All of my gunshot wounds were cataloged in an urban ER. In each case the victims — and I use that term loosely in certain cases — had obviously been shot at least long enough to be taken to the hospital. I pieced the previous history together via discussions with the cops and paramedics.

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We invest our time and treasure improving our skills with firearms so that, should the unthinkable occur, we will be ready. Here are some insights concerning what happens on the other end of the gun. These anecdotes have shaped the way I pack heat.

Case No. 1: Always Bring Enough Gun

Our hero presented to the ER with left knee pain. He had an unremarkable exam save some discomfort with manipulation of the joint. There were no obvious wounds. He offered no history of trauma. I shot an x-ray of his knee as a matter of routine. The .25 ACP FMJ bullet was minimally deformed and resting comfortably within the joint capsule. When confronted with the image, a look of enlightenment washed over his face.

The previous evening he had been out with friends at a local watering hole. The music was loud and the place was hopping. He fished around in the front right pocket of his jeans for his smokes and inadvertently stroked the trigger of his Jennings .25. He was surprised when the gun discharged, but thankful not to have been injured. The racket of the honky-tonk was adequate to mask the sound of the gunshot. He reported no pain at all.

Further investigation turned up the tiniest wound perhaps three inches north of his knee on the medial (inside) aspect. The spot could easily pass for a mosquito bite. The Orthopedists fished out the bullet and he went home to party another day.

Case No. 2: Penetration Is Important, but It’s Complicated

The 17-year-old young man presented to my clinic complaining of penile discharge. He was found to have good old-fashioned Chlamydia — the “Clap” in the Vulgar Tongue. His medical history reported a gunshot wound, so I inquired as to the details.

About six months prior this young man had run afoul of his drug dealer. When confronted with his inability to pay for some illicit pharmaceuticals, the unlicensed pharmacologist terminated their professional relationship with a single .22 LR to the head.

The round impacted at the medial aspect of his left eye, tracked along his skull base, and exited just to the left of his spine, leaving him minimally inconvenienced overall. He healed completely without surgery and even retained his vision. Thankfully we got his newfound STD treated so that he could go forth and spread his seed yet further.

Case No. 3: A Properly Jacketed Hollow Point Means Not Having to Say You’re Sorry

This young man was shot in the face with an unknown handgun. The exit wound was in the right aspect of his occiput (the back of his head) and was about the size of a lemon. The cops knew very little about the scenario save where they found him. Interestingly enough, despite a pathologically unsurvivable wound, his body didn’t get the memo that he was dead for maybe another 15 minutes. Incapacitation, however, would have been instantaneous.

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I poked around the exit wound later and uncovered a nearly intact bullet jacket lodged between his scalp and his skull. It measured 11mm on a piece of handy EKG paper. The round had been a .45 ACP.

Case No. 4: Never Forget the Fundamentals of Gun Safety

The conflict had its origins in the unrequited affections of some fair lass. The subject and his opposite number resolved to settle the dispute via a brief exchange of gunfire. The man clearly had not done enough reading on the fine art of concealed carry, so he had just dropped his heater into his right front pocket sans holster.

While grappling for the gun, his finger stroked the trigger and it went off in his pocket. The 9mm FMJ round subsequently center punched the shaft of his penis at about its midpoint leaving it unnaturally angulated. He gave me the impression that his wound also resulted in instant incapacitation.

All thoughts of love were banished from his mind. The young stud’s opponent thankfully declared victory so he could get to the hospital. We consulted the urologist and moved on to the next crisis.

Case No. 5: Bullets Can Surprise You

Our patient was an exceptionally large gentleman who had been a player in a drug deal gone south. As the man sped away in his ample Caddy, the jilted drug dealer threw a single 9mm ball round his way just out of meanness. The patient felt he had escaped unscathed. When he arrived at his domicile, he noticed blood on his shirt. That’s why he met me.

The bullet penetrated the steel trunk of the car, passed through the rear seat, transited the front seat, and lodged in the man’s ample back fat. The surgeons ultimately fished the bullet out, as it was a relatively shallow wound, and the man was otherwise unharmed. I was shocked that a simple 9mm FMJ round could move so far.

Case No. 6: Sometimes it Really Is Simple

The man was, by our local standards, a veritable canonized saint. He had a job at a mini-mart and was standing at the front door of his baby mama’s house (his term, not mine) after work with a jumbo bag of diapers. Some miscreant came up behind him with a gun and demanded money.

The young man explained that he had no money but offered the robber the Pampers as a consolation prize. Unimpressed, the criminal shot the man through the leg and departed to ply his nefarious trade elsewhere.

The wound was through and through. There was no bony involvement, and the nerves and blood vessels remained intact. I cleaned and dressed both the entrance and exit wounds, got the poor guy some pain meds and antibiotics, and sent him on his way. As he departed the ER he was grumbling sincerely about the incontrovertible injustice of the world.

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Case No. 7: Always Unload Your Gun Before Handling It

The gentleman was watching television when he inadvertently dropped his TV remote. Groping blindly for the contrivance underneath his recliner, he happened upon a forgotten .22 pistol. Hefting the dusty weapon, he could not recall if he had left it loaded or not.

Determined to put that question to rest definitively, he drew a careful bead on his big toe and squeezed the trigger.

I actually commended him on his marksmanship. At a range of perhaps three feet he punched that zippy little .22 round straight into the center of his toenail and through the underlying flesh and bone. As an additional bonus the bullet also blew out his TV screen. He walked into the ER under his own power.

Case No. 8: Things Are Not Always as They Seem

The gladiator was heavily muscled and covered with gang tats. It took five of us to restrain him long enough for a proper exam. The cops said he had been shot with a .380 ACP pistol maybe 15 minutes before we met. He was cursing us vigorously throughout.

The only stigma of injury was a small black hole between his sternum and his right nipple. There was very little blood and no exit wound.

Over the next few minutes, the man’s demeanor changed dramatically. He began begging and pleading with us to keep him alive. In moments he was ignoring us altogether and shouting passionately for Jesus. Then blood began to froth out of his mouth, he arched his back, gurgled horribly, and died.

The man had exsanguinated into his lungs from damage wrought by a single .380 ACP FMJ round that had thoroughly ventilated his pulmonary vasculature. By the time we could substantively intervene, he was gone. However, he could have fomented a great deal of mischief before he succumbed to this single perfectly placed round inflicted by the same sort of pistol I carried every day.

Final Ruminations on Gunshot Wounds

I once read that, on average, 60 percent of those hit with gunfire at any spot spontaneously fall down. It is the other 40 percent that you have to worry about. Bullets can be notoriously unpredictable in human flesh, and real life bears little similarity to the movies. If ever called upon to use your defensive firearm for real, engage the threat until the threat is no longer threatening.