This piece about an experience that I had in medical school discusses suicide.

I was in the critical care ER yesterday, where the sickest, most acute patients are triaged. There was no shortage of noteworthy cases, but the one that stood out to me the most was that of MC. He was brought in by EMS on a stretcher, screeching and naked save the diaper they’d thrown on, with a gastrostomy tube flopping out of his stomach. The lacerations to his left scalp, arm, and knee indicated that the 68-year-old male had fallen during his apparent overdose attempt. He was tossed into one of the trauma bays so that the Trauma Alert team could look him over. As he thrashed against them, unable to answer questions about his name, location, or the date, there stood on a nearby table a DNR order that he seemed to have framed in glass. I assumed that EMS must have found it next to his body back home. 

He resisted us to the best of his disoriented ability, screaming he was cold and wanted to die. Nurses circled around him and poked and prodded to establish IV access. A resident encouraged me to look for intra-abdominal bleeding using an ultrasound probe, and my cold hands began working against him, too. EMS told us that a home nursing aide had found him on the floor next to a scattering of empty pills bottles, mostly opioids, which had been prescribed for pain from the cancer that had ravaged his prostate, penis, and brain. He seemed to have “won,” according to our records, but clearly lost something along the way. MC had crushed his pills, gotten drunk, and then used a syringe to inject them through his gastrostomy tube. It hadn’t worked. Now, here he was, suffering. 

When he was carted off to a scan and the assemblage dispersed, I searched our records, wanting to see if I could find some clues that would help me understand how he had ended up here. There were a handful of admissions over the last decade, but no explicit OD attempts (DNR and all), only falls and drunkenness and the persistent denial that he never drank, just this one time… As I went further, skimming through old psychiatry consultation notes, I saw the mention of a wife and a son – who had died just years apart, ’97 and ’99, from the sudden rupture of a brain aneurysm and an unpredictable earthquake in Venezuela. MC had held it together for the two intervening decades, but now here he was, nearly overdosed, at the end of his rope. 

He screamed many things when he returned from the scan, but one of them was the name of a doctor. Seeing as no one else seen inclined to call, I found the man online and phoned his office. Within a minute, I was passed from a receptionist to a secretary and then the doctor who had not only prescribed MC the opioids, but also known the man for 20 years (as well as his mother, and his grandmother). He claimed he’d seen MC every 3 to 4 weeks. “Was he drinking?” he asked, “because then this was an attempt. You’d better call Psychiatry…”

Eventually, my shift ended and I left the ER, MC still writhing in a hospital bed somewhere. As I drove home, I thought about how he’d been treated from the second he’d arrived: like a junkie who tried to kill himself. I could not fault the assemblage, who saw this shit everyday, who didn’t have the time to look through old psychiatry notes or call the family doctor – that was a luxury of time that fell to me, the medical student. Of course, there was not much more I could have done for him (still disoriented, screeching), but I still cannot shake the man from the tragedy that had befallen him two decades earlier. Maybe there’d been a happier time – family vacations on the beach, first birthdays and lost teeth, a hope for a future – that had been shattered like a ceramic family plate. 

He was not simply a junkie trying to overdose; he’d been a father and a husband; now, here he was, a broken man, suffering, suffering…

I must look to find the dignity in every person, which deserves not only respect, but cherishing. Sometimes, it will be hard. Yet if not me, who will?

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