A million years ago, I attempted a respiratory therapy vocational program. Obviously, I didn't make it. However, I did learn a lot, during my one clinical rotation. I treated (means wrote down specific information under the supervision of an actual clinician) a patient who was in a vegetative state after a botched dental procedure.
So, no. There is no "routine" or "simple" surgical procedure.
There is also no “simple” gunshot wound. Yet movies, television shows, and books persist in using the “just a shoulder/arm/leg/flesh,” wound device. More than simply overused, the device is patently irresponsible and contributes to a fundamental misunderstanding of the life-long effect of gun violence on survivors.
Yes, this is a pro-gun-control piece, read or click away accordingly—also, spoilers
Texas’ best writer of historical fiction, Elmer Kelton understood the importance of facts. Educated as a journalist at the University of Texas, Kelton was a news reporter and editor for over a decade before his first book was published.
Elmer was also an actual cowboy and worked as such while writing his first novel. So—roping, ranching, and rodeoing—he wrote with boil-lancing honesty about the cowboy life. What Elmer had no experience with was gunshot wounds. In his rare poorly-thought-out line, Lafey Dodge (a hired gunman) is shot in the arm by Rascal McGinty. When escorted out of town by the hero, Lafey states that he’s had worse injuries from opening canned food with his knife.
For context, the Colt Single Action Army (dubbed the Peacemaker) Rascal used was most commonly chambered in .44 (that means the bullet is almost half-an-inch in diameter) which results in a 1-inch wound, (at least).
NOT just a flesh wound
From at least half-a-dozen movies, most Americans are aware of the Gunfight at the O.K. Corral. Less commonly known is the aftermath where family and friends of the two brothers killed ambushed Marshal Virgil Earp. Virgil was shot twice, in the arm and back, with a 12 gauge.
Again, for context, (a 12-gauge shotgun shells ejects 12, .33 caliber balls with each shot). Eight balls went through Virgil’s back, settling against his hip. Four hit his arm. Easy-peasy, right?
The four balls shattered Virgil’s left arm, necessitating the removal of his elbow. The only doctor available gave Virgil one-chance-in-five of survival. Ultimately, Virgil would survive but would never use his left arm again.
You’ll note that big flat bone at the shoulder: the shoulder blade. Thing is, the shoulder blade is not flat. With multiple plans/angles if the bullet his the shoulder blade your best possible outcome is for the bullet to pancake and/or become embedded. Otherwise there’s a good chance that the bullet will pinball right into the chest cavity where there are vital organs and multiple avenues to Boot Hill.
Then there is a major artery, a nerve cluster, and multiple lymph nodes. In short, lots and lots can go wrong with a shoulder/arm wound. Also, clavicals hurt like a fothermucker and take forever to heal. Write accordingly.
...it’s only a scratch…actually, five or six scratches…
Robert B. Parker’s Spenser series was a groundbreaking work of detective fiction. Thoroughly modernizing the private investigator subgenre, Spenser is often far more human than predecessors, Mike Hammer, (Mickey Spillane) or Philip Marlowe, (Raymond Chandler). His world includes tender relationships with his companion Sarah Silverman and adopted son, Paul Giacomin. His world also prominently features characters of all ethnicities and genders, belief systems and sexual orientations, (with mixed results) it all contributes to Parker’s bedrock-solid foundation of street-smart practicality. Until it comes to gunshot wounds.
With gunshot wounds, Parker’s PI is super-human. Rough-and-tumble, Spenser is shot no less than four times over the course of 30 novels. In every single instance, Spencer is successfully treated, makes a self-effacing joke, and then sports the scars as badges of honor. No lasting complications, no trauma disorders, for that matter, no psychological impact at all.
Part of this is rooted, I’m sure, in Hemingway’s influence on Parker. But Hemingway, (an ambulance driver during the First World War) understood the trauma of injuries. Robert Jordan most definitely dies of his gunshot wounds in For Whom the Bell Tolls. Likewise, Harry dies of sepsis from a minor cut, in The Snows of Kilimanjaro.
Speaking of sepsis
In the movie Resevoir Dogs, hold-up man, Larry tells his wounded companion, Freddie, that gut shots hurt the most but he’s not going to die. Yeah, maybe not immediately. But with that degree of bleeding, (Freddie paints the the car interior with his blood) and the high likelihood that a bowel was at least nicked if not punctured and now there is fecal matter mixing with the blood flooding his abdominal cavity means he will be in septic shock really soon and really dead soon after that.
Freddie most certainly wouldn’t be alive, (much less lucid) for the multiple hours depicted in the film.
Good thing you don't need abdominal muscles to do...well, everything.
So, who does it well?
Author Michael McGarity is a former cop. He’s seen gunshot wounds and the aftermath. Hence, his protag, Kevin Kerney reflects that reality. In Tularosa, we meet Kerney, recently retired by a gunshot wound that has left him nearly crippled in one leg. In successive books, we see Kerney’s daily physical therapy regime necessary for him to simply walk. We also see his bad leg fails him more than once.
Science fiction stories based in war-correspondence fact
Before Karen Traviss hit the big time and substantially contributed to Mandalorian lore she was a BBC defense correspondent. She also served in the army as well as the navy reserves in the UK. That informs the tremendously rich language and command of character we see in her work. It also informs her understanding of wounds. Kal Skirata, a Mandalorian military trainer, (and Traviss’ greatest creation) becomes a drill-instructor on Camino after one of his ankles is shattered, leaving him unable to function in combat. Skirata walks with a pronounced limp and suffers near-constant pain.
“The French call that one ‘courage’...I’d keep that if I were you.” Jack Crawford, Silence of the Lambs
Like Elmer Kelton, Thomas Harris started as a journalist. He also researched deeply with the FBI. He understands wounds. As a result we know that Will Graham didn’t just survive Hannibal Lecter’s attack—mostly by the reference to the colostomy bag he had to wear while recovering from Lecter’s knife work. But he also understands the psychological toll surviving takes. Like Graham, shellshocked by his experience with Lecter and then ruined by his confrontation with Francis Dolarhyde, Clarice Starling does not emerge unscathed by her first firefight.
Jame Gumb set an ambush for Starling in a pitch-black room. Provisioned with night-vision goggles and etermined to have Starling's scalp (literally) for his collection, Jame lies in wait with the intention of shooting her in the face. Then he cocks the hammer on his revolver. Clarice zeros Gumb from the sound and shoots him dead. Still Gumb gets off a shot. While his bullet misses Clarice, grains of late-igniting gunpowder tattoos her cheekbone like a birthmark from hell.
In the successive book, we see that Starling is haunted by the mark of her trial by fire, even as she takes pride in her mark of courage.
In writing wounds, make them as heavy (or not) as you chose. Just remember the dramatic potential in logical extrapolation of the severe and the "superficial" wounds our heroes and villains suffer. To do less is lazy, at best.
The photo at the top, Reservoir Dogs movie poster (Miramax Films) and the photo above, shoulder anatomy, (Gray’s Anatomy) do no belong to me. They are used here for educational/instructional purposes as covered by the Fair Use Doctrine.
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