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My Sword Sings - Book One - 'My Sword' Series  by Agape4Gondor 6 Review(s)
SurgicalSteelReviewed Chapter: 35 on 11/7/2006
It's not so much that water increases blood flow - warm water (higher than body temp) can raise your heart rate and increase blood flow, cold water (I'm imagining fountains wouldn't be warm) would tend to slow the heart rate. But being in the cold water makes you hypothermic (medicalese for cold) and makes the clotting factors in the blood not work so well. But truly, someone could bleed to the point of nearly irreversible shock withing minutes from the injury you've described - and even if you assume a roughly mid-1800s level of medical knowledge (which I do in my writing) and that folks know enough to replace lost blood with saline or even attempt blood transfusions, outside of either the Houses of Healing or a well-organized medical camp, you're not likely to have the resources to reverse shock immediately available.

*shrugs* It's not just that I'm a surgeon, I'm also fascinated with medical history, have read a Civil War era text for Army Surgeons, and am working my way through Larrey's 'Memoirs of Military Surgery.' I'm geekly that way. ;)

SurgicalSteelReviewed Chapter: 35 on 11/6/2006
Surprisingly to many, you can in fact survive having a carotid ligated. There's a rich collateral network at the base of the brain called the Circle of Willis which is fed by both internal carotid arteries and the two vertebral arteries. As long as it's intact (not damaged by years of atherosclerosis, etc), you can sacrifice three out of four vessels and still have enough blood flow to the brain for normal function. Same for the jugular - rich collaterals drain the brain, so you can ligate one and the blood flow should preferentially drain out the other side. You may get swelling on that side of the face short term, though.

It'd be the blood loss without fluid/blood replacement that'd get people. You can bleed to death in a matter of minutes from that sort of injury.

Author Reply: Well, since you've offered... since I hadn't know about ligating and such - I'm wondering... after his neck was sliced... he fell into the pool... doesn't water increase the blood flow... wouldn't he be more prone to bleeding to death because of being in the fountain for many moments???

SurgicalSteelReviewed Chapter: 35 on 11/5/2006
Ligating a vessel is basically just tying it off above and below the injury - or we'll say 'clamp clamp cut tie tie.' Clamps on either side of the injury, finish dividing it, tie around both clamps. The injury you describe is *potentially* survivable, but unlikely to be survived, if that makes sense. A few would survive it, but it sould be rather unlikely, esp. if he'd lost a lot of blood prior to trying to repair the injury. Hemorrhagic shock alone could kill a person.

And if you have any medical questions, I'm happy to help in any way I can. Ask half my f-list on LiveJournal, I'm more than happy to play medical beta if anyone needs one. surgsteel@hotmail.com. :)

Author Reply: Thanks so much for the kind offer. I will 'bug you' when needed.

As for this - I think the sword cut his jugular veing and the carotid artery and I really can't see him surviving that - can one really clamp off the jugular vein, the carotid?

That's why I had the poor healer trying to sew the carotid back together...


SurgicalSteelReviewed Chapter: 35 on 11/4/2006
Minor medical issues here - by having someone *repair* rather than *ligate* a vascular injury, you're assuming a very high level of medical knowledge and expertise - one that wouldn't have been widely available until the 1900s. As recently as WWII, standard practice was to ligate injuries even to the carotid and the jugular, and I've personally ligated someone's inferior vena cava.

Otherwise, nicely done.

Author Reply: Thanks SS for the review...

This chapter absolutely blew me away because there was NO way that the end result was going to be what it was.

But then a nurse-friend of mine told me that no one could have survived the blow as I described it... so I had the surgeon do what he could... what I thought was the only remedy - not having the surgical background that you have... I didn't know anything about ligate - I've got to go to the internet and find out what on earth that is....

As for the descendants of Numenor - I give them huge credit for all kinds of stuff - a people who could build Minas Tirith, the impregnable tower at Nan Curunir, and the Argonath - were capable, IMHO, of doing just about anything!

If I could have saved..... oh dear - but that definitely means the sequel would not exist as such... and I think the muse definitely decided Faramir was STILL going to be Steward - no matter what!

Thanks for reading - and know I agonized over these last few chapters.

Raksha The DemonReviewed Chapter: 35 on 10/17/2006
And tragedy strikes even in the hour of victory. I wonder if Indis will blame herself for Boromir's death, though she probably will be too busy to think much about it for awhile.

Poor Grimbold.

Is Captain Hurin the same Hurin of the Keys seen in ROTK (the book)? I always thought he might be a distant relative of Denethor.


LarnerReviewed Chapter: 35 on 10/12/2006
I am in grief, Agape, for this apparent double loss. I hope they find the one who sponsored this, and it would be wonderful (if it is indeed Saruman) to make him pay NOW.

Author Reply: Larner - forgive my lateness in the reply.

I went around the house for days after writing these last two chapters... my heart was broken. I had not meant for this to happen. Not in the least, but Boromir did not duck. I could not help him.

Then a nurse friend of mine told me the wound was too grievous for repair...

There is a light at the end....(I hope)

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