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 Dear Fiction Dr., My protagonist is a cop who’s been shot in the lung five years previously. He is in good shape and is not a smoker. What, if any, long term consequences would he have from a lung wound? I don’t want it to be serious enough that he couldn’t continue on the job after the wound healed. I’m looking for something mild, to remind him of his injury, but not so severe as to make him disabled.Thanks, Hi Carol, Here’s the scoop on your gunshot to the lung. To avoid major long-term consequences, the injury would have to be such that a thoracotomy (ie. cutting between the ribs to access the lung) was NOT necessary. If a thoracotomy was necessary, and subsequently a lobectomy (ie. removing a segment of the lung) then your cop would have decreased lung function for life. That means he would be short of breath any time he had to run, like a chronic smoker or asthmatic would be, and may end up connected to a portable oxygen tank as he got older.A ‘through and through’ gunshot wound that does not hit any major vessels or organs would enable your cop to survive without much sequelae. For example, a bullet wound in the right middle or right lower lobe area. The entrance wound is usually small and round if there is no deflection by the rib. The exit wound is larger with more ragged edges (which the surgeon would have to ‘debride’ or clean-up) so the cop would have a larger scar at the exit site. He would also have a scar from where a temporary chest tube had to be placed. The chest tube is a flexible plastic tube that the surgeons insert through the side of the chest to drain the blood from the pleural (membrane that covers the lung) space. This is a good description of the procedure of chest tube insertion: http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm You can see what a chest tube actually looks like inserted in a real patient here Even though it looks pretty grim in that photo, once the bruising resolves most patients are left with a pretty small scar. However, apparently they can experience discomfort or tugging from the site even years later. Note this patient’s description from http://www.city-data.com/forum/health-wellness/316180-chest-tube-scars-problems.html “I've had chest tubes on 3 occasions. The last, along with a VAT, was about 10 years ago. All were left side, emergency, for spontaneous pneumos. The last was a tension pneumo. I have not had any trouble with the scar, although the docs assured me I would not notice anything different before/after the VAT when breathing and that is not true. I can still feel a sort of "tug" inside, like on or near the lung (wherever the nerves there are --I have no idea) every time I take a deep breath or yawn. I'm a runner so I feel it quite often. They should not speak of that which they don't know..... Don't know if that's at all helpful, but man do chest tubes hurt!” I hope that helps with your story. Let me know if you have any further questions. Best regards,
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