Ten Medical and Forensic Mistakes Writers Should Never Make by D. P. Lyle, MD
Writers make mistakes. An anachronism here, a blunder in logic there, departures from common sense everywhere, and of course the all too common break from real world possibilities that plagues even the most well-written story. It’s part of the process. Sitting alone, bouncing clever ideas off your computer screen offers little feedback. But readers notice such breaches. They shake their heads, close the book, snuff out the light, and go to sleep. Not the ringing endorsement you wished for. Here are some of the most common medical and forensic mistakes writers make. Mistakes you want to avoid.
The Quick Death: Death rarely arrives instantly. Sure it can occur with heart attacks, strokes, and extremely abnormal heart rhythms but trauma, such as gunshot wounds and blows to the head, the staples of crime fiction, rarely cause sudden death. Yet, how often has a single shot felled a villain? Bang, and he drops dead. In order for that to occur, the bullet would need to severely damage the brain, the heart, or the cervical (neck) portion of the spinal cord. A shot to the chest or abdomen leads to screaming and moaning and bleeding and expletives, but death comes from bleeding and that takes time. How long? It depends on what’s damaged. If a major artery is opened, the bleeding is brisk and death can follow in five minutes, even less. If the bullet or knife blade only strikes tissues and organs, the bleeding is slower and death can take many minutes, or hours, or not at all.
The Pretty Death: I call this the “Hollywood Death.” Calm, peaceful, and not a hair out of place. Blood? Almost never. Except in slasher movies of course and here massive bleeding is the norm. More often, the deceased is nicely dressed, lying in bed, make-up perfect, and with a slight flutter of the eyelids if you look closely. Real dead people are not pretty. I don’t care what they looked like during life, in death they are pale, waxy, and gray. Their eyes do not flutter and they do not look relaxed and peaceful. They look dead.
The Bleeding Corpse: Your detective arrives at the scene a half hour after the murder. Blood oozes from the corpse’s mouth, from the stab wound in his chest, or from the vampire fang marks on his neck. Houston, we have a problem. You see, dead folks don’t bleed. When you die, your heart stops, and the blood no longer circulates. Rather it stagnates and clots and stagnant and clotted blood does not move. It does not drip or gush or ooze or gurgle or flow or trickle from the body. It lies there, separates into a dark red clot with a halo of straw-colored serum, and then dries to a brownish stain.
The Accurate Time of Death: Determining the time of death is neither easy nor very accurate. It’s always a best guess and is always stated as a range rather than an exact time. Yet, how many times have you seen the medical examiner (ME) confidently announce that the victim died at “8:30 last night”? I always wondered exactly how he made this determination. Was it rigor mortis, body temperature, or lividity? Was it the presence or absence of certain bugs? The truth is that none of these is accurate. The decline in body temperature, the appearance of rigor, the development of lividity, and the appearance of flies and bugs are effected by many variables so are mostly unpredictable. The touted guidelines for each of these are like stop signs in Italy--merely suggestions. In real-life, the ME would say that death likely occurred “between 8 p.m. and midnight.” But that might make him appear wishy-washy and Hollywood and writers like their heroes to be smart. Smarter than they could possibly be. Stick with a range and you’ll be more realistic.
The One-punch Knockout: You’ve seen this a million times. One character socks another character in the jaw. He goes down like a sack of potatoes and is apparently written out of the story since we never hear from him again. Really? Think about a boxing match. Two guys that are trained to inflict damage and they have trouble knocking each other out. And when they do, the one on his back is up in a couple of minutes, claiming the other guy caught him with a lucky punch. Listen to me. Only James Bond can knock someone out with a single blow, and maybe Mike Tyson, but your car-salesman-turned-amateur-sleuth cannot.
Another common scenario is when a character is hit in the head, placed in the trunk of car, driven 50 miles, tied to a post or a bed or whatever, and then a bucket of water is thrown in his face to revive him. He sputters and is suddenly wake and alert. Not going to happen. If someone is knocked unconscious and doesn’t come around in a few minutes, something very bad is going on. Like a brain bruise (cerebral contusion) or bleeding into or around the brain (subdural hematoma). These require a hospital and a neurosurgeon, not a bucket of water.
The Disappearing Black Eye: If your character suffers a black eye in Chapter 3, she will have it for two weeks, which depending on the time frame of your story just might take you to the end of the book. She will not be “normal” in two days. A black eye is a contusion (bruise) and is caused by blood leaking from tiny blood vessels that are injured by the blow. It takes the body about two weeks to clear all that blood from the tissues. It will darken over two days, fade over 4 or 5, turn greenish, brownish, and a sickly yellow before it disappears. On a good note, by about day 7, she might be able to hide it with make-up.
The Quick Healing: Do you know why boxers wear gloves? To protect their hands and faces. Back in the bare-knuckle days, broken hands and cut and bloody faces were the norm. Gloves made the sport more civilized. So, if your character gets in a fist fight both he and his opponent will suffer cuts and bruises and broken teeth. He will not walk away unscathed. His cuts will need stitches, his bruises ice, and a trip to the dentist is likely. Each of these will take a couple of weeks to heal.
If your character falls down the stairs and injures his back, he will not be able to run from or chase the bad guy or make love to his new lover the next day. Give the guy a few days to heal and make him limp and complain in the interim. If he breaks an arm, he’ll need four weeks minimum.
If he’s stabbed or shot and, as so many protagonists do, sneaks out of the hospital the next day to continue his pursuit of the bad guys, all will not be forgiven. He will have pain that will limit his ability to run and jump and fight and do all those hero things. The chances that his wound could then become infected are real and would greatly complicate his situation and might even kill him.
If his car goes over an embankment and tumbles into a ravine, he will not simply crawl out and walk away. At best he’ll be banged and bruised and at worst will have broken bones and injured internal organs.
The Instant Athlete: Your PI drinks too much, smokes two packs a day, and eats fast food on a regular basis. After all, stake outs are boring. His belly flaps over his belt and he gets short of breath climbing a single flight of stairs. He will not be able to chase the villain for ten blocks. Two on a good day.
If you create a scene where your character must run down a bad guy, make him capable of such a pursuit. Remember “Babe” Levy (Dustin Hoffman) in Marathon Man? He was student, slight of build, not athletic appearing in the least, yet he had to run for his life as Dr. Christian Szell (Sir Laurence Olivier) and his Nazi thugs chased him endlessly. But he was capable. Earlier in the film we learned that he was distance runner and ran around the reservoir in Central Park everyday. He could run for his life.
The Untraceable Poison: Of all the questions I receive from writers this is number one. Seems that all crime writers want an untraceable poison. Sorry, no such thing. True it might not be found or maybe not even searched for, but if it is looked for and if the ME has good blood or tissue samples, he will find it. With fancy equipment like Gas Chromatography-Mass Spectroscopy (GS-MS) virtually any chemical can be identified. This combination gives a “chemical fingerprint” of the compound in question.
The most common drugs involved in overdose deaths are alcohol, narcotics, amphetamines, cocaine, and various tranquilizers and sedatives. The main reason is that these are readily available either on the street or in the medicine cabinet. Each of these is revealed by a simple and cheap drug screen. So if your killer employs one of these, the ME will know it in a couple of hours.
But what if the toxin is more exotic? Maybe cyanide or thallium or the toxin of a blue-ringed octopus? This is trickier. These don’t show up on routine drug screens and must be tested for with time-consuming and expensive protocols. Maybe the ME doesn’t have the time, interest, or budget to do a full toxicological examination. Maybe he simply attributes the death to some natural cause and saves the county a ton of money. Happens all the time and it can happen in your story. But, if he pulls out all the stops, he will find the drug.
The Instant Lab Result: The world is not like CSI. Not even close. Those CSI folks get results in a New York minute. Sometimes faster. They crack computers, perform autopsies, complete esoteric toxicological testing, and create DNA profiles before the first commercial break. In the real world such testing typically takes days, even weeks. Sure a tox screen can be done in a couple of hours but sophisticated confirmatory testing takes time. DNA profiling can be done in a few hours, but before the ME reports his results he will often obtain confirmation from another lab, particularly in high-profile cases, including those that crime writers dream up. Give your ME a realistic timeframe to do his work. Your readers will notice if you don’t.
The devil is always in the details. Get these details right and your story will be much stronger.