MedMal in Thrillers

Medical Malpractice in Mysteries and Thrillers by D. P. Lyle, MD

Too often, fiction writers commit medical malpractice in theirs stories. Unfortunately, these mistakes can sink an otherwise well-written story. The ones I repetitively see include:

Bang, Bang, You’re Dead: Not so fast. No one dies instantly. Well, almost no one. Instant death can occur with heart attacks, strokes, extremely abnormal heart rhythms, cyanide, and a few other “metabolic” poisons. But trauma, such as gunshot wounds (GSWs) and blows to the head, rarely cause sudden death. Yet, how often has a single shot felled a villain? Bang, dead. For that to occur, the bullet would have 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 a lot of screaming and moaning, but death comes from bleeding and that takes time. Sometimes, a long time.

Ask any emergency physician or nurse. GSW victims reach the ER with multiple holes in their bodies and survive all the time. This is particularly true if it’s Friday night (we called it the Friday Night Knife and Gun Club), during a full moon (yes, it’s true, a full moon changes everything), or if the victim is drunk. You can’t kill a drunk. That’s a medical fact. They survive everything from car wrecks to gunshots to falling off tall buildings. The family van they hit head-on will have no survivors, but the drunk will walk away with minor scratches, if that.

Sleeping Beauty: I call this the “Hollywood Death.” Calm, peaceful, and not a hair out of place. As if simply asleep. Blood? Almost never. Trauma? None in sight. The deceased is nicely dressed, stretched out on a wrinkle-free bed, make-up perfect, and with a slight flutter of the eyelids if you look closely. Real dead folks are not so attractive. 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. And feel cold. It’s amazing how quickly after death the body becomes cold to the touch. It has to do with the loss of blood flow to the skin after the heart stops. No warm blood, no warmth to the touch.

Sleeping Beauty also doesn’t bleed. You know this one. The hero detective arrives at a murder scene a half hour after the deed to see blood oozing from the corpse’s mouth or from the GSW to the chest. Tilt! Dead folks don’t bleed. You see, when you die, your heart stops and the blood no longer circulates. It clots. Stagnant or clotted blood does not move. It does not gush or ooze or gurgle or flow or trickle from the body. 

Trauma? What Trauma?: You’ve seen and read this a million times. The hero socks the bad guy’s henchmen in the jaw. He goes down and is apparently written out of the script, since we never hear from him again. It’s always the henchmen, because the antagonist, like most people, requires a few solid blows to go down. Think about a boxing match. Two guys that are trained to inflict damage and even 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 Jack Reacher or Mike Tyson. A car-salesman-turned-amateur-sleuth cannot.

And what of back eyes? If a character gets whacked in the eye in Chapter 3, he will have a black eye for two weeks, which will likely take you through the end of the book. He will not be “normal” in two days. A black eye is a contusion (bruise) and results from blood leaking into the tissues from tiny blood vessels, which are injured by the blow. It takes the body about two weeks to clear all that out. It will darken over two days, fade over four or five, turn greenish, brownish, and a sickly yellow before it disappears. On a good note, by about day seven, a female character might be able to hide it with make-up.

Similarly, what of the character who 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. He will need a few days (or maybe weeks) to heal. And he will limp, whine, and complain in the interim. And if he breaks something, like an arm or leg, he’ll need several weeks to recover.

I Can Run, and Jump, and Fight Like an Olympian: The typical fictional PI (maybe real ones, too) drinks too much, smokes too much, and eats donuts on a regular basis. He is not training for the Olympics. He will not be able to chase the villain for ten blocks. Two on a good day. And hills or stairs will reduce that to a very short distance. Yet chase montages in movies and books often seem to cover marathon distances. And then a fight breaks out. 

Of course, some characters can do all this. Not the PI mentioned above but maybe Dustin Hoffman can. Remember “Babe” Levy (Dustin Hoffman) in Marathon Man? He had to run for his life as Dr. Christian Szell (Sir Laurence Olivier) and his Nazi bad guys chased him endlessly. But early in the film we learn that he runs around the reservoir in Central Park everyday. He constantly tries to increase his distance, improve his time. He could run for his life.

Hopefully when you run across medical malpractice in your reading you’ll be forgiving and enjoy the story anyway. But maybe not.

D. P. Lyle


© Douglas Lyle 2015