Medicine: The Wandering Bullet

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It began as just another hunting accident. Young James W. Kelley, 17, was stalking deer in the Maine woods when his friend's .22-cal. rifle discharged accidentally. Kelley was hit in the head. "I didn't feel a thing," he says, "but suddenly everything went black. I remember falling on my hands and knees and hollering 'I'm blind!' "

At Gary Memorial Hospital in Caribou, X rays showed that the bullet had passed through Kelley's brain from a point below the right ear and had lodged in the left side of his skull. Dr. Frederick J. Gregory found that the boy's blindness was the result of bleeding inside the skull that caused pressure on the brain. When the hemorrhage was drained and bone fragments were removed, the boy recovered his sight. As for the bullet, it seemed best to leave it where it was.

Kelley recovered rapidly and was ready to go home when the doctors decided on a last-minute X ray, a final checkup for safety's sake. The results were astonishing: the bullet seemed to have disappeared. Then another X ray found it—lodged in the right ventricle (lower chamber) of Kelley's heart. Medical annals are full of cases in which wandering bullets have traveled from the chest, say, to such unlikely places as the knee. But the young Maine hunter had set what astounded doctors thought might be something of a record. Having been shot in the head, he wound up wounded in the heart.

Kelley was rushed by ambulance to Maine Medical Center in Portland, where Dr. Clement A. Hiebert had to do a 3½-hr. open-heart operation using a heart-lung machine to remove Kelley's bullet. But no less remarkable than Kelley's survival was the strange and tortuous route that the bullet fragment had followed. Slowed by smashing through his skull, it had landed in the left transverse sinus (a large vein). Then it had ''flowed" in the blood stream along the transverse sinus, down the main jugular vein and superior vena cava, into the right auricle (upper chamber) of the heart and through the tricuspid valve into the right ventricle. Thanks to the heart's muscular contractions, the fragment had worked halfway through the heart wall. If it had gone all the way, Kelley, who was ready to go home last week, would probably have died—just as if he had been shot in the heart in the first place. As it is, he will go home for Christmas.