to depict realistic fortitude too.
Writing a believable healing process is similarly effective because it underlines the stakes. Why should the reader worry if a character gets hurt when the last injury didn’t actually mean anything for their health? If you want to really hurt a character then try to give them time to heal. Otherwise, you’re telling the reader that injuries don’t really matter in your world.
One of the best things about fantasy films is the inevitability of someone getting dismembered or decapitated. Whether it’s Aragorn slicing Lurtz up in The Fellowship of the Ring or (and this one’s not quite fair) the mighty Black Knight in Monty Python and the Holy Grail, dismemberments are one of the genre’s most prized tropes.
But can you really survive the loss of a limb? People in movies do all the time but, in reality, the odds aren’t on your side. There’s a reason amputations are normally carried out by trained medical professionals: it turns out that blood pressure really earns its name. A fresh wound of this type will throw out blood at a ridiculous rate and, seeing as blood is the thing carrying oxygen around your body, once your arm is chopped off your brain will become oxygen-starved incredibly quickly, meaning you’re likely to pass out in less than a minute. Once you’re out cold, it’s only a matter of time until your organs begin failing.
Of course, if you’re able to stop the bleeding quickly then you can survive dismemberment, but you (or your characters) will have to act quickly. Direct pressure applied to the wound will buy you time and a tight tourniquet will do in a pinch, but you’ll absolutely want to avoid moving about afterwards. Cauterisation is also a good (if unpleasant) idea, which is why we can forgive Star Wars for having Luke skipping around post-loss of hand.
Of course, even if you stop the bleeding, the main threat in the weeks following is infection. The type of gaping wound left by a severed limb is like a black hole for harmful bacteria and, unless your character is regularly applying some kind of antiseptic (be it a herb poultice, a medical cream, ethanol, or antibiotics), they’re unlikely to make it far.
In short, dismemberment is an immediate and massive emergency. If your character has taken this type of injury, it’s something they need to deal with immediately—cut the quipping and ask yourself why they haven’t fainted yet.
The money-shot of all blade-based violence, decapitation is at least simple in that you don’t have to worry about healing time or how being decapitated affects your character’s day-to-day business. The real question is: just how easy is it to chop off someone’s head?
Pretty damn difficult, it turns out. It took the headsman three strikes to decapitate Mary, Queen of Scots, and Margaret Pole, Countess of Salisbury, is said to have suffered through ten strokes before her head came off.
While humans’ necks are far flimsier than those of trophy animals like deer and lions, they’re still far from easy prey: a would-be head-chopper would need a heavy, sharp blade, a powerful arm, and a good eye for accuracy (not to mention a moment or two to prepare). This means no swordsmen swiping off heads left, right, and centre with their one-handed short sword, please.
Besides, clean decapitations are a little overdone. You’d probably be better off having your character make a horrible mess of it.
Where to get hit (and where not to)
As anyone who’s ever hit their funny bone on something will know, there are parts of the body you’d really rather protect. Obviously, it’s better to get shot in the arm than the face (though both wounds can easily kill you), but there are also a whole series of major arteries, pressure points, and fragile and painful bones you should be aware of. Look at how British fantasy writer David Gemmell lets us know a couple of brigands aren’t getting out alive:
Baloc ran forward, his sword flashing towards Waylander’s neck, but Waylander ducked under the sweeping blade and rammed his right-hand knife in to the man’s groin. Baloc doubled over and fell, dragging Waylander with him. As the last robber ran forward with sword raised, Dardalion’s arm came up and swept down. The black blade thudded home in the robber’s throat and he toppled backwards to writhe on the dark earth.
– David Gemmell, Waylander
Why the groin? Well, Waylander’s not just being sadistic—the femoral artery (the biggest artery in the leg) is best accessed in the slight hollow where the groin joins the upper thigh. With a severed femoral artery, the robber’s doomed to bleed out in only a minute or so.
The throat is another obvious spot to protect: the common carotid artery and the jugular lie just beneath the jaw, and together form another nice ‘press here to kill’ button. But there are other major arteries to be aware of too: the temporal artery above the eyes, the brachial artery in the inner hollow of the elbow, the radial artery in the wrist, the popliteal artery at the back of the knee, the posterior tibial artery in the ankle, and the dorsalis pedis artery in the foot. Turns out humans are a big, squishy series of viable stabbing targets.
Similarly, there are certain bones that will be especially painful to break or to get hit/stabbed/shot in. The kneecap is the most famous of these, and in general the knee is a real nightmare zone due to how complex the joint is. Other areas to avoid breaking include the pelvis, where nerve clusters render any injury pretty agonising, and the clavicle (collar bone) will not only be savagely painful at the time of the break but will stay painful for weeks afterwards (unlike most broken bones) due to the number of surrounding ligaments.
Infection and complications
The specifics of the injuries you’re writing will differ, but complications like blood clots can arise from cuts, bumps, and bruises. Even with something seemingly straightforward, like drowning or fire, the human body is so complicated that people can die hours later, even if they seemed fine at the time.
Infection offers a similar type of threat, albeit one that antibiotics have largely removed from everyday life in the modern world. Still, getting those antibiotics might be a hurdle for your characters, especially in a fantasy or historical setting.
Patching up and moving on
While I’ve tried to cover the most common injuries that are dished out in genre fiction, there are many more aspects of injury to think about. After all, an injured character can completely alter the course of a plot, and physical wounds can leave behind mental scars. Perhaps your protestor who was choked out by a policeman falls into panic attacks if anyone comes near his neck, and perhaps your recently amputated veteran still feels his phantom limb or even imagines sensation in his prosthesis. These kinds of detail can pour authenticity into your text and amp up both realism and reader engagement.
So be careful next time you’re tempted to have a character shrug off an axe to the shoulder, a broken rib, or an open cut. These things don’t just go away, and your fiction should take things like pain, healing time, risk of infection, and loss of ability into account. After all, you wouldn’t expect your recently shot-in-the-knee secret agent to be scaling chain-link fences any time soon.