Writing About Pain: Taking an Injury from Bad to Worse

When we put characters in dangerous or unfamiliar situations, they can get hurt, and when they do, things become harder to do. Injuries can mean reduced mobility, pain makes it difficult to think clearly, or something they must do (win a fight, escape a threat, or be independent, for example) may become all but impossible.

Injuries and pain can cause an array of problems, generating tension and conflict. Readers also tend to become more invested when something happens to a character, either because they care and want them to be okay, or readers feel a rush of schadenfreude because a nasty character is finally getting what they deserve.

A writer’s mindset is all about How can I make things more difficult for this character? so it can be tempting to pile on the injuries and pain, but this isn’t always a good strategy. Too many ouchies and a protagonist won’t be able to continue their quest, meaning they can’t logically achieve an important goal (unless the author manufactures a ‘Hail Mary rescue’ that will feel contrived). Or, if injuries are piling up like a serial killer’s body count, readers might get angry and feel the author is going too far. So we really want to find the sweet spot of making things hard, not impossible for the character.

When you need to make life challenging, rather than adding new injuries, a better option may be to add a complication.

In the right circumstances, even a small injury can cause big problems. Cuts get infected. Bites may be poisonous. A blister can make it hard to run fast enough to escape. Complications are not only realistic, they raise the stakes and make readers worry, generating tension.

How to take an injury from bad to worse

Being unable to treat the injury. Some problems require medical intervention, but that doesn’t mean your character can access help. They might be on a remote hiking trail, in the middle of a farmer’s field, or simply unable to go to the hospital because if they do, it will alert the authorities. When a character can’t get the help they need, this not only ramps up the pain, it ramps up the consequences.

An underlying condition. Does your character have a clotting disorder that means a cut on their thigh won’t close? Are they being treated for an illness that leaves them fatigued? Will that concussion re-awaken difficult side effects caused by a previous traumatic brain injury? When you want to make an injury more complicated and particularly dangerous for a character, think about what underlying conditions or illnesses they may have that will make it harder to function.

Infection. Your story doesn’t need to be in the middle of a Zombie Apocalypse to cause characters to worry about viruses. Wounds exposed to the wrong conditions can cause fever or delirium, compromising your character’s ability to function and make rational decisions. Untreated, infection can lead to blood poisoning, gangrene, or even flesh-eating disease. Yikes.

Reduced mobility. If your character breaks a bone or injures their back, they may be unable to move on their own. This can put a strain on others who must step in to help, causing delays or forcing them to expend energy they need for other things. If your character is on their own, say with a broken leg at the bottom of an embankment, an inability to move much will become a crisis if they cannot source food, water, or find help. Sitting or laying prone too long can also increase blood flow related issues, making injuries worse and healing slower.

Muscle tears or nerve damage. A bike accident, overdoing it at the gym, or a pell-mell flight from a pack of wild dogs can mean more than bruises. A muscle tear or nerve damage can affect mobility and dexterity, and generate high levels of pain. These injuries take time to heal, and sometimes require special treatments or even surgery. So think carefully about how this type of complication might play out in the story. Your character might be damaged in a way that their recovery may not fit the timeline for conflict resolution.

Scar tissue. Everyone has a few scars, but what if your character’s reduces function in some way, or even disfigures them? What will this mean as far as their dexterity and range of movement, or how other people view them? Will it close doors because they’ve lost their edge as far as a skill goes, or reveal a lack of depth in their relationships because people can’t accept this change?

Extreme swelling. Injuries cause tissue to swell, and if this happens to a body part that is confined somehow (a swollen foot stuck in a boot, or a wedding ring cutting off circulation due to a broken finger), it can cause intense pain and the need for intervention to avoid losing the limb.

Improper healing. Sometimes a character can’t get help when they need it, and the injury starts to heal in a way that is less than ideal. Bones may not be fully aligned as they knit together, causing a limp or malformation. A deep cut that can’t be stitched in time can lead to an ugly scar, loss of sensation, and reduced function.

Fears or phobias being triggered. Characters who have suffered past trauma may have their deepest fears awakened when an injury occurs, especially if they are reminded of that painful experience. Or a phobia of doctors, hospitals, dying, or another fear can make them resistant to being treated.

Addictions. A character in recovery will not want to risk medication that could trigger a relapse. Instead, they may have to bear extreme levels of pain to stay drug free, or have no choice but to have drugs in their system so a surgery can be performed, or an infection is stopped before it can spread.

Making the injury worse. When there’s danger present or a character is faced with a ticking clock, they can’t take it easy. A strain the character must ignore to escape a threat can become worse if it isn’t treated. Over time, increased fatigue or reduced strength will make a character unstable and more prone to additional injuries, too.

Ideally, injuries should push characters to think of creative solutions to their problems.

When they do, it makes for great reading. Too, characters who don’t give up (even though they may want to) are the ones readers admire most!

Other Posts in This Pain Series:

The Three Stages of Awareness
Different Types to Explore
Describing Minor Injuries
Describing Major and Mortal Injuries
Invisible Injuries and Conditions
Factors that Help or Hinder the Ability to Cope
Everyday Ways a Character Could Be Hurt
Best Practices for Great Fiction