Despite significant medical advances since 1968, Robert F. Kennedy’s gunshot wound to the head would still have been fatal if it had happened today, according to Duke researchers.
The analysis was published June 19 in the Journal of Neurosurgery, marking approximately 50 years since the assassination on June 5, 1968. Authors include Duke ‘surgical historian’ Theodore “Ted” N. Pappas, MD; Nandan Lad, MD, PhD, associate professor of neurosurgery, Jordan M. Komisarow, MD, a chief resident in neurosurgery, and Megan Llewellyn, a medical illustrator in the department of surgery.
Although the story of the senator’s assassination has been told repeatedly in the press and recounted in numerous books, this paper represents the first analysis of his injuries and subsequent surgical care to be reported in medical literature, according to the authors.
In the paper, the authors provide an analysis of the mechanism of injury, the care received immediately after the injury and leading up to the emergency craniotomy, the clinical course, and the autopsy, which includes an artist’s depiction of the head injury. They consulted various primary sources, such as newspapers, police reports, testimony and eye witness statements.
Rear view of the path of the bullet. (Illus. Megan Llewellyn)At the time of his assassination, Kennedy had just won the California Democratic primary and delivered a victory speech to supporters at the Ambassador Hotel in Los Angeles. He was walking back through the hotel’s kitchen when he was approached by Sirhan Sirhan, a 24-year-old Jordanian immigrant. Sirhan Sirhan fired 8 shots with a .22 caliber Iver-Johnson Cadet revolver, and three of those bullets struck the Senator.
Multiple physicians responded to the attack, which was witnessed by more than 50 people. Two of the bullets that Kennedy received—one in the shoulder and one at the base of the neck—would have been non-life threatening, according to the paper. However, a third, which struck the post auricular region of the brain, turned out to be fatal.
Kennedy survived for almost 26 hours after the injury, as neurosurgeons worked around the clock to repair the damage. He underwent an emergency craniotomy, which involves removing devitalized tissue, providing relief of intracranial pressure, and controlling hemorrhage.
The senator would likely have undergone the same procedure today, according to the authors, however, the surgery might have been aided by a CT scan of the head, arteries, and veins, which was not available until the 1970s. A CT scan makes use of computer-processed combinations of many X-ray measurements taken from different angles to produce cross-sectional images of specific areas of a scanned area, allowing for a more precise look inside an object.
The work of the neurosurgeons might also have been made easier with an operating microscope, which, according to the authors’ analysis, was not available at that time.
“Although the bleeding and the effects of bone and bullet fragments were controlled through the neurosurgical operation that spanned 3 hours and 45 minutes using a large craniotomy flap, the damage had already been done,” said Lad. “Despite maximal medical management, the continued cerebral edema that followed was aggressively managed with steroids and diuretics but continued with elevated intracranial pressure that contributed to brainstem herniation and brain death.”
View of damage to the brain from top. (Illus. Megan Llewellyn)The care that the senator received immediately after the injury is also analyzed in the paper. Kennedy was first taken to a small hospital, Central Receiving Hospital, where he spent about 45 minutes, before he was transported to a larger facility, Good Samaritan Hospital, due to the severity of his wounds. Although immediate care after trauma can sometimes impact the result of care, Duke neurosurgeons think that in this case, it did not.
“The delay was unlikely to make a substantive difference in the senator’s outcome, in my opinion,” said Komisarow. “From what we can tell he suffered extensive brain damage that would have been difficult to overcome, even in the present day.”