House does not belong to me, by which I mean House the TV show, House the character, and even the House I live in, which still belongs to the bank...and I make no representation otherwise in any way, shape, or form.
Three factors determine the extent of injury from a gunshot wound. One is velocity, or the speed at which the bullet travels as it leaves the muzzle. Another is frontal area, meaning the surface area of the bullet that strikes the target. The third is the distance the bullet travels before it is stopped—for example, by lodging in the neck and abdominal cavity of a middle-aged doctor.
The 9 mm Glock 19 is a medium-velocity weapon with a relatively short barrel. Its cartridges are small, carry little gunpowder, and travel less than 1500 feet per second. Nevertheless, they can create a hole three to six times the size of the bullet's frontal surface area, because the frontal area flattens and spreads as it hits the target. The nose of the cartridge deaccelerates rapidly at this point, but its center of gravity is located near the base, so momentum carries the bullet forward, tumbling end-over-end and leaving further tissue damage in its wake.
Distance is a factor because air resistance slows the bullet. Increasing the distance between gun and target decreases the bullet's velocity, reducing its kinetic energy. Unfortunately, most victims are shot from close range—such as half the width of a standard conference room.
The kinematics of the experience are likely to go unappreciated by the victim, whose immediate response tends to be purely visceral. Author George Orwell, wounded by a sniper in the Spanish Civil War, described "the sensation of being at the centre of an explosion. There seemed to be a loud bang and a blinding flash of light all round me, and I felt a tremendous shock … I knew immediately that I was hit …. I had a numb, dazed feeling, a consciousness of being very badly hurt, but no pain in the ordinary sense."
The hip-hop artist Gravy, who was recently shot outside a New York City radio station, described a somewhat different experience. "The only thing I remember is falling, and knowing I'm shot—just don't know where. It's not like, when you get shot, 'Oh, I got shot here.' Nah. You know you hit, so your mind frame is—you pumped, your adrenaline is going."
About adrenaline: Generations of Hollywood gunfight scenarios have taught us that shooting victims invariably fly backward and are dead before they hit the floor. It's probably what the assailant expected when he planned his attack. The doctor was working from a different script. Small-gauge weapons can inflict lethal wounds, but they don't necessarily take the victim out of the game immediately. Instead, a burst of adrenaline might propel him forward rather than back. The world of gun enthusiasts abounds with legends of animals and humans who withstood a full round of ammunition and managed to beat the bejesus out of the assailant before perishing from blood loss. Military personnel and law enforcement agents who carry 9mm pistols in the line of duty speak of the Glock with less reverence than collectors because they lack the stopping power of a larger-calibre weapon, and when you need to take down an opponent—say, he's coked to the gills on crystal meth and coming straight at you with a knife, or you need to make a hasty getaway from a busy urban hospital—stopping power is essential.
Seeing their boss get shot was easily the most horrifying spectacle any of diagnostics department staff had ever witnessed. Watching him rise to his feet and face his attacker came a close second. Greg House winced as he tried to straighten; touched his side and came away with blood on his fingers; touched his neck and picked up more fresh blood. He regarded the gunman with contempt.
"God, you're a lousy shot," he mocked, spraying more blood with every word. "Can't even take out a one-legged doctor at close range. Who are you, anyway? You were never a patient of mine."
Eric Foreman was the first shake off the paralysis that had immobilized the team. "House, lie down!" he barked. "You're wounded, you're hemorrhaging—get down!"
Adrenaline can be a very short-lived high. House turned toward Foreman's voice, suddenly bewildered. He opened his mouth to speak and choked up fresh gobbets of blood instead. His knees buckled. Foreman and the other male team member, Robert Chase, caught him under the arms and lowered him to the carpet. Allison Cameron, the remaining member, picked up the conference room phone in a shaking hand and punched "0." "Get me ER," she said hoarsely.
The gunman watched them with a blank expression, his anger apparently spent. Chase turned on him savagely.
"Get the fuck out of here," he snarled.
The gunman backed toward the doorway. Outside, the corridor was filling up with anxious, milling hospital personnel.
"Stop him! He has a gun!" cried Cameron, but the news only caused the crowd to part gingerly as the gunman made his way to the elevator bank.
House was meanwhile responding to the double insult and blood loss by transitioning to hemorrhagic shock. His pulse quickened and became thready, his breathing more rapid, his blood pressure dropped. The sense of outrage that had driven him to his feet dissipated and gave way to confusion. He was suddenly, acutely aware of the foreign objects lodging in his neck and side.
"The bullet, it's hot," said Gravy. "It makes you feel like you can't move, like something is holding you." He added, "You got to get shot to understand."
As Foreman and Chase began searching for entry and exit wounds, House had the peculiar sensation of standing behind them, evaluating their technique but unable to direct them. He heard Foreman tell Cameron to get some clean t-shirts from the stash House kept in his lower desk drawer, and he wanted to protest—the bloodstains would never come out—but the right words wouldn't come to him. Chase bent over him and began delicately probing his neck. The Aussie's face kept fading to white. House opened his mouth to speak, and a salty trickle ran out of the corner of his mouth and down his neck. Chase paused and fixed him with a look.
"It's under control," he said firmly. "You can relax now; we'll take it from here."
How professional he sounds, House thought distantly. Maybe they do know what they're doing.
And on that happy thought, he allowed the darkness to claim him.
All three fellows were conscious that they had entered the "golden hour," the period when following correct trauma management procedures means the difference between temporary incapacity and permanent injury or death. Foreman began directing the ER personnel who responded to the scene. Chase applied compression to the abdominal wound with grim dedication. Cameron tended to the neck wound and chanted words of encouragement to the unresponsive patient.
A gurney whisked House away to the ER, although "whisking" was easier said than done. The hospital was in an uproar now; the corridors were now jammed with staff and visitors, anxiously trading rumors and opinions. Cuddy appeared and strode alongside the gurney firing questions no one could answer yet. Wilson brought up the rear, looking stunned and saying nothing.
The procession inspired commentary from the sidelines. "This is only the first time that asshole has been shot?" smirked a cardiologist with a history of bad blood between him and House.
Cameron brought the parade to a halt as she turned to face him.
"A man has been shot," she reminded him, her voice shaking with rage. "At least have the decency to keep that kind of crap to yourself until he's in the OR." The gurney moved on.
"Who was that?" asked the cardiologist's companion.
"House's groupie," came the answer. Chase made as if to go back and confront him, but Foreman pressed him forward.
At last they glided through the automatic doors of the ER. House roused himself briefly. "Hello," he said. Heartened, Cameron reprised her central message: "You're going to be okay."
"You don't know that," House mumbled. The team exchanged a look: this was reassuringly pessimistic. Then, mysteriously, he added, "Tell Cuddy I want ketamine," and passed out again.
The ER staff moved forward to take over, their expressions grim as they assessed the damage.
The bullet gets all the credit in a gunshot wound, but it doesn't work alone, especially when delivered at close range. Hot gases from exploding gun powder and metal fragments from the bullet and the gun barrel are blasted into the body at the same time. The gases char the tissues, and the gun powder and metal fragments are deposited along the wound track. The edges of the entrance wound are abraded and haloed with a dirt ring caused by the bullet "cleaning" itself on the skin as it passed through. The wound also may be infiltrated with fibres from clothing that were dragged into the body along with the bullet.
An abdominal wound is complicated by the fact that the internal organs are packed under pressure and will try to escape if there is a weakness in the walls that bound them. When Chase removed the compression bandage from House's stomach and a nurse began cutting away his bloody t-shirt, a paraumbilical omentum—a fold of the peritoneum, the membrane that lines the abdominal cavity—protruded from the wound. Cameron blanched.
"Get her out of here," Foreman told Chase, jerking his chin toward the door.
"I'm fine," Cameron protested, but a moment later another inch of peritoneum worked its way out of the hole and her knees started to buckle. Chase put an arm around her and led her from the room.
House faded back in and tried to speak. Blood appeared in the corners of his mouth.
"Shut up," Foreman advised him. "I'll let you run this show as much as possible, but don't try to talk. Is it starting to hurt?"
House closed his eyes and nodded.
"The anesthesiologist is gonna want to know what medications you're on. Have you taken any Vicodin today?"
A heavy-lidded look from the patient.
"How much? Five milligrams? Fifteen? Thirty?" A nod. "House, it's not even 2 o'clock yet! All right, all right, never mind. Are you taking any other meds?"
A slight pause, then a faint headshake. Foreman noted the hesitation and moved on.
"Let's get the scary stuff over with. Can you feel your arms and legs? Any numbness or tingling in the extremities? Move your right arm; now the left. Lemme see you move your left foot; now the right. Grab my fingers—ow! Damn, man, you don't have to pull them off!" He whipped off a sneaker and poked at House's foot with a pin, using a hair more force than necessary. "Did you feel that?" Foreman looked up at his boss' face: House's eyes were closed, but he had lifted his right hand and extended the middle finger.
"I think you're gonna live," Foreman said drily, and for the first time since the gun appeared, House smiled.
In the waiting area Chase did his best to comfort Cameron, who was furious with herself for her unprofessional weaknesses. These included vomiting into a wastebasket as soon as they left the ER. Her co-worker's efforts at making her feel better just made her angrier.
"I'm a doctor, for god's sake," she seethed, "and I acted like a goddamned Homecoming Queen."
"You're upset—anyone would be," Chase soothed. "Seeing someone you know get shot is a traumatic experience. Seeing his guts crawl out of the hole is even worse."
"You didn't hurl," she said accusingly.
"No," Chase acknowledged, "but tonight I'm going to get very drunk, and I may have a nice technicolor yawn before morning."
Foreman appeared and dropped heavily into a chair, rubbing his head with both hands.
"They're taking him to Imaging for pictures," he said wearily, "then straight into surgery for celiotomy. We'll know more once they open him up, but he had a fit when I told them they could cut up those crappy Levis, and he flipped me off when I did the pinprick test, so he's not at death's door yet."
"What about the neck wound?"
"Everything seems to be working. Obviously he can move his fingers, and he definitely has feeling in his feet. They got the bleeding under control, too, so the bullet must've just nicked the external jugular and passed right through."
"It'd be a miracle if it did," said Chase. "The guy was standing right over him."
"With the two of you standing right over him," Cameron reminded him. "He was shaking pretty badly."
"Did you ask him if he knew the shooter?"
"Yeah. He's sure he's never seen him before."
There was a moment of silence. Wilson entered the waiting room and dropped heavily onto the sofa.
"What do we do now?" wondered Chase.
"One of us should probably check on Tongue Guy, make sure someone is following up with him," said Foreman. "Cameron, could you take care of that? Chase, you start looking into this ketamine thing—what does House want with animal tranquillizer? I assume he's not just looking to party."
"What are you going to do?" Cameron asked.
"I'm gonna swing by his place, see if—" Foreman swallowed the rest. Cuddy was walking toward them, followed by a pair of gentlemen whose suits and ties did nothing to disguise the fact that they were cops.
"I'm sorry to interrupt, doctors," she said, "but these men are detectives from the city police department, and they need to talk to you."