Not a medical mistake: how my protagonist survived hanging upside down.
Updated: Sep 29, 2022
A look at modern evidence and an unfortunate real-life tragedy.
Photo above taken from HowstuffWorks.com
Note: No spoilers and no gruesome photos in this post. However, there is a discussion of pathophysiology, causes of death, and a true story that ended in tragedy.
I highly recommend reading this post before you read my book, Enemy's Keeper: Forbidden Ties (Enemy's Keeper Book 1).
Some readers have expressed disbelief at how one of my protagonists ("Character X")
1) Hung upside down for approx.16hrs from one ankle
2) Got shot once with a crossbow while wearing padded armor
3) Could talk 6 hrs into his predicament
... and lived to escape.
His survival and escape are entirely plausible. And let's remember that I'm writing historical fantasy here, so tall tales are part of the fun :)
How Character X survived one crossbow shot with minimal blood loss has already been discussed here, featuring a live Youtube demonstration showing how the arrow just bounced off the gambeson armor...
I'm a pathologist by day and a writer by night. Pathologists are physicians trained to perform autopsies, determine causes of death, diagnose disease (including cancer) under the microscope, employ genetic studies in diagnosis, and more. Thus, I pull from my medical knowledge and cite current literature in this blog post. Feel free to ask me questions!
Hanging upside down: Why does it kill people?
Reference: Forensic Pathology Reviews, Volume 3, Chapter 3
Click above to read a free excerpt of the chapter without gruesome photos.
Based on animal models, both "positional asphyxia" and "cardiac overload" are mechanisms of death.
Positional asphyxia: someone suffocates because their position prevents them from breathing properly. While hanging upside down, the weight of the intestines compresses the lungs.
Cardiac overload: the volume blood suddenly dumped into the heart from the lower body makes the heart work harder to pump properly. Over time, the heart fails altogether.
The author of the forensics textbook also states:
"It is observed that elderly people, and in particular elderly with preexisting cardiovascular diseases, seem to be more prone to death in a head-down position than others. This suggests that final heart failure is the cause of death rather than cerebral or pulmonary dysfunction."
Therefore, a young, healthy, and fit person will last much longer than someone whose heart was not functioning well prior to suspension upside down.
My protagonist was a healthy and fit 20-year-old; he had everything in his favor to survive. But how long can he last?
How long can someone survive hanging upside down?
Image credit: Pinterest
It's a good thing that the medical literature lacks experimental evidence on this matter. The author of Forensic Pathology Review readily admits:
"Another point of uncertainty is the survival time after coming into an inverted body position. Reports in the earlier literature claim that agony after head-down hanging may last many hours up to 1 day. The cases described in this chapter suggest a similar survival time...
The survival time depends on the strength and endurance of the victim's cardiovascular system."
So there. It is plausible that a character hanging upside down for 16 hours can make it.
Once again, his blood loss from a low draw-weight crossbow arrow would've been minimal because he was also wearing 30+ layers of linen padded armor. This was explored in my previous blog post.
Bruises on his face, arms, some bleeding from his ankle and superficial cuts, etc, would have made him miserable, but these injuries will barely contribute to the cause of death by hanging upside down, which is heart failure.
It also rained heavily around12hrs after Character X got stuck, providing him with much-needed hydration.
How long can someone stay lucid hanging upside down?
Character X was awake and coherent in speaking to another character about 6 hrs later. This is again possible. I cite here the real-life tragedy of a man who lost consciousness and died about 28 hrs after being suspended.
John Jones and the Nutty Putty Cave
Photo above from howstuffworks.com.
In November 2009, a 26-year-old man in Utah became stuck in a section of Nutty Putty Cave 150 feet below the surface. His harrowing tale is retold in this poignantly written article by The Salt Lake Review. I cried while reading it...
John was very stuck. At 6 feet tall and weighing 200lbs, he had gotten wedged almost straight up-and-down, at a160-170 degrees angle, in a tunnel 18 inches wide. This small space would've severely limited his ability to take a deep breath, making his situation worse than Character X's in my novel. Character X could a least inhale freely, being suspended from a bridge.
(I also fully acknowledge that my story is fiction, so the suffering can not even be comparable between the two men)
John passed away around 28 hrs later because he could not be rescued.
12 hrs into his predicament, he told one of his rescuers, Ryan:
“Help me get out. I don’t want to be on my head."
“I’m sorry I’m so fat. It would be so much easier for you guys to get me out of here if I wasn’t so fat.”
This article also notes that "John, a devout Mormon, had connected with several of the volunteers who had tried to free him through shared faith. The two talked about their missions for The Church of Jesus Christ of Latter-day Saints and spoke Spanish together -- Ryan had served a Spanish-speaking mission in Texas, John in Ecuador."
I bring up these points to illustrate how one does not necessarily lose consciousness or become incoherent even after12 hours upside down. John and Character X are of similar age and probably of similar fitness levels. It is thus entirely plausible that Character X in my novel remained lucid 6 hours into his predicament and spoke to another protagonist.
But if Character X also got shot once, can he still free himself?
Yes. It depends on where the crossbow arrow struck and if his abdominal muscles were compromised enough to prevent him from doing an upside-down crunch...
Which people nowadays, such as YouTuber Scott Herman, do as a workout:
In my novel, the arrow superficially struck the side of a pelvic bone and left Character X's abs intact. Character X also describes using his cape to pull himself up later in the book.
As amazing as my character's survival tale may sound, it is still plausible. And my novel was a work of fiction. Remember that real-life survival stories continue to grab us in modern times. They are fascinating precisely because they are "implausible". There's a whole tv series, titled I Shouldn't Be Alive, featuring amazing survival stories like these:
"Climb out of Hell" Survivor: Jordan Nicurity.
November 2009. Jordan Nicurity, a Canadian photographer, falls 20 feet from a cliff face and shatters his pelvis while on an expedition to Hornby Island, British Columbia. He is forced to crawl more than a mile through horrendous conditions, only to find that the only way to get to safety is to scale the very cliff that he had fallen from in the first place.
"Avalanche of Terror" Survivor: Ken Jones
In January 2003, Ken Jones, a British climber, is caught in an avalanche in the Carpathian Mountains and falls off a 75ft cliff. With a shattered pelvis and broken femur, he crawls for 7 miles to reach the nearest road in temperatures as low as 5 degrees Fahrenheit (−15 degrees Celsius).
Incredible, but these things happened! And I dare say what Character X went through doesn't sound as amazing after reading all these true stories...
What is your favorite survival story? Let me know in the comments below!