Saturday, February 12, 2005

Deadeye Dick

A man walked into the ER. Complaint: Headache. Nil else of note. Well, you walk in through this door, you're gonna get scanned. Here's a surprise finding: a bullet in the brain. A large one, too. This one requires a closer look. Measurements: 7.62 mm x 39 mm. I've done my military service, and I know what THAT means. Time to interview the fellow a bit. Yes, by the way, I was shot in the head in Somalia a few years back. It seems there had been some kind of riot, and this man had been doing some shopping in the marketplace when he was suddenly hit by a round. The entry point was at the very top of his skull, and the CT scan showed that the bullet was located in a fluid compartment in the back of the brain, sharp end pointing straight downwards. A shot in the air amidst the riot, the gravitational parabola, a chance in a million, and this guy gets it straight in the head. Other than dropping his bananas, he had seemed fine. No brain could survive a direct encounter with the business end of an AK-47 assault rifle, but this particular round had taken the high road. I'm secretly a geek, and I get fascinated by stuff like this. So I made some calculations. Based on the conservation of energy principle, a bullet like this shot straight up would climb to 24,500 m (80,000 ft), and come back down at the original muzzle velocity, 700 m/s (2300 f.p.s.). But that's not true because air resistance slows it down both ways. It seems the Army geeks have been puzzled enough by this and conducted some experiments, and found out that the actual downward velocity of a similar bullet would be about 90 m/s (300 f.p.s.). It seems that's enough to pierce the skull, but the energy is low enough to make survival possible.

Headshots are nasty. Often there's just a neat little hole on the outside, but on the inside, it's a mess. We see quite a bit of them here. Some murders, some of them execution-like, but mostly self-inflicted, with a .22 caliber pistol. The problem with the .22 is that the energy is low, and the victims often survive initially, and as a result are operated on and spend days or weeks in the intensive care unit. Eventually most of them die (which is generally the intended outcome when one chooses to shoot himself in the head), but some survive to find their lives even more miserable than before. Sometimes it seems kind of futile to desperately try to save them, since they didn't want to live anyway. I wonder if anyone has ever sued their doctor for saving their lives after a suicide attempt? Wouldn't be surprised, really. Damned if you do, darned if you don't, right?

Shotgun is a more drastic weapon of choice for relieving oneself of earthly worries. Done correctly, it's a sure way to go. But carelessly performed, all you get is a terrible mess. Let me explain. Now, if you put the shotgun muzzle in your mouth, point the weapon horizontally, straight back, NOT upward, and squeeze the trigger, you're all set for a permanent vacation. But based on what I've seen, here's how NOT to do it: tilt your head back, press the muzzle against the underside of your chin, then squeeze the trigger. Bad idea! You'll blow off your face, but you'll live. After extensive plastic surgery, you'll go home looking real ugly, and possibly blind. It's embarrassing, really.

To end this rather grim post on a positive note, I remember a young lady who was shot in the head, point-blank range, by her jealous husband, and had a severe injury but survived, was heroically operated on several times, recovered, and visited us, wearing a nice dress, and while she had a mild paralysis, she seemed like an interesting and attractive woman, which means that the best part of her brain was saved.


radclyffe said...

Hi Stuart
As a NON MEDICAL person - -i HATE blood and guts- who worked for several years in the ER i found your posts to be quite interesting--

i know for me when i was in the ER it was hard as there was no one to talk to about what I saw and was involved with -- there was no therapy so to speak and there were many nights when sleep simply refused to come due to the lingering visions of horror that i had seen that night...

i have a feeling that part of your Blogging intent is to vent those very same visions or problems or people--- and for that i am glad you have found this outlet--

i am going to add your blog to my links - -i have just begun my blog this past week so there isnt much there yet and i havent had any visitors but i will tell my friends about u-- i still have several in the medical field and i am sure they will enjoy reading your posts--

one friend is a trauma flight team nurse and has been for over 15 years--

i have rambled on enough here --
looking forward to more of your posts--
do take care

Stuart Ressler, M.D. said...

Thanks for the encouragement, glad you like it -- nice to see a visitor, and I've only just started. A word of warning, I've decided against self-censorship, so this blog may get a bit rough sometimes..


kituska said...

I like your blog so far.
And I'm sure it will become more and more interesting.
the rougher the better

Anonymous said...

Mouth.... Horizontal.... Got it!