A Shoulder to Die On

Before you inflict an obligatory shoulder injury to your protagonist, N. Lawrence Mann urges you to consider aiming elsewhere. Learn why!

We’ve all seen it: The heroin takes a bullet in her shoulder area, where the chest muscle meets the shoulder bone. She falls back, winces in pain for a few beats, and then musters just enough strength to outsmart the bad guy and win the day—and has the wherewithal to sit up and give a thumbs up to the chief of police while her arm rests in a makeshift sling as the ambulance door shuts and she is carted off to the nearest hospital.

It happens a lot, and with good reason. The shoulder is a convenient place to be wounded, as it is a significant enough part of the body where the audience takes the wound seriously yet isn’t a vital organ. This may be true, but it doesn’t mean that a knife or bullet to the shoulder could be any less deadly. Here’s why:

The Problem

An endearing perk of growing up with a physician as both a movie buff and father is you are allowed insight between the curtain of Hollywood embellishment and medical reality. If a character has held their breath for too long underwater, my sister and I would hear about it. Likewise, IV needles being thrust straight into the undersides of elbows (and not at a severe angle) were similarly called out. This acquired knowledge has greatly benefitted my writing, keeping it honest, medically speaking. The shoulder wound is no exception. In fact, I have yet to incorporate a shoulder wound into a story, knowing his bologna alarm is out there (sorry, Dad)!

First off, some of the larger vessels of the body run through the shoulder. These include the subclavian artery and vein, which are the basic blood supply to the upper extremity (upper arm, lower arm, and hand). In addition, the brachial plexus—also located in that area—is the major nerve supply to the upper extremity as well. Not to mention that the shoulder itself is a very complex ball-and-socket joint that, hampered by traumatic injury, can lead to lifelong disability (and that is if you survive the initial blood loss from major vessel trauma).

Even if these significant bone, vascular, and neurological structures are not directly injured during such a wound, significant soft-tissue injury (muscles, ligaments, and cartilage) would require immediate surgical exploration and debridement (cleaning and extraction of bone chips, bullet bits, glass, etc.). If you survive a significant shoulder wound, the chances of permanent disability probably exceed 30 percent.

So how much time would you have if you have taken a bullet to the shoulder, you ask?

If the subclavian artery is severed, blood loss will be immediate and massive. Without prompt, emergent response (IV fluids, blood transfusion/blood pressure support) and immediate transfer to a facility equipped to handle this type of trauma, this same shoulder wound we have belittled in our countless favorite plotlines may result in death in a matter of minutes.

Obviously, every body type reacts differently to trauma, so it’s challenging to put an exact number here. Either way, it is safe to say that after sustaining this wound, you are not getting in your car to chase the bad guy, not fighting the good fight against that elusive antagonist for the climax of the story, and not holding down the fort anytime soon while using your good arm to hold your rifle as you take aim against evildoers—none of it. You are done. Even if you have severed your subclavian vein (not the artery), this still would result in major blood loss and incapacitate you in a very short amount of time. Any makeshift sling would be inadequate to the control the amount of hemorrhaging we are talking about. Granted, it would aid in immobilizing a shattered shoulder, but that would be the least of your worries at that point.

Upper extremity is more significant to daily life than people realize, and the consequence of a severe injury to it can be long-lasting. Individuals who sustain these wounds experience prolonged rehabilitation and, many times, never fully recover. In other words, they never regain full use of their arms. So plan accordingly if you have a recurring character who just shows up in the next book or script as if their shoulder wound from a previous story had never occurred. Otherwise, my dad’s bologna alarm will be triggered (with sound and fury).

The Solution

Think in terms of nicks instead of gashes. Do your best to avoid the temptation to embellish the significance of the wound. Keep in mind that the only shoulder wound (knife, bullet, arrow, etc.) that would not result in significant bleeding, disability, and emergency care would be a through-and-through injury on the outer deltoid muscle (commonly referred to as the shoulder muscle) or the outermost region of the trapezius muscle (which connects the neck to the shoulders). You want 2 or 3 centimeters of maximum depth here. Anything deeper would likely impact the clavicle, the scapula (shoulder blade), and the large vessels in the shoulder. There’s simply not a lot of room for error before the loss of blood would render you incapacitated or dead.

Don’t worry. These nicks bleed a lot. You can keep them as messy as you see fit. No one will have to know the true significance of the wound unless you feel compelled to divulge it.

And if your characters really need a place to get shot, try a through-and-through wound in the gluteus maximus (Forest Gump might prefer “buttocks”) but avoid hitting the pelvis, which brings forth a whole different set of anatomical disasters reserved for an entirely different article.

In short, get shot in the ass for goodness sake, not the shoulder.

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Comments

  1. Janie Mathis

    This book sounds great! Would love to read it!

  2. John Smith

    My head is spinning from all these medical-knowledge truth bombs! Now I know about all of these things that can go wrong and I’m…worried! I want my innocence back!

  3. Daniel M

    looks like an interesting read

  4. Penni Ellington

    I love this article and can’t wait to read this.

  5. Jevon guidry

    This book sounds really good. Can’t wait to read it

  6. Elena

    “Coma dreams” seems very interesting and I am looking forward to reading it! Thanks for the chance =)

  7. Desmond Warzel

    Count me in, please!

  8. susan beamon

    Since my great enemy osteoarthritis has seen fit t invade both of my shoulder joints, I feel for your shoulder wound traumas. I may not bleed out, but sometimes trying to move my arms can bring tears to my eyes.

  9. Lori P

    Very interesting “deep dive” into shoulder wounds. I’ve seen at least 2 bullet-to-the-shoulder wounds in the last week alone on crime dramas and in both cases the victim was barely incapacitated at the end, which was generally within a few days. What are the odds?

  10. Irene Yeates

    Thank goodness!! I often remark out loud when I ascertain that some aspects of crime fiction is downright ludicrous. I am a reader/researcher at heart, and I check these anomalies out. Don’t get me started about some crime movies/TV programs that stretch the truth. Though they cannot hear me, I vocally chastise and shame them. Your book sounds like a winner; hope I am too!!

  11. Carolyn

    If the heroine was on heroin when she was shot, she would probably wouldn’t have felt it at all… Sounds like a very interesting book!

  12. Karen Queen

    The book sounds great!

  13. Cindi Hoppes

    What an interesting introspect! Many thanks for the chance to win your book…
    Cindi

  14. Joy Isley

    This author seems like he has a sense of humor. Can’t wait to read this one.
    The book cover looks enticing.

  15. April

    Fascinating feature and wonderful giveaway. Thanks.

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    Extremely interesting post. The book sounds captivating and intriguing.

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    Sounds great! Would love to win.

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    Yes

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    Sounds great!

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    I like books with medical themes. Would love to have it.

  21. Darlene Slocum

    Sounds like an interesting variety to my reading list.

  22. Laurent L

    Very interesting. People get shot with no effects in movies all the time.

  23. Christal M

    Looks good

  24. Susan Lutman

    Loved the medical description of shoulder injuries. Would love to win Coma Dreams. Thanks for the opportunity.

  25. Jeffrey Malis

    Very interested in reading this… Will certainly seek out Book One of the series. Thanks for the article and the entry chance!

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  27. Susan Morris

    I can relate to this topic because my younger brother died from a gunshot to the shoulder. Would love to read this new book!

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  30. Deb Philippon

    I really found this interesting . Thank you, and wish me luck!

  31. Andrew Beck

    I didn’t know shoulder wounds could be so complex! I’ll have a new attitude reading about shoulder wounds, to see if the writer takes them appropriately serious.

  32. Karen Terry

    Sounds like a great read.

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    Thanks for the opportunity to win!

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  54. Sophia

    Thanks for all the info , but the getting shot in the as* part lol , why would anyone prefer to shoot at our as* out of all the places they could 😂 , I was writing a scene where the bad guy shoots at the female lead but hero shields her with his back , imagine getting shot in the as* at that time lol 😂 , so like anyone else , I chose the back shoulder , but thanks for info once again 😊

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