I think the picture is not fake. It may be enhaced (sharpened a bit). I used to work for the military as a Hospital Corpsman. One of my assignments was Biomedical Photography, and it is not uncommon for a camera to be in an ER. The photo was probably taken after he had been cleaned up a bit. I have seen similar wounds inflicted on people and they were still able to sit up ect. I imagine the guy didn't live that long and they probably pumped him full of pain killers. But it is possible to live awhile with that type of injury...I treated a guy who was blown in half by a gernade and he lived a full 6 - 7 hours after it had happened.
Rob