Pants on Fire, or Pants Under Fire

I remember a time when I was really new. I was in the field training program, new enough to still be stuck perma-attending, when my FI and I were sent to a drive-by shooting just outside of what would be considered downtown. We arrived to find a scared 17-year old male who had a story about being shot in the leg during a drive-by. “Gang members” drove up to him, asked who he claimed, and shot him when he said he loved his momma and Jesus. Shot for no reason. It was indeed a sad, sad commentary on modern life.

Officer, he was well dressed, looked Italian, in his early 40s, chubby...
By US Bureau of Prisons [Public domain], via Wikimedia Commons

He said he had been shot in the left calf, so we put him on the bed in the bus. I started to cut his jeans from the cuffs upward while my FI looked at me with an expression of disdain and frustrated anger and a police officer took the victim’s statement. (By the way, you could tell that I was new because I was actually cutting the patient’s jeans. Now I know that you only have to cut the bottom seam on a pair of jeans and the rest rips in a straight line really quickly.) As I was cutting, I had a brief thought that it was weird that there wasn’t a bullet hole in his jeans. But I knew that bullets did odd things from time to time. Maybe it was small caliber and didn’t make much of a hole so I missed it. Or something. One way or the other, I was way to busy to think discrepancies like that through.  

You see, back then I didn’t do a good job of investigating when my brain asked “What the F*ck.”

Anyhow, as I was cutting up the inside seam of the kid’s pant leg, I indeed came to the bullet hole in medial aspect of his inferior calf, right where the gastroc muscle ends and the lower leg narrows. This isn’t necessarily a life-threatening wound, assuming that there were no other findings. I made a mental note to check for expanding swelling and to ensure that the dude had pedal pulses. 

Out of habit, mostly, along with wanting to complete the job, I continued cutting the patient’s medial seam of his jean leg. I found a second wound at the superior part of his medial calf, just inferior to the knee. Wow. He didn’t even feel the second one. Adrenalin, huh?

I continued cutting while I absent mindedly pondered life and the human ability to not feel all pain. I came to a third bullet hole just superior to his knee. I still didn’t stop to investigate the larger, “What the F*ck” question. I suppose people get shot multiple times and only feel one wound. Or something. And what the hell were the gangsters using, some kind of machine gun or something? Dude had a line of wounds right up his leg.

While thinking about all of that, my hand continued to squeeze the trauma shears along his pant seam until I came to what I hoped was the last bullet hole. This one was at his left groin, just to the side of his sack. There was gunpowder stippling around the wound. 

Weird, I thought. How did they get that close to him during a drive by? (See – I told you I was new.)

My partner, who was not new, saw the wound and said, “You little liar!”

No, no, dude.  The other kind.  The pants on fire kind.
By LPLT (Own work) [CC-BY-SA-3.0], via Wikimedia Commons

The cop, who was in the back with us getting the patient’s statement, suspect information, and such, was apparently not new either. “Where is the gun? Where’d you put it, dammit! If a kid finds it, I'll hold you responsible!”

I am not a smart man. As proof of that statement, I offer the fact that I still didn’t know what was actually going on. The patient made a brief but valiant attempt to continue the gangster drive-by story, before it collapsed under the weight of evidence.

“I threw it into the bushes over by the swimming pool,” he finally admitted in a weak, defeated voice.

Now I finally began to catch on. Our patient was putting a handgun into his belt when it went off. The round barely missed his left nut before entering his thigh, exiting his thigh just above the knee, then reentering his leg at the calf, and coming out of his calf when it narrowed again. It stitched right down his leg and all he felt was the lower calf wound.  So he knew he needed help, but didn’t want to get in trouble. Thus, the imaginary gangster story. 

The three big lessons that I took from that call were that everybody lies (at least sometimes, a little), there is no substitute to thinking about findings that don’t match the story, and that there is no substitute for a complete exam. Even when you think it is a simple calf shooting call, the complete secondary exam finds all kinds of stuff.