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Gunshot Wounds and the Breathtaking Power of Random By Will Dabbs, MD

I daresay most of us carry a gun regularly. It behooves us to approach that soberly.

The details really don’t matter much, but the 9mm defensive gun discharged in the man’s lap. The bullet was a top-end, state-of-the-art expanding hollowpoint — the best money could buy. That’s when things got interesting.

The man reflexively dropped his pants. The entrance wound was in the left groin, angled outward. The gun went off at contact range. There was no exit wound. Without conscious thought, the man shoved his right thumb deep into the hole. He could feel the powerful pulsing of his femoral artery. When queried, he admitted, yeah, that hurt a lot.

One bystander was in health care. By mutual agreement, it was decided that this man should assume responsibility for the wound. They lowered the victim to the floor and prepared to swap. When he removed his thumb, blood shot forcefully across the room and tracked up the wall. The guy rightfully torqued down on the wound and got the bleeding slowed but not stopped.

This is the high-performance bullet that the surgeons pulled out of this guy’s leg. It performed exactly, precisely as intended.

Details

Just like real estate, gunshot wounds are all about location. This one was bad. The injury was too far north to accommodate a tourniquet. The second man threw his weight behind the situation to get the hemorrhage under control. This was predictably excruciating.

There was no reasonable way to assess the details on site. Somebody dialed 911 and got an ambulance energized. Then reality settled in.

Retrieving his cell phone, the man punched up his wife and had The Talk. He told her what had happened and that he might not survive. He asked her to tell the kids he loved them.

The ride to the hospital was expeditious. A great deal of chaos followed. However, he had been lucky — incredibly, breathtakingly, lyrically fortunate. Though grievously injured, his femoral artery was not transected. Had that been the case, he likely would not have survived the ambulance ride.

Geometry

When you look at a naked person from the front, the pubis forms a Y independent of gender. When first learning human anatomy, medical students remember the word NAVY. Whether working from left or right, the major structures are oriented nerve, artery, and vein leading into the Y.

Arteries are high-pressure vessels that transport blood from the heart to the rest of the body. Veins are low-pressure plumbing that return blood back to the heart. Nerves are obviously the information-carrying structures that facilitate both sensation and movement. You don’t want to shoot any of that. However, if the objective is not to die, the artery is the most acutely critical of the three.

Performance Anxiety

The bullet behaved exactly, precisely as intended. Those horrifying razor-sharp petals deployed on impact and decelerated the projectile until it came to rest just underneath the skin on the far side of his thigh. Curiously, in my experience, that happens a lot. Skin is really tough stuff.

Human flesh is a heterogeneous amalgam comprised of tissues of wildly varying densities. Blood, vessels, muscle, tendons, and bone all conspire to turn a bullet’s transit into a study in rabid chaos. While this same bullet fired into ballistic gelatin would have produced a uniform, almost artistic result, this man’s leg upset the symmetry of the thing to a degree. Regardless, it still made a great big bloody mess.

The Butcher’s Bill

It is seldom like the movies. You typically leave a bullet in place unless it is threatening something significant. In this case, however, the diabolical thing was like having abandoned a box cutter underneath the skin. A surgeon later numbed the site and removed the razor-sharp projectile from the opposite side of his leg.

Miraculously, the guy eventually recovered. The plumbing remained intact. The wildly-gyrating buzzsaw cut through a fair amount of quadriceps muscle, but that did ultimately heal fairly well. The man still has a significant denervated patch on the anterior aspect of his thigh wherein he has no sensation, but he kept his leg and didn’t bleed out. On balance, he took the win.

Philosophy

There is an internet-based church that orbits around packing with a hot chamber. Acolytes of this holy dogma espouse their theology with insensible verve. The Hot Gun sect alleges that Empty Chamberers are apostate and destined for ballistic hell. The Empty Chamberers invariably quote the holy writ of Israeli close combat training to support their particular spiritual doctrine.

All I can say is that I have never known anybody personally who died because they got ambushed and did not have time to charge their handgun.

By contrast, this gentleman is the sixth person I have personally met who got shot unintentionally because of a misadventure with a hot weapon. Personally, I intentionally dabble in both.

There are times I pack hot and others when I do not, particularly when I am working around children. Some will take umbrage with that, but powerful scientific machines cannot accurately measure how little I care.

There are a great many life lessons to be found here. The first is that luck trumps everything else. This guy was not particularly irresponsible. Guns are freaking dangerous, and this was a terrible, tragic accident.

Chaos typically comes at you from unexpected quarters and out of the clear blue sky. To prevail, we must remain ever vigilant. That, and it helps to be really lucky as well.

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