BBC Sherlock Fan Forum - Serving Sherlockians since February 2012 » An interesting NEW perspective

RavenMorganLeigh · February 28, 2014 9:17 pm

Swanpride wrote:
@belis Thank you...I suspected that the precise dates are in the whole study, but my fannish soul is not that strong that I would subscribe just for that. Mmm...that's interesting...so most of the gunshot victims didn't even need an operation? I guess in this case we can even go so far to theorize that Mary was actually aiming for a grade I-III injury, but got unlucky and hit something which caused the heavy bleeding.

@RavenMorganLeigh Thanks for trying...we were actually discussing how high the survival rate for shots which do hit the liver only is. Obviously very high....

I don't deny that in real life, nothing is that neat...but at least it is now proven that Mary did indeed pick a target with a high survival rate. That this was unbelievable risky is a given (after all, Sherlock's heart stopped).

I should have coffee before I post. :-)

Seriously, I think if you go shoot someone-- in the liver--on purpose, because you think there's a high chance for the person you shot to survive, you will go to prison for attempted murder.

Even if you keep asserting that, "Oh, I was just trying to wound him grieviously enough that my husband would have to stop and try to keep him alive, so I could get away and continue lying to him about my past", you'd have a hard time convincing a jury, the judge, etc.

But that's TV for you.

Just sayin'. :-)

RavenMorganLeigh · February 28, 2014 10:40 pm

Swanpride wrote:
Certainly...but Mary didn't have to convince a jury, she had to convince John and Sherlock, who have their own view on right and wrong.

What I am saying is any way you cut it, it was still attempted murder. The fact that John and Sherlock are willing to sweep it under the rug just makes me question their judgment. :-)

besleybean · February 28, 2014 10:42 pm

Because they also sweep each other's murders under the rug.

belis · February 28, 2014 10:57 pm

It may well be an attempted murder. If it was though, it was a poor effort on Mary's part. If she wanted him dead why shoot him somewhere that gives him a relatively good chance of survival? I think it's unlikely that she was aiming for a heart and missed. I think it's pretty unlikely that she knew that she will hit the IVC. Why did she aim where she did?

besleybean · February 28, 2014 11:00 pm

She's an assassin.
If she'd wanted him dead, he would be.

Willow · February 28, 2014 11:11 pm

belis wrote:
It may well be an attempted murder. If it was though, it was a poor effort on Mary's part. If she wanted him dead why shoot him somewhere that gives him a relatively good chance of survival? I think it's unlikely that she was aiming for a heart and missed. I think it's pretty unlikely that she knew that she will hit the IVC. Why did she aim where she did?

She was deliberately inflicting a probably lethal but not immediately lethal wound, to prevent John coming after her, having previously established that John was on the premises by asking Sherlock.

Counsel for the prosecution would rip her to shreds if she attempted to argue that she thought it would give Sherlock a relatively good chance of survival; attempted murder using a firearm carries a 30 year tariff. The fact that she had asked about John establishes premeditation; she couldn't claim that she had panicked because she had taken the time to establish the presence of a witness, who needed to be deterred from coming after her, and the prosecution would destroy her on that fact alone.

SolarSystem · February 28, 2014 11:15 pm

besleybean wrote:
She's an assassin.
If she'd wanted him dead, he would be.

If I am not very much mistaken, he died, he was dead. And he's certainly not alive because of Mary.
Maybe we could just stick to the facts.

RavenMorganLeigh · February 28, 2014 11:27 pm

Willow wrote:
belis wrote:
It may well be an attempted murder. If it was though, it was a poor effort on Mary's part. If she wanted him dead why shoot him somewhere that gives him a relatively good chance of survival? I think it's unlikely that she was aiming for a heart and missed. I think it's pretty unlikely that she knew that she will hit the IVC. Why did she aim where she did?

She was deliberately inflicting a probably lethal but not immediately lethal wound, to prevent John coming after her, having previously established that John was on the premises by asking Sherlock.

Counsel for the prosecution would rip her to shreds if she attempted to argue that she thought it would give Sherlock a relatively good chance of survival; attempted murder using a firearm carries a 30 year tariff. The fact that she had asked about John establishes premeditation; she couldn't claim that she had panicked because she had taken the time to establish the presence of a witness, who needed to be deterred from coming after her, and the prosecution would destroy her on that fact alone.

Thank you, that's the point I was trying to make. Add to that, threatening the victim, covering up the crime, and then going after the victim with a weapon with a silencer--- well, she'd be in prison. For that alone. Let's not even bring into this all the different countries that may have charges of their own...

Last edited by RavenMorganLeigh (February 28, 2014 11:28 pm)

besleybean · February 28, 2014 11:31 pm

Are we expecting a high profile court case on this or something?

Willow · March 1, 2014 12:29 am

belis wrote:
Willow wrote:
'Gunshot injuries of the liver: the Baragwanath experience.
Degiannis E1, Levy RD, Velmahos GC, Mokoena T, Daponte A, Saadia R.
Author information

Abstract
BACKGROUND:
This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience.'

This is double the number of cases in the study relied on by the meta writer; it really does not make any sense to choose the small case series when you have one twice as large with different results.

There is also the blindingly obvious fact that case series can only cover the number of people who survived sufficiently long to reach the hospital and be treated. I would suggest that no one in their right minds assumes that all patients shot in the liver survive until they reach hospitals though obviously I do not wish to trespass on your territory
I can’t argue with the fact that neither of the studies takes into account people who expire before reaching the hospital. It’s an important limitation, which illustrates the challenges of trying to practice evidence based medicine. It’s not that easy to find studies that apply perfectly to the population we are interested in.

There is however an important caveat. Wellingtongoose uses the 8% statistic to compare the mortality rates between liver and thoracic injuries, not to talk about mortality in absolute terms.

‘The mortality rate for the entire group attributed to liver injuries was 8% (12). Thus the chances of surviving a shot to the liver are 92 percent. Compare this to a thoracic gunshot wound which has a mortality rate of around 20-30%.’
Consequently we can forget about people who die outside of the hospital as the same confounder is going to apply to both groups of interest (liver and thoracic injury).

Why did he choose to reference this paper and not the larger study? I suspect the main reason is that to obtain the mortality rate from Baragwanath study you need to do some leg work. The abstract doesn’t provide that information. To read the full article you either need to pay or be a subscriber. The

When you get hold of the full article some calculations are required.

Out of the total sample of 304 patients 19 died directly from their liver injuries giving a mortality rate of 6.2 %. That’s lower than figure quoted by Wellingtongoose. Majority of patients (241) ended up with grade I-III injuries and most of them didn’t need operating on. Only 4 of those patients died as a direct result of the trauma to the liver.

So in fact the larger study does confirm that liver is not such a bad place to be shot at in a grand scale of things.

Thank you; I'm glad that you don't understand why the author chose the smaller study either, other than that he couldn't be bothered to do the research.

However, you appear to be ignoring some important points. The confounder is not removed because it is perfectly possible that liver gun shot injuries result in much higher mortality rate at the scene than gunshots to the thoracic area. There is no equivalence between them which could support that conclusion.

It is generally recognised that the sepsis deaths are a result of the gunshot, yet you seem not be including them. Is this is intentional, or am I overlooking something blindingly obvious?

Particularly bearing in mind the fact that the massive increase in gunshot victims was in the last year or so of the five years covered by the review, radically skewing the series, and the vast increase in the use of high velocity guns, generally recognised as greatly increasing the chances of death, also skewed the series. Establishing the type of the gun used is essential to determine the risk; relying on the assumption that all guns are created equal is not going to extract useful information if you want to find out who is most likely to die.

As far as I can tell Wellington Goose belongs to the all guns are created equal lobby; he makes no attempt to differentiate the types, and in doing so he is making unfounded claims about risks.

But I suppose that, if he couldn't be bothered to do the research, tthen he's not going to be bothered about trifling details like comparing apples with apples, and oranges with oranges...

Willow · March 1, 2014 2:31 am

besleybean wrote:
Are we expecting a high profile court case on this or something?

Well, I don't know about you but in my view Mycroft prefers matters to be taken seriously.

On the other hand, I did an investigative job before I retired early, to spend more time with my doctors; and I had to always rely on the facts, though I had also to fight cases through the Courts. But for most of those occasions I was working on the balance of probabilities; there are occasions when I had to prove it beyond reasonable doubt, and those are harder.

But it would have been easy to convict Mary; her ego is so huge that she's a walking bomb and she could never be able to tell that she was being stroked by the investigator. Mary, unfortunately for her, is profoundly conceited.

Willow · March 1, 2014 2:45 am

RavenMorganLeigh wrote:
Willow wrote:
belis wrote:
It may well be an attempted murder. If it was though, it was a poor effort on Mary's part. If she wanted him dead why shoot him somewhere that gives him a relatively good chance of survival? I think it's unlikely that she was aiming for a heart and missed. I think it's pretty unlikely that she knew that she will hit the IVC. Why did she aim where she did?

She was deliberately inflicting a probably lethal but not immediately lethal wound, to prevent John coming after her, having previously established that John was on the premises by asking Sherlock.

Counsel for the prosecution would rip her to shreds if she attempted to argue that she thought it would give Sherlock a relatively good chance of survival; attempted murder using a firearm carries a 30 year tariff. The fact that she had asked about John establishes premeditation; she couldn't claim that she had panicked because she had taken the time to establish the presence of a witness, who needed to be deterred from coming after her, and the prosecution would destroy her on that fact alone.

Thank you, that's the point I was trying to make. Add to that, threatening the victim, covering up the crime, and then going after the victim with a weapon with a silencer--- well, she'd be in prison. For that alone. Let's not even bring into this all the different countries that may have charges of their own...

Though of course she would have been better of in an English jail; we don't use capital punishment...

RavenMorganLeigh · March 1, 2014 4:37 am

Willow wrote:
RavenMorganLeigh wrote:
Willow wrote:
She was deliberately inflicting a probably lethal but not immediately lethal wound, to prevent John coming after her, having previously established that John was on the premises by asking Sherlock.

Counsel for the prosecution would rip her to shreds if she attempted to argue that she thought it would give Sherlock a relatively good chance of survival; attempted murder using a firearm carries a 30 year tariff. The fact that she had asked about John establishes premeditation; she couldn't claim that she had panicked because she had taken the time to establish the presence of a witness, who needed to be deterred from coming after her, and the prosecution would destroy her on that fact alone.

Thank you, that's the point I was trying to make. Add to that, threatening the victim, covering up the crime, and then going after the victim with a weapon with a silencer--- well, she'd be in prison. For that alone. Let's not even bring into this all the different countries that may have charges of their own...
Though of course she would have been better of in an English jail; we don't use capital punishment...

No kidding-- we Americans just can't seem to get past our Victorian ideas of capital punishment. (Grumble)

Last edited by RavenMorganLeigh (March 1, 2014 4:37 am)

besleybean · March 1, 2014 8:25 am

Capital punishment was around centuries before Victoria,it is not a Victorian concept.

RavenMorganLeigh · March 1, 2014 9:19 am

besleybean wrote:
Capital punishment was around centuries before Victoria,it is not a Victorian concept.

What I mean is that we in the US are still stuck in 1800's mentality about putting people to death. :-)

besleybean · March 1, 2014 9:26 am

Quite so.
I confess, I am eternally delighted we haven't yet any prospect here of a referendum on capital punishment...
Sadly, we have plenty of our own in the : ' hang 'em, flog e'm ' brigade.
Barbaric.
I suggest those who want state executions go and live in some nice country that does provide such a service, I dunno: say Iran or North Korea etc.
MODS: apologies for OT posts...I'm in a bad mood about politics, today!
Well ok, I suppose that's everyday!

belis · March 1, 2014 9:49 am

Willow wrote:

Thank you; I'm glad that you don't understand why the author chose the smaller study either, other than that he couldn't be bothered to do the research.

However, you appear to be ignoring some important points. The confounder is not removed because it is perfectly possible that liver gun shot injuries result in much higher mortality rate at the scene than gunshots to the thoracic area. There is no equivalence between them which could support that conclusion.

It is generally recognised that the sepsis deaths are a result of the gunshot, yet you seem not be including them. Is this is intentional, or am I overlooking something blindingly obvious?

Particularly bearing in mind the fact that the massive increase in gunshot victims was in the last year or so of the five years covered by the review, radically skewing the series, and the vast increase in the use of high velocity guns, generally recognised as greatly increasing the chances of death, also skewed the series. Establishing the type of the gun used is essential to determine the risk; relying on the assumption that all guns are created equal is not going to extract useful information if you want to find out who is most likely to die.

As far as I can tell Wellington Goose belongs to the all guns are created equal lobby; he makes no attempt to differentiate the types, and in doing so he is making unfounded claims about risks.

But I suppose that, if he couldn't be bothered to do the research, tthen he's not going to be bothered about trifling details like comparing apples with apples, and oranges with oranges...

I think I can forgive him that his geeky zeal didn't extend to digging up the original literature. He acknowledges it in his blog that whilst he references facts and figures from time to time (to his credit) he doesn't make an attempt to create articles that would withheld standards of peer reviewed publications. He writes for fun about fictional characters, not creates evidence based medicine. That doesn't change the fact that if he did use the study you proposed we would arrive at mortality rate of 6.2%.

There are limitations to this approach however we are looking at perioperative mortality rates here. So we do compare apples with apples. Also Sherlock did make to hospital therefore this is the population of interest.

I'm ignoring sepsis. I'm working with the data provided in your article. In this series of 304 patients there were 2 deaths related to sepsis. Both occured in patients having associated bowel injury from a second gunshot wound.

The increase in overall numbers would not skew the series in any way. Series is a sample. We look at sample of 304 patients here in a given time frame. What would make this sample less aplicable to our circumstances is that

a) it's done in the 90s- surgical technique moved forward so one could argue that mortality today is even lower
b) It's done in South Africa, in a 3rd largest trauma centre in the world, gunshot wounds are bread and batter to those people. There is less expertise in the UK, which could potentially increase mortality. You could actually argue that it's a miracle that Sherlock survived at all as judging by locations of his postoperative wound his surgeons clearly had no clue what they were doing. The only operation you could perform through this incision really is a removal of gall bladder. ;)

Does anyone know exactly what weapon Mary shoots in that scene? We assume this to be high velocity wound and it probably is but since we are dissecting it in such minute details it would be good to know.

It’s important to note that I’m not trying to prove here that being shot in the upper right quadrant of your abdomen is risk free and doesn’t result in early or late complications (like sepsis). Of course it does. What the point of Wellingtongoose argument (and mine) is to try and prove that the mortality associated with being shot in the liver is lower than for thoracic injuries. Available evidence has its limitations and we have to work within those constraints. Is there any evidence to disprove the fact by showing higher perioperative mortality in liver as opposed to thoracic or head injuries?

If you wanted you could postulate that Mary is such a brilliant shot that she aimed precisely for the IVC and knew very well that Sherlock has about 90% chance of bleeding out to death allowing for John to be delayed on the scene. You could argue that if she wanted a ‘safe’ liver shot she would have moved away from the mediastinum reducing the risk of hitting all sort of important things. I’m not sure how much anatomical knowledge she has though to get into such nuances. Also it’s pretty much impossible to know the exact position of blood vessels by looking from outside. As you have pointed out before there are individual variations in anatomy, often staggering.

So in the nutshell I do buy Wellington’s explanation because it fits with my head canon. I do acknowledge that there are alternative ways of looking at it. I don’t think either can be argued to be completely wrong at this stage because we don’t have all the information and evidence.
The discussion itself is very thought provoking and stimulating though. It has been a long time since I read any surgical research papers. lol

Willow · March 1, 2014 4:35 pm

Belis

I'm glad you're enjoying it; and thank you for digging it out, and interpreting it for us all. My usual source for informed analysis has only just returned, and has gone straight into the joys of the nightshift.. I suspect that I would be happier with the idea of someone able to pick their spot were it not for the fact that my lungs do extend considerably below the point where they are supposed to stop; I really don't want someone accidentally shooting me in the lung. Actually, I'd prefer that they didn't shoot me at all

I am not the person to enquire of regarding laparoscopic surgery; there is a reason why they don't do exploratory abdominal laparoscopy on people like me, and the reason is me. I always try to cheer anaesthetists up by pointing out that whilst I do, technically speaking, have a history of RA under anaesthesia, it was only because they took out my diaphragm by pumping gas into my abdomen, causing everything to go south very rapidly. The anaesthetists usually cheer up for a completely different reason viz. they can offload me on the consultant

I get sidetracked into the fascinating history of a 3000 bed hospital with 1500 patients suffering from stab and gunshot wounds, which pitches its ad for electives to people like John. It's a tragic part of South African history, but it's always worth reminding ourselves that it can happen elsewhere. One moment they were puttering along with a few dozen trauma cases and the next they've got 2000 gunshot wounds in a year; it's a remarkable testament to the dedication of the people working in that hospital that so many survived, though it's worth noting that some of their methods of dealing with gunshot wounds to the liver are apparently regarded as heresy. On the other hand, as you note, they were really rather good at it, so a spot of heresy here or there isn't something which would trouble me.

Your last point is the killer for the gunshot as surgery thesis; if she doesn't have the knowledge to judge anatomical nuances then she could not do what Sherlock said she did. I absolve Sherlock from the charge that he's an idiot on this one because he said it whilst his brain wasn't getting much oxygen, and, in any event, I'm not convinced he believed it; my head cannon says that 'Its the baby, stoopid' is a far more likely explanation.

But we interpret what we see and hear and construct our own hypotheses; I was a fan, but not in fandom, until the end of this last season so I hadn't a clue that, for example, Sherlock was regarded as a villain for cruelly abandoning his true love by a section of fandom. It never occurred to me that people would dislike Mary simply because she exists as an obstacle to what they think is true love ie. Johnlock. My reservations about Mary were because she was too good to be true; Moftiss don't write Mary Sues so clearly there was something wrong somewhere.

It's still pretty strange to me, but I'm learning as I go along...

besleybean · March 1, 2014 5:15 pm

It's a fascinating subject.
I'd like to know if the Johnlockers thought Irene was such a threat, or if they've ever really worried about Molly..

mrshouse · March 1, 2014 5:30 pm

Why always fussing about the johnlockers?? What is wrong in just enjoying that mofftiss found such a great pairing by -well- accident? There are tons of pairings in tv or movies, romantically linked or not- that just don't work at all, that just don't reach the first seats in cinema with their chemistry. These two just bounce off each other, why not enjoying it but have a third party just to make a point?? I liked Sherlock and Irene quite a bit, actually. I just don't care if great pairings are male-male, mixed, whatever, as long as they are great on screen.