What’s It Like for Shooting Survivors to Live With Bullet Fragments Inside Them For Years

For many gunshot survivors, the injury does not end when the wound closes.

Oronde McClain was 10 years old when a drive-by shooting changed the rest of his life.

A bullet struck him in the head. He spent eight weeks in a coma. Surgeons removed one-third of his brain. He had to learn to walk and talk again.

Twenty-five years later, McClain still has seizures. The right side of his body remains partly paralyzed. And inside his brain and skull, 36 bullet fragments remain.

For many survivors of gun violence, the shooting does not end in the trauma bay, the operating room or even after the wounds close. Pieces of bullets can stay in the body for years, sometimes for life. They may cause pain, anxiety, mobility problems and, in rare cases, lead poisoning. Yet doctors do not always discuss those risks with patients, and many survivors leave the hospital without a clear understanding of what remains inside them.

The Bullets That Stay

Every year, about 115,000 firearm injuries occur in the United States. One study estimated that about 75 percent of survivors live with retained bullet fragments.

Doctors often leave fragments in place because removing them can be more dangerous than leaving them alone. A fragment lodged near the brain, spine, major blood vessels or deep tissue may be impossible to extract safely.

“We don’t go after bullets. Instead, we go after the damage that the bullets have done,” Dr. Erin Hall, a trauma surgeon, told NBC Washington.

RelatedPosts

Poor cookware might be lead poisoning an entire continent
The Five Weirdest Things People Have Tried To Combine With Guns
With a few cheap changes, your smartphone can now detect lead contamination in water
Flint’s water is deemed safe, Michigan Governor determined to end free bottled water service

Modern ammunition may make this more common. Hollow-tip bullets, designed to expand and cause more tissue damage, are less likely to exit the body cleanly. They can break apart, leaving metal scattered through tissue, bone or organs.

×

Get smarter every day...

Stay ahead with ZME Science and subscribe.

Daily Newsletter
The science you need to know, every weekday.

Weekly Newsletter
A week in science, all in one place. Sends every Sunday.
No spam, ever. Unsubscribe anytime. Review our Privacy Policy.

Thank you! One more thing...

Please check your inbox and confirm your subscription.

McClain said doctors warned him that removing the fragments in his head could kill him or leave him with more deficits. But no one told him about lead.

“They told me that they can’t take it out because if they take it out [from my head], I might die or have more deficits. They did not tell me anything about lead or anything like that,” McClain told STAT.

A Rare but Serious Risk

Most modern bullets contain lead or a lead alloy core. If fragments remain in the body, the toxic metal can sometimes enter the bloodstream.

“If someone is shot and they are living with a metal fragment inside of their body, it may serve as a source for metals to leach out,” Jamaji Nwanaji-Enwerem, an emergency medicine physician and professor of environmental health, told STAT.

Lead poisoning from retained fragments is thankfully not common. A Centers for Disease Control and Prevention report examined about 150,000 people with elevated blood lead levels. Roughly 500 people with levels of 10 micrograms per deciliter or higher had retained bullet fragments, making up less than one percent of cases.

But retained fragments appeared more often in the most severe cases. Among people with blood lead levels of 80 or higher, about 5 percent had retained fragments. The highest reported reading in that group exceeded 306, a level that can be fatal.

The symptoms of lead poisoning can be easy to miss. Adults may develop fatigue, irritability, abdominal pain, memory problems, headaches, nerve damage, high blood pressure or anemia. Those symptoms may appear years after the shooting, making it difficult to make the connection.

Colin Goddard, who survived the 2007 Virginia Tech shooting, told NBC Washington that his symptoms emerged almost a decade later.

“The short-term symptoms are hard to recognize. It’s things like fatigue, irritability, memory loss, stomach pain,” he said.

“What’s been driving me forward to try to do something is to stop the long-term impacts from happening, which are kidney failure, cognitive decline — a bunch of really intense things. Because once they happen, there’s no undoing it,” Goddard said.

Some doctors say fragments near joints may pose a higher risk, because joint fluid could help degrade the metal.

A Deeper Burden

The fragments can also become psychological burdens.

At MedStar Washington Hospital Center in Washington, D.C., one of the region’s busiest trauma units treats about 600 survivors of violent injuries each year. Many leave with bullets still inside them.

“It’s a marker of the worst day of my life. It’s the marker of pain and suffering and probably a whole constellation of unfortunate circumstances and terrible, terrible happenings. And it’s physically inside you as a reminder,” Hall said.

Randi Smith, an associate professor of surgery and trauma surgeon at Emory University, studied the mental health effects of retained fragments after seeing many such patients during her surgical training in Philadelphia. In one study, people with retained bullet fragments had higher depression scores.

“For some people, the bullet is a constant reminder of the trauma that they’ve endured,” Smith told STAT.

Smith described a young mother with a fragment in her shoulder. “She never wanted to hold her child on that side because of the pain of the retained bullet being rubbed on. She also didn’t want to transfer that negative energy to her child,” Smith said.

McClain, now a gun violence survivor media advocate with the Philadelphia Center for Gun Violence Reporting’s Survivor Connection, hears similar fears from other survivors.

“They feel [the fragments] in their chest all the time, they’re nervous. They can see it every time they wake up. It reminds them of what happened, it reminds them of the scene. It’s not like you are looking at a scar, you are looking at a bullet. That’s frightening,” McClain said.

Not every survivor experiences fragments the same way. Smith said some people see them as proof of survival, as if to say “I made it through a tough time, and the bullet reminds me of how far I’ve come.”

But doctors say patients deserve to know the risks either way. Routine blood lead testing for people with retained bullet fragments is not standard care. Some researchers and clinicians argue it should be considered, especially when symptoms appear or fragments sit in higher-risk locations.

Smith said even basic disclosure remains uneven.

“Some people are not even told that they have a retained bullet fragment, so how could they even look for information about it if they don’t even know they have one,” Smith told STAT.

For McClain, the issue is not abstract. It is deeply personal.

“We are in this club that we didn’t sign up for. We feel like we could die at any moment because we have a foreign object in our body,” he said.