Writing about Pain: Describing Major & Mortal Injuries

As you may be aware, we’re smack dab in the middle of a series of posts on writing a character’s pain, and today’s is a doozy. Our last post explored common minor injuries your character might encounter and the pain associated with those. Today, we’re leveling up to discuss the severe and even fatal injuries that could befall someone in your story. But before we get to that morbid list, let’s talk about a common life-threatening thread that runs through them all and will be an issue for most characters undergoing serious physical harm.

Physiologic Shock

Many severe injuries result in a loss of blood or reduced oxygen in the blood supply. Sometimes this is a natural result of the trauma, when too much blood leaves the body or vascular system and there isn’t enough circulating to the organs. In other situations, the body redirects blood to where it’s most needed in the moment, which leaves other parts of the body untended. In either case, the vital organs aren’t getting the blood and/or oxygen necessary to sustain them.

Because shock so often accompanies physical trauma, a character who’s been seriously hurt will likely experience this symptom, so it’s important to know what it looks like. Common indicators associated with this kind of shock are as follows:

Shallow breathing
Uncontrollable shivering
Irregular heartbeat
Clammy skin
Dilated pupils
Light-headedness
Nausea
Mental confusion

You’ve probably heard that people can die of shock, but that’s not technically true; they die from the severe injury that interrupted their blood or oxygen flow, with shock being a secondary symptom from the injury. Shock is just an obvious indicator that something is terribly wrong and that immediate measures need to be taken to get the issue under control before too much damage is done.

Now let’s take a closer look at the most common mortal injuries that could befall your character, as well as the pain and other processes associated with them.

Stab Wounds

This form of puncture wound can cause damage to blood vessels, organs, or the spine, resulting in rapid blood loss, organ failure, and potential death. Wounds to the chest and abdomen are particularly dangerous because of the vital organs that can get nicked. But stab wounds to the extremities are still serious because of potential vascular damage.

Associated pain: The patient may experience sharp or stabbing pains from tissue damage, as well as burning and shooting pains associated with injury to the nervous system.

Gunshot Wounds

Gunshot wounds are another kind of puncture wound. But unlike stab injuries, these wounds can cause greater damage because of their high-velocity nature and the bullet’s ability to bounce around and hit multiple targets, resulting in rapid blood loss, internal bleeding, organ failure, and potential death.

Associated Pain: A patient with a serious gunshot wound and minimal nerve damage will experience the same kinds of pain as someone who has been stabbed. As blood loss increases and shock sets in, the pain may diminish until the patient loses consciousness.

Dismemberment

This type of cutting injury occurs when a part of the body is severed from the whole. Accidental dismemberment is often instantaneous, with the victim being unaware of it until it’s done.

Associated Pain: There will be significant and severe pain in the area of the dismemberment as severed nerves are exposed. But shock will kick in very quickly, numbing some of the pain and possibly creating a dissociative effect to separate the patient from their pain.

High-Impact Traumas

These injuries are the result of the body’s collision with another moving or stationary object. Car accidents, falls, sports injuries, and physical violence are common causes that can result in so many problems, including broken bones, a crushed airway, brain trauma, collapsed lungs, torn blood vessels, and displaced organs.

Associated Pain: If the injury is localized—say, a hand that’s crushed in a workplace accident—the pain will be focused on that area. Pain resulting from organ injury might be described as aching, squeezing, or cramping in quality, but because the organs are located close to each other in the body’s trunk, it may be hard for the patient to pinpoint exactly where it’s occurring.

Severe Burns

Third-degree burns that cover a significant portion of the body are often life-threatening because of the risk of infection, edema, dehydration, and other complications. These differ from first- and second-degree burns, which can often heal with at-home treatment, leaving only minor (if any) scarring.

Associated Pain: Despite their severity, third-degree burns destroy nerves, which often results in less or lower-quality pain in the affected area. However, there will be considerable pain in the surrounding areas as the severity of the burn lessens to second- and first-degree burns where the nerves are intact. And, unfortunately, treatments in the form of topical applications, the changing of dressings, debridement, and skin grafts will intensify the character’s discomfort after the initial trauma has passed.

Asphyxia Injuries

These injuries deprive the body of oxygen, often resulting in damage to the brain and organs and leading to death. Types include strangulation, suffocation, choking, drowning, smoke inhalation, asthma attacks, and anaphylaxis associated with allergies.

Associated Pain: In each scenario, the kind of injury will determine the pain involved. Smoke inhalation will cause headaches and pain in the throat and chest as irritants are ingested and swelling ensues. Strangulation will cause pain in the throat and the feeling of pressure building in the brain as the flow of oxygen is cut off. Asthmatics in the throes of an attack often describe it as feeling like an elephant is sitting on their chest. The causes of asphyxiation vary widely, so careful research is required to know the kind and quality of pain your character will experience.

Poisoning

This injury occurs when someone swallows, touches, inhales, or otherwise comes in contact with a toxic substance that can result in serious injury or death. This may include substances that are poisonous by nature (cyanide, arsenic, etc.) and those that become toxic when they’re misused, such as household cleaners or prescription medications.

Associated Pain: A character’s response to a poisoning will depend on the kind and amount involved. Common painful responses include abdominal pain, headache, vomiting, diarrhea, and seizures. If poisoning is in the cards for one of your characters, thorough research into the kind of poison and the body’s response to it is needed to write their pain realistically.

Electric Shock Injuries

The body is essentially a complex electrical system, so any influx of high-voltage electricity can wreak serious havoc. The injuries associated with electric shock are myriad, including internal and external burns, brain trauma, spinal injuries, chest pain, muscle pain, and damage to the heart.

Associated Pain: Shocks of this nature don’t tend to last very long. But in the moment, a character undergoing a severe electric shock can experience burning sensations, a clamping and seizing of the muscles, respiratory paralysis, arrhythmia, and possibly cardiac arrest.

These are the body’s physical pain responses to fatal and near-fatal injuries. But as we learned in the second installment of this series, pain goes beyond the physical. And while near-death and deathbed experiences can be notoriously quick, they can also bring moments of clarity, where thought and emotion come to the forefront.

Mental, Emotional, and Spiritual Responses to Major Injuries

Fear and Anxiety: regarding their pain, the outcome of their circumstances, the probability of death, and how their leaving could impact loved ones
Determination: Determining to fight with everything they have to survive; redoubling any mental or physical efforts
Despair: giving in and giving up their hold on life
Dissociation: A sense of being separated from their pain and any physical sensation, as is the case in an out-of-body experience; viewing their circumstances from outside of themselves, which provides the ability to think and process what’s happening
Reflection: The “life flashing before your eyes” scenario, where the character is able to review their choices and experiences, both good and bad
Regret: Wishing they had done more with their time, they’d taken or not taken certain actions, they’d worked harder to resolve certain conflicts or build key relationships, or they could have more time with loved ones
Doubt: Questioning what they’ve always believed about death and the afterlife
Spiritual Clarity: A person of faith being comforted as they recall that there’s something and someone waiting for them; a character returning to the spiritual beliefs of their childhood
Acceptance: Gaining a sense of peace regarding the reality of their situation; embracing the inevitable

As is the case with so many aspects of storytelling, someone’s pain level and intensity during a severe or fatal injury will depend on a variety of factors relating both to the situation and the character. Deciding what the specific situation will be is your first step. The second is knowing what kind of pain is involved. And finally, you’ll need to figure out the character’s response to it. Hopefully this post has provided a basis for making those decisions.