The Last of Us Episode 8 was brutal. Although we didn’t see any infected, it played into the show’s overall theme that humans are far worse in this post-apocalyptic universe. As Ellie struggles to keep Joel alive, she gets him medicine to treat a stab wound and save his life. So, what medicine did Ellie give Joel, and did she even administer it correctly?
Ellie gave Joel two penicillin shots but applied them directly to the wound. Although it could work in theory, it’s not standard practice and would likely cause side effects or have no effect at all. Her doses were quite large, and administration is usually done intramuscularly (thigh or buttocks).
Of course, the plot required Joel to improve, so it had to work. Still, if the penicillin was injected into the abdomen, there was too much of a possibility of hitting fatty tissue instead of a muscle, rendering the dose absolutely ineffective. Also, had she accidentally hit a vein, it could have had major side effects – even death. Let’s explore this scene from a scientific, medicinal standpoint.
What medicine did Ellie give Joel (and how did she get it)?
Before we get to the medicine administration itself, another important part of The Last of Us storyline is how Ellie got it in the first place.
Back in Episode 6, we witnessed Joel suffer a nasty stab wound to the abdomen, and he barely survived, being semi-comatose for quite some time. Ellie somehow got him to the basement of some suburban house and found an old needle and string, doing her best job stitching Joel’s wound.
She’s not a doctor, nor does she have medical knowledge, but it seemed to help stop the bleeding. The problem is that the wound needed to be treated further and prevent infection, requiring medicine.
Fast forward two episodes, and Joel is still nearly comatose, while Ellie has to pick up the slack and learn how to survive, feed them both, and provide them shelter and safety until Joel gets better.
As she ventures out into the woods to hunt for food, she shoots a deer that survives for long enough to run away. When Ellie catches up, she sees two men have already found the dead deer, wanting to return it to their group.
Tensions rise, but they make a deal – half the deer for some medicine. The leader, David, instructs the other guy to return to their settlement and get ‘two bottles of penicillin and a syringe.’ That’s the medicine Ellie eventually gives Joel.
Anyway, as David and Ellie wait for the medicine to return, they talk and slowly realize that the group that attacked Joel and Ellie at the University – and caused Joel’s injury – was a part of David’s community.
David lets Ellie go for his own reasons, and she returns to Joel with the penicillin, which will eventually save his life.
What is penicillin?
Penicillin is an antibiotic – well, a group of several different antibiotics – that are used to treat various infections caused by bacteria. It’s synthesized from Penicillium molds and was first discovered in 1928 by the Scottish scientist Alexander Fleming.
The first successful administration of penicillin happened in 1938, when Fleming’s student, Cecil George Pain, administered the antibiotic to treat an eye infection of a patient. Later, Howard Florey and Ernst Boris Chain purified penicillin for the first time, laying the ground for the penicillin we now know, which is still widely used in modern medicine.
Fleming, Chain, and Florey shared a Nobel Prize in Physiology or Medicine in 1945 for penicillin’s discovery, purification, and administration.
As I’ve mentioned, there are several different types of penicillins. The most used ones are synthesized from the P. chrysogenum mold using deep tank fermentation and purification. Some (rare) types of penicillin are administered intravenously – meaning directly into one’s blood system) – or orally – meaning, through the mouth and into the digestive system.
However, most penicillins must be administered intramuscularly – meaning they need to be injected with a large needle directly into a muscle. Intravenous administration of such types of penicillin can have major side effects, even death.
If not administered properly into the muscle, even if there are no side effects, an improper injection can render the medicine completely ineffective.
Did Ellie inject the penicillin correctly?
So, Ellie got two bottles of penicillin and a syringe from the two guys who stole her deer. Or traded with her for it, whatever. She has no idea what she’s doing or how to administer the medicine properly.
She takes a huge dose of penicillin-like. It looked as if she pulled out the entire bottle – and injected it directly into the site of Joel’s wound. She then does the same thing again in the morning, injecting another huge dose into Joel’s abdomen. So, would that work? Did Ellie inject the penicillin correctly?
Well, it’s absolutely not standard practice and would never be something that a trained medical professional would do, but it could work. I mean, it’s highly unlikely, and there’s a bigger chance that it would cause side effects or be ineffective completely, but in a universe where Joel had to get better for the show to go on, it could work.
As we now know, penicillin has to be administered intramuscularly, not intravenously, as it can cause major side effects if done so. Luckily, Ellie didn’t do that but injected the penicillin into Joel’s abdomen.
Standard practice would be injecting medicine into one of the larger muscles on a human’s body – most commonly, the thighs or buttocks. If injected into the abdomen, there’s a strong possibility of hitting fatty tissue instead of a muscle, which would render the medicine useless.
Also, if the needle is too large, it could lead to Ellie hitting a vital organ, which could cause major side effects. Neither of that happened, though, and it seems that she got lucky and hit the muscle, making the medicine effective. It’s highly unlikely that this would happen in real life, but that’s why it’s a TV show, right?
Another pressing matter is the dosage, which seemed rather large. And yes, it was too large for a single shot of penicillin – and Ellie did it twice! Again, luckily for her, antibiotic overdoses are rarely dangerous or life-threatening, but they can cause side effects like diarrhea, stomach pain, etc. Joel can consider himself lucky, as he didn’t even experience that.
The bottom line is while Ellie’s injection of penicillin was completely wrong, she got lucky, and everything turned out fine. She could’ve hit fat, rendering the medicine useless, or an organ or a vein, causing major side effects. The dosage she gave Joel (twice) would almost certainly give him stomach problems, at least, but all is well if it ends well.
One can’t fault Ellie for not knowing how to administer the medicine properly; thankfully, nothing wrong came of it. Had she been a trained medical professional, however, she would’ve taken about half the dose she administered to Joel and injected it somewhere in the thing or buttocks area. In other words, it could’ve been a lot worse for Joel, but they just got lucky.