Monday, March 17, 2014

Medical Mondays: Surviving a Shot to the Head

Boy, it's been a while since I did a Medical Mondays. I've been continuing to get medical questions from writers, but finally have a chance to breathe and blog about one of them. 

Here's one from a blogging friend many of you know, the talented Jessica Bell! Jessica is author to several books, including Bitter like Orange Peel and String Bridge, as well as the Writing in a Nutshell series, and is an editor of Vine Leaves Literary Journal. 

Jessica asks:

"One of my characters shoots himself in the head to commit suicide. Is there anywhere he can point the gun and still survive? I also need him to be in a coma for 8 months, (I can make it less if need be). Is it possible he could wake up from that and still have full brain function?"


Great question, Jessica (but a sad one!) A person can definitely suffer from a GSW to the head and survive, but the odds are generally slim. The majority of GSW to the head result in death (90% or so). So for this scenario to work, there are a few details that would have to happen.

1. Brain structures to hit and miss. The less brain tissue the bullet encounters, the less damage. There is some duplication between the left and right hemispheres of the brain, so ideally the bullet should not pass through both sides of the brain, only one side. Also, it would be important to miss certain structures, like the brainstem (responsible for your heart beating, breathing) and other central structures, like the basal ganglia and thalamus. The bullet should miss the ventricles, which are fluid-filled structures inside the brain. Damage to those might cause excessive fluid to build up in the brain. So, an ideal bullet trajectory in this scenario might be going from the left forehead through the top of the left skull, missing those important structures and "skimming" the top of only one hemisphere.

2. The bullet. It should be small caliber and have a low velocity. The more energy a bullet has, the more energy is imparted to the brain tissues as it passes through, causing more destruction. Smaller bullets and slower bullets cause less damage. So Jessica's character would need to be shot with a low caliber handgun as opposed to a high powered weapon. 

3. Complications. Since Jessica needs the patient to be in a coma for a long time, but have minimal long term damage to the brain, she may have to build in several complications to keep him sick in the neuro ICU.  Any GSW will cause brain swelling, so a coma makes sense for a while if there is a lot of swelling. Add in more problems, like a brain infection, or extra fluid building into the brain that needs a drain (ventricular drain, shunt, or temporary removal of a piece of skull), or a later brain bleed that needs an extra surgery to stop the bleeding. 

Below are several articles that highlight the issues that occur in head GWS, as well as info on those rare survivors. Sadly, this scenario was very much in the consciousness of Americans when Representative Gabrielle Giffords survived an assassination attempt. 

What does it take to survive a bullet to the brain? By LiveScience 
Surviving a gunshot wound to the head, by MedicineNet 
Q&A with a neurosurgeon on the status of Gabrielle Giffords 
Living Miracles: Survivors of Gunshots to the Head 

Thank you Jessica for a fascinating question. Good luck on your WIP (and good luck to your character!)

40 comments:

Natalie Aguirre said...

Interesting question and answer. Only something you want to think about for a story. Hope that helps Jessica in writing her story.

Old Kitty said...

Oh wow. But it's good to know there's a chance, albeit slim and small, of surviving such a horrid thing! Yikes! Take care
x

Dianne K. Salerni said...

I just want to chime in with a historical oddity: Samuel Whittemore, the oldest known combatant in the Revolutionary War. He was 80 when he participated in the Battle of Concord.

According to Wikipedia: He was shot in the face, bayoneted thirteen times, and left for dead in a pool of blood. He was found alive, trying to load his musket to fight again. He was taken to Dr. Cotton Tufts of Medford, who perceived no hope for his survival. However, Whittemore lived another 18 years until dying of natural causes at the age of 98.

Casey L. Clark said...

Great post! This helps me with a piece I have on the back burner... Thank you! :)

Barbara Watson said...

Every now and again there are news stories of brain injuries that people survive (a nail gun one I heard not long ago - wow!). I'm symphathetic to this gun-shot character already...

Deb Salisbury said...

I love Medical Mondays! But I'm glad breakfast was a few hours ago.

I hadn't realized that so many brain injuries of this type were fatal. I'll be more careful with my characters' heads.

Alex J. Cavanaugh said...

Sounds like it would have to be one lucky shot.

Elizabeth Seckman said...

My brother's dog survived a head shot. Lost an eye, but other than that was fine.

Excellent post.

Artemis Grey said...

Uh, I'm going to throw my 2 cents in here, just because no one's clarified the exact manner in which the shot was fired. In the discussed scenario it's inferred that the character is pointing the gun at the side of their head (temple shot) but a sizable number of suicides/attempted suicides either put the barrel of the gun into their mouth, or under their chin. In both of those situations, the chances of living can be elevated by shooter error.

When someone puts the gun in their mouths, the trajectory can be at a low angle, meaning that the bullet to pass below the brainstem instead of actually going through the brain. Likewise when someone puts the gun under their chin (pointing up) they can have the gun too vertical, causing the bullet to pass through the sinus passages but missing the frontal lobes of the brain. The result, if a large caliber bullet is used, can be catastrophic facial damage, but not death, or if the caliber is small, then the damage could be fairly minimal.

Karen Lange said...

I am really glad to hear this is a fictional character! Makes me shudder to think of it otherwise.

Have a great week!

mooderino said...

Gruesome question but very enlightening answer.

mood
Moody Writing

Liza said...

I always find these Medical Monday posts fascinating for what people are asking as well as the answers.

CA Heaven said...

That's a bizarre, but fun, post by a doctor >:)

I don't like guns, so in my stories people take lives by other means.

Cold As Heaven

J E Oneil said...

That really is a cool question. I have to admit, I never really thought about what caused a coma before. Good thing I haven't used one in a story. I'll have to remember this, just in case.

SA Larsenッ said...

Interesting question and thorough answer. I'm sure those complications after would make things intriguing and keep tension a high.

Mason Canyon said...

Intriguing question. I didn't realize the survival rate was as high as 10 percent. I would have guessed maybe 2 percent. Very informative post.

Donna Hole said...

Good to know a bullet to the head will pretty much do ya in.

.....dhole

Angela Brown said...

I was thinking of the Senator when I read this question and your answer, Lydia. I also remember a fictional character from Fight Club having a poor shot in a suicide attempt leave him very much alive from the way things looked.

Matthew MacNish said...

I've been looking forward to this post, since I knew it was coming, and haven't been here in forever.

I would just chime in to say (since I've read this story) I would highly recommend having Mick us a 9 MM semi-automatic pistol like a Glock 17 or a Beretta 92 (both of which are common in the US, and hopefully Australia as well) and should hopefully be a small enough caliber to make this work medically. Alternatively, he could use a .22 caliber pistol, which would make the medical side more plausible (it's a smaller bullet) but those kind of guns are not nearly as common, and would be less likely to fall into Mick's possession (thus making the logistics a bit more of a stretch).

Crystal Collier said...

Nice. I was reading about this probably a year ago because my oldest asked about the possibility of surviving. It's completely insane.

Southpaw said...

Disturbing but interesting.

Maurice Mitchell said...

Doesn't the body have an incredible ability to heal Lydia? Gabrielle Giffords is the most well-known of these cases. What a fascinating and detailed answer.

Slamdunk said...

Always an A+ for your medical monday posts. Dr. My students are now on the chapter of death investigations--I warn them to save the all-you-can-eat buffet breakfasts until after class and certainly not before.

Enjoy your week.

Theresa Milstein said...

It's so great that you do these posts. We authors want to make sure we're accurate. I know how tricky head injuries can be.

Kelly Polark said...

Wow! Interesting question and answer!! I like how Matthew chimed in too with some gun knowledge! I have no idea about either guns or wounds so very informative.

Tricia J. O'Brien said...

AAAAAA! I'm such a wimp, but I couldn't stop reading this post. What a wealth of information, even if it's kind of icky. I adore these Medical Mondays whenever you do them. :)

LD Masterson said...

My grandson came by while I was reading this and asked what I was reading. I told him, instructions on how to shoot yourself in the head but not die, with options for prolonged coma and levels of brain damage.

He just walked away, shaking his head.

Lydia Kang said...
This comment has been removed by the author.
WordsPoeticallyWorth said...

Thank you. Love love, Andrew. Bye.

mshatch said...

Horribly fascinating; I enjoyed every word ;)

Ruth Schiffmann said...

This is a great feature.

Jenny Woolf said...

Wow, fascinating. I do like these posts and always look out for them, it's such a different view of writing and medicine.

A Lady's Life said...

oh gross!lol

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