“She’s cut her throat”. This was the message I received while having a cup of coffee in the mess. As I arrived at her side in casualty, so did the whole emergency team. I was the gas man. It was my job to look after her airway and breath for her if she couldn’t.

She had a large bulky bandage around her neck that was bright red, soaked in blood. Blood was all over her face and clothes. Her hair was matted with it. She was making bubbling noises and she was unconscious. We assumed from blood loss. I put the laryngoscope in her mouth. I had a good view of her voice box and could see the vocal cords. I placed a tube into her windpipe and attached it to a ventilator, turned it on and gave her a hundred percent oxygen. Well at least that’s what I thought I was doing. Every time the machine pumped, it showed resistance. Something was wrong and she was going blue.

“This lady is not getting oxygenated, Look at the colour of her blood”, someone shouted at me. I already knew there was a problem, “Will you bloody-well do something about it.”

“I know. Hang on a bloody minute”.

“You haven’t got time to mince about for God’s sake”. This guy had got a couple of intravenous lines in and was filling her up with plasma, His routine was flowing nicely and mine wasn’t.

I looked with the use of the scope. The tube was in the right place. I could see it going between her vocal cords. Then I placed my stethoscope on her chest amongst all the debris lying about and could hear no air going into her lungs, ‘Bloody weird’, I thought.

“Will someone help me rip these F…. ing bandages off her neck please”, I shouted.

There were layers and layers of them, all sticky and saturated with blood. Suddenly my tube came into sight. It was poking out of her neck. It went in her mouth and out of her neck through the possibly self inflicted incision. There was something comical about it. She’d sliced right through her wind pipe. I pushed another tube through the blood and gore via the hole in her neck and into her lungs. I connected this to the ventilator and she started to go pink, ‘Phew! what a relief’,

“There’s something else wrong you guys. Before, I have resistance again and it’s increasing. The airway is blocked or maybe she has a suction wound somewhere. ” A quick clean and an examination of her chest revealed no wounds, “What the hell is going on?” I asked out loud. I couldn’t find anything at fault and then suddenly whatever was wrong corrected itself. Soon she was stabilised and the anaesthetic and surgical teams took over her care.

A few weeks later I asked the surgical registrar, “Whatever happened to that lady who cut her throat”? “We discharged her today into the care of the psychiatrists. She had notes a mile thick and this is not the first time she has tried to knock herself off. I think she is up to about ten times. Her social history is appalling.

“She has two kids that are under the care of social welfare. Her husband is an alcoholic who beats her up on a regular basis. Half these notes are suicide attempts and the other half are broken arms, legs and head
injuries, all inflicted by him”.

“Oh well, no doubt she will be back again. What the hell can the psychiatrists do for her with her history and background. God, it makes you wonder whether we are doing people a favour dragging them back into this world. Maybe she’d be better off dead. Still who are we to judge. Ours is not to reason why, ours is but to do or, …. She’ll make it one day.

P.S.

2019 – whoops what follows is a bit embarrassing. Still it’s what I wrote back in the 90s.

If you really want to cut your throat, keep your head bent forward. Holding it backwards pulls the arteries into the back of the neck and away from the knife. So someone told me once. If you do it this way, you will only cut your wind pipe. You can now breathe through the hole in your neck and this is a messy business. Think of the people who are going to have to clean the mess up.

Suicide in the form of overdosing is a common time-consuming part of a casualty doctor’s work. (not sure about 2019) It’s very hard to maintain compassion when one case is a fifth attempt in a few days or the second one in the middle of the night.

As young doctor I became very cynical of the whole suicide business. I considered these people to be a nuisance and wondered why the hell they did not make a better job of it. The demand from the public was that these people should receive more consideration from the hospitals and their staff. I remember ex-patients writing their stories in the local paper complaining of the harsh treatment they’d received – being stomach-pumped, for instance.

I still have no doubt that if someone really means to commit suicide, then they will succeed. Most attempted suicides are a sad, destructive, manipulative game. As far as I can see, suicide is often a hostile and punishing act. Now I am sure this does not apply to all, but …… This is not to deny that the person doing it is in great pain but it is to say there are more effective ways of dealing with their pain and less unpleasant ones for others to deal with. I mean, fancy blowing your brains all the over the walls and ceiling and leaving the bits for someone to clean up.

One man near to where I lived did just this. Luckily someone got to the house before his daughter. She demanded to see him in the back of the ambulance. She asked for the body bag to be unzipped. Rage flowed through her body and she let him have it verbally and physically.

I was called to a house early one day. Two kids had spent the night with their friends. They came home before going to school and found their dad hanging in the hallway. Before you hang yourself, go and see some photographs of hanging people and think of the poor folk like me or your loved one who have to come and cut you down.

A solo mum came back home one day. She went to the fridge to find that her eighteen year old boy had eaten her yoghurt. The carton lay on the floor crushed. They’d had an arrangement over the yoghurt in the fridge. He had his and she had hers. This was the first time in years he’d eaten hers. She walked to the back room and there she saw his legs dangling through a window. He’d hung himself from an oak tree in their garden.

Right now I have more compassion than when I was younger. However, if I was to be dealing with the situation day on a regular basis, I’m not sure it would last. If you are going to kill yourself make a good job of it. If you don’t, don’ t expect sympathy, Be prepared to be dealt with by people who will be either disturbed or lacking patient. Suicide is not an effective tool for finding sympathy and it is a very good one for hurting others and being a nuisance

My unsympathetic advice is to get honest, take courage and encounter your difficulties. Deal with your anger and hostility. Express your desire to punish people in more productive ways rather than presenting them with a corpse. I can imagine the rage these words will produce and yes, I am over the top. Yes, these people could do with help. Yes, there isn’t much effective help available. Yes, I am human and I have my responses to this destruction. It makes me angry. I don’t feel sympathy. I feel pissed off

2019

Wow! I know if I was a casualty doctor now I would far less reactive. I’d know I have no idea what a suicide victim’s life is like – how desperate, hopeless, lost; what kind of a hell hole they are living in. How f’d up their relationships are. It’s not my business to judge and I have ended up pretty non judgemental these days; there but for the grace of god. I’d just get on with the job at hand. Refer the patient to social services, psychiatrists etc and know there is no reliable magic bullet round the corner for this lost soul and hopefully one day they will find peace of mind.

So many wounding hurts over the years, maybe many small ones, sort of unnoticed, laughed off, minimised which over time lead a person into a deep dark hole where they don’t see the light above and just keep digging. What do you think?