Multiple gunshot suicide occurs when a person commits suicide by inflicting multiple gunshots on themselves before becoming incapacitated. It excludes suicides where the firearms are operated byother people, such as suicide by cop. Multiple gunshot suicides are rare, but possible. In one study of 138 gunshot suicides, 5 involved two shots to the head, the first of which missed the brain. A suicide with 4 gunshots to the head has been reported. Incapacitation from a gunshot injury results from a decrease in the functioning of the central nervous system. In a suicide by firearm, immediate incapacitation can be achieved by direct disruption to brain stem tissue. Rapid incapacitation can be achieved indirectly by cerebral hypoxemia resulting from massive bleeding from the heart, the thoracic aorta, or the pulmonary artery. Damage to other major organs – the lungs, kidneys, liver, spleen – results only in delayed incapacitation. Incapacitation by a shot to the head is achieved when the bullet penetrates the cerebrum; however, numerous bullet trajectories, including a shot between the eyes, do not achieve this penetration. In 1978, poet Frank Stanford put three bullets into his own heart with a pistol. The remarkableness of this act inspired the Indigo Girls song "Three Hits". One particular case has been documented from Australia. In February 1995, a mancommitted suicide on parkland in Canberra. He took a pump action shotgun loaded with four 12-gauge No. 2 shot shell cartridges, and in a stooped position, pressed the muzzle into the centre of the chest before shooting himself. The load passed through the chest without entering the ribcage before exiting below the left nipple. The deceased then cycled the shotgun's action, ejecting the fired shell. The deceased then walked fifteen meters, before shooting himself in the right side of the throat with the charge exiting out of the left side and taking a fragment of jaw with it. At this point, the shotgun potentially fell to the ground causing the ejection of both the spent cartridge and one unspent cartridge. The deceased, now breathing through a gunshot-induced tracheostomy, picked up the shotgun and then walked 136 meters to a hill where he sat down on the slope and loaded the fourth cartridge from the magazine and into the weapon's breech. The deceased then removed his shoes and held the gun against his chest with his hands and operated the trigger with his toes. This shot entered the thoracic cavity and demolished the heart, killing him.
