Shot To The Head

I was up early for my run, part of my training for a half marathon later this year in Placencia, Belize.  Distance running is not popular here, and I think most Belizeans wonder if someone is actually chasing me down the dirt road south. Sitting at the kitchen counter I had just finished my breakfast and was slowly getting ready for my day.  The phone rang, always a bad sign, I did not know the number. As I answered I could hear noise in the background and a soft voice saying, “Dr Sam? Dr Sam?”.  I knew immediately it was Merari, our young front desk lady at Saga.  “You have an emergency”, she said.  There are not many times that I get called to work in the morning before I am supposed to start, most things can wait until I arrive for the day.  I inquired to Merari what the issue was.  I couldn’t quite understand at first but thought I heard the words “shot” and “head”.   I asked her to repeat herself, “They shot him in the head.”, was all I heard.  I asked her if the dog was alive, she sat the phone down for a minute to double check, indeed yes.  I told her to put pressure on the wounds with a towel, find Ingrid (our technician) NOW, and I’d be there soon.

I was literally sitting there dripping in sweat. I knew once I left I would not be back home until at least lunch. I ran to the bathroom for the fastest shower of my life, foregoing any makeup or efforts at nice hair (scary, I know), I threw on my clothes and jumped on my bike. In minutes I was running into the shelter and burst into the clinic room.  At the desk sat Ingrid very calmly, on the table was a dog covered in a blanket, no one else was around.  “She’s already dead?”, I asked desperately.  Admittedly this was partly out of sadness and selfishly partly out of disappointment that I had rushed all for not.  But, she was, in fact, still very much alive.  She had been given an injection for pain but was in shock.

Under the blankets I found a medium sized blonde female pitbull mix.  She had been shot once in the head, a single bullet had entered her skin on the top left of her skull and exited the back of her neck.  This was not a case of abuse or neglect, and the authorities were aware.  In the end it was not my business to know the how and the why, just to try to save the dog.  I could not recall having treated a fresh gunshot wound in the past.  The entry wound was smaller and very neat and tidy, the exit was larger and more rough around the edges.  There was a mild amount of blood coming from each.

Entry and Exit Wounds

In the situation in which this happened, she was forced to lay outside for a few hours before she could be brought to the clinic for care, her body was in shock.  We started a bolus of IV fluids, as well as antibiotics and more medications for pain and inflammation.  She could feel and move all her limbs, but her pupils were small and fixed and I feared that the bullet had entered her brain.  We decided to take her for x-ray to see if her skull had been shattered.  There was a glimmer of hope when we moved her, as her pupils became normal and she responded to us. Once stable enough, we drove her down the road in the golf cart to get a radiograph.

Skull X-Ray

Although there was a spot near the base of her ear that made me wonder if the bullet had grazed her skull, it was clear that it had not entered her brain or spinal cord.  The thick muscle that covers the top of her skull and is particularly large in this type of dog, had protected her.  There were also no bullets inside her.  Off we went, back to the clinic.  I did not feel like anesthesia would be the safest option at that time nor did I feel that I should close her wounds, so we continued some IV fluids and put a light bandage over her neck wound to absorb the bloody fluid.  We let her rest.

Having a Sleep after a Long Morning

She spent most of the day in this position, but by the time I came back to check on her later in the evening after I left the gym, she was sitting up interacting with me.  I had no idea if she’d love me or hate me once she was feeling better, but she seemed like a nice dog.  When I came in the next day she was eating and drinking.

Day Two

I decided to let her wounds continue to heal by second intention (filling in on their own over time) so that I would not trap fluid or bacteria inside the path that the bullet took.  We continued with oral antibiotics and anti-inflammatories and she was doing much better.

After a week her head looked great but her neck wound was not filling in well.  I decided to anesthetize her to explore the wound.  I found a very large open pocket caudal (towards her rear) from the opening that was not visible just when looking from the outside.  I opened this up completely, causing a big incision, removed any of the damaged and dead tissue, and sutured her neck up in multiple layers.

Wound and Closure

 

All Healed Up

 

Soon enough, this dog that I initially thought would die or need euthanasia was fully healed.

She is a loving, wiggly, cute, girl.  Not bad for a shot to the head!