A little while ago I finished Rise of the Tomb Raider on PS4, the sequel to 2013’s gritty reboot, Tomb Raider (I’m sorry for using the word “gritty”). The game is extremely well put together and is a ton of fun to play, but one thing that stood out to me was just how much Lara Croft gets the shit beaten out of her by wild animals, armed goons and unforgiving environments, and miraculously keeps on going. It borders on the ridiculous, even after toning it down a bit since the first game. I know I’m not the first to make this observation, but I actually happen to be somewhat qualified to comment on the life-threatening injuries Lara sustains because I’m a doctor. Yep; when I’m not writing nonsense about video games I work in a hospital on a hip fracture unit, and while I don’t have as much experience in Emergency Medicine as I do in other areas, I thought it would be fun to put some of my medical knowledge to good use by taking a look at some video game injuries and seeing how realistic they actually are.

I’m going to make this an ongoing series, and I would love to hear your suggestions for any gaming moments that have made you think “hang on, could they really survive that?” I’ll start with a few of my own and break down how the character sustains the injury, what the medical implications would be, and what kind of prognosis they would have. (Basically I’m going to be one of those guys who watches a sci-fi film and comments on how unrealistic the physics are.) Let’s kick things off by diagnosing some of the brutal punishment taken by everyone’s favourite posh adventurer, Lara Croft.

Patient: Lara Croft, AKA the Tomb Raider

Presenting complaint: road traffic accident, fall from significant height

In the clip above, Lara inexplicably avoids getting torn to shreds by high-calibre gunfire from a freaking helicopter, then gets pinballed around the inside of her truck as it crashes and flips over a few times. This is a high-speed collision and the very least she would be left with is a serious concussion and some broken ribs, but that’s pretty optimistic. She could easily suffer a fractured spine, which at worst could leave her paralysed or, if the break occurs near the base of her skull, could sever her spinal cord and kill her instantly. The trauma to her head could cause bleeding within her skull, which would need close monitoring on an intensive care unit and may need cranial decompression surgery. If her rib fractures are bad enough they could puncture and collapse one of her lungs, or lacerate her spleen causing massive intra-abdominal bleeding. But hey, this is a video game, so Lara somehow drags herself out of the car, stands up to run away and then –

BOOM! The truck explodes, launching her off the side of a cliff where she tries to jam her climbing axe into a rock to stop herself from plummeting to her death –

– almost certainly dislocating her shoulder in the process. The axe doesn’t hold and she falls at least 10-15 feet and lands hard on her back. Then, like the hero she is, she staggers to her feet, grits her teeth and says, “no turning back”.

Diagnosis: Personally, I would turn back, Lara. I would turn back and find a hospital as soon as I could. Frankly I have no idea how you’re not dead, but I’m willing to suspend my disbelief because it’s pretty darn entertaining. Let’s take a look at some of the potential injuries our plucky adventurer could have sustained:

• traumatic head injury, which at best would give her a concussion, and at worst could cause intracranial haemorrhage and possibly death;
• multiple rib fractures, which could lead to a lacerated spleen or pneumothorax;
• flail chest, where a segment of the rib cage is detached from the rest of the chest, and pulmonary contusions, causing respiratory failure;
• spinal fractures, which, depending on the level at which they occur, could damage the spinal cord, causing paralysis and even death;
• shoulder dislocation;
• limb fractures – Lara could have easily broken any of the rest of the bones in her body as she became a human crash test dummy, most likely one or more of her arms and legs.

Real life prognosis: possibly dead, or at least what we in the medical profession would call “not very well at all”.

Video game reality: get up, shake it off, climb down a steep rock face and explore some ancient ruins.

So there you have it. I realise how silly it is to poke holes in video game logic, and obviously none of this is meant to be taken seriously, but it’s fun to take a step back and appreciate the more ridiculous side of gaming from time to time. Please let me know in the comments if you liked what you’ve read, and send me some suggestions for some classic video game injuries that I can over-analyse. Until next time!