Sunday, September 16, 2012

After a fall down the stairs, what would keep an elderly witness awake long enough to call for help?

In my WIP, the killer pushes the 80-year-old witness to his previous murder down the stairs in her home. It’s a long, straight flight of 10 carpeted stairs. The elderly woman is otherwise strong and in good health. He thinks she’s dead and leaves before the neighbors can respond to her barking dog.

I want her to be conscious long enough to push a button on her cell phone. And I want her to survive but be in a coma and incommunicado for much of the rest of the story. What injuries would she be likely to have that are severe but allow her to make it?

Your help is much appreciated.

Hello, Susan.

Two choices that would work well—subdural hematoma or epidural hematoma.

What might work is this:

A fall down the stairs with a blow to the head. Doesn’t have to be severe, doesn’t have to cause a skull fracture or even a cut/laceration.

Subdural hematoma—a blood collection between the membrane covering the brain—the dura—and the brain itself. Older people can get these fairly easily, even without severe head trauma. The pupil can be enlarged on the side of the bleeding. This is the one I’d favor for your witness.

Epidural hematoma—a blood collection between the skull and the membrane covering the brain, known as the dura. This type of injury comes tearing the veins between the skull and the dura—the “bridging veins.” The tear results in bleeding, which compresses the brain. These are more dangerous, and less likely to occur in the elderly.

Both the subdural and epidural varieties have the following signs: the patient usually has a “lucid interval” (a period of time where your witness would be awake) of a few minutes up to a couple of hours can occur. This would give her enough time to push the button on her phone. Without prompt treatment, the patient thereafter lapses into a coma.

Depending on whether you want her to have surgery and recover, or be out of it for the rest of the book, either one will work. Again, I’d favor the subdural hematoma given the fall and her age.

Hope this helps!

Cheers, Kelly

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it. Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Susan, great question. Even before I read Kelly's answer I was thinking a head injury. I've even heard or read somewhere of people having head injuries and being conscious for several days after said injury and not knowing until they fall into a coma. Thanks for posting - E :)

    Elysabeth Eldering
    Author of FINALLY HOME, a middle grade/YA mystery