Sniper Victim Was a Textbook Case for Doctor

WASHINGTON -- When Saturday’s sniper victim was rushed into the operating room with a bullet in his abdomen, he was fortunate enough to have as his surgeon the man who literally wrote the textbook on such devastating wounds.

It was Dr. Rao Ivatury, editor of Textbook of Penetrating Trauma, whose practiced hand helped save the life of the 37-year-old man struck down in the parking lot of a Ponderosa steakhouse in Ashland, Va., by a high-velocity .223-caliber bullet fired by the Washington-area sniper.

The man’s injuries were a textbook case of what such bullets can do, said Ivatury, who has treated thousands of similar cases.

“It looked like it almost exploded inside, causing a huge amount of damage,” said Ivatury, chief of trauma surgery at Virginia Commonwealth University’s Medical College of Virginia Hospitals in Richmond.

The victim, who was not identified at the request of police and his family, was in critical but stable condition Tuesday at the Medical College of Virginia Hospital. He has improved every day, according to hospital officials.

High-velocity rounds such as the sniper has been using cause much more devastation than the average handgun bullet.

“The .223-caliber [ammunition] that the sniper uses goes in and creates a large path of destruction, which is why it killed most of the other people,” said Dr. Marsh Cuttino, the emergency room doctor who treated the victim.

“When one of them enters the skin, it makes a small hole the size of a pencil eraser,” he said. “But a large tube of destruction -- five to 10 times the size of the bullet -- is generated by the shock wave as the bullet travels through the tissue.”

If Tuesday’s shooting of Conrad Johnson, a bus driver in the Maryland suburbs of Washington, is connected to the sniper, it would bring to 10 the number of people killed in the rash of shootings that began Oct. 2.

The man who survived Ivatury’s surgery is one of only three to survive.

Any kind of bullet can kill a person in seconds if it pierces the aorta or another major blood vessel, because the victim quickly bleeds to death.

But the bullets used by the sniper can cause a person to bleed to death quickly even if the aim is not as precise, doctors said. Often the bleeding is all internal, so a bystander might not see any blood.

To keep his patient alive, Ivatury’s team had to take out everything that was bleeding, including parts of the stomach, pancreas and spleen, and use sutures and clamps to control bleeding in other areas, the doctor said.

The man needed a second surgery to repair the organs.

Ivatury said he had done “thousands and thousands” of similar surgeries from 1980 to 1998 while working in the Bronx section of New York, where gang and drug violence was common.

But Ivatury said the location of the bullet also favored Saturday’s victim. “If the bullet was a little more to the right or to the back, he would have had major vascular injuries and he could have died.

“I was always fascinated with these injuries, and there was not a specific book that addresses these injuries,” Ivatury said. So he and some colleagues wrote one; it was published in 1996. Several chapters deal with treating traumas caused by high-velocity bullets.

Dr. Jonathan Groner, trauma director at Children’s Hospital in Columbus, Ohio, said it is rare for a doctor in the U.S. to have much experience treating these kinds of wounds unless the doctor served in the military.

Groner treats gunshot wounds, but not from high-velocity bullets. Such surgery would pose a significant challenge for him, he said. “I can sew up a hole in an artery. I can’t sew up a bomb crater.”

“The way the bullet reacts when it hits its target varies depending on the specific type of bullet used,” said Tom Diaz, senior policy analyst for the Washington-based Violence Policy Center, a gun control group.

“But even the simplest .223-caliber bullet will cause significant if not devastating damage.”