Help, I'm stuck & need a doctor's advice!

[meg_evonne]

I'm really stuck on a technical medical writing delimna.  Is there a doctor in the house or surgical nurse or military service medic or someone you know?

Only on a sci fi board would people understand what I need.  A woman, transformed into large bird is struck by an energy ball under her right wing.  She is in the process of turning back into her more substantial human form to take the hit.  Essentially she gets a baseball size hole burned into the ribs under the arm which would completely shatter & destroy the ribs in that location.  The force of the blast causes a lung to collapse, destroys her spleen, damages a major artery or vein into the heart and leaves her liver pretty much smashed.  I can find research on the soft tissue, but the ribs are proving beyond my internet research.

Can the parts of the rib under the arm just be removed?  Is that leaving enough support for the lung?  If not, I'm assuming that a series of rods and plates might be used to replace the missing sections, at least until they heal--but I can't have metal in a transforming character.  If nothing else, can I use a whale bone or something like the women used to wear in their clothing (stays? I think they were called) in the 1800's? Anything other than metal, you know? 

Like I said I'm stuck... Merck and Mayo have a ton of stuff on fractured ribs, but nothing on sections of ribs that are simply gone in that area...  Any help would be greatly appreciated!

[Tasmin21]

My best friend is a doctor (and she's used to acting as my medical consultant for my writing. *grin*) so I'll shoot her the question and see what she says.

[meg_evonne]

That would be so GREAT.  Thank you!  Somehow I didn't know how to fit it into my next physical.   

[Lord Nedd]

Meg,

My wife is a Internal Medicine doctor (whose father is an orthopeadic surgeon).  I posed the question, how do you deal with a destroyed ribs.  Her response was that regrettably, there is no really good response for when the ribs are entirely destroyed.  The patient is likely to die from the other collateral damage around the ribs as well as the inability to breathe due to rib destruction. 

There are no known surgeries for dealing with rib repair.  We typically bind the ribs and hope that they repair.  Ribs need to be able to flex and bend, so long repair rods and their ilk are not a workable solution.  If enough of the fragments of the ribe are intact, you can perhaps hope that they will refuse, but it is likely that the patient will have permanent damage to those ribs so that they are perpetually broken.

That was the quick solution that she gave me before she ran off to go running.  Perhaps someone else will give you a better solution.

Hmm.

-LN

[Blaze]

Heya, what tech level is the story?  Where does it take place and are there magical healers, because you are going to have real trouble without a liver.  Tissue matching a lycanthrope might prove, shall we say, impossible? 

It seems obvious that you want the character to live.  If that is a given, let me know.  Then we will deal with all these other issues... 

Oh, and is the doctor a mad scientist?

Bwa ha ha ha...

I mean *hugs*

[Shecky]

Ribs supply support and form for the torso; without entire ribs, that's compromised. At the very least, your character will be severely motion-restricted, both from physical constraints and from diminished breathing capacity.

Maybe try an old scifi/fantasy standby - have the character rapidly bounce back and forth between forms. You're essentially looking for an iteration-to-reset. Or have her "discover" a "new" aspect of her transformation ability: the capacity to alter consciously her physical form (i.e., "think" new ribs in place). I suggest this because medically, she's kinda screwed.

[meg_evonne]

Well, I put her in the worst medical position she could be and I meant too.  There will be magic involved which was handling the liver--repairing at a submolecular level.  Looks like I need another magic doctor in there just for the ribs...   What we will do to a character, just to further a relationship or the plot.   

[Blaze]

It seems to me that if you do have magic healing, and you don't want to stress the body too much, you can use cadaver bones and replace the missing ribs that way, cut out the damaged portion of the ribs entirely and then insert a section of rib from a donor. 

This will allow her to recover, and might even allow for some interesting side effects, such as needing to finish something the donor started, or simply craving a food she never even liked before, it doesn't stray too far from the medical establishment, shaved bone from elsewhere on a person can be used as a base for laying down new bone (as in cranial closures.)

When the Gibson girl look was in, women actually went in and had some of there lower ribs removed for that perfect hour glass figure.  If these lower or "free floating" ribs are intact, they might be removed and shaved and used as replacement material also then you wouldn't need a donor. 

How many ribs did the bird form have? you can always say that since the bird only had X ribs on that side then only X ribs were destroyed.

Lots of way to play it.

I would be happy to help you bounce ideas back and forth.

[Tasmin21]

And word from my best-friend-the-doctor:

Okay well, to start with if the author wants to crush his charecter's spleen she would need to be hit on the left side.  The liver is on the right side however, the hit would have to be lower on the rib cage to hit the liver, or angled down from the armpit.  other structures you can hit are the aorta, which does lie more to the right (but would kill her pretty quickly, the inferior vena cava (main vein that feeds into the heart) he could hit pretty easily.  As for the ribs, yes you can remove part of a rib and be okay, I've seen 2 in a row removed before but in think more than that would be pushing it.  That area would be more vunerable to damage, and repeat collapsing of
the lungs.   You can use bone grafting to fill the hole.  A graft from the
charecter herself can be taken, usually from the hip bone (illiac crest) depending on the size, or a cadaver doner can be used as well.

[meg_evonne]

You guys are so AWESOME!  Thank you!  This is more than enough to get me going.  I sort of like the cadaver bone angle.  I'll ignore spleen, already have the aorta being replaced as it is...

[Paynesgrey]

Another unpleasant issue to consider is based on the high water content of soft tissues.  A blast of energy that could burn a hole in a bulkhead or chair imparts a lot of heat, not just kinetic energy.  The water in those tissues will turn to steam...instantly, and explosively.  The Gods of Physics are love us not at all when we Squishies get in their path.  Most Sci Fi ignores that, lasers, the phasor injuries in Star Trek, Star War's style "blasters", Babylon 5's PPG's all leave nasty burns, but burns which don't take into account the explosive damage caused by instantly turning a portion of the body's water into steam.  David Drake's miltiary SciFi, such as "Hammer's Slammers" basically maintains that even if you're just "winged" by an energy weapon, you're going to go "Ploot!"  Same with projectiles, such as gauss guns/rail guns (think a "Mag-lev" bullet) travelling at a significant portion of the speed of light, would turn a "graze" into Cat Food Generating Event.

"Force beams", "Gravitic weapons" or "needle focus force-field projectors, such as in Webber & White's book "Insurrection" could do an end-round on this, by claiming the weapon does not generate heat, just kinetic energy.  You might want to make it a teeny-tiny energy ball, or clarify that it's some weapon that doesn't create thermal energy on impact.  Even those have drawbacks in "flesh wound survivability", as "Hydrostatic shock", the reaction and sudden increase in pressure from even a standard bullet, can be more damaging to the squishy parts than the trauma caused by the bullet.  There's an old barracks tale of a Viet Cong who got shot in the heal while diving for cover, the bullet came out his thigh, but the hydrostatic shock blew the top of his head off.  (That one might be just a military "urban legend", but I'd rather not find out first hand.)

Most readers will not be aware of that, or will allow suspension of disbelief to cover for it, but it's something you might want to keep in mind.

Good luck with the writing!