Coughing Up Blood

This post involves blood and death in a rather descriptive way, so continue reading only if you have the stomach.

My current WIP is set in war, and it inherently entails lots of death. This encouraged me to do some research in this area, morbid as it is, to find out how to end a character’s life in a way that is not cheesy.

You’ve probably seen this many times in movies:

The character is mortally wounded, and the love of his life is holding him in her arms. A trickle of blood pours out of his mouth, and we all know what’s going to happen. It’s too late to save him! In those final moments, he tells her how much he loves her, and the key to the security deposit box that is holding their fortune is in a safe at his mother’s apartment and the code is 4242. He wishes they had more time together to spend that fortune. But life is never fair.

It is very romantic, isn’t it? But is it realistic?

To answer this question, we have to consider where the blood comes from. On the right, you see the insides of a human body. As shown here, there is only one way for blood to reach this guy’s mouth ― if it’s not originating in the mouth that is. In fact, there are two pipes. One is the esophagus, and the other is the trachea (windpipe). Thus we have three main scenarios to consider:

Scenario 1: Punctured Abdomen

OK, have another look at the picture. Anything lower than the stomach is not connected to the esophagus, and so will not cause any blood to course up the person’s throat. So, the only way would be to either puncture the stomach, or the esophagus itself. What’s more, there are muscles preventing anything from getting out of the stomach (sphincter) and up the esophagus. Otherwise, we’d throw up every time we bent, and gymnastics as a sport wouldn’t even exist.

Now, let’s say the stomach is punctured. Blood has to collect in there before it can be evicted. If the gap is large enough for a drainage, nothing will come up. And a big hole (like those in some movies that you can see through) will also impair the stomach’s movement, which is a crucial organ in the vomiting process.

So, let’s assume the blood wells and the stomach evicts the blood, causing the victim to vomit mouthfuls. As you can imagine, it has more than blood in it, and is not at all that romantic. And the person is probably not talking. Just think of the last time you said loving words as bile coursed its way up your throat.

Note that if you’re stabbed in your liver or any other part in the lower abdomen, it will be damn painful, but you won’t vomit blood. And look how high the stomach actually is. It is just below the lungs. So, unless your character is stabbed somewhere close to their chest, you should forget about dribbling blood from the corner of their lips for dramatic effect. Because it will be unrealistic.

Scenario 2: Punctured Lung

Lungs are full of blood vessels which, if cut, can fill the lungs with blood, hence the phrase: “drowning in your own blood”. In this case there will indeed be massive bleeding from the mouth. But how the blood comes out is different from the first scenario. While in scenario 1 the person vomits blood, in this scenario they cough up blood (also known as haemoptysis).

Something to keep in mind here is that lungs are full of air. So, the blood that comes out will not be as fluid as they show in the movies. Yes, blood is fluid. But you know what else is fluid? Egg whites. But what happens when you beat egg whites, or in other words insert air bubbles into them? You said it. They become foamy!

There are lots of tiny tubes in our lungs that hold air. As they fill with blood, these air bubbles have no way of escaping, so they have no choice but to mix into the liquid. As a result, the blood that comes out of the person’s mouth is frothy.

Consistency aside, the character will probably be struggling to breathe. To see how that feels, try breathing some water (don’t do it!). They probably don’t have time to say all those beautiful words before they die (up to the e of goodbye by the way). Even if they stop trying to breathe and focus on talking, they just can’t. We need clear air to pass through our vocal cords. So, the only thing the loved one will hear from them would be weird noises as they choke. And it’s not gasping either. Gasping still needs clear air to make the sound we’re all used to.

Scenario 3: Punctured Throat

This is the most believable reason why somebody would bleed from their mouth. But this only happens if the killer cuts through the jugular vein and the esophagus at the same time, opening a passage. Otherwise, the blood will only be pumped out at the front of the neck. The angle and the depth of the cut is also important. But in any case, the victim will get some blood in their mouth. It’s only a matter of which passage is wider for the rushing liquid to exit.

Sealed Wound

Up to now we’ve only talked about stabbing. When it comes to gunshots or arrows, there is another factor you need to consider.

Is there enough blood?

You see how they always say, “Put pressure on the wound?” The main reason behind this is that it helps block the vein, and slow down the bleeding. If somebody is shot, there is a chance that the bullet ends up just at the right spot to seal the vein, and even fuse it if it’s hot enough. That’s why it’s normally not a good idea to take the bullet out before the person is in the hospital. This fact also has something to do with why warriors break the arrow that pierces them in movies instead of pulling it out. It is partly because of the arrowhead, which will cause more damage as it passes throw them again, but most importantly because the arrow itself may be sealing the blood vessels, and taking it out would cause more bleeding.


When writing a scene where a character is wounded, we should always ourselves where they’re hit, and whether that would cause what we’re writing. This post was part of what I’ve understood from the anatomical point of view. I hope it was not too disturbing. I wish you have a wonderful weekend.

Happy writing!