The news reports of the wounds suffered by the Boston bomber suspect being treated at Beth Israel Deaconess Medical Center grow more interesting by the hour.
ABC News is now reporting that the suspect has a wound in the back of the neck, which is leading investigators to conjecture that the wound may be the result of an self-inflicted wound in an unsuccessful suicide attempt. One scenario being discussed is that the suspect may have placed the end of the gun barrel in his mouth and pulled the trigger but failed to kill himself. There are several problems with this scenario and it seems to be dubious.
From a purely clinical point of view and assuming the suspect did not flinch and give himself an off center shot through the cheekbone, this would be a very rare outcome.
Almost always, when a person swallows a gun barrel and pulls the trigger, massive tissue damages occurs and death is usually very rapid. Damage to the spinal cord and midbrain structures, pons, and medulla that control the respiratory drive occurs, if not from being in the direct line of the bullet then from the shock wave of the bullet trajectory.
Also, generally the back of the skull and neck would be obliterated from the large energy field applied to tissues at the exit site (FYI, most trauma surgeons will tell you that JFK was shot from the front and the large skull wound was the exit site.)
In self-inflicted gunshots into the mouth, the cerebellum that controls gait is usually destroyed. The vertebral arteries are usually obliterated also and there is blast effect to the higher brain parenchyma. Sight in one or both eyes can be lost through damage to the optic nerves
It just seems highly unlikely that a person could survive that injury and then be able to have the intact neural structures to climb out of a boat under his own power, as was apparently evident from a published photo of the suspect.
If by slim chance that is the case (perhaps the trajectory of the bullet was more toward the feet than the usual angle of more toward the top of the head), the patient would have surely received an early tracheostomy or cricothyrotomy (surgical airway placed through the cricoid membrane) to secure his airway in the setting of massive facial trauma.