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synicalhorrors · 12 days ago

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A Deep Dive into Curly's Injuries

CW: Medical discussion and graphic themes.

I see a lot of people discussing Curly's injuries in the fandom and I thought that I would take some time to absolutely word vomit information for consideration as someone training in the medical field.

Burns and Calculating Total Body Surface

Starting off simple, we’ll discuss the following burns:

First degree burns only affect the outer layer of the skin (epidermis). Second degree burns, or partial thickness burns, affect both the epidermis and part of the layer underneath (dermis). Third degree burns, or full thickness burns, affect all layers of the skin, fat, and muscle. Third degree burns DO NOT HURT as they destroy the nerves.

Typically you will not see significant 4th degree burns premortem- they are often postmortem and resemble more of a char. The body is basically cremated/incinerated. I'll touch more on this further down.

The rule of nines is the method for estimating the percentage of affected body surface (size of the burn). I used this to roughly estimate that Curly is burned anywhere from 82-91% of his total body surface. We don't see his backside, but assuming he walked into the cockpit before the crash it is POSSIBLE that his backside isn't as burnt.

Note the R-Baux score and prediction of burn-related mortality (TBSA – Age + [17 x R] TBSA: total body surface area R: 1 (Inhalation injury) or 0 (No inhalation injury)

Amputation Possibility and Weight of Risk

While there are a lot of factors to keep in mind when it comes to Curly’s condition and subsequent survival, in order to connect reality and canon the following needs to be considered.

We'll go over two of the most popular interpretations post-crash:

1. Anya performing amputation as a preventative measure.

We have to think about the veins and arteries in the human body when discussing rudimentary amputation.

Note: Arteries carry blood away from the heart to the body, while veins carry oxygen-poor blood back to the heart. Arteries and veins are connected by capillaries. Direction as follows:

Risk to major arteries and veins would potentially result in excessive blood loss (we will focus on arteries since they are larger in diameter and their ability to withstand high pressure from pumping blood). Repairing arteries typically requires surgical intervention.

Curly's right arm ends at the wrist, while his left ends midway up the forearm. This would sever the radial and ulnar arteries.

Curly's right leg ends just below the knee. The popliteal (back of the knee) artery is the continuation of the femoral artery- one of the largest arteries in the body.

Curly's left leg ends about midway down his calf. We can assume that severs the posterior and anterior tibial arteries.

The image below is a quick edit and isn't an accurate representation of location, only a rough diagram.

Note: The legs network of small arteries are available to SOMEWHAT compensate for blood flow if one of the major arteries is damaged, but it likely wouldn't be enough to prevent excessive blood loss.

We CAN consider cauterization in emergency situations; however it would require some ingenuity and a significant heat source. Small tools that could be repurposed to cauterize Curly’s wounds would do more harm than good, and it is likely that Pony Express has banned large, heat producing objects. They ARE on a space freighter with artificial gravity and set oxygen levels, after all.

Lack of proper equipment and medical knowledge would make amputation unsurvivable.

2. Curly's limbs were eviscerated by the crash.

This is where we talk more about the possibility of fourth degree burns and what that means.

Fourth degree burns are the most severe type of burn that affects muscles, tendons, and bone.

Where to position Curly in the cockpit during the crash is… tricky.

It’s difficult to imagine the angle he would need to be in order to sustain full body burns and loss of limbs. This is the part I pondered the most, and I think a good explanation would be electrical burns from the control panel on impact.

Electrical burns are carried by nerves because it is the path of least resistance. Extremities are more susceptible to damage when a current passes through them. (Yes, this means his genitals are gone too. Sorry, folks!) *See article on electric extremity injury under Read More

Facial Injury and Eye Trauma

Moving towards Curly’s face we come back to our discussion of third degree burns, which I’ve explained a bit above. I do want to note that the survival of his left eye interested me the most while compiling this post.

Your eyes don’t melt in extreme heat (goofy ahh Indiana Jones shit).

Your eyes are mostly composed of water, which makes them resistant to combustion. Since we never directly see the eye socket beneath the bandaging it’s reasonable to assume that his right eye is not entirely destroyed but instead severely damaged (flattened, scarred, cloudy). Without eyelids or even eye drops his remaining eye would dry, potentially blinding him if the heat on impact didn't.

Another point of interest is Jimmy manually manipulating Curly’s mouth several times throughout the game.

This rounds back to third degree burns and the damage to the superficial masseter muscle (moves the lower jaw upward – mastication, or ‘protrusion of the mandible’), the deep masseter muscle (retraction of the mandible – mastication, or ‘closing the jaw with force’), the temporalis muscle (mastication, enabling jaw movement for chewing, biting, and grinding), and surrounding tendons.

Knowing this, a ‘slack jaw’ position would cause visible oral damage like dry mouth and halted saliva production. I’ll touch more on this below.

Loss of Skin and Infection

The skin is the largest organ in the human body with a variety of life sustaining functions like protection and excretory function.

In Curly’s condition, the loss of his skin leaves him open to systematic infection. Skin protects against infection by producing antibacterial substances (defensins and cathelicidins), which greatly increase when injury or inflammation are present. Without skin your body's natural defenses no longer protect against bacteria.

Pathological vulnerability is the key factor in this section. A severe and sometimes fatal response to infection (sepsis) would likely occur under these conditions without proper medical care and antibiotics.

Administering Water, Food, and Medication

This section is where some interpretation comes into play.

The average healthy person can survive approximately three weeks without food and 3 days without water (both vary greatly). According to the games timeline he was kept alive in this state for four months, which means that somehow, in some way, they were able to get him enough nutrients for basic human survival.

This was likely in the form of paranutrition bags and IV fluids since Curly does not seem to have the ability to move his mouth or swallow on his own. When your mouth is kept open for extended periods of time you stop salivating as frequently because the act of swallowing, triggered by the build-up of saliva, is no longer happening.

When having medication administered, Jimmy can be seen (or more so heard) shoving the pills down Curly’s throat with his fingers.

I can’t help but speculate that additional damage was done to his esophagus and vocal cords since there isn’t a way to push the pills far enough down to avoid the steady breakdown of the medication in his throat.

Without properly swallowing pills Curly most likely developed pill esophagitis (irritation of the esophageal lining), which causes painful acid reflux.

Speculation of Internal Injury

This is more presumptive than other sections.

Due to previous notes regarding the source and nature of Curly’s wounds, it is reasonable to assume that not only is smoke inhalation a contributing factor, but ash, technological equipment, and shrapnel also run the possibility of entering his lungs on impact.

However, when I was looking into photos of the cockpit post-crash it brought another potential inhalation/consumption risk to mind; the expanding foam.

It is known that it expands to cover potential weak spots in the ship, so the strength of the substance needs to withstand the pressure of space and maintain the artificial gravity. The cockpit is covered in it, so it is possible that in some way Curly was physically in contact with it when the crash occurred.

Whether he ingested or inhaled it something to consider, but externally there must have been some effort removing the foam from his already burnt skin.

So, what does this mean, Leo? What’s your point?

Well, there is no real point to be made. Everyone is going to interpret things differently! I just thought it would be cool to put forth some real world medical knowledge and compare it to canon! I AM STILL IN TRAINING and I have a lot to learn, but I wanted to put something together for you guys! You can take something from it, or nothing at all!

Final Notes:

Realistic Prognosis (prediction of outcome):

Without medical treatment total body third degree burns are NOT SURVIVABLE.

Extended periods of festering and infection would make skin grafting impossible (There is some wiggle room with this depending on how you perceive medical care to have changed- but I do think it's important to consider the limits of the human body).

🖤 If you made it to the end, thank you for reading! 🖤

Thank you so dearly to my love, my life, @13nn0x for the help compiling information and just generally being the sexiest person alive.

Some extra articles to refer to:

Note: Some articles include images but I put a warning on the ones that do.

(CW: Includes Photos) Clinical spectrum of electrical burns - A prospective study from the developing world by Ashok Kumar Sokhal, Krishna Lodha, and Rajkumar Paliwal. LINK

(CW: Includes Photos) Electro-Amputation of Lower Limbs Due to a High-Voltage Shock: Report of an Unusual Case by Suraj Sundaragiri, Senthil Kumaran M, Venkatesh Janarthanan, Chaitanya Mittal, Gerard Pradeep Devnath S. LINK

Ocular Burns by Gregory C. Patek, Amanda Bates, and Allison Zanaboni. LINK

Drug-Induced Esophagitis by Fatima Saleem and Ashish Sharma. LINK

Better among the two for Burn Mortality Prediction in Developing Nations: Revised Baux or Modified Abbreviated Burn Severity Index? by Sheerin Shah, Renu Verma, Rajinder K Mittal, Ramneesh Garg. LINK

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