(expanded from a blog post written in 2016)

Maybe it’s because I am a physical therapist and my husband is a physician, but we really hate medical shows. We recently rewatched DOCTOR STRANGE and both of us started yelling at the TV during a scene where Strange and another doctor are looming over a patient in the OR as they are about to do brain surgery and neither of them are wearing masks.

If you ask me to suspend disbelief over magical portals into multiverse realms, I’m there, but get something so basic wrong and you’ve lost me.

So back to the movie. . . After a brief cut-away, the scene continues and we next see both doctors wearing masks. AARGH. Continuity, anyone? (There are other continuity issues in the movie, but that’s a different blog post.)

But even worse than the medical care being depicted wrong, I get really bent out of shape when injury, illness, and disability is done poorly.

Injuries need to serve a purpose in your narrative

Choosing to injure your character is like every other choice in a story. It has to exist for a reason. Preferably more than one reason. Does the injury deepen characterization? Drive the plot? Limit your character’s abilities? Force your character to problem solve more fully? Change the way others relate to them?

If the only reason the character is injured is to engender sympathy, then the injury is a thin device and adds little to the overall narrative. One of the dangers of incorporating injury and disability in a story is falling into the cliché of the ‘noble victim.’ Equally problematic is when the character is injured or disabled simply to motivate the actions of the non-injured protagonist. Both choices remove agency from the character and render that person into a plot-device.

But injury and disability can be written well. One of my favorite depictions of physical disability in speculative fiction is the Vorkosigan novels by Lois McMaster Bujold. The protagonist, Miles Vorkosigan, was exposed to a poison in utero that prevented normal growth of his bones. He is considered a mutant by many in the rigid conservative society in which he was born for his deformities and has fragile bones. His frailty forces him to compete in a vicious political landscape using his wits and his will. He is both brilliant and insufferable and a wonderful, fully realized character.

Injuries need to have consequences

A second pitfall in writing injuries is when the injuries serve the needs of an immediate plot point but have no follow through or consequence in the story as a whole. This is something common to thrillers where the hero gets shot only to be patched up by a sympathetic side character and then saves the day when any mere mortal would be writhing on the floor waiting for emergency services. Getting injured hurts. Even if no vital organs are damaged, the shock post gunshot or stabbing or burn can easily take down the strongest, most fit individual.

Shock is a protective reaction by the body and is part of a complex series of reflexes that take place without conscious thought. Typical shock reactions include: decreased blood pressure, rapid, weak pulse, lowered core temperature, rapid, shallow breathing, nausea or vomiting, dilated pupils, and loss of consciousness.

It’s far more likely that your injured character will go into shock than run into the lair of the bad guys, rescue the damsel, and ride into the sunset. And shock, if untreated, can actually be fatal.

One of the protagonists in my Halcyone Space series is dealing with the aftermath of a head injury he sustains in DERELICT, book 1. His impairments are disabling. He experiences nausea and vomiting, crippling headaches, vertigo, and is unable to focus on his computer screen or read. His experience of his injury and the choices he makes as a result of not improving drives his plot arc in ITHAKA RISING, book 2. He believes only a neural implant device will help him, but his young age is a contraindication. So he finds a black market source for one. There are consequences to his actions, ripples that effect him, his family, and the political landscape.

The cover character in PARALLAX (book 4) is an upper extremity amputee. In the world of Halcyone Space, technology allows for prosthetics that are nearly indistinguishable from physiologic limbs, but she chooses a more primitive looking device. She has specific reasons for that choice that are critical to her character, backstory, and plot.

Injuries need to be written realistically

Another problem in writing injuries is when the author gets the physiologic details wrong. Absent magical healing or hugely advanced tech (and even those need to have limits and consequences), injuries take time to heal. Even the mildest of tendon strains can take several weeks to fully heal. Broken bones can take six to twelve weeks or more depending on the severity of the fracture and the overall health and age of the person. Deep cuts and penetrating wounds are a huge infection risk, as are burns. Infections can be fatal, even in a technologically enhanced world.

I had a 25 year career as a physical therapist before I became a writer. My specialty area was orthopedics and chronic pain management. When my characters get hurt, they are well and truly hurt. Their impairments continue to have consequences throughout the series.

My advice to writers wanting to show the realistic consequences of injuries, illness, or disability is this: Work backwards. That will keep you focused on continuity.

Decide the impairments and limitations you need your character to demonstrate first. Then build the mechanism of injury to get there. There are a multitude of websites that discuss symptoms of various injuries, illnesses, and disabilities. Some include:

These sites are a great starting point. To go deeper, speak to a medical professional (if you ping me on Twitter @lisajanicecohen I’ll do my best to help out), and someone who has dealt with the condition you are considering. And, like anything else, know that one person’s experience will not be generalized to all. This is especially critical in writing a character with a disability.

Want to harm your character? Remember three key issues: It must serve a purpose, it must have consequences, and must be portrayed realistically. Otherwise, you risk weakening your story and losing your reader.

LJ Cohen is a Boston-area speculative fiction writer. After a 25 year career as a physical therapist, she now uses her anatomical and medical knowledge to harm the characters in her science fiction and fantasy novels. You can find her work at http://www.ljcohen.net