Three Bullets to the Head?

How a gunman in Wisconsin managed to shoot himself over and over again.

The house in Crandon, Wis., where a sheriff’s deputy killed six people

Arizona Rep. Gabrielle Giffords is in critical condition after being shot in the head on Saturday morning. “ I am very optimistic about her recovery,” said a doctor at the University Medical Center in Tucson, while acknowledging that the bullet went through her brain. In 2007, Michelle Tsai explained how one might survive a gunshot to the head. The article is reprinted below.

A sheriff’s deputy in Wisconsin killed his ex-girlfriend and five others at a house party on Sunday, then fled. When he was caught hours later, he used his .40-caliber Glock pistol to commit suicide—shooting himself twice from under the chin, and then once through the right side of his head. How’d he manage to shoot himself in the head three times?

He kept missing the brain. A gunshot to the head isn’t always fatal; when the gun is aimed upward from the chin, the recoil can angle the muzzle toward the face. In this case, the bullet travels through the mouth and nose instead of back into the head, where the brain lies. The victim of such a wound would suffer serious injuries to the face; he might also suffocate if the bullet hit part of his nose, or if bits of flesh block the breathing pathway. But the pain isn’t necessarily excruciating; survivors say it’s like being punched or kicked in the face. A victim might even remain alert enough to use his hands, or, in the case of the sheriff’s deputy, to reposition his gun and try again.

The severity of a self-inflicted bullet wound to the head depends on a few factors. The larger the bullet, the more damage, since the projectile destroys any tissue in its path. Hollow-point bullets that shatter are especially dangerous, as the fragments can spread into a larger swath of brain tissue.

But where the bullet goes is most important: the farther from the center of the brain, the greater the chance of survival. If a bullet grazes the tip of one of the lobes of the brain, the patient will probably live with proper medical treatment. If a bullet enters just one hemisphere, it’s still possible to make a reasonable recovery. Someone who took a shot just to the front of the brain might suffer personality changes, like Phineas Gage, the 19th-century railroad worker who became obstinate and profane after an accident. A patient with a wound to the side of the head usually arrives at the hospital unconscious but breathing.

The gravest bullet trajectories cross from one side of the head to the other, striking the center of the brain along the way. Here lie the brain stem, the diencephalon, and other structures that together govern basic life functions such as breathing, the heart rate, blood pressure, and temperature. A bullet through the mouth, Hitler-style, can kill immediately if it strikes the brain stem.

Whatever the angle, gunshot wounds to the head are usually fatal. According to unpublished data from the University of Maryland, of 264 such victims from 2000, all but 29 died on the spot. Of the 27 who were accounted for, only 18 made it into an operating room. Eight survived with significant disabilities; 10 had a good recovery.

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Explainer thanks Bizhan Aarabi of the University of Maryland Medical Center, Robert Levine of the University of Texas School of Medicine at Houston, and Dave Ross of Penrose Hospital in Colorado Springs, Colo.