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In Sergio Leone's Once Upon a Time in the West, Cheyenne gets shot on the left side, just above the belt (intestines?) by Morton. This is revealed only at the end of the film, when he finally succumbs to the wound. In the meantime, lots of time has passed and he has done quite some things, never showing he's been injured, like it's nothing, to the point the viewer knows nothing about the shot until the end.

My question is, how realistic is this? That he never tries to do anything in order to save his own life, like going to a medic or something like that?

From this post on Quora I read things such as

Bad, very bad! Soldiers don’t like to get shot in their abdomens. Some even resorted to drink only water before battles. Also, most realistic war novels have a story about a guy who got shot in his abdomen and continues to die in about 2–3 days screaming!


First there would be pain, bleeding, leakage of intestinal contents into the abdomen and sometimes out of the wound.

Then infection of the abdominal cavity would set in, called peritonitis.

Intestinal obstruction, dehydration, hypovolaemic shock, sepsis, multiple organ dysfunction syndrome, multiple organ failure then death


A hole in the stomach or the intestines will cause stomach acid or intestinal bacteria to contaminate the peritoneum, causing a peritonitis, a serious infection that can be fatal if not treated within half a day or so. If the pancreas was damaged it could cause a severe pancreatitis.


Unless you get med evacuated quickly expect a long slow painful death from sepsis

So, my guess would be he knew that there was no escape (especially given the medicine progress at the time in which the story takes place), and just peacefully waited for his own demise without even trying to avoid it.

In this case, even knowing it's a movie and not a medical documentary, my question is how realistic it is that he didn't suffer excruciating pain to the point of screaming or having hallucinations by fever, even shaving more or less half an hour before passing away. Is it a poetic license kind of unrealistic, meaning things are a little simplified and softened for the story's sake, or is it outrageously fallacious?

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It's completely unrealistic. I'm a doctor. I've seen people completely incapacitated by smaller wounds.

We may allow for a short period of him being driven to overcome the pain by adrenaline and sheer willpower, but I agree with the other sources that you have quoted: he would have become very sick very quickly following that kind of wound:

  • The location of the wound is such that he would have perforated either his small or large intestine (or both), leading to escape of food waste and bacteria into his peritoneal cavity.

  • Without fluid resuscitation and antibiotics, he would have quickly developed an overwhelming infection.

  • The body's response would be to increase his heart rate and shut down blood flow to non-essential organs (this is the proper medical definition of being "in shock").

There is no way he would have been able to do all the things depicted in the movie after his wounding.

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