By Will Dabbs, MD
It was a pretty typical evening in our busy urban ER. I don’t recall ever doing a full shift without at least one gunshot wound. My personal record was seven. People are bad. That timeless truism was on reliably gory display most any given evening.
The Presentation
Our hero was a young African-American male of perhaps 22. He seemed intact at a glance save a fairly pronounced limp that favored his left leg. I initiated our relationship with my standard, “What can I do for you, stud?”
The man was not in extremis. He plopped down heavily in the chair in the exam room and began complaining mightily about pain in his left knee. I posed the obligatory questions about how long it had been bothering him and whether or not he had experienced any particular trauma. He said he just woke up this way, but that it had been getting worse all day. He vehemently denied any ancillary mischief of any sort.
His exam was unremarkable. There were no obvious external stigmata of injury. His knee was indeed a bit globally swollen, but I had seen much worse. I tugged and pushed, but he didn’t much care. He just really didn’t like bearing weight. I ordered an X-ray and moved on to the next crisis.
The problem was obvious at a glance. X-ray films are two-dimensional depictions of three-dimensional objects. That’s why they typically shoot several views. They are also simply graphical depictions of varying gradations in density. Air is black. Bone, being fairly dense, is light grey. Metals come through as white. This poor schmuck had a bullet in his knee.
It wasn’t much of one, but it was a bullet nonetheless. I studied the thing in some detail there on the X-ray box. It was about a quarter inch across. There was minimal deformation, so I presumed it was hardball. These were the days before digital X-rays, so I grabbed the most impressive film of the lot and made my way back to this guy’s bedside.
“You been shot lately, brother?” I queried amicably. That’s when the lights came on.
T’was a Dark and Stormy Night…
This guy had been out the previous evening at his favorite watering hole courting trouble. The music was loud, the women were hot, and a grand time was being had by all. As he fished around in the right front pocket of his low-slung trousers for his smokes, he inadvertently brushed the trigger on his EDC gat and the thing went off.
This was not some tricked-out P365 or Hellcat. This gun aspired to someday become a Hi-Point if it ate right, exercised regularly, and habitually attended Sunday School. It was some kind of Jennings/Jimenez/Bryco .25 ACP Crapmaster. Such trash guns are typically striker-fired and meticulously crafted of cast Zamak, roll pins, and baseless dreams. However, they are distressingly reliable, at least on that first shot. This gun had discharged inside the young man’s pants, scaring him witless. However, the muffled report was drowned by the surrounding baseline cacophony. He had looked about furtively, realized his compatriots were none the wiser, and duly returned to his beer.
The Fantastic Voyage
He was still wearing the same pants. He turned his right pocket inside out to expose the previously-undiscovered powder burns and a tiny little hole. The diminutive little bullet had exited his pocket, transited within a hair’s breadth of the lucky dude’s manhood, and entered his medial thigh. The entrance wound could have been easily mistaken for a mosquito bite. There was no blood. The bullet had subsequently tracked down his leg and come to rest inside the joint capsule of his left knee. Every time he took a step, he pinched that rascal between the tibia and the femur. I have no idea how he stood it.
I got him a tetanus shot and called the orthopedic residents to come meet their new play date. I never saw the young man again. As a gun writer, I’ve spilt rivers of ink debating the finer points of caliber, muzzle velocity, and stopping power, whatever that actually is. Gunshot wounds are most typically quite horrible. However, sometimes, it really is possible to get shot point blank and not even know it.
