One Punch: A Doctor's Story

Dr Michael MurrayDr Michael Murray, Consultant Neuro-anaesthetist at the Institute for Neurological Science, based at Glasgow’s Queen Elizabeth University Hospital, is part of the surgical team that regularly treats victims of one punch crime.

He’s frank about the devastating medical consequences possible from a single punch. “Sometimes the physical punch itself is enough to cause the damage. It can fracture a bone, tear an artery, sometimes it’ll just tear a vein. They’re smaller, a bit more fragile and tend to bleed a bit more slowly.

“Very often what happens is that people just lose consciousness when they’re knocked to the ground. The problem with being knocked to the ground is that most people’s brains are six feet in the air. By the time they hit the ground they’re doing about 13 miles per hour onto concrete or a hard floor. Then it’s a combination of the punch and the deceleration injury of hitting the concrete that causes the damage.”

The brain is not repairable

Dr Murray confirms that bruising and bleeding on the brain is hugely damaging. “The brain has several problems. One, it’s soft. It doesn’t get repaired very easily. And it’s in a non-expandable box. If the brain gets bruised and it starts to swell, or there’s bleeding on the brain, there’s nowhere for that swelling to go, the pressure simply builds up. That can happen within minutes. If there’s bleeding, that can take minutes, or hours. The pressure builds up so much that the brain starts to cut off its own blood supply as it squashes. And then the brain dies. The brain, in essence, is simply not repairable.”

The impact of this damage can be lifelong, Dr Murray says. “In terms of long-term consequences of a punch, there are two main classes of injury, physical and psychological. The brain is the only organ you can damage twice. There are immediate and long-term complications. Very often we have to take people for emergency brain surgery, take the top of the skull off, evacuate the clot.

“Sometimes we have to resect [cut out] parts of the brain if that part is dead. Often we have to leave the skull out of the body until the swelling goes down again, to save the patient’s life. A recent study showed that helps people survive, but you’re twice as likely to be disabled, if you do survive.”

The results of brain trauma can be life-changing. “Some people are left unable to speak,” Dr Murray says. “People with squashes lower down on the brain stem, and they’re unable to swallow, patients then need a tracheotomy. They get visual disturbance, sometimes they have motor weakness and effectively have a stroke. As the brain is damaged or moved [as a result of a punch], it compresses and damages the part that controls movement. So a lot of people can be left wheelchair-bound or severely disabled. There is sometimes a degree of recovery but very often this change is permanent.”

Psychological damage

Other issues with how the brain functions also arise. “Longer term, the brain is an electrical organ so often, if it’s damaged, it’ll short circuit, and epilepsy is the natural consequence.” But the psychological impact can be equally disabling. Dr Murray continues, “Often people have personality changes, memory loss, they can’t concentrate, they have recurrent headaches. Psychologically, if this has been the result of a trauma or a violent injury, very often people have Post-Traumatic Stress Disorder.

“We know that if people have a brain injury as a result of violence they’re much more likely to develop addictions, get depressed. That depression is more likely to be resistant to treatment, and sadly many of these people take their own lives. In fact, we know that even a single concussion can double your chances of suicide in six months.

“One of the most recent surveys showed that there’s a much higher chance of premature dementia from brain injury, especially in young people,” he adds.

Ask for a message to those planning a night out, Dr Murray says, “Look after your brain. You wouldn’t drop your laptop onto the payment from six feet up. With your laptop you can take it in and get repaired or replaced. But you can’t do that with your brain. If you damage your brain that’s it, there’s no alternative.”

The role that alcohol plays

With regards to the role alcohol plays in one punch crime, he’s emphatic. “It’s very unusual to get a situation where two people are hitting each other and they’re both sober. In 13 years I don’t think I’ve seen a sober head injury coming in.”

Dr Murray finishes with a stark message for those planning a night out. “Watch what you drink. When you drink you get less inhibited… you can be more aggressive. That single punch may end someone’s life. And if they do survive, it may make what’s left of their life unbearable. Keep your hands in your pockets. And look after your brain.”

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