Wednesday, January 30, 2013

Recovery After Gunshot Wound to the Head

My character attempted suicide with a small-caliber revolver as a teenager. He survived and became a police officer. I need to know about recovery time, stages of recovery, rehab, and possible lingering effects of the trauma.
It’s going to depend on your scenario.

It’s not unusual for someone to survive a GSW to the head. Suicides tend to put the gun against their temple, and take out the optic nerve. They end up blind and with some facial deformity, depending on the gun.

Since your character is a police officer in the future, you can choose anything from the bullet “ricocheting” off the skull and traveling under the skin (without penetrating the bony calvarium—the bone of the skull) to going through part of the motor strip (which controls muscle action), which would give rise to the need for rehab. One caveat—he might never overcome those mechanical deficits enough to work as a police officer; witness Congresswoman Gabby Giffords. She’s better, but she’d never qualify for police work.

**Consider having the bullet penetrate the skull, but do minimal damage to the brain itself by traveling beneath the bony calvarium. The brain is a tricky, and you can pick and choose to a certain extent about what deficits you’d like to induce.

Rehab in this case would be directed at relearning motor functions in the damaged area; physical therapy for strengthening, occupational therapy for fine motor skills. Maybe speech therapy.

Begin with sitting up in bed for fifteen minutes, and go from there. Again, the duration of rehab is going to be proportional with the amount of damage. If a small amount of damage, I’d say a week to ten days in the hospital, four to six weeks at a rehab hospital/facility, and maybe outpatient therapy for a couple of months beyond that. The patient would be expected to do exercises at home on his own.

Lingering effects of the injury include easy fatigability, more muscle weakness when tired, sleep-deprived or hungry, and possible abnormal emotional reactions from inappropriate laughter to crying. It’s also not uncommon for these patients to end up with a seizure disorder. Posttraumatic stress disorder also isn’t uncommon, as is depression and a lower frustration threshold.

One of the most interesting GSWs I’ve seen was a man who’d been shot in the forehead. He had decreased ability to process pain, an increase in irritability, and poor decision-making—none of these would be good in a cop.

Questions? Comments?

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Interesting, Kelly, great information. I was surprised to learn from our local coroner about a young man attempting to commit suicide via a gunshot wound to the head. He pulled the trigger and when he didn't die, he kept going to the mirror to see what he was doing wrong. Took him five bullets. Really sad.

    1. That IS really sad. Unfortunately, it's a testament to people not knowing how to "do it right."
      Thanks for reading and commenting!

  2. Then there was the bad guy I was forced to shoot. My first round entered the left side of his head just above the left TMJ and then traveled downward, exiting a bit below the right lower jaw directly beneath the ear. He fell down and then immediately stood to continue firing at me, like the wound was nothing more than a minor irritation. Of course, the bullet took a few teeth with it as it entered and exited the mouth.

    The bullet traveled the path it did because the suspect was hiding in a drainage ditch, which was 35 yards or so away, and several feet lower than where I stood.

    1. Very interesting, Lee. And a great illustration of how unpredictable the course of a bullet can be.
      For law enforcement, it demonstrates one bullet may not be enough to stop a suspect. Glad you got out of it in one piece.
      Thanks for commenting and contributing.
      Cheers, Kelly

  3. Kelly, this is excellent information for a writer. I'll have to use it soon. It's great to have a resource like you.

    1. Thanks, Lynda. I'm glad you find it useful! Thanks for reading.