Medical Bloopers: Don’t Try This At Home

When Mel Gibson slaps his dislocated shoulder back into place in any of the Lethal Weapon films ad nauseum, I always cringe.

I don’t cringe because it’s painful, which I assure you it would be. But because, reducing a dislocation that way, a real person would inevitably fracture the humerus, the long bone of the upper arm. Sure, some people can pop their shoulders in and out of joint voluntarily. Their ligaments are loose. They need only to relax their muscles to slip it back in, no force or loud crack is necessary. However, everyone else needs sedation and medical help to reduce the joint, sometimes anesthesia and even surgery. No one can violently slam the ball of the humerus into the joint without injury, though it’s become a staple of action movies.  Blame me for being a retired physician and picky. A novelist friend reminds me that fiction is telling the real truth with imagination, but I find myself often challenged to suspend my education along with my disbelief.

One of my favorite authors, I’m sorry to say, wrote a recently published scene where his detective protagonist listens to a Medical Examiner who ought to be relegated to making house calls on Fantasy Island.  Unlike a Coroner, who may or may not be a medical doctor, the M.E. is always a physician.  He or she methodically examines human anatomies, perhaps several a day, taking them apart like dismantling broken clocks.

Two medical examiners looking down at operating table
Do these glasses make us look smarter?!
To summarize this Medical Examiner’s report to the detective: Three hollow-nosed 9mm shells were removed from the body. The first shot entered the chest, piercing the right ventricle—that’s the pocket in the heart that pumps returned venous blood from the body to the lungs for aeration. This first bullet exploded the heart, continuing on its path until embedding in the fourth thoracic vertebral body, though it did not fracture it (break the bone). With that impact, however, the victim’s spinal cord was severed, causing paralysis of the legs. He, therefore, fell onto his back on the floor. While he lay paralyzed, this M.E. says, the next two shots pierced the right and left lower sternum (the breastbone). They each struck a lung, but did not exit the body. The bullets were trapped by the musculature of the back. Death occurred within a minute of the first shot.

So what’s wrong with that?  And where’s Waldo, and who took the cookie from the cookie jar, while you’re at it? Good mysteries are, of course, based on questions, but the evidence provided to the reader shouldn’t be so questionable, and if you think through it, some of these issues don’t require a medical degree to wonder about.

We’re told that the bullet which struck the spine at T-4 without breaking any bone also “severed the spinal cord.” What’s up with that? It couldn’t touch the cord nestled inside the vertebrae if it didn’t even fracture the spine, right?  So how did it damage the cord enough to paralyze the victim and drop him to the floor?

It couldn’t have.

Anatomical diagram of spine

Thoracic vertebral bodies sit in front of the spine shielding the cord. Further, they are bound together with very strong gristle tissue. They cannot be significantly moved or dislocated without tremendous force, something like being run over by an army tank.

You can contuse the cord and lose function, but our questionable Medical Examiner said “it severed the cord.” I must assume an M.E. making a visual inspection knows the difference between a contusion and a laceration. I also assume three beers is my limit, but once I pass that number, I can’t remember whether I’m right or not.

Suppose, somehow, the force of the bullet’s impact could injure the anterior cord that’s behind the vertebral body at this level. Unfortunately, the motor power to the legs at T-4 runs at the very back of this cord, furthest from the vertebral body being impacted by the bullet. These back-seat nerves alone could not have been contused without taking out the windshield and steering column, too. As described, it is anatomically impossible for this victim to have suffered a laceration of the cord and lower body paralysis. Oh, well.

9mm bulletsWe’re also informed the murderer used 9 mm hollow-point shells. These cartridges usually are packed with enough powder to blow your doors clean off. So why didn’t the following two bullets to the lungs make it out the victim’s back to deform against the floor or even pierce it? The magic bullet in Dallas’s Dealey Plaza went a few hundred yards and then through a skull, a neck, a chest, an arm and into a leg. Okay, I’ll suspend my disbelief on that one for national security, but . . . 

The investigator hypothesizes the victim quickly reached over to grab and hide an ejected shell casing in his mouth prior to dying.   People with exploded hearts die extremely quickly from lack of oxygen to the brain. People who are also paralyzed from the waist down with exploded hearts can’t move very well to grab leftover ordnance, because their lower body is a dead weight and their brain is dying. Every muscle’s cramping from lack of oxygen. If you have ever run too far and too fast for your conditioning, you know what I mean. The movement required to chase rolling shells with three gunshot wounds to the chest would be extremely painful and unlikely, especially while dragging dead weight as your exploded heart isn’t pumping, 

You see my problem?  You may encounter similar issues, because crime novels are set in every area of the country and every occupation, especially involving medical, scientific, legal, and law enforcement professionals.  Sometimes knowing a subject too well interferes with the fun of the ride.  But when (fictional) death’s on the line, medical information at some level almost has to be provided.  I still enjoy this award winning crime novelist’s work, but I wonder, to paraphrase My Cousin Vinny: Are the laws of physics suspended in your novels?  Certainly the laws of physicians are.

Have you encountered murders that seem to be impossible, or so unlikely you couldn’t enjoy the story?  Do you wonder about the reality of frequently portrayed methods of injury and death?  Has your own knowledge as a specialist been offended by an author you love reading (anyway)?

I’ll be glad to know I’m not alone.

Images courtesy of Spine Universe and An Nguyen Photography


Dr. Lewis Preschel a.k.a. Madison Muttnick M.D.

Comments

  1. Michael Terreri

    Well done, Dr. Muttnick. I enjoy your criticism almost as much as your fiction. Keep on.

    Michael Terreri

  2. Laura K. Curtis

    I love this! I hope you dissect many more “medical mysteries.” There’s no excuse for sloppy research, and I am always fascinated by stuff (like medicine) I know nothing about.

  3. Jill

    Can’t wait to read more from you!

  4. Cindy Dunn

    Thanks for the analysis, Doctor. I hope you (or the Mad Mutt) are available for consultations as I may need your expertise one of these days…

  5. JFN

    Accuracy is of utmost importance. It is what separates the amateur vehicle of literature from the pro.
    Do not apologize for knowing the way it is. Keep your stories accurate. Make it your mission

  6. jill preschel

    Accuracy is the most important!! I agree

  7. Harvey Self

    This is amazing thanks for sharing this blog I have become a fan of your blogs now. This blog is so interesting and informative.

  8. Mr John

    This is very informative and interesting for those who are interested in blogging field.

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