#this post is writing advice

Hello, valiant readers! Aunt Scripty here. This post  was submitted by a lovely anon who wanted to share their story with all of you. Nonny, thanks so much for being willing to share this with all of us.

Hello, Aunty Scripty. (Hello anon!!)

I noticed that you had multiple submissions from people describing their experiences after having attempted suicide. I didn’t see anything that was exactly like my experience; I don’t know if this will be helpful to anyone, but I figured it couldn’t hurt.

I have attempted suicide twice, both times using SSRIs. The first time, I had a gap in my memory beginning about an hour after taking the pills until the next morning, with the exception of a few flashes of things that may or may not have happened (pulling out an IV, having a catheter removed). According to what I heard later, I was oriented to person but not to place or time, I was having trouble retaining information, and I was repeatedly not cooperative with nurses. I was held in the ER all night while I was treated (I believe it was just supportive care – I had nausea/vomiting/diarrhea for hours but no other symptoms other than the change in mental status). I was then transferred to an inpatient unit early in the morning. I remember that I was on one-to-one observation for the entirety of my stay there. My clothes had been taken and I was wearing a hospital gown; I had bandages all over my arms because I’d removed at least 2 IVs. I was held in that unit for about a day, while being given IV fluids for hydration, until a specialist (I believe it was a psychologist) was able to evaluate me. I was basically told that either I could consent to a stay in the hospital’s psych ward, or I would be remanded against my will.

I consented because I was scared of being forced to undergo an extended stay against my will. I was held in a psych ward for about four days. We had scheduled meals and group/individual therapy, but were otherwise allowed to do as we pleased – which was not much. There was one TV in the main room there and a few magazines and books. I was able to get permission for a small pencil after two days, and was allowed my one clothes after one.

The food was terrible. The patients housed in the ward ranged from people struggling with addictions to patients undergoing psychotic breaks to patients with severe depression and anxiety. There were a range of ages. To be honest, I think it hurt the effectiveness of the ward to have us all doing group therapy together like that, because it was scary for newcomers or patients with less severe problems to be housed with patients who were aggressive and violent. Visiting hours were for an hour in the evening, but special arrangements were made for my parents because it was Ramadan. My parents were also allowed to bring me food, which was nice.

I was very leery about taking any psychiatric medication after my overdose and because nothing had worked so far, but the mental health provider on the ward pressured me to accept the meds and implied I wouldn’t be released unless I took them. To be honest, I didn’t really feel safe going home, but I also felt that staying in that environment was not doing me any favors, so I did whatever they suggested until I was released. I definitely feel that my concerns and needs were not taken seriously there and that the pressure was on me to accept responsibility and promise not to hurt myself again so that they could discharge me and focus on other patients.

After my second attempt, I drove myself to the ER. I had no symptoms at all except for some nausea, and I was held overnight until a social worker could evaluate me. She was extremely kind and understood my concerns about being admitted again, so she agreed that I could go home that evening provided I followed up immediately with my regular therapist and agreed to see a psychiatrist (at that time, my medications were being managed by an NP in my therapist’s practice).

So there you have it! Thanks again for your submission, Nonny!

And my dearest writer-friends, if you have a story of a brush with critical illness, an admission, an injury that writers commonly get wrong, I’m always taking submissions with personal stories!

xoxo, Aunt Scripty

disclaimer   

Pssst…. yo, hey. You interested in… eBook? The first one is FREE, man!! 

@infiniteregress17 asked, via PM (due to length): 

Hi, what a useful idea creating this blog! My question is about burns. My character opens a door behind which a fire is raging. Another character shoves him away in time to save his life, but he burns his hand and arm sufficiently to put the communication device embedded in his arm out of action. They need to escape from the burning factory, and so he needs to keep moving. Soon after they are dunked in an underwater river and I figure he’s going to need rescuing then. After that they have to run along a tunnel. They get to the end, and have to swim through a broken grill to get out. The other guy will help him, I figure his arm will be pretty useless and painful, and bits of his jacket will be stuck to the burn.  I have my other guy urge him on, and he nearly passes out at one point, but keeps going until they can get some first aid. My question is, what is he going to experience? Is  what ive described realistic? Thanks for your advice! 

First off, thank you for the love! It’s actually really beneficial to your burned character to be dumped in a river, because burning is a process that keeps going once it’s started. It’s like taking a roast out of the oven: it will keep roasting, because it’s already hot enough to keep cooking  itself for a while. We usually irrigate burns for 20+ minutes with sterile water to cool them down.

“Useless and painful” for a dominant hand and arm burn sounds about right. Pain from burns is absolutely excruciating. But I think your character can get through all of this and still have it feel reasonably realistic. Good luck with your story!

Hey humans! So a while back I answered an ask about falling off a horse. While I tried to give the best answers I could, it’s important to know that a) horses scare me (because they’re 1200-pound beasts with steel feet, of course they scare me, seriously read this post, NO THANK YOU), b) I don’t live in an area where riding accidents are common, and c) …. actually there is no C, I just like having things in 3s.

But the lovely @vanillivilovesreus submitted this awesome post on horse related trauma, and I think it’s really cool and really important. *Please note that I have not verified this against any form of textbook*, mostly because my basic paramedic textbook and a lot of my A&P books were damaged in a bit of in-apartment flooding a few years ago, and in the spirit of moving forward and not backwards, I’ve bought a bunch of esoteric textbooks on peds critical care and more rather than replace my (pedantic) paramedic textbook. Which I should probably do. Someday. If I don’t break down and spend $200 I don’t have on Rosen’s or Tintinalli’s….. *sigh*

But! This is an amazing post, it all stands to reason, and I’m incredibly grateful! Thank you again. xoxo, Aunt Scripty.

@vanillivilovesreus, take it away!

So I saw that question what would be expected if someone fell from a horse and was dragged for a short distance and I thought I’d butt in, because the idea that you fall backwards rubbed me the wrong way and this got a little out of hand. My riding experience is limited, but I get by and I thought maybe people might be interested in all kinds of injuries that can happen around horses and I have seen a few accidents and heard a lot of stories. (English is not my native language, so I apologies in advance for any spelling/ grammatical errors.)

Now, you can get hurt around a horse without actually riding the horse (or even getting close to a horse, if we take accidents around the barn into account). But let’s just imagine a usual lesson as I know them. In most cases you’ll start with cleaning your horse (and before you can do that you need to get it out of their box/ paddock/ whatever). I had more horses step on my toes than I can count and depending on the horse that might be uncomfortable but doesn’t actually hurt, but it might as well break a toe/several toes if we’re talking vicious, giant horse. Though that’s why you wear riding boots around horses.

Some horses might bite or kick or at least try to. A light bite hurts like hell and might result in a bruise, really strong bites - those usually affect fingers, because fingers fit perfectly into a horse’s mouth - can break bones or maybe take off part of the finger too.

If a horse kicks you, you better hope you are close to the horse because the further you are away, the more force is behind the kick. Injuries vary a lot depending on that. If you’re close to the horse and it’s more of a knee jerk reaction on it’s part, you can easily get away with a hoof shaped bruise. The stronger the kick, the worse your injuries. Depending on where you are hit, you might crack your rips, lose your breath for some time, get a concussion or, if you are unlucky enough to be hit on the head, you might actually die.

When a horse breaks into a panic while being led, for the love of god, let go! Don’t kid yourself, you won’t be able to keep up or hold the horse back, so you’ll be dragged along at some point - probably sooner rather than later and that will at the very least result in road roash, but you might also break something.

Now you’ve made it onto the horse, congratulations! All is well and fine, until you fall.Every horse rider will fall at some point. It is not the end of the world. In most cases you’ll pad the dust of and get back on the horse. So what can happen if you fall? In most cases,you won’t fall backwards, but forwards or to the side. I had a fall which was actually more of a slithering off the bare horse back, where I landed on my feet, took two steps back and fell on my ass. Happens sometimes. Also, most falls are over before you can think about it. One second you’re on your horse, the next you’re on the ground with no memory of how you fell (though that changes with the frequency of falls). So, you fall fowards/ to the side and you don’t consciously react - see where this is going? You are very likely to sprain a wrist, hurt your arm in anyway or break your collarbone.

Head/ neck and back injuries mostly happen during jumping or at cross country or something equal, because it’s fast, the height is even greater and you have no way of influencing your landing and you have momentum. If you don’t know what you’re doing and try any of that, there is a very real danger that you at the very least break some bones. It is very, very possible that you end up partly or completely paralysed or dead.

I never ever encountered a barn where they would let you participate in a lesson without a helmet and there are good reasons for this! Many riders will also wear a back protector of sorts. A helmet helps a lot, especially if we’re talking about arena underground, which is relatively soft. I once fell on a ride through the forest and boy was I happy about my helmet. Stones and roots are not your friends.

Can you be dragged along after a fall? That’s unlikely, but I’ve seen it happening. In theory, the stirrup is constructed to separate itself from the saddle if pressure is exerted pulling back, but some of these mechanisms might be old and therefore stuck or maybe you’re dealing with a saddle that doesn’t have one of those (although I never encountered this). However, if you get dragged along, add roadrash to the injuries you already have from the fall plus quite probably injuries at the ankle/ foot.

Can a horse trample you (to death)? Theoretically, yes of course. 800 lbs is a small, light horse. However, a horse won’t run into you/ step on you unless it doesn’t see you aka is in a great big panic. What might happen though is that you somehow fall under the horse and with its next step it treads right onto you.

So,

tl;dr you can make a lot of injuries and their severity believable around horses, because it mostly is a gamble how you fall.

Hey everyone! The lovely and wonderful @towertumblng sent in this post about nightmares and vomiting. If you have a post you think the readers could use, or you have some expertise you want to share, why not Submit a Post?

Thanks to Joseph and here’s to you all! xoxo, Aunt Scripty

While vomiting in and of itself isn’t necessarily a symptom, any health issue that causes nocturnal panic attacks could be just what you’re looking for. While something like PTSD would rest on some kind of trauma, people can have Generalized Anxiety Disorder or Panic Disorder without having necessarily experienced anything traumatic at all.

Nocturnal panic attacks can also be caused by disruption of breathing while someone is sleeping (there are a few different causes for this but the only one off the top of my head is sleep apnea), which can cause someone to hyperventilate (or hypoventilate and then overcompensate once they’re awake). And, again, while this doesn’t necessarily tie in the vomiting, some people can feel so physically stressed after a panic attack that it probably wouldn’t be unrealistic if your character did throw up from the experience.

That being said, nightmares themselves can be bad enough that they, too, can cause nocturnal panic attacks on their own. Is your character under a lot of stress? Is there something they aren’t addressing that’s creating nightmares so terrifying that it’s throwing them into a panic attack while they sleep? As adults we tend to underestimate the force of a nightmare - it’s just a dream right? We typically think of upsetting nightmares as associated only with children or serious trauma. But adults can get them too, and yes, even bad enough that it pushes someone to panic - and possibly being physically ill. And it’s something I imagine your character may be more and more susceptible to the less sleep they get over time.

Your official ask got eaten–the upside is that I think I’ve figured out why that’s happening. BUT. The question was about a slower version of Wolverine-esque regeneration. What are the downsides?

Cancer. The downside is cancer.

Cancer is, at its core, just a cell that copied its DNA wrong, and shut off a lot of the things that tell a cell to stop dividing, so it just… keeps going. Cancer actually behaves a lot like a healing wound, in terms of cell division (and, interestingly enough considering that they draw and make new blood vessels, anaerobic resipration–again, like a healing wound.) Oncologists have called cancer “the wound that never heals” because of this.

What does this have to do with regeneration? Well… kinda everything.

There’s an error rate to everything, including copying DNA in animals, and RNA in viruses. There are antiviral meds that work by pushing the virus to replicate faster, until the RNA can’t replicate itself without making errors, and ultimately killing off the virus in that person.

The same thing is possible in a person. The more frequently you divide cells, which is a key part of regeneration, the more likely you are to have errors. (This is why the GI tract, which makes a new lining for itself about every 2 weeks, so often gets cancer somewhere along the line). And one of those errors may become cancer. Hope this was helpful, or at least interesting.

What’s up, keyboard trolls?! I’ve been getting some pushback from some writers about my recent post on the knocking-someone-unconscious trope, and I wanted to take a second to address it. Mostly I’ve been challenged to provide a better alternative, which is totally reasonable.

So if we can’t knock people out with head injuries, how do we neutralize enemies without killing them, Aunt Scripty?

(First of all, yes, head injuries can knock people out, it’s just that anything that’s hard enough to knock them out is enough to also kill them or cause permanent brain damage.

This is a really good question, and one I’ve thought about quite a bit. There are a couple of options that I can think of, but I want to make one thing absolutely clear:

Your characters have to be morally prepared for the fact that any of these techniques could still be lethal. If they’re going to be “neutralizing” someone, that means that they may be forced to take a life. It’s a not-so-good option, it’s not the desired outcome, but it’s a very real possibility. If they can’t stomach that thought (or you don’t want to deal with the fallout afterwards), they may need to find another way to accomplish what they want.

Option A: “Be quiet and put your hands up or I’ll shoot you in the head.”

Why is that gun chained to the….? Okay, fine. New plan. Shaw?

That’s better. (Side note: do not fuck with Shaw.)

A gun to the head can be very convincing indeed, although your characters have to be ready to pull the trigger if the person offers resistance. A gun should never be drawn if the person drawing it isn’t ready and willing to use it. This should be followed by another character, either the subdued themselves or a second protagonist, duct taping someone’s mouth and binding the hands and feet. (Don’t put anyone on their stomachs and don’t hogtie; these are risky.)

Option B: Ketamine.

You guys, ketamine is my very favorite drug. (By which I mean medication. I have actually never done a drug that was not prescribed to me, and I’m not just saying that in case my bosses find this blog.) [if they found this blog I would be in a world of shit anyway, and i would tell you if i had tried anything interesting, which i have not.]

Of all the sedatives one could theoretically use for a chemical takedown, ketamine would be my choice, primarily for its safety. Benzodiazepines would definitely work, it’s just that one of their major side effects is respiratory depression in high doses. (We routinely use 10mg of midazolam IM at work; I would caution that while this is (usually) (eventually) effective, it takes a few minutes before the struggling winds down, and patients may need airway support if this is done.)

Ketamine, on the other hand, works very well, and patients maintain their own airways pretty well, as well as managing secretions (swallowing). It’s a very popular anesthetic in adult, pediatric, and veterinary medicine (there’s a forthcoming post about sedatives vs analgesics; ketamine actually does both).

The reason I like it for this purpose is multifold. For one, it’s just a neat fucking drug. It doesn’t cause the typical unconsciousness that other anesthetics do; ketamine causes the brain to still be awake, but basically get shut off from the outside world, meaning that the person’s eyes may remain open, and they may have rapid eye movement, but they will not be aware of any outside stimulus. This is really unnerving the first time you see it. Watch this child below:

This kid is fully anesthetized and pain free, even though she looks awake.

It isn’t an instant onset, though, because nothing (except MAYBE propofol) is.

For two, there is basically no upper dose limit on ketamine. Once upon a time a child accidentally got100xthe appropriate dose and was absolutely fine; she was just…. anesthetized for 24 hours. Y’know. Just cuz.

An appropriate dose of ketamine, given in the muscle, is 5 mg/kg; basically, everyone under 220lbs would get 1x 500mg dose (5mL syringe) in the thigh, even though for a smaller person (50kg/110lbs) this is a double-dose. As the mg/kg dose rises, onset quickens; typically it’s about 2 minutes from injection to sedation, but again, quicker in smaller people.

The one thing worth noting here is that actually the max volume any one muscle can really take in is about 5mL, so you may want to have your character duel-wield syringes loaded with ketamine (5ml each) and go for one in each thigh, or double-stab the assmeats, if the person they’re taking down is particularly big.

She will fuck up your day. (source)

You could even do a “will one syringe do?” moment, where your characters have to decide  whether one syringe will “do the job” or if they need two. The cutoff for a single syringe working is probably around 100kg, or 220 lbs.

One thing here is worth going back to, which is the 2-minute onset. Two minutes is a long time, even if functional resistance is lost sooner. People get angry when you inject them in the butt without their consent. Even if they’re going under sedation, they may struggle and fight and make noise. So your characters need a plan for what to do when the target doesn’t go down immediately.

It’s also worth noting that there can be complications with ketamine. Some people’s larynxes briefly freeze up (laryngospasm), some people get transient apnea, and some people transiently desaturate (blood oxygen % goes down). All of these fall under “probably fine”, but it is worth noting that your characters still may kill someone with ketamine. It’s safer than a head strike or shooting someone, but it’s not 1000% guaranteed to be survivable.

Oh, and a certain number of people, coming up from a ketamine sedation, will have godawful hallucinations, because ketamine is a hallucinogen; this is called an emergence reaction, and may be dramatically useful. Imagine being a bad guy and walking into a room: one of your minions is lying on the floor, eyes open but clearly not awake, and the other is screaming and hallucinating in the corner.
Neat.

Option C: The Sleeper Hold / Choke Hold / Kill Someone Hold (NOT SAFE, MINIMALLY EFFECTIVE)

This is a common technique in martial arts. Here we see Hulk Hogan doing this to a reporter (who is a willing participant; we’ll get to why I believe this video in a moment)

Watch how quickly this works: the hold begins with pressure at 0:39, he goes completely limp 7 seconds later (0:46).

Hogan used: Blood Choke! It was very effective!

The downside? The victim wakes up/lifts his head another 11 seconds after that (0:57). In the intervening 11 seconds, Hogan has dropped him on the ground so hard that he hit his head on the hard floor and opened up his scalp. (You can see this at 1:09, when he turns around and the back of his jacket has a good hard smattering of blood on it.)

There are two reasons I believe this video is real: one is the head strike and the blood involved; the other is that he actually sued Hogan for the injury.

There are two kinds of choke holds: blood chokes, which compress the carotid arteries, and air chokes, that compress the trachea and prevent people from breathing. As we can see above, a blood choke is rapidly effective, but also rapid offset. They’re relatively safe in young people, but anyone who may have some plaque building up in the carotid arteries they may have a stroke if the plaque gets broken off from the artery wall.

Air chokes can fracture tracheas and kill people, but they’re probably effective for a little bit longer than above, and are routinely used in martial arts as a “victory hold”, so there’s that.

Option D: A+C or B + C = Effective?

The “ultimate” trope-done-right version of getting a sentry or other bad guy under control may just be a combination: a blood choke for temporary unconsciousness, during which a nice dose of ketamine gets injected in the thigh, or a bad guy willingly takes a sedative rather than get shot in the face.

So that’s it for this post!

I hope you all liked it and found it at least remotely useful. As a personal note, I ask you not to try any of these things in real life, and I also give you my Disclaimer of Infinite Justice. Thanks for reading!

xoxo, Aunt Scripty

The Script Medic is supported by generous donations on Patreon. Have you considered donating?

Heyo blog-monkeys! The lovely  mirandamnit wrote in mentioning her blog! I haven’t had a chance to check in on everything, but the articles I HAVE checked over are spot-on and excellent resources! Give this one a shot!

xoxo, Aunt Scripty

Take it away, mirandamnit!

Hello, Auntie! You’re wonderful! Anyhoo, I’ve got a bit of a budding writing advice blog myself. I’m a pre-med student who constantly bugs her ER doctor uncle for advice.
(Burns)
http://aminoapps.com/p/fyvif
(Broken ribs)
http://aminoapps.com/p/8as8s
(Broken bones)
http://aminoapps.com/p/4gzo3
(Head trauma and unconsciousness)
http://aminoapps.com/p/60seq2
(Blood loss)
http://aminoapps.com/p/hhhvn
(Pain and Shock) http://aminoapps.com/p/u47lk
(Stab wounds)
http://aminoapps.com/p/zef03

Love you, Auntie! Keep up the awesome work.

First, A Word On Nomenclature

Let’s lay this one out right now: this post is talking about uncomplicated rib fractures, not ones that puncture the underlying lung, or have concomitant damage to underlying organs (like the liver). This is not here to talk about flail chest.  

“Broken Rib” = “cracked rib” = “nondisplaced rib fracture”. The only difference is, “broken rib” can also refer to a shattered rib, or a rib that’s sticking into the lung, but for the purposes of this article, this post is here to talk about a pure, simple, straight-up broken rib or three. Otay? Otay.

Causes: Primarily Blunt Trauma

Broken ribs can be a side effect of a gunshot, of course, but they’re usually a product of some form of blunt trauma, whether that’s getting thrown a blanket party or getting bounced off a wall, or landing awkwardly from a fall, or getting punched with brass knuckles, or hit by an angry old man with a cane. The middle ribs–those in the middle of the chest–are typically the ones that get fractured.

Billy Badbones Gets Beaten

It’s a trope played out time and time again: Billy Badbones is Bad to the Bone. And by that I mean, some jackass has taken a bat to Billy’s chest from behind. He feels something crunch in his chest as the bat collides. (Or maybe he dumps his motorcycle, or falls off a climbing wall onto an inconvenient rock.)

….okay maybe don’t fall off your motorcycle naked. I’m just saying. (Who even MADE that gif….?)

ANYWAY. Billy tries to be a real Bad-butt, but after his breathing grows progressively worse, he finally bites the bullet and goes to the hospital. Where his doctor looks at his shiny chest x-ray, and tells him….

“Billy Badbones, you broke your ribs.”

Great! So…. now what?

Typically, Billy won’t need surgery (or splinting)

It is possible to have broken ribs threaten the lung or underlying tissue, or be so displaced that they need to be surgically repaired. But typically, there’s no need to surgically repair ribs; most rib fractures are nondisplaced (the bone ends stay put).

As for splinting–putting a belt or a binder on the chest–it’s actually a bad idea. On the one hand, it reduces motion and thus reduces pain. On the other hand, it contributes to the potentially-fatal complication of pneumonia, because the lungs can’t really move air (or gunk) around. So rib fractures aren’t splinted.

First: Pain. He will have lots.

Broken ribs are painful. They hurt. They hurt because, unlike other fractures, they can’t be splinted. It used to be common practice to tie a belt over the rib, or splint it, but we found out that doing so actually increases the likelihood that Billy will get pneumonia. So there’s no splinting. It’s rare to need surgery for “just” a broken rib or two, especially if the rib doesn’t threaten the underlying lung.

But that doesn’t mean it won’t hurt, because it will. The ER doctor has a number of options  for treating pain. An especially effective combination would be a nerve block–an analgesic like lidocaine injected in such a way as to numb the nerve for the affected rib(s) for 12-24 hours–plus something like Percocet for the first 3-7 days, and then probably high-dose ibuprofen after that.

Of course, in America we throw narcotics at everything that moves, so he might be on the Percocet for months; he may even develop a nasty addiction. But that’s neither here nor there.

Billy will also be given a set of discharge instructions, including how to care for his ribs. He’ll have to do some deep breathing or coughing exercises every couple of hours, and he’ll be encouraged to do light activity, like walking. A good set of instructions can actually be found here: https://medlineplus.gov/ency/patientinstructions/000539.htm.

Sleep May Be Hard At First; Coughing and Sneezing Will Be Hell

A lot of people with broken ribs describe issues surrounding falling asleep, especially if they typically sleep on the same side as the affected rib(s). This is usually because of pain.

Meanwhile, involuntary motion of the chest, like coughing or sneezing, are gonna suck. They’ll hurt, badly, for some time, but most especially during the first two weeks. (Hate your character? Make them break their rib during allergy season!)

Rehab is Deep Breathing and Coughing.

But didn’t you just say that’s what will hurt? Why yes, yes I did. However, the chest wall needs to get its flexy back, and deep breathing and coughing help the lung’s immune system attack invaders. So it’s important, not just for healing but for preventing pneumonia, that Billy do some exercises where he coughs and takes deep breaths every couple of hours.

As he heals this will hurt less and less, but at first he may need to time his pain medication to when he’s about to do his rehab (probably 30 minutes before for peak effect). He’ll also be encouraged to hold a pillow against the broken ribs while he does this one.

Exercise: He can do some (but not a whole lot) (at first)

Like we said above, walking is encouraged, but nothing strenuous involving the chest for at least a month, especially not lifting weights, fighting demon spawn, or saving the world. Running is also a terrible idea, because the impact of foot-vs-ground travels much further than you realize, biomechanically speaking, and he’ll feel every step in his ribs. It might be something he tries once, early in his recovery, and doesn’t try again for quite some time.

Honestly, his pain tolerance will say a lot about his ability to exercise while healing. Exercise can generally be taken as tolerated, but pain is a powerful motivator to not do something.

Now, this is where drama and reality butt heads. The truth is that you will likely need Billy back on his feet sooner rather than later. This is fine–again, he can walk, probably drive (unless the narcotics make him woozy), think, talk on the phone, etc. And he can do a little physical activity–but pain can be dramatically useful too. He might start chasing a bad guy only to find he simply can’t run that far without wanting to die from pain like fireworks going off in his chest.

Best-Case Recovery Time: 6 Weeks, More If He’s A Moron

Gradually, as the bone heals, he’ll get stronger, but it will take about 6 weeks to fully heal. Some people take less, as low as 4, but realistically it’s 6. And some people have significant pain long after, especially if they’re pushing themselves too hard. Walking is okay, but running is not; lifting of heavy things should take at least a month off.

But what protagonist has a freaking month to not pick up heavy things, or shoot a gun (remember, recoil is a bitch), or move a couch?! Billy is an active guy, okay?!

Yeah, well, Billy is setting his recovery back something fierce, and hurting himself A LOT in the process.

Pitfalls, and How to Avoid Them

I think the biggest pitfall to writing rib fractures is that often times, writers forget that they injured their characters. Wherever you keep your notes, put a big note: Billy Badbones – Broken ribs – EVERYTHING HURTS!

Think about doing the thing you are going to have your character do in the first few weeks after the fracture. Does it involve heavy breathing? IT WILL HURT, and probably prevent them from doing it. Billy Badbones WILL NOT BE BONING HIS GIRLFRIEND for at least a couple weeks. It will hurt him way, way too much.

So that about wraps up rib fractures!

All of this is, I hope, useful for helping you write better broken ribs. It’s all subject to the Disclaimer, of course, but I think we all knew that by now, didn’t we?

Thanks for reading! xoxo, Aunt Scripty

Hi everybuddy! Aunt Scripty here. Today’s guest post is written by Nana, a Licensed Massage Therapist in the US.

This is part 1 of a 2-part post on the basics of what massage therapy is (and, more importantly, isn’t). I’m so excited to have Nana’s posts here on the blog!

Keep in mind that even though this is a guest post, and I have not 1000% verified everything in it, it is still subject to The Disclaimer Of Doom. (The Doomsclaimer?)

I hope you all enjoy!

Nana, take it away!

Hello! LMT Nana here! (@theoremofwhat ) You’re probably wondering what the heck I’m doing here. Or what the heck an LMT even is. I’m here today to help Aunt Scripty in her quest to dispel some Mythconceptions surrounding the medical field in a two part post on my specialty: Massage Therapy.

For the uninitiated, your first thought is probably something along the lines of, “LOL, happy ending, yo!” I’m here to smack that right out of your head.

Let’s start off with what Massage Therapy actuallyis. Defined by the medical dictionary,

“Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or causing movement of or to the body.”

Okay. What the heck does that mean? I’ll put it into context for you. A massage under this definition is when a trained person uses their hands, forearms, elbows, or other parts of the body to apply force to the patient’s body, or stretching/moving joints, for the purpose of loosening muscle and connective tissue, or to stimulate fluid flow (blood/lymph).

Sweet. That’s down. Let’s continue.

Massage is one of the oldest forms of medical care, …..

….with origins going back almost 5,000-4,000 years in Polynesian, Egyptian and Chinese cultures, these are passed down through written and oral traditions. Massage became popularized in western medicine by Hippocrates, who believed that massage was a highly effective and underutilized tool that requires a great deal of knowledge and training- views still held today by professionals.

The full history of massage is quite long and complicated- something I won’t go into here. It’s quite the drama, part of which contributes to some modern Mythconceptions that organizations like the American Massage Therapy Association (AMTA) are trying to smash out by regulating the practice and increasing public awareness. Studies into the history of massage, and even observances in modern populations have shown that the urge to aid hurts by applying manipulation through the hands is likely an ingrained impulse in humans.

Knowing this, one would think that just anyone could get up off the street and give a massage. While many a family member or good friend has helped that “knot” (called a trigger point) in your shoulder, giving a full body massage with the intent of aiding healing requires a lot of hands on training and knowledge of the human body. You wouldn’t want a receptionist diagnosing your cancer- you don’t want a receptionist handing your massage either.

Let’s go over the qualifications for a massage therapist, known professionally as a Licensed Massage Therapist (LMT) standardly, and/or BCTMB if they are Board Certified. 

Here in the United States (where I am) regulation is left up to the individual states. I am licensed through the state of Utah, so many of the laws and regulations I will be defining for you will be through that lens. If you would like a good launching board for other states, head here. 

The AMTA suggests a minimum of 500 hours of training for licensing, but states such as New York require up to 1,000 hours. Here in the state of Utah 600 hours is the minimum requirement. This translates to about 7-12 months of schooling.

During the course of schooling a therapist will spend most of their time learning medical Anatomy, Physiology, Pathology, and Kinesiology. Basically? How the body is made, how it works, and how it moves. They are then trained in how this information applies to injury, illness and rehabilitation.

The rest is hands on training, identifying in person what abnormal tissue feels like, how to change it, when you should and can, when you should not massage, and areas of endangerment. And this is a VERY brief overview.

Aside from the all important training in medical A&P, we are given intensive training in the ethics side of massage. This is perhaps one of the most important separators between a LMT and a non licensed individual. LMTs are unique in the medical community because we have a specific training in how to touch.

Touch is one of the most sensitive things in the modern community- many suffer from Touch Deprivation because of stigma surrounding touch. Many perceive touch as a sexual thing. Others will react negatively to touch due to trauma in their life. Massage therapists must be prepared to present the massage in a way that cannot be perceived in a sexual, or threatening way, and may receive extra training to deal with victims of violence.

We receive training in how to conduct the massage- specifically in how to greet and interview the client, how to drape (the covering and un-covering an area to be worked.) and how to interact through out the session and how to end it. 

To be licensed in the state of Utah, I had to undergo 600 hours of schooling by an accredited school. In my case it was a technical school focusing on medical careers: Nursing, Physical Therapy, Personal Trainers, and Dental Assisting. My actual course was almost 700 hours- ten months of school in total. After passing my schooling I took a national exam called the MBLEx, a test monitored by the FSMBT. (Which is terrifying, by the way. I legitimately cried when I passed. Most do not pass the first time around.) The Utah Division of Occupational and Professional Licensing required proof of my schooling and my testing scores, along with proof of residency and I was fingerprinted. 

Once licensed and practicing you also need to understand that LMT’s have what’s called a scope of practice. This means we can only do certain things under our license, primarily, massage. We cannot diagnose, or prescribe anything. We are trained in Pathology so that we may identify potential symptoms, but we are under strict laws to only bring up our suspicions and direct you to your primary care physician or a specialist. We can suggest common, well accepted home lifestyle changes/ remedies with the caveat that the client must still check with a doctor before starting anything new. You should never take anything a therapist tells you as gospel truth because even if they have had excessive continuing education or 20 years of experience, we are not doctors.

Now that you know all this, let’s go over the common Mythconceptions we face in media. Because guess what? Massage is a largely misunderstood area and has been misrepresented so often I want to tear my hair out. These are things you should AVOID in your writing. Personally? I don’t care if you’re actually writing a story about a prostitute that wants to hide their illegal activities under the label of a masseuse. Figure something else out. I don’t really care if you’re going for a laugh, or a shocker. It’s an entire industry that you are undermining and actually inhibiting real world people from getting help.

• Massage Therapy is purely for pleasure/pampering/rich people. Or, Massage Therapists are sex workers.

This is one that causes the most harm to my blood pressure. While massage is excellent for general mental health, it is also good for almost all areas of health, both as a preventative measure and an aid in recovery. I personally specialize in injury recovery- even more specially in rotator cuff injury. (The rotator is my favorite muscle group.) Others specialize in automotive accidents, surgery rehabilitation, trauma recovery, geriatric care, arthritis, sports, autistic children and adults, and hospital massage(for very ill people). The list is endless, actually. Specializing therapists can work independently or attached to doctors/ physical therapists/psychiatric professionals.

Changes in health care and pricing have made massage much more accessible. Many offices will accept insurance as a form of payment, and more and more insurance companies are paying for it. The industry standard in charging is $1 a minute- and considering the amount of training and the wear on the therapist’s body, this is more than fair. Other businesses will offer specials and memberships aimed at making regular massage more affordable to the average american. Depending on the office/private practice you visit, they will even help you with payment plans for your care. So even if your character is struggling financially, there are alwaysoptions.

Massage being perceived as a sexual thing is a complicated subject, largely due to abuse of the term in history and cultural views(as mentioned above.) And it’s actually a dangerous one. Many, if not most, therapists are female.(This is beginning to change and it’s really exciting.) It’s not unheard of for a skeevy guy to go in for a ‘happy ending’, get refused by his law-abiding therapist, and attack her. I have not yet experienced this- but friends and coworkers have. Prostitutes masquerading as therapists also enforce this view that a massage is sexual.

In the 1800s, police began to crack down on certain businesses and drove prostitution from these places into massage parlors and bathhouses- leading to the degradation of the term “masseuse”.

So please. Do not use the term masseuse/masseur. As a professional I would say this would be the only time to use this portrayal of sex and massage- historically- and as long as you also make the commentary that there were legitimate practitioners at the time and this was an abuse of the term.

Please, please, please, do NOT use this in a modern setting unless you are prepared to make some very direct commentary on this abuse of the industry.

Aunt Scripty’s Note: Having gotten lectures from the FBI about this, it’s also important to know that a lot of the cheap / fake “massage parlors” you see (the really, REALLYeasy to spot kind) are fronts for human trafficking. The “employees” may be victims of forced prostitution, held against their will or manipulated by others stealing their passports, and other atrocious human rights abuses. When you portray massage in your fiction as having “happy endings” or a front for prostitution, you are actually advertising for human rights abusers.

Now that we have that gross lump out of the way, moving on to number 2.

• Depictions of a Massage in Advertising and Media.

You’ve all seen the classic image of a beautiful woman working on an equally beautiful human with the client laying face down, head resting on their arms, a gentle smile on their face with a blanket neatly arranged around their midsection, the beautiful therapist standing over them and tenderly dragging their fingertips across their skin, or placing hot stones right on the spine, and they are surrounded by nature and flowers or some shit.

WRONG WRONG WRONG.

I googled ‘massage’ and looked up images. I had to scroll for a good long while before I even found something that ALMOST represented what an actual table looks like, what proper body mechanics look like, what proper draping looks like. It’s vomit worthy. And holy-mother-of-profanities. You would NEVER rest hot stones directly on skin, much less the SPINE. 

The last thing I want on my table is flowers and fluffy shit. It’s unhygienic, potentially allergy triggering, and just in my way. Licensed practitioners follow strict guidelines set up by the local Health Department, and follow Universal and Standard Precautions set by the CDC. This prevents transmission of disease. 

My actual table is not so glamorous: made of standard wood or steel with a nice firm pad on top, ankle/knee bolster, and a face rest. (The face rest is either not too bad, or HELL, depending on the person. But it’s a necessary evil. That face rest is there for breath-ability when you are completely face down and I’m working on shoulders/neck.) We can dress them up in nice sheets and blankets, table warmers and the like. But they still need to be cleanable. 

And you’re definitely not going to look glamorous getting a massage. At times a client is so relaxed they end up drooling and snoring. It’s fantastic. Moaning and groaning is totally normal in a non-weird way. Falling asleep and waking up disoriented is also very normal. Twitching is also normal- although it feels weird. This is a sign of the muscle releasing.

If your character suffers from any anxiety, they may struggle to fall asleep on the table, or relax completely- they may attempt to exert some manner of control over the massage- by holding arms and legs, fidgeting, or they may relieve tension through talking. All of this is also 100% fine, but the therapist will likely try to help them relax in order to allow the massage to be as effective as possible. 

Next is the portrayal going the opposite way: guy goes in to get a massage and is practically torn apart and beaten by his therapist in order to get a “deep tissue” massage. This leads into the next Mythconception:

• Massage HAS to hurt or leave you sore to be effective.

I’m not going to lie. Some times a massage does hurt. Sometimes it does leave you sore afterwards, technically you get a work out during a massage. Sometimes those muscles and fascia are so bound up and tight that releasing it is Not Fun™. Some muscles just don’t like to be worked. (Hee-llO subscapularis and psoas.) But there ARE ways around it. There are very gentle ways of coaxing a muscle, tendon, or aponeurosis into it’s natural state. 

Also. DEEP TISSUE DOES NOT MEAN DEEPER PRESSURE. Repeat after me, children: Deep tissue does not mean deeper pressure. A gentle relaxing massage can have bruising deep pressure(not that I recommend it, and it’s probably not relaxing anymore!) Deep tissue is a specific modality with techniques to accessing deeper muscles under superficial layers of skin, connective tissues and surface muscle. It’s actually a very slow and focused type of massage. You don’t move fast unless warming up the superficial layers. It can utilize deeper pressure, but does not have to.

You might feel sore the next day; absolutely. You might feel a bit like you have the flu. This is common, but not the norm. You can wake up the next day feeling 100% fine. These not fun effects are though to be caused by the muscles getting a work out during the massage- just like the gym. The flu effects are thought by some to be caused by gunk pushed out of the tissue and back into the blood and lymph systems, or by dehydration due to increased circulation. This is why therapists will commonly tell clients to drink a lot of water/hydrating fluid after a massage. One single cause is not nailed down by researchers yet. Regardless, you should never be so sore that you can’t function the next day. That’s called an injury. (There are some applications of this in Physical Therapy, but I am the last person to ask about that.) 

• Men give the deepest massages/Women only do the ‘fluffy stuff’

Again, this is silly. Take me for example: I am 5 foot zero and weigh 110 pounds, struggle lifting more than 50 pounds, and I have made a big biker guy cry on a dare. I was often the one in school to get the deepest pressure once I learned how to apply myself. (We tiny women actually have a reputation in the industry for this!) It’s not about strength or body type. It’s all about your body mechanics and leverage. I wish I had pictures of me pushing my foot/ standing against a wall to get deeper pressure into a client’s traps. Cuz it looks awesome. Plus, muscling your way through a massage is most likely to injure you as a therapist.

• All massage is the same.

Massage is a scientific art form. This translates to there being as many styles of massage as there are therapists and clients. It all is dependent upon how/ what the therapist feels, personal experience, and training bias. Each client will receive a massage tailored to their body.There is no universal technique guaranteed to work on everyone. Every body is a wonderful, unique body. Every body.

I personally combine techniques from Deep Tissue, Structural, and Shiatsu massages. This for me turns to a relaxing massage that targets connective tissue to release longstanding holding patterns or to prevent them from forming after injury. I also specifically target techniques to stimulate the Endocannabinoid system. (Yeah. You read that right. Endocannabinoids.)

• You shouldn’t get a massage if you are pregnant/ have cancer.

It used to be believed that massage could terminate pregnancy or spread cancer cells. Recent research shows the opposite to be true. Medical Massage has been shown to decrease unpleasant side effects of pregnancy and cancer treatments. There are different treatments for cancers that would be a contraindication (such as radioactive implants) and other medical conditions during pregnancy that would warrant it as well. There are other medical conditions or medications that require abstinence from massage, but that is in Part Two.

• Massage is a new thing made up by hippies/ My character in a High Fantasy World/historical setting wouldn’t experience/need massage.

This is just silly. As we’ve seen in in our history, Massage is ancient, maybe even ingrained into our species. Massage was originally a tool of Shamans and other ancient healers- and very common in Midwifery. The applications of massage are endless in all time periods and worlds.

As for the hippy thing- Yeah. A lot of us are absolutely more ‘crunchy granola’ than the rest of our medical world friends. Many believe and receive training in Energy Work including Reiki, accupressure, and other meridian massages. I won’t post any information on it here as this is a medical website and we do not have scientific proof of any of it yet. But it does happen, and at the VERY least has a strong placebo effect, so if you want to include it in your story, go for it. Just put some proper effort into how these things go down.

(BTW, you’ve probably seen some manner of funny human making jokes about their weird experience with an 'auric massage’ and the therapist just floated their hands above them, right? That’s because energy healers do not have the licesce to touch. As far as my current knowledge goes, there is no government regulation regarding energy workers of this class.)

• Massage is a magic cure all

This may be originating more from bias within the profession- we all want to think what we do will help humanity live better all the time. Massage has HUGE benefits and many, but can’t fix anything and everything- and it certainly won’t fix you in one session. When I was recovering from a particularly nasty whiplash injury it took 6 months of bi-weekly appointments in conjunction with other therapy to fix me. How exactly this will work out I’ll cover in my second post.

• Massage is a woman’s industry

This is mostly true, based only on statistics. It’s believed that only 12% of LMT’s are male. This is changing, slowly. It’s true for some pretty messed up reasons, and those reasons should die. Those who want to hide from some brutal feminist truth should leave now. 

NOTE: What I am about to say does NOT apply to those of you who have suffered through any kind of trauma. Your worries and fears are valid and will be treated as such by any competent therapist. 

Many people, male or female, simply do not trust male therapists- due to homophobia and gross concepts of masculinity, that being worked on by a male will make them gay/seem gay, or the fear that they will be accosted/fondled, even if they have no history of such a thing happening to them.

I straight up call out anyone who has the homophobic view as fucked up. Sometimes the thought isn’t even consciously homophobic. Casual bigotry is still bigotry. This also shows an underlying belief that all touch is somehow sexual.

So if your character doesn’t want a man touching them because it’s 'gay’, what does that say about them preferring a woman’s touch?

This also highlights the shitty idea that only women can be caretakers/healers/provide a service for tips or so on. It’s a similar situation to how people are surprised at or even mock male nurses, belittle high ranking female anything, or how a woman can’t be a soldier or cop. But that is a debate for another time. Just know it’s fucked up and please don’t perpetuate it, please do everything you can in your stories to change this view.

If you are going to a reputable business there is no worry about any of these things of course- for anyone. Laws, company policies, and personal ethics will prevent any misconduct on the therapist’s part. 

Here’s a few things to read up on regarding this: 1,2, 3: This one is long but one of the best.

It’s a fact of life for massage therapists that at some point in our careers that we will be propositioned, or accused of inappropriate conduct (even if it is only perceived misconduct, or someone angling to get a free service).

This is not to say that misconduct doesn’t happen. Unfortunately it does. If you are including this in your story please frame it as something that is quite not okay on the part of either party, and show that the proper action is taken by authorities. This should never be portrayed as okay ever. (I’m looking at you- “hand of glory at the end of my Thai Massage Dean Winchester.”)

So there’s a number of Mythconceptions busted here. If you want to continue your research, hit up a local practitioner in your area- Many are more than excited to spread their knowledge! If you made it all the way through, congratulations! Your prize is reading Part 2: When your character will be needing/receiving massage, when they won’t or really shouldn’t, how a modern set up will go and how the therapist might be, and possible applications in a non-modern set up!

Hey everyone! Aunt Scripty again.

I hope you enjoyed  that post as much as I did. Thanks again to Nana for her expertise and experience, as well as writing-focused perspective!

If you are a healthcare practitioner and want to clear up some myths about YOUR specialty, hit me up and let’s talk!

xoxo, Aunt Scripty

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