matt-damon_laboeuf_mattie_texas-rangerFour riders surrounded the Texas Ranger, LaBoeuf (Matt Damon).

Suddenly, the horseman on the Ranger’s left threw a lasso over his shoulders and quickly pulled the Ranger to the frozen ground, dragging him on his face and belly. All hell broke loose as Marshal “Rooster” Cogburn (Jeff Bridges) started firing his Winchester at the riders from his concealed position.

This classic scene in Joel and Ethan Coen’s 2010 production of True Grit is one played over and over again in Westerns. As a modern doc, I have always wondered what real and hypothetical injuries could befall the unlucky cowboy caught up in such an unfortunate situation. If dragged at a gallop for minutes over rocky, uneven terrain, he could suffer terribly from severe fractures and head trauma, later to die of blood loss, stemming from internal injuries.

Not so in the current scenario. The Coens decided to portray LaBoeuf as being dragged only a short distance on his face while simultaneously sustaining a through and through left shoulder wound, possibly caused by an errant shot from Cogburn’s rifle.

Basically ignoring the shoulder wound, at least, for the moment, Cogburn concentrated upon grabbing and repositioning the Ranger’s mangled tongue that was “bit almost through.” “Should I just yank it free?” Cogburn asked the suffering and bleeding Ranger, as he recounted the story of a teamster thrown from a horse who “bit his tongue off [and]…after a time…learned to make himself more or less understood.” Cogburn also realistically quipped, “Very well. It is impossible to bind a tongue wound.”

Within minutes we saw LaBoeuf cleaning his Sharps carbine, sitting without discomfort on a chair in a cabin, speaking fluently about his failed pursuit of Tom Chelmsford, alias Tom Chaney (Josh Brolin). His wounded left shoulder and upper chest area were wrapped with a bandage revealing only moderate bloodstains.

Initially, our attention was directed at LaBoeuf’s tongue injury. In the subsequent scenes, LaBoeuf received no treatment for this problem, except the offering of softened food by Mattie Ross (Hailee Steinfeld). Clinically, LaBoeuf recovered with unrealistic success, in record time, from his tongue-biting episode. He appeared to my ears to have a post-injury change in his speech, but it was very subtle.

Clinically interpreting this scene, I combined my medical experience with that of my longtime colleague, and ENT surgeon, Dr. William C. “Pete” Lillydahl. We agreed that only the most severe tongue injuries need sutures or antibiotics. The rest are allowed to heal without treatment, usually without ensuing infection. The Coens receive a medical B- for their depiction of LaBoeuf’s tongue injury and recovery.

But what about that gunshot wound to the shoulder? In most cowboy movies, being shot through the shoulder is as common as having to shoot your horse. The Coens’ problem is that the wound depicted in this movie was far too close to the midline away from LaBoeuf’s left arm. Based upon the location of the two holes in LaBoeuf’s jacket, my bet is that he was shot from the front, because the hole in the back of his jacket looks more like an unusually small exit wound.

Given the depicted location, the bullet that caused LaBoeuf’s seemingly insignificant “shoulder wound” would have probably broken some ribs, collapsed his left lung, severed a vessel near his heart and then shattered his shoulder blade upon exit, leaving him to die within minutes.

Too bad. The only thing that the Coens got right about the shoulder gunshot occurred when LaBoeuf initially cried, “I am theverely injured!” as Cogburn and Mattie came to his aid. The Coens receive an F for this medical faux pas.

But I guess we should lighten up and not take the Coens’ “tongue ’n’ cheek” rendition of poor LaBoeuf’s suffering too seriously. After all, who would have hauled Mattie and the marshal out of the snake pit later in the movie?

Dr. Jim Kornberg holds an MD and an ScD. He is an environmental medicine physician and an engineer. He lives with his wife Sally on their ranch in the mountains of southwestern Colorado.

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