Just so you are given fair warning, this is the big disaster that really sparks the main conflict of my story. So, it's not a huge spoiler, but it is one.

My protagonist James, is a 21 year old orchestral violinist. He is fairly active both from practicing (It is physical activity!) and helping his grandparents maintain their land during the summers. Here is my medical timeline so far:

1. Someone does something to spark all of this. I'm not sure yet if a blood thinner or a blood pressure med like Midodrene would be best, or if there is another root cause I could explore. Basically he gets knocked out, and something is administered that said bad guy thinks will make it look like he died from an existing medical condition - that he had a brain aneurysm or stroke or something, then fell, hence the head injury.

My protagonist is found and brought to the hospital, treated for concussion, no further problems found because said bad guy works in the hospital and switches out James' blood with his own before the blood test is run. Information curtesy of my sister who works in blood bank - it would be easy to do.

Goal: find something he could administer that would have a delayed enough effect he would be released as fine, but to be watched as you would with a standard concussion. It is only known that he was knocked out.

2. At some point the next day (?) he notices a bit of right hand weakness (I will likely express this with him having difficulty bowing some passages while he practices.), but nothing else. His friends see that something is wrong, he just doesn't seem present, and convince him to go to the ER. An MRI shows he is having a stroke, but there aren't any severe symptoms. The next morning-ish the ER doctor releases him because he is walking and talking and seems fine.Starting with point 2, I'm actually using a real event I heard from the person it happened to.

Goal: Portray the order of tests, etc. accurately. They can't find the root of the problem yet for my plot, so if the root cause would have shown up I may end up needing to combine this somehow with point 1. Said bad guy is in jail at this point, so he won't be able to do anything else to instigate things.

3. For three days there isn't any change in how he is feeling, then at the end of a concert there is a sudden rush of symptoms : Sudden, intense headache; inability to comprehend his sheet music; nausea/vomitingI may take that out because it's gross... or just try to mention it in a non-gross way... ; sudden severe weakness down right side, slurred speech. In the scene, they sort of snowball, so it's not like one moment he's fine and the next he's completely debilitated. EMTs come, he's taken to hospital unconscious. The person I talked to woke up about three days later with a completely dead, although not numb, arm and some other symptoms. So this is more dramatic, but I'm using the same timing between incidents.

They do whatever they would do, it is found that he has had another or worsening of the same stroke. She said the hospital told her the stroke had been going on the whole time... not sure how they could know that. Since they would re-run bloodwork they would find the root cause and deal with it.

Goal: Portray accurately (probably from James' perspective, so there will be some holes) what would happen, how long he would be unconscious/in the hospital. When would they start therapy, etc.

4. He is left with near-paralysis of his right side, the ability to comprehend speech but not speak himself due to lack of muscle control (Apraxia), the "ability" to communicate through attempting to write with his left hand, and of course a whole lot of distress over his condition. He will recover to the point where he has a charmingly lopsided grin, can walk (Maybe with a tendency to limp or use an awkward gate?), can write/use his right hand (although a bit clumsily.). As to the violin, I may allow him to play but to portray his right hand like that of a child just learning to play, where his left is still that of a proffesional.

There you have the big picture!

No idea, but watching the thread. Two notes:

1. It seems "James" is a very unlucky name for a protagonist.
2. I have some Tinny scenes coming up that deal with a stroke victim so I'll be reading up as well.

Do you have a tortured James, too?
Feel free to follow along! One thing I have learned so far is the difference between a left-brained and right-brained stroke. This link has some good starting points for the differences - Originally James' opposite side was going to be paralyzed but then I realized that didn't match the symptoms I wanted.

I have now edited the original post. The biggest question at the moment is if this big timeline looks viable/what root cause could bring about the symptoms. Once I have that, adding detail to the individual scenes shouldn't be as hard.

Hello!

My first thought on reading your question is a blood clot -- would that possibly work for your situation? The great thing about clots (for stories, not for real people!) is that they move. So your protagonist could have a mostly or completely asymptomatic clot, perhaps in the chest or neck, which could eventually migrate up to the brain and cause a stroke.

Now, if you're looking for how that could be intentionally caused, I would have to dig a bit... there's not a lot of resources on how to cause clots, for obvious reasons.

My Mom just wondered if the blunt trauma to the head could cause a clot... the main thing is that the bad guy needs to think James will die, but he ends up surviving and later having a stroke. So that *could* come into play...

My instinct was to reach for my copy of Deadly Doses: A Writer's Guide to Poisons, but I immediately remembered that I left it (with most of the rest of my books) on my bookshelf halfway across the country . But if you can get it from your library (or via InterLibrary Loan), it might be helpful.

Well, if he seems fine for awhile, even a few days, the clot would need to originate somewhere else and slowly migrate to the head so it can block blood flow to the brain. I don't know whether there's a poison that would cause a clot, but if so that could work nicely!

Well, rather than Googling "Poisons that cause clotting" I Googled "Medications that cause clotting" and there are quite a few! Some are used to neutralize or reverse anticoagulant drugs, some are used before surgeries to prevent heavy bleeding. If my bad guy gave James something like that... I guess he would assume James would be dead in a few days, and that people would think he fell down the stairs for some other reason... in the original he's going for pretty immediate. Hmmm...

Blood thinners - can work quickly, are likely to cause brain damage before other visible symptoms, dissipate from the body fairly quickly.

Clot forming drugs - Would have the potential for delay since the clot would need to travel. As I am researching those it looks like administering them too fast can cause major problems and death. The problem is my bad guy would know that, so there would need to be a reason he doesn't go the fast route... or that he thinks it will act fast and it doesn't...

Is the clot-triggered stroke (Ischemic) rather than a hemorrhagic stroke sounding better to you at this point? I liked hemorrhagic but I can definitely see the benefits of the other, and ischemic is what the doctor believed that lady had.

Hmm, well if he goes with a poison/medication, it would probably show up in his bloodstream if he died right away. But if for some reason his symptoms didn't seem too bad at first, they might not do a blood test then, and then by the time the stroke happened the substance could already be out of his system, so maybe it couldn't be traced back to the bad guy as easily?

I'm liking ischemic stroke for your plot as I understand It, just because of the potential for delay.

Literally the only thing this doesn’t work with is the timeline, but the poison of rhododendron would cause the effects your looking for.

Initially it just slows the heart rate, which causes the individual to knock out. Their breathing slows too so they’ll go cold and appear not to be breathing. Pretty darn close to dead.

Later vomiting, diarrhea, etc. occur and the continued slowing of blood would cause brain cells to die and essentially the stroke effect you’re looking for.

That’s the closest thing to my knowledge, but again, the timeline is off.

What about two poisonings. A first attempt that fails to advance beyond unconsciousness and is misdiagnosed as something else. Then a few days later, a Second poisoning intended to produce death, only yields brain damage. By that time, they have correctly diagnosed the cause.

That is a very good point, and makes a good case for a planned delay! I did a search, and autopsies aren't as common now as they used to be (partly because of the extra cost to the hospitals, it seems). Still, my bad guy is the sort to have all his bases covered. Yep, the delay is how I am building up to the first disaster, so ischemic is sounding better the longer I think about it.




First of all, that is scary because we have a rhododendron bush... That is very interesting! Would it be some sort of special preparation he would have access to? I've been investigating drugs he could misuse because he works at a hospital, but this is an interesting option. (Do you know how it would be stopped, or where I could find more information on this?)


Yes... that could work on multiple levels. I would need to delay when he gets put in jail, but that could make for some awkward meetings... "Hey, sorry you were feeling badly yesterday." *Is inwardly fuming that his plan didn't work.* As I think about those two characters that is sounding really fun. It would also give me more control over what happens no matter what the bad guy does... In that scenario I'll have to see if I can incorporate James getting knocked out/the craziness that ensues as the second incident, while having the first be less noticeable. Or I could still have the bad guy end up in jail the first time, and have someone else try to finish the job (which would be a logical option.)

I likely won't have internet access until next week, so I'll give this some time to sink in and we'll see what works! Thanks for your help everybody!

That is a very good point, and makes a good case for a planned delay! I did a search, and autopsies aren't as common now as they used to be (partly because of the extra cost to the hospitals, it seems). Still, my bad guy is the sort to have all his bases covered. Yep, the delay is how I am building up to the first disaster, so ischemic is sounding better the longer I think about it.




First of all, that is scary because we have a rhododendron bush... That is very interesting! Would it be some sort of special preparation he would have access to? I've been investigating drugs he could misuse because he works at a hospital, but this is an interesting option. (Do you know how it would be stopped, or where I could find more information on this?)


Yes... that could work on multiple levels. I would need to delay when he gets put in jail, but that could make for some awkward meetings... "Hey, sorry you were feeling badly yesterday." *Is inwardly fuming that his plan didn't work.* As I think about those two characters that is sounding really fun. It would also give me more control over what happens no matter what the bad guy does... In that scenario I'll have to see if I can incorporate James getting knocked out/the craziness that ensues as the second incident, while having the first be less noticeable. Or I could still have the bad guy end up in jail the first time, and have someone else try to finish the job (which would be a logical option.)

I likely won't have internet access until next week, so I'll give this some time to sink in and we'll see what works! Thanks for your help everybody!