#BITING KILLING MAIMING SHAKING THE WRITERS

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[pacing hard enough to wear a groove in the floor] what the fuck does the first page of All Roads mean.

[aion-rsa]

The Public Enemy Solidified Gang Rule Under James Cagney for 90 Years

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William Wellman’s The Public Enemy (1931) turns 90 this weekend. When the film first came out, a theater in Times Square showed it nonstop, 24 hours a day, seven days a week. The movie marks the true beginning of gangster movies as a genre. Mervyn LeRoy’s Little Caesar may have hit theaters first, but The Public Enemy set the pattern, and James Cagney nailed the patter. Not just the street talk either; he also understood its machine gun delivery. His Tommy Powers is just a hoodlum, never a boss. He is a button man at best, even if he insisted his suits have six buttons.

The Public Enemy character wasn’t even as high up the ladder as Paul Sorvino’s caporegime Paul Cicero in Martin Scorsese’s Goodfellas. But Cagney secured the turf Edward G. Robinson’s Rico Bandello took a bullet to claim in Little Caesar, and for the rest of his career Cagney never let it go.

Some would argue genre films began in 1931. Besides mob movies, the year introduced the newspaper picture with Lewis Milestone’s The Front Page and John Cromwell’s Scandal Sheet; Universal Pictures began an unholy run of horror classics via Tod Browning’s Dracula and James Whale’s Frankenstein, with the two turning Bela Lugosi and Boris Karloff into household names; and Howard Hawks’ Scarface would land the knockout for the gangster genre, even if it didn’t get released until 1932.

Sadly, the classic “Gangster Film” run only lasted one production season, from 1930 to 1931, and less than 30 films were made during it. Archie Mayo’s The Doorway to Hell started the ball rolling in 1930, when it became a surprise box office hit. It stars Lew Ayres as the top mug, with Cagney as his sidekick. For fans of pre-Code Hollywood, it is highly recommended. It includes a kidnapping scene which results in the death of a kid on the street. Without a speck of blood or any onscreen evidence, it is cinematically shocking in its impact.

Both Little Caesar and The Public Enemy earned their street cred, defying the then-toothless 1930 Motion Picture Production Code, which preceded the Hays Code. After New York censors cut six scenes from The Public Enemy to clear it for release, the Motion Picture Producers and Distributors of America (MPPDA) set further guidelines for the proper cinematic depiction of crime.

Public Enemy director Wellman was an expert in multiple genres. He spit out biting satires like Nothing Sacred (1937) and Roxie Hart (1942), and captured gritty, dark realities in The Ox-Bow Incident (1943) and Story of G.I. Joe (1945). He won his only Oscar for A Star Is Born (1937). The Public Enemy is the first example of what would be his trademark: stylish cinematography and clever camera-work. The dark suspense he captures is completely different from the look of German expressionism. It captured the overcast shadows of urban reality and would influence the look of later noir films. His main character would inspire generations of actors.

“That’s just like you, Tom Powers. You’re the meanest boy in town.”

Orson Welles lauded James Cagney as “maybe the greatest actor who ever appeared in front of a camera.” Will Rogers said watching Cagney perform was “like a bunch of firecrackers going off all at once.” The New York City born performer explodes in this movie. Even in black and white, Cagney’s red hair flares through the air like sulfur on a match. It turns out to be a slow burn, which will reach its ultimate climax in 1949’s White Heat. The Public Enemy is loaded with top talent, but you can’t take your eyes off Cagney. Not even for a second. You might miss some tiny detail, like the flash of a grin, a wink, or a barely perceptible glare.

Cagney had a simple rule to acting: All you had to do was to look the other person straight in the eyes and say your lines. “But mean them.” In The Public Enemy, the characters communicate without lines. When Tom and Matt Doyle (Edward Woods) sneak a peek into Larry the Limp’s casket, we understand this is the first time the two young thugs lost someone their own age. The scene barely implies how fortunate they are not to be in that box, but their curiosity is as palpable as the loss of their last shred of innocence.

Cagney was originally cast as Matt, and scenes were shot with him in the role. The parts were switched mid-production, but they didn’t reshoot the flashback scenes, making it look like the pair swapped bodies between 1909 and 1915. It’s a shame because Frankie Darro, who plays the young Matt, made a career out of playing baby face Cagney, and later joined the East Side Kids franchise.

Former “Our Gang” actor Frank Coghlan Jr. took on the role of young Tom. He takes the lashes from his cop father’s belt, backtalking him the whole time. Tom Powers is reprehensible. He never says thank you and doesn’t shake hands. He delights in the violence and sadism. Powers doesn’t go into crime because of poverty; he just can’t be contained. Cagney’s mobster mangles, manhandles, maims and murders, and still needs more room in his inseam. 

Dames, Molls, and Grapefruits

Besides defying the ban on romanticizing criminals, both The Public Enemy and Little Caesar broke sexual codes. There are explicit signs that Rico Bandello represses his sexuality in Caesar. Scenes between him and his friend Joe, and his gunman Otera, thinly veil homoerotic overtones. Public Enemy’s Powers, by contrast, subtly encourages the gay tailor who is openly hitting on him.

There are strong indications Putty Nose (Murray Kinnell) is grooming Tommy and Matt for more than just fenced goods. Look at the way Putty sticks his ass in Powers’ face while he is shooting pool. Putty Nose’s execution at the piano is creepily informed by the unspoken sins between the men. Tommy relishes the kill.

However, Tommy doesn’t relish being manhandled when he’s too drunk to notice. While the gang goes to the mattresses in the movie’s gang war, Tommy is raped by Jane (Mia Marvin), his boss Paddy’s girl. Powers protests the best he can, but the camera angles leave no doubt. Tommy wakes up hungover, horrified, and feeling impotent. Matt, however, has no trouble getting “busy” with his girlfriend Mamie, played by Joan Blondell, in one of the scenes trimmed by the censors.  Blondell, Jean Harlow, and Mae Clarke, who plays Tommy’s girlfriend Kitty, represent a glitzy cross-section of white Roaring Twenties glamour. In the opening credits, when Harlow and Blondell smile at the camera, male audience members of the time blushed.

Harlow was Hollywood’s original “Blonde Bombshell,” starring in the movie that coined the term. Her earthy comic performances would make her a major star at MGM, but she was a dud to critics of The Public Enemy. Hers was the only part which was criticized, and the reviewers were brutal, declaring her voice untrained and her presence boring.

Harlow’s greatest asset had to be contained within the Pre-Code era. Straddled with a wordy part as a slumming society dame, she is directed to slow her lines to counter the quick patter of the rest of the cast. Yet Harlow uses that to her benefit in the film’s best moment of sexual innuendo. While telling Tommy about “the men I’ve known,” she pauses, and appears to be calculating them in her head before she says, “And I’ve known dozens of them.” When an evening alone with Tommy is cut short, Gwen’s exasperation over the coitus interruptus is palpable. Members of the Catholic Legion of Decency probably had to go to confession after viewing the film for slicing.

Most people know The Public Enemy for the famous grapefruit scene where Powers pushes a grapefruit into his girlfriend’s face. “I wish you was a wishing well,” he warns, “so that I could tie a bucket to you and sink ya.” Tommy treats women like property. They are status symbols, the same as clothes or cars. Kitty’s passive-aggressive hints at commitment get on Tom’s nerves. He can only express himself through violence. There are rumors Cagney, who would go on to rough up Virginia Mayo in White Heat and brutalize Doris Day in Love Me or Leave Me, didn’t warn Clarke he was going to use her face as a juicer. According to the autobiography Cagney by Cagney, Clarke’s ex-husband Lew Brice loved the scene so much he watched it a few times a day, timing his entrance into the theater to catch it and leave.

Both actors have said it was staged as a practical joke to see how the film crew would react. It wasn’t meant to make the final cut. Wellman told TCM he added it because he always wanted to do that to his wife. The writer reportedly wrote the scene as a kind of wish-fulfilling fantasy.

The screenplay was written by Harvey F. Thew. It was based on Beer and Blood by John Bright and Kubec Glasmon. The unpublished novel fleshed out press accounts of the bootlegging Northside gang leaders, Charles Dion “Deanie” O’Banion, Earl “Hymie” Weiss, and Louis “Two-Gun” Alterie. Cagney based his Tommy Powers character on O’Banion and Altiere. Edward Woods was doing his take on Weiss. The book reflected the headlines in the Chicago papers, which reported Weiss smashed an omelet into his girlfriend’s face.

Read more

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By Tony Sokol

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Key Largo, Lauren Bacall & The Definitive Post-War Film

By David Crow

The Trouble Squad

The Public Enemy borrowed from the day’s headlines in other ways too. Hymie Weiss was assassinated in October 1926. It was the first reported “machine-gun nest” murder. It is recreated in the killing of Matt Doyle. While shooting the sequence, Cagney ducked real machine gun fire to bring authenticity to the scene. Also taken from real life is the fact that after O’Banion was killed in ‘24, Alterie’s first reaction was to do public battle with the killers. This is similar to Tommy’s final shootout at Schemer Burns’ nightclub headquarters.

Leslie Fenton’s dashing mob captain Nails Nathan (“born Samuel”) flashes the greatest grin in mob movie history. He is based on Samuel “Nails” Morton, a member of O’Banion’s mob. Both “Nails” were driven to their coffins the way it is depicted in The Public Enemy. The real Morton died in a riding accident in 1923, and “Two-Gun” Alterie and some of the other gang members went back to the stables, rented the horse which kicked Nails in the head, and shot the animal. Mario Puzo may have been inspired by this scene when he wrote The Godfather. It is not only tie to the Francis Ford Coppola movie. Oranges have as much vitamin C as grapefruits. Another similarity between the two films is the threat of being kidnapped from the hospital by a rival gang.

The Powers brothers’ relationship vaguely echoes the one between war hero Michael and Sonny Corleone, who believes, as his father does, soldiers were “saps” to risk their lives for strangers. Donald Cook, who played Mike Powers, didn’t pull any punches on the set. In the scene where he knocks Tom into the table before going off to war, he really connects. Wellman told Cook to do it without warning so he could get that look of surprise. Cook broke one of Cagney’s teeth, but Cagney stayed in character and finished the scene.

“It is a wicked business.”

After the stock market crash, get-rich-quick schemes seemed the only way through the Great Depression. The gangster was an acceptable headline hero during Prohibition because the law was unpopular with the press. But after 1929, the gangster became the scapegoat villain. The Public Enemy was the ninth highest grossing film of 1931. But the genre lost its appeal after April of that year, as studios pumped out pale imitations and audiences got tired of the saturation, according to the book Violence and American Cinema, edited by J. David Slocum. Religious and civic groups accused Hollywood of romanticizing crime and glamorizing gangsters.

The Public Enemy opens with a dire warning: Don’t be a gangster. Hoodlums and terrorists of the underworld should not be glamorized. The only MPAA rule the film didn’t break was portraying an alliance between organized crime and politics. The studios passed the films off as cautionary tales which were meant to deflate the gangster’s appeal by ridiculing their false heroism.

Through this hand-wringing, however, Cagney turns false heroics on its head with the comic brilliance of a Mack Sennett short. Stuck without a gun, he robs a gun store armed with nothing but moxie. Powers never rises in the organization. He takes orders and whatever the boss says is a good cut, only asking for more money once from Putty Nose. Unlike Rico, who rose to be boss among bosses, Powers has no power to lose. This is just the first gig he landed since he was a regular “ding ding” driving a streetcar, and it connected with audiences like a sock on the button. They identified with the scrappy killer, and it surprised them.

Even Gwen notices Tommy is “very different, and it isn’t only a difference in manner and outward appearances. It’s a difference in basic character.” Strict Freudians might lay this on his mother (Beryl Mercer), the greatest enabler Cagney will see until White Heat. Ma Powers’ little boy is a budding psychopath knocking off half the North Side, but look at the head on his beer. For audiences at the time, Tom was the smiling, fresh-scrubbed face of evil. He is consistently unsympathetic but likable from the moment he hits the opening credits.

Like Malcom McDowell’s Alex in A Clockwork Orange, he is the fiend’s best friend. Even if it is Tommy’s fault his best pal Matt gets killed. While Cagney spent his career ducking his “you dirty, double-crossing, rat” line from Taxi, the actor wasn’t afraid to play one in Powers. He’s not a rat in the sense he’d snitch on anyone. He’s the last of the pack who sticks it out for his pals when his back is up against the wall.

A Hail of Bullets

Tommy Powers goes by this credo: live fast, die young, and leave a corpse so riddled with bullets, not even his mother can look at his body when he’s done. But then, no one can end a film like Cagney. He’s danced down the White House stairs in Yankee Doodle Dandy (1942), been rolled across the concrete steps of a city church in The Roaring Twenties (1939), and was blown to kingdom come in White Heat. He gets two death scenes in The Public Enemy, a rain-soaked climax, and a denouement as scary as The Mummy. Tommy only brings one gun to the gang fight, and by the time he hits the pavement, he’s got more holes in him than the city sewage system.

“I ain’t so tough,” Tommy says on his final roll into the gutter. Cagney’s first professional job was in a musical drag act on the Vaudeville circuit, and he called himself a “song and dance man” long after retirement. For The Public Enemy, conductor David Mendoza led the Vitaphone Orchestra through such period hits as “Toot Toot Tootsie (Goodbye),” “Smiles,” and “I Surrender Dear.” But the song “I’m Forever Blowing Bubbles” is the one which lingers in the memory. Martin Scorsese has cited it as a reason his films are so filled with recognizable music.

Street violence comes with a natural soundtrack. Transistor radios accompany takedowns. Boom boxes blast during shakedowns. Car stereos boost the bass during drive-by shootings. In The Gang That Couldn’t Shoot Straight, mobsters feed quarters into a jukebox to cover up sounds of a beating.

In The Godfather, Part II, a street band plays traditional Italian songs while Vito Corleone puts bullets in the neighborhood Black Hand, Don Fanucci. The last thing we hear in the abrupt close to the mob series The Sopranos is a Journey song. The first thing Tommy’s mother does when she hears her boy is coming home from the hospital is drop a needle on a record.

The ending leaves us with two questions: Who killed Tommy, and what’s his brother going to do about it? We figure whoever did the job on Powers was probably a low-level button man from Schemer’s rival outfit. Probably even lower down the ladder than Tommy, and on his way up, until another Tommy comes along. Crime only pays in the movies, Edward G. Robinson often joked.

Mike’s reaction to the bandaged corpse is ambiguous. He’s already shown outward signs of the trauma following the horrors of war. Is he clenching his fists in anguish or anger? Is he broken by the battlefield or marching off in vengeance, a soldier on one last duty? Cook’s exit can go either way.

After 90 years, The Public Enemy is still fresh. It’s aged better than Little Caesar or Scarface. Cagney wouldn’t play a gangster again until 1938, but the image is etched so deeply in the persona, audiences forget the vagaries of villainy Hollywood could spin, and the range of characters Cagney could play. He and the film continue to influence filmmakers, inform culture, and surprise audiences. Tommy Powers was just a mug, but those streets are still his.

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[scriptmedic]

Injury Profiles: Concussion

Welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends. 

Today we’ll be talking about Concussions. For the rest of the Mangled Mondays series, [click here].

Lethality Index

1 – nonlethal unless this is a misdiagnosis of a more severe injury

What Is It?

A concussion is a form of trauma to the brain, wherein the brain bounces off the inside of the skull, caused by blunt-force trauma.

A concussion is a form of traumatic brain injury (TBI), known as a Mild TBI, or mTBI. Typically, an mTBI comes with a brief period of unconsciousness (0.5–5 minutes). The length of unconsciousness is often an indicator of the severity of concussion, though not in all cases.

Concussions are the mildest form of traumatic brain injury. Two other entries in this book are labeled TBIs: epidural hemorrhage and subdural hemorrhage (EDH and SDH, respectively).

It’s important to understand the big difference between these injuries. While a concussion may cause some injury to the brain, mostly because of swelling after the impact, a concussion doesn’t cause bleeding inside the skull, while the other two are defined not by the presence of bleeding but by its location.

  In the moments after a head injury, it can be downright impossible for a character to tell the difference between these three common head injuries. All three can cause a loss of consciousness; all three can cause seizures due to the impact; all three can cause disturbances in memory or coordination.

The difference is that in a concussion, the character generally improves, starting at about the 24-hour mark; bleeding in the brain may kill a character with EDH or SDH by this time.

  Characters who have sustained a concussion will likely not remember the exact cause of it. That’s because the head strike interferes with memory. They’re likely to ask “What happened?” repeatedly, because they may not be able to remember the answer.

It’s also not uncommon for a character to seize after their concussion. This is because the brain has struck the skull and caused itself some disruption; electrical activity fires randomly across the brain from place to place.

The seizure, if it occurs, will likely be fairly short – typically less than a minute – but may be longer. The shaking or spasms will likely involve the whole body (clonic), and there may be a period of rigidity beforehand (tonic). This is what used to be called a grand mal seizure, which is French for big bad seizure. The character may urinate, defecate, or bite their tongue; in the absence of a witness to the event, any of these will be taken as evidence of a seizure by responders and by providers.

After a seizure, it can take between 5 and 15 minutes for the character to regain consciousness, and they will do so slowly and gradually, with various levels of disorientation. This phase is called the postictal phase. Characters won’t know where they are or what has happened, and may behave violently (even normally nonviolent characters may do this; it’s known as postictal psychosis).

  It’s also quite possible for a character to have a concussion without losing consciousness. This happens frequently in low-speed collisions such as head-to-head sporting injuries, with American football producing a great many “conscious concussions.”

  Clinical Signs

Loss of consciousness immediately upon impact.

Disorientation or dazed appearance.

Possible loss of bladder and/or bowel control and biting of tongue.

Difficulty retrieving old memories (retrograde amnesia).

Difficulty storing new memories (anterograde amnesia).

Due to anterograde amnesia, the character may repeat the same question numerous

Pupils are equal on examination.

Possible swelling or cut at the impact site.

  Symptoms

Headache.

Confusion.

Sleepiness.

Inability to recall the injury or events leading up to it, or events afterward.

Nausea and one or two instances of vomiting.

Repeated vomiting, or worsening nausea after a few hours, are warning signs of intracranial hemorrhage (moderate to heavy bleeding inside the skull).

How Does It Happen?

A concussion usually occurs…

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The brain is a gelatinesque structure inside the cranium (skull). When the head strikes an object, the brain continues moving. A concussion is the result of the brain colliding with the interior aspect, or surface, of the skull.

It’s even possible to have a concussion without the head itself striking anything; severe whiplash (a sprain or strain of the neck) can cause a concussion.

Immediate Treatment

Field care for the concussion may involve the following:

Removal of a threat, such as eliminating attackers.

Ensuring that the character is in a safe place.

Treating the seizure by rolling the character onto their side, protecting their head from any hard objects nearby, and allowing them to seize. Nothing should be placed in the character’s mouth, because of the risk of choking, vomiting, and aspiration.

Characters who try to stand up may be encouraged to stay down until the worst of their dizziness passes.

If available, supporting characters will likely want to summon professional medical help (send for a doctor or call 911, as the setting permits.)

Characters playing sports should not be permitted to continue the game after a head injury that is, or is likely to be, a concussion. Of course, neither stories nor real life always match what should

Definitive Treatment

Surgery

Concussions do not require surgery, though overlying injuries such as skull fractures might.

  Hospitalization

Concussions per se do not require hospital admission. They do, however, require evaluation in the emergency department, if one is available.

A character presenting to an ER with a concussion will get a neurological evaluation by an ER doctor. (The doc is likely not to need a neurologist to make a correct diagnosis, but may ask for a consult anyway.)

The doctor or provider may then order routine bloodwork and a CT scan, to rule out a direr brain injury (such as an epidural, subdural, or subarachnoid hematoma, the first two of which make up the next two entries in this book). Blood sugar will also be checked to make sure hypoglycemia isn’t present.

The “may order” above refers to the fact that some concussion patients don’t get scans. It’s realistic for a character to either get a scan or not get one; for the exact guidelines, search for the Canadian Head CT rules. However, as a writer, I say “go for whichever works best for your story.”

  If the character suffered a scalp laceration during the concussion, this may need sutures (stitches) or staples. If they have a skull fracture, this will be apparent both clinically and on the CT scan. In fact, it’s an excellent reason for a doctor to order a CT scan. Most skull fractures do not require surgery.

The character can safely be discharged home if there is someone around to care for them for the night. That person will be given instructions to wake the patient up 3–4 hours after falling asleep to make sure that they can be woken up and can answer questions coherently.

There is no value to forcing the character to stay awake; this is a misconception of Hollywood. Rather, the character should be woken only to check and make sure their neurological state isn’t deteriorating in their sleep, which would be a marker of a subdural hemorrhage (SDH).

  In the Austere Environment

Caring for a concussed character outside of a hospital setting will involve an initial evaluation and close observation to make sure they’re not getting worse. There are no real interventions to encourage healing except for allowing the character to rest. This especially means brain rest; the character should avoid stimulation with screens, loud music or noise, stress, excess fatigue, etc.

Headache may be treated with acetaminophen (Tylenol) but not ibuprofen (Advil / Motrin) or aspirin, as the latter can encourage bleeding.

If the character has a significant scalp laceration, the wound should be cleaned with water and closed with sutures (a fishing hook and line work well). Superglue is usable but not ideal, as it can damage the skin. It is, however, effective.

The Rocky Road to Recovery

Capabilities Retained

The character will retain all motor skills, though may have some trouble with balance and may have some transient difficulty with exceptionally fine motor skills. The character will remember who they are and the identities of key individuals.

  Disabilities: Temporary

Symptoms after a concussion typically get better within a week, though in some cases, they can last far longer.

Retrograde amnesia is the inability to remember events prior to the injury. This does not include identity amnesia — the character will retain memories of who they are. However, they may not remember the hours, days, or weeks leading up to the concussion.

Anterograde amnesia is the inability to form new memories after the event. This affects everything from remembering where they are (in a new setting) to keeping promises and obligations they’ve made since the injury, since the character doesn’t remember making the commitment. Notebooks and calendars are very helpful for characters suffering anterograde amnesia beyond the first day or two.

Anterograde amnesiacs will often ask the same question repeatedly, even if it’s been answered, because they are unable to recall that their question was asked, let alone answered.

Anterograde amnesia typically lasts for the first 12 to 72 hours after the injury.

Executive dysfunction is a broad term for difficulty with certain aspects of cognition, including maintaining focus, managing time, planning, organizing, prioritizing, etc. Executive dysfunction may mean that characters become easily distracted, behave inappropriately, or are unable to go to work or to school.

  If you’d like some story time, my own mTBI in high school obliterated memories of the day. I stored only 5 memories from the moment of my injury through the end of the day. I remember waking up afterward and seeing blood on my hand and being worried; I remember talking to the school nurse and being afraid that she’d figure out I had a pocket knife that I wasn’t supposed to have; I remember someone in the ER cutting off my shirt; I remember waking up in the car on the way home and being cold under my hoodie; and I remember waking up on the couch and trying to watch Lord of the Rings and put on mac’n’cheese. (I burned the mac’n’cheese.) I was very tired the following day and stayed home, but I was back to school on the day after.

  Disabilities: Permanent

Concussions typically have no long-term effects.

However, post-concussion syndrome (PCS) is a possible outcome, in which your character may experience some — but not necessarily all — of their “temporary” disabilities for weeks, months, or years after the fact.

  Features of Recovery: Hospital Stay

Characters suffering a concussion with neurological symptoms that are worse than expected will likely be kept overnight for observation, but most characters can go home the same day as their injury, provided they have someone to watch out for them.

Supporting characters will be told to keep an eye on the afflicted, and to wake them every 4 hours for the first 2 days to ensure that they can be woken. (If they cannot be woken, they are likely suffering from a different type of head injury called a subdural hematoma.)

While characters suffering PCS may return to the hospital for follow-ups, they will not be admitted unless their condition worsens severely.

The New Normal

Characters who sustain concussions will, in the absence of post-concussion syndrome, be neurologically intact and recover to their baseline. (No Disability.)

Characters who develop PCS will have some lasting disability. (Partial Disability.) Over time and with support and occupational therapy, they may develop systems to aid them with their ongoing symptoms. These may involve note-taking and journaling.

  Future Risks

Characters who incur multiple head injuries over the course of their lifetime may suffer significant neurological trauma from it, even if no one instance is particularly dire. This is known as repetitive head injury syndrome (RHIS). It is also called chronic traumatic encephalopathy, or CTE, and is a common condition among boxers and players of American football.

RHIS affects neurocognitive function, including IQ, reaction time, increases aggressive behavior, and more. RHIS also places your character at significantly elevated risk of depression at all ages, as well as dementia, specifically Alzheimers, as they age.

Worse, RHIS puts your character at risk of sustaining more head injuries! The threshold for an impact to damage the brain is lowered significantly.

  In extremely rare cases — only 17 have ever been reported and another 18 suspected — a character who receives a second brain injury while recovering from the first may collapse and die within minutes. This is known as second impact syndrome (SIS). It’s suspected that SIS has to do with the way blood vessels dilate and shrink during recovery, but there haven’t been enough cases to know for sure.

Total Recovery Time (Typical)

Mild: 1 day to 1 week

Moderate: 1–2 weeks

Severe: months to years

Sensory

Sights: The character may or may not have any external sign of injury. They may get a “goose egg” (hematoma, a “bump” of pooled blood under the skin), a scalp laceration, or nothing at all.

If they seize, the character will have uncontrolled movements of all extremities. They may bite their tongues, and may lose consciousness. If they lost continence, their garments may appear wet from the urine.

Sounds: There should be some sound as the injury occurs, such as, a smack, a whack, or even a crunch.

Smells: If the character lost continence during the seizure, they’ll smell of urine or feces.

Tastes: If the character seized and bit their tongue hard enough to bleed, they will taste blood in their mouth. The character may not taste significantly different to an outside observer.

Medslang

A neurological exam would be called a “neuro exam.”

A doctor muttering to themselves might say the “cranial nerves are intact.” This refers to a set of nerves that control facial muscles and are not a part of the spinal cord.

“Pupils symmetric” refers to the pupils being equal in size. They may also be said to be PERRL: pupils equal and round, reactive to light.

The character’s level of consciousness is measured with the Glasgow Coma Scale, which produces a score ranging from 3 to 15. (A paper clip has a GCS of 3, as do brain-dead humans. A GCS of 15 is normal, and a person who can open their eyes on their own and follow commands but is confused has a GCS of 14.) When spoken out loud, GCS is spelled out: gee-see-ess.

Key Points

Your characters will most likely lose consciousness, but don’t have to.

One of the features of concussions is that they do not worsen after the injury. Characters should steadily improve.

Memories of the event, and hours to days before the event, may be lost (retrograde amnesia).

The character may not be able to store some or any memories from after the event (anterograde amnesia).

Characters should recover fully, but may have symptoms that last for a long time (post-concussion syndrome, PCS).

Characters who suffer multiple concussions over time may have significant brain damage because of it (repetitive head injury syndrome, RHIS).

In extremely rare cases, a character who suffers a second head injury while recovering from the first may suffer extremely rapid deterioration and death (second impact syndrome, SIS).

xoxo, Aunt Scripty

[disclaimer]

This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.

Signed print and digital editions of the book are available for preorder [on IndieGoGo] through 10/15. Unsigned digital editions are available on [Amazon] and [everywhere else].

Injury Profiles: Concussion was originally published on ScriptMedicBlog.com