south africa can be a violent place, but sometimes one can't help cracking a smile.
one case i remember was basically a form of domestic violence. a woman was shot. the bullet entered her right breast, passed through her diaphragm, through her liver, through the upper pole of the right kidney and out her back. her abdomen was soft. she remained stable. the ct showed no signs of continuous bleeding or any intra abdominal calamity. i observed her in icu and she did well. the hematuria cleared up. the liver sorted itself out. the intercostal drain was removed after about a week and she went home.*
i can't help myself. i always ask what happened. her story i remember well. she, her boyfriend and a friend of her boyfriend were together somewhere. they were either drowning their sorrows or celebrating something. whichever of the two, it was facilitated and lubricated by large amounts of alcohol.
the boyfriend and his friend were both cops and one or both of them had their service guns that night. at some stage, the friend apparently stole the boyfriend's gun. he went off to hide it, but my patient saw him. she confronted him and told him to give it back.
in the ensuing argument, according to her, the friend fired a warning shot into the air and then a second shot into my patient.
in my mind i pictured the scene. i don't know why the one cop stole the other's gun. i don't even know if he really did. maybe he had lost his and was afraid of repercussions at work and in his drunkenness it seemed like a good solution. maybe the ethanol caused a more imaginative version from my patient. but i do know she was shot.
the thing that made me laugh about this story was the warning shot. i could just imagine the thought process that went through his inebriated mind. in the moment of anger that drove him to commit this crime he must have remembered his police training. instead of just shooting her outright he had the presence of mind to first fire a warning shot into the air. i can't think what the warning shot was warning her to do. was she supposed to stop nagging him? was she supposed to just keep quiet? or was it just a warning of what was about to befall her?
she clearly didn't heed whatever warning it was.
*although that is not the aim of this post, maybe i should say a bit about the so called conservative management of gunshot abdomen. the literature only supports two cases where it may be possible. the first is gunshot abdominal wall (this is strictly speaking not actually a gunshot abdomen). the second is gunshot of the dome of the liver without any real intra abdominal trajectory of the bullet. i personally think that it can be extremely dangerous to even attempt so called conservative management of gunshot abdomen and it is usually best to open if there is any question at all.