Just a flesh wound: movies vs reality

It doesn’t look good for our hero. He’s out of ammunition and the bad guy is drawing a bead on him. He decides to risk it all on one last, desperate attack. He springs into action but as he does the bad guy gets off a shot.

Luckily, the bullet hits our hero in the shoulder. Ha, no problem. In a second he has disarmed and disabled the bad guy, wounded shoulder and all.

Flip over to another channel, and Forrest Gump is in the war. Even though the movie is only five commercials deep, he gets shot. He is wounded in the, ah, BUTT-tocks. He recuperates by lying on his stomach, wearing a man-diaper and eating ice cream.

We sought out Dr. Jeff Kalina, co-director of the Houston Methodist Hospital Emergency Department, and asked: what’s the best kind of flesh wound to get in real life?

“A bullet striking the human body anywhere can cause an incredible amount of damage,” he says, “but it’s not always fatal.”

He’s seen the movies where someone is shot in the shoulder and fights even harder. “It’s more likely that a bullet hitting someone in the shoulder is going to cause some major damage to the bones and the joint in there,” Kalina says. “It may not kill you, but it will pretty much stop a lot of movement on that side of the body.”

And what about Forrest Gump? Getting shot in the rear end is pretty much always played for laughs in the movies but Kalina says it’s not so funny in real life. “Pelvic veins run all through that part of the body, like a spider web,” he explains. “There’s a real good chance a bullet going in back there is going to hit something important.”

So let’s ask Kalina to tell us where one can be shot and still have the best chance of survival. “Anywhere below the knee or in the calf … it might hurt, but you won’t die. On the outside part of the upper leg, either side of the upper body,” he says. “(In 1981) President (Ronald) Reagan took a bullet through the lung and he recovered completely.”

In fact, the 70-year-old President didn’t immediately realize he had been shot. Reagan thought he had broken a rib when a Secret Service agent pushed him into a car. But Reagan took a bullet in the chest, lodging in his left lung just an inch away from his heart.

What saved the President was the fact that the bullet ricocheted off an armored limousine before striking him, probably reducing much of the projectile’s lethal velocity. And the fact that Reagan received almost immediate medical care certainly helped in his recovery.

White House Press Secretary James Brady was shot in the head, permanently disabling him. When Brady died earlier this year, his death was ruled a homicide – caused by the gunshot wound he received nearly 33 years ago.

It’s tough to predict what can happen when a bullet enters the human body. “A bullet never travels in a straight line inside the body,” says Kalina. “It can be deflected by bone or large, thick muscle mass. It can cause a little damage, or a lot.”

A bullet never travels in a straight line inside the body. It can cause a little damage, or a lot Click To Tweet

Kalina once saw a patient who had been shot in the side of the head. Instead of going straight through, the bullet was deflected by the man’s skull and traveled over the curve of the skull under the skin and exited the other side. He lived.

“There are literally thousands of stories like that,” Kalina says. “But more often than not, bullets do serious, permanent injury and kill people. Movie fantasy is fun; getting shot in real life is not.”

Concussion: movies vs. reality

Our hero sinks back into the shadows, waiting for the night watchman to make his regular rounds. He doesn’t have to wait long. He swings with the butt of his pistol and renders the guard unconscious with a blow to the head. “Sweet dreams,” he says. “You’re gonna wake up with a wicked headache.”

Stop the video. For decades, good guys and bad guys (and girls, too) have been knocked out with a bop on the head, a sock to the chin or a quick karate chop. The movies’ all time knockout champ has to be super spy James Bond, who usually comes into consciousness bound and gagged for the next cliffhanger. The hapless detective on The Rockford Files was knocked out pretty much every episode of the TV show’s six-season run.   

We asked Dr. Kenneth Podell, a neuropsychologist and co-director of the Houston Methodist Concussion Center: Is it really possible to smack someone in the head and render them unconscious?

The short answer is yes, it is indeed possible, but the complications come after. “If you hit somebody hard enough with an object to cause unconsciousness, you could also be hitting them hard enough to break the skull,” Podell says. “It depends on the weapon … one with a large surface area (like a frying pan) dissipates the shock over a larger area, while a smaller weapon focuses the force and can easily fracture a skull.”

It doesn't take a big blow to result in a concussion that carries many long-term health effects Click To Tweet

Podell has seen many cases of people suffering long-term effects from concussion after receiving a blow much less violent than those usually depicted in movies. A person coming out of an unconscious episode, waking up as if from a nap, does not happen most of the time. “There’s a kernel of truth there but a blow substantial enough to cause unconsciousness is also very, very dangerous,” he says.

Let’s speed up the video a bit and check out this part: two combatants grapple fiercely in hand-to-hand combat, and the battle is at a deadlock. Suddenly, one uses an explosive head butt to stun his opponent and gain the upper hand.

“Again, this has a bit of truth to it as well … the front, top part of the skull is the thickest part and can theoretically be used as a weapon,” Podell explains. “But remember that’s also the other guy’s thick skull, so the butt-er needs to select a weak point on the butt-ee, like the bridge of the nose or the side of the head.”

Podell cautions that any kind of head injury has the potential to be very serious and have long-term complications. Concussion can cause dizziness, shaky balance, confusion, headaches and memory loss that can linger for weeks or even months. If you suspect you or someone you know may have had a concussion, please immediately seek medical care. 

Like many other physicians, Podell regularly sees things in movies that don’t really line up with real life. He tries to check his expertise at the door, he says, and suspends disbelief to enjoy the fantasy on screen.