Killing your character convincingly – Tuberculosis (TB)

You have created a character and breathed life into them in the pages of a story. Now you need to kill them off and have chosen TB, but how do you make it realistic? What is it, how and what happens? How, why and when would your character die? What changes, if any, would you need to write into your doomed character?

Read on to answer these questions and help you kill your character with conviction.

For more information on the process of dying see ‘Killing your character with conviction – Staring Death in the Face’

What is TB

Tuberculosis (TB), once known as consumption, is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person. The released infection can stay airborne for hours. TB mainly affects the lungs, but once inhaled the infection can spread through the body via the bloodstream.

There are many kinds of TB, mainly catagorised by where in the body the infection inflicts the damage. Non lung TB is a general term for TB that doesn’t originate in the lungs. Bovine TB can be spread to humans via infected dairy products and carried by the gut.

During the 19th Century TB accounted for 25% of all deaths in Europe and was called the White Death.

Fact: Today two thirds of the Worlds population are infected with TB.

Why your character dies

TB destroys the lungs from the inside, eating the lung away and replacing it with blood and liquefied tissue. Your character drowns in the remains of their lungs.

The same destructive infection can be spread through the body causing fatal Cardiac Tamponade (fluid in the heart), liver failure and TB meningitis affecting the brain and spinal cord.

TB mainly affects the lungs, but once inhaled into the lungs the infection is spread through the body in the bloodstream.

The infection can affect the tissue covering around the lung (the pleura, causing inflammation known as pleurisy), as well as the skin, bones, lymph nodes in the throat, urinary tract, bowels, sexual organs and nervous system. The nasties appear in different forms, generally as granular deposits, nodes and abscesses in and on organs. In bones these nasties eat into soft tissue (cartilage etc) before moving onto the harder stuff.

TB in the bones happens in the weight bearing joints and spine causing the tissue to die. In Potts disease the spine collapses sometimes leading to spinal compression, paraplegia and hump (a gibbus)

On the skin it appears as a range wonderfully named warts, lesions and ulcers on the knees, elbows, hands, feet, face, calves and neck, such as Prosecutors Wart, Lupus Vulgaris, Scrofula (Kings evil) and Bazins disease.

Prosecutors Warts

Lupus Vulgaris

Scrofula

Spinal TB

How TB Develops

Around 6 weeks after being inhaled into the lungs the infection develops and can be spread without showing any symptoms if the immune system is healthy (latent TB). Months or years later if the immune system is compromised the infection can reactivate anywhere in the body, but generally in the lungs.

“The TB infection takes 6 weeks to develop, but can remain latent for 20 years”

Your character could be anyone working or living in Africa or Asia where TB is endemic, either very young, old or have the any one of the array of causes of a suppressed immune system. Similarly they could be living and working in the UK with recent immigrants.

It’s estimated that one third of the world’s population is infected with latent TB, of which 5-10% could become active and 1.5 million could die per year according to the CDC.

TB is concentrated mainly in developing countries and countries where there is malnutrition, poverty, poor health and social disruption. It does however exist in the UK among social alcoholics, healthcare workers and those who are HIV-positive.

Symptoms of PrimaryTB:-

A persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody.

Night sweats

Weight loss

Tiredness and fatigue.

Symptoms of the spread of TB:-

Swelling in the neck

Fits or seizures

Pain of loss of movement in the joints

Fever

Loss of appetite

Headache

Abdominal pain

Confusion

TB is diagnosed by a physical examination for swellings in the neck, liver and spleen. Other diagnosis techniques are by Chest xray and sputum samples, CT scan and organ biopsy. Also a skin test (injecting Tuberculin under the skin to test for a reaction) and cultures of bone marrow and blood. Culture tests can take 4-12 weeks, but the skin test can give results in 72 hours. Non lung TB is diagnosed with exploratory surgery.

TB can cause chronic pneumonia. The cause and symptoms of both are not dissimilar and can lead to an initial misdiagnosis.

The treatment for TB is long term multiple antiobiotics (over 6-9 months)

People with HIV or a weak immune system are at a much greater risk of dying from tuberculosis, because the TB infection can be much more difficult to treat and control. Tuberculosis is the primary cause of death for people with HIV.

In addition to being in contact with a person who has active TB, other risk factors for TB infection include:

HIV infection, diabetes, certain cancers, and other conditions that weaken the immune system such as drug and alcohol abuse.
Traveling to, living in, or immigrating from areas of the world with high rates of TB, including Latin America, Africa, Asia, and Russia
Living or working in a location where TB is more common, including prisons, homeless shelters, immigration centers, nursing homes, and healthcare facilities.
Having had a Gastric Bypass or Gastroectomy
Existing chronic disease such as Sillicosis (damage to the lungs from breathing in sillica dust) or Celiac disease (autoimmune disorder of the intestine)
The homeless or those living in poor conditions

TB was thought to be a disease all but wiped in Europe 30 years ago, howeve, a recent Daily Mail report stated that cases of TB in the UK had hit a 15 year high with over 6,000 cases, three times the level of 1984. Over half the cases were people not born in the UK with London having the highest concentration of cases in any European city.

The choice of TB as a vehicle to kill off a character is not only perhaps the most unpredictable and gruesome, but also the most currently relevant.

THE END

References :-

https://www.nhs.uk/conditions/Tuberculosis/Pages/Introduction.aspx

https://www.blf.org.uk/support-for-you/tuberculosis/what-is-it

http://www.netdoctor.co.uk/conditions/infections/a5682/tuberculosis-info/

https://medlineplus.gov/ency/article/000624.htm

https://www.nhs.uk/Conditions/Tuberculosis/Pages/Symptoms.aspx

https://www.everydayhealth.com/tuberculosis/death-from-a-preventable-disease.aspxhttps://www.msf.org.uk/issues/tuberculosis