Monday, July 13, 2015

Medical Mondays: Dealing with a Fictional Amputation

Hello friends! I received this question recently, and it brings up a lot of the fictional issues that can come with a surgical procedure. The question comes from Deb Salisbury, a blogging friend and an expert in historical fashions.

My thirteen year old MC injured his foot, contracted gangrene, and had his foot amputated at the ankle.

Would he be up and wandering around town on crutches after ten days? Or twenty?

After six months of good healing, how much trouble would he have walking in a wool-stuffed boot if he lost his crutch? Would blisters or sores form if he wasn't used to it? At the very least, he's emotionally dependent on his crutch, in my story. Would he still be physically dependent on it?

FYI: The story is fantasy in nature, and there are magical elements in the world, which will be helpful for staving off infections. I would also assume that surgery wasn't terribly sophisticated, as we are dealing with pre-modern techniques and instruments in this world. 

There are also a few more assumptions. First, that the character at baseline is healthy (this matters for wound healing and general strength). Second, that there were no complications to surgery (I know--this is a BIG assumption. Historically, amputees often died soon after surgery from massive hemorrhage or infection. But for this story, we need our character alive and only with an amputation. So. Let's assume the surgeon/medical person could somehow tie off or cauterize blood vessels, creative a nice flesh flap to cover the wound, and sew it all up nicely). In this idealized case, the superficial aspect of the wound ought to heal within two to three weeks. 

However, the deeper parts of the leg tissue from the amputation itself takes a longer time to heal, up to eight weeks, and even then it's a continuum of healing. So I was glad to hear that he wasn't faced with using a prosthesis soon after surgery, which might not be realistic in this world. 

He probably could use crutches within a few days after the surgery, and using a prosthesis at the six month mark would likely be okay. It would be tough on him, though, because I'm assuming without modern prosthetics, the boot won't fit great, the wool would be rough and he hadn't yet "hardened" his stump to this kind of pressure and stress yet. There would be issues with blisters and stress on the skin. His muscles in that leg would also be weak from disuse (no tried and true physical and occupational therapists in this fantasy), so he'd have to deal with that too. At the beginning of using the prosthetic boot, my guess is he'd be dependent on the crutch, but not after he got used to it and built up his stamina. 

For more information, here's a great overview by Johns Hopkins on dealing with an amputation before, during, and after the surgical period. 
Here's the National Amputation Foundation website with FAQs for new amputees. 
This is a great essay on the history of amputation, by Meghan Wooster. 
And also for history's sake, this is a great Pinterest board with photos of historical prosthetics. 

Thanks Deb for a great question!

Monday, July 6, 2015

Bonus CATALYST Scene!

Hey guys! I posed this bonus scene from Vera's POV in Catalyst for the YA Scavenger Hunt a few months ago. Here it is, and I hope you enjoy it!

To read a bonus scene from Control from Cy's POV, click here. :)


I am green.
Hear me roar.
Well, I’m greenish.
This is what I say to myself in the mirror in the morning. I’ve dragged myself from Hex’s four, deliciously heavy arms, out of the common room where we’ve all taken to sleeping at night. We’re all too chicken to sleep alone these days, though no one will admit it.
Back in my room, I push aside the softened, dying vines that used to creep from floor to ceiling. It used to look like a jungle in here; now it’s as if winter has permanently taken root. We have to conserve energy now, and I’m only allowed enough power to fuel the clamshell tanning bed where I get my daily dose of UV.
I study my reflection with a critical eye. My face is greener than the rest of my body, which is turning that un-tasty shade of pond scum and fall leaves. No matter that my curves are perfectly intact. Hex says my body is a figure-eight racetrack and I heartily agree, particularly when I’m kicking his ass in Kendo. I love how that pisses him off.
 But I mourn the absence of sunlight in my life. The chloroplasts in my skin ache for photons, for drenching solar radiation. There is no other way to explain the way I feel, locked away from the sky because we can’t risk showing our faces outside of our home, Carus. We can’t go up to the agriplane anymore.
Dammit. I’m hungry as hell.
After a breakfast of soil brownies, I go straight to Marka’s room. She’s like our den mother, and ever since the Senator’s assassination, she’s been locking herself up and watching the news incessantly. Carus isn’t safe anymore. Worry is shrinking her already thin frame. She might disappear in a stiff breeze, and it terrifies me. But terror is a good friend. It makes me mad, and anger is how I fuel myself with the energy to fight. Fight who? We’ll find out soon.
I sit on the bed and Marka barely notices.
“Did you eat breakfast?” I ask.
She barely shakes her head. Her eyes are glued to the screen before her. Nervousness gnaws at me, and I start chewing my fingernails, which still taste of nitrogen and phosphorus from breakfast.
Soon, Hex and Zelia show up. Hex puts two hands on my shoulders, and they’re steady, but I can still feel the apprehension in his fingertips. Zelia sports dark circles under her eyes, and her hair is violently frizzy. She probably lost another night of sleep, and it’s no wonder. We all miss Cy, but she loved him most, and carries his loss like an infection that sickens her. She won’t talk to me. She won’t talk to her sister, Dyl, about it, either. I’ve never been good at warm and fuzzy. I hover near her at bedtime, at meals, hoping that just being around is enough. When I hold her with a glance that says Are you okay? I miss him too, she always looks away.
There’s only one cure for her despair. Cy.
I look away from Zelia, only to find Marka watching me with her concerned doe eyes. Even now, I remember that look. Memories flood me, of lying in a cold, stinking gutter, crying as warm hands leave me behind. After being discovered and deposited in a dark, locked room at the local orphanage, those big eyes of Marka found me. She swaddled me with an extra blanket and picked me up.
“Aren’t you the most beautiful thing that ever sprouted on this earth?” she cooed.
Hex says it’s not possible to have memories from when I was a baby. Maybe I’m making half this up. Maybe I’m just recalling what Marka told me as a child. But I swear, I remember her eyes. They understood the love I’d wanted from my parents, and hurt I received in return. They spoke of more love and pain to come, whether I liked it or not.
The news conference begins, and Marka’s eyes snap to the screen.
My skin goes icy, because somehow I know. This conference will bring no good news.
Today is the beginning of the end, and we all know it deep in our bones.