Indexing Title: CLEYSONs Medical Anecdotal Report [05-05]

MAR Title:  Suicidal patient as a teacher

Date of Medical Observation:  June 5, 2005

 Narration:

             It was one peaceful Saturday afternoon; I was at the newly renovated emergency room when I saw a fierra at the entrance of the hospital. The car door was opened and I got a glimpse of a man lying down and noticed his omentum was eviscerated. I alerted my colleagues that a trauma patient is about to be wheeled in. As we were assessing the patient, I asked his companion what happened and who stabbed the patient; he said that he inflicted the injuries to himself. Then my junior resident called my attention and told me that I really have to look at his neck. When I lifted the towel over his neck area, I was stunned, my heart missed a beat, and my eyes were popping out for I cannot believe what I saw! I asked myself how a man could inflict this kind of injury to himself. What I saw was a jagged edge cut over his neck and his thyroid cartilage was fully transected at its superior border, it was bobbing up and down as he swallowed. I was able to view the inner mucosal lining of his upper respiratory tract as well as his esophagus. Although there was no major bleeding going on, I palpated for his carotid arteries and found out that it was not injured. At that moment, I can feel the panic building in me for I know that I am not that skilled in dealing with head and neck injuries. I called up the consultant on duty and referred the patient, he instruct me on what to do for he cannot immediately come because he was at the operating room doing a case. I called up my seniors, the ones living near our hospital asking them if they could help me. As we were waiting for them, we explored the abdomen, minimal hemoperitoneum and a 0.5 cm thru and thru perforation at the body of the stomach were noted. In the neck exploration; all was fully transected up to the level of the carotid sheath. A tracheostomy tube was inserted and primary repair of the mucosal lining was done. On his fourth post operative day, he pulled his tracheostomy tube, he doesn’t want anybody to touch him and he even blamed us for saving his life. After quite sometime, he was more cooperative so we were able to place the tracheostomy back to its position. After a long talk with his mother and a conversation with our Psychiatrist, he was very cooperative and he was even thanking me for giving him a second life.

 Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)

             In residency training, a licensed doctor was specializing on a certain branch of medicine. During the years of training we have a lot of teachers; they are the consultants, our co residents, interns, clerks and most especially the patient. They will teach us not only knowledge regarding our chosen field but they will give us lessons about life and personalities and relationships.

             In my years of training, I was taught to humble myself, to know my limitations, to accept my shortcomings and be strong enough to ask for help of others.  A friend once told me “pasyente ang bida dito, hindi ikaw o kung sino pa man.”  This only means that we should put our patient first before our training and our pride. We should always think what is best for them and not what will be best for our skills. We should acquire knowledge, be the best we could be to save a thousand of lives. Maybe through this we will be able to see the real beauty of being a doctor. This has always been my wake up call to keep my feet on the ground.

            Suicide from Latin words sui caedere, it is the act of intentionally ending one's own life. It is considered a sin in many religions, and a crime in some jurisdictions. On the other hand, some cultures have viewed it as an honorable way to exit certain shameful  or hopeless situations. And I do believe that no one will commit suicide without any reason at all. In manning the emergency room, I have encountered patients who commit this act. I have always thought of what pushes these people to commit that act? We all have problems; I cannot say that my problems are heavier than the others, or maybe their problems are heavier than mine.

 I have come across a line saying that “Suicide happens when pain exceeds the resources for coping with pain.”  After reading this I came to a conclusion that it really doesn’t matter who you are or how strong a person you are, but if you were pushed in a situation where all your known resources runs out and all you the road that you see are dead ends, you will think of ending your life; the question is if you will execute it.