Mutiny: The True Events That Inspired The Hunt for Red October

No windows admit the light of day or the stars at night. No radios at the end of the hall play music. No whir of fans or other machinery can be heard. No one is talking somewhere else in the building, the voices barely a murmur. It’s not hot, nor is it overly cold.

It is an indifferent place. Anonymous, like the people who pass through it.

But it is the end, and all prisoners who come to this point finally understand that this is the very last place on earth that they will ever see. This is the very last bit of the living world that they will experience. Begging, pleading, bribing, screaming, crying, cajoling, threatening will not have any effect. It’s possible that there are miracles, but not in a place like this.

According to a study by the NewYork-Presbyterian Hospital, almost every victim who is shot in the head and arrives in the ER deeply comatose will die. In these cases very little can be done to try to save the person, because, according to the report, “of the futility of the situation.”

One of the common tests is the Glasgow Coma Scale. The higher the score, the more likely it is that the patient will recover, and therefore the more aggressive the treatment should be.

Three tests are given, one for eye opening, in which a score of 4 means the victim’s eyes are open and 1 means the eyes remain closed no matter what is said or done to them. Verbal responses run from a score of 4, which means that the victim can talk and make sense, to 1, in which the words make no sense, and finally to 0, where the patient says nothing. Another test is for motor responses, in which a score of 6 means the patient can respond to a command, such as lifting an arm when asked to do so, to 2, in which the patient might twitch, and finally 1, in which there is absolutely no response, even to a pinprick to the bottom of a foot.

Next the ER nurse or doctor looks for some other signs of life or the possibility of survival. What are the sizes of the pupils and their reaction to light? Is there any drainage from the mouth or ears? Does the chest expand evenly? Are the heart tones within limits? Are the lung sounds clear on the right and left? Are wheezes or crackles present? Is the abdomen soft, flat, rigid, or distended? Is the patient incontinent? Does the victim have movement and reactions in the upper and lower extremities? Does the victim have normal movement of the back, or is he or she paralyzed?

If there are any signs of life the victim should be immediately given a normal saline solution for fluid replacement. Blood should be drawn for laboratory analysis.

Above all, if there is to be any chance of survival, the victim should be placed so that he or she is comfortable and can breathe without trouble. He or she should be covered in warm blankets, especially around the head, neck, and shoulders, to prevent shock.

The wound should be cleaned and covered with a sterile dressing.

Drains should be put in place—a nasogastric tube to reduce the risk of the victim throwing up and drowning on his or her own vomit, and a Foley catheter to decompress the bladder and so that the medical staff can check the victim’s urine output.

Then there is blood loss that has to be considered. A small man of around 150 pounds has about five quarts of blood in his body. If he loses about three-quarters of a quart, his heartbeat will increase to try to push what’s left to all the organs so that they will survive and function. He’ll become light-headed and nauseous and will begin to sweat.

If he loses a quart or so, his blood pressure will drop dramatically. The damage to his system becomes almost irreversible unless something is done soon.

Then, with around a 40 percent bleed-out, with loss of nearly two quarts of blood, the damage is complete. The victim goes into shock, which leads to cardiac arrest, and it’s game over. Nothing can be done to revive the victim. He dies.

According to Patricia Ann Bemis, RN, CEN, who conducts an online nursing course on stab, gunshot, and penetrating injuries: “Penetrating injuries to the brain have a high mortality rate. Missile wounds from high velocity weapons [such as a 9mm pistol at contact range] can penetrate the skull. All patients with brain… trauma are assumed to have cervical spine injury until proven otherwise by a negative X-ray or CT.”

A brief NewYork-Presbyterian Hospital article on cranial gunshot wounds warns that death will most likely occur if any combination of factors piles up against the victim: a low Glasgow Coma Scale score, an older age, low blood pressure (because of blood loss or other problems), lack of oxygen after the trauma, dilated, nonreactive pupils, and a bullet trajectory that plows through several lobes of the brain or the ventricular system.