Suicide Ain’t Painless

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Suicide Ain’t Painless

Some of the best advice I ever received as a medical student was from my chief resident when I was an eager young fourth-year on my first trauma rotation. “Never run to a gunshot wound to the head,” he said. “They’ll either survive until you get there or they won’t survive no matter how fast you run.” The corollary to that axiom is “Think donor. The life you save may not be the one in the trauma bay”.
Gunshot wounds to the head are a particularly difficult type of trauma to deal with. When self inflicted, they automatically create a lot of ambivalence for the trauma team. It’s hard to work to save a life that the patient himself didn’t think was worth living. And shooting yourself in the head, unlike taking pills or cutting your wrists, is a statement of a fairly serious intent to end your life.
Mostly it is an act of despair, although sometimes it seems understandable. Not a choice I would make, but understandable for the patient. I am not a psychiatrist for a reason–I have little patience with neurotics and depressed people whose only purpose in life seems to be inflicting their own misery on everyone else around them. So depression, despair, loneliness, all the usual reasons people cite as the cause of their suicidal motivation don’t strike me as particularly valid reasons to put a gun to your head. In those cases, it’s an act of supreme selfishness.
On the other hand, a patient faced with a long and debilitating and ultimately fatal illness may see suicide as a rational act to avoid a futile and costly struggle that will have the same outcome in the end as a bullet in the brain. Again, not necessarily my choice, but understandable. I’m a firm believer in property rights. The ultimate property right is the right to decide what to do with your own life. If suicide seems a rational decision, I support your right to make that choice. Just get it right the first time and make sure no one else is hurt in the process.
That last part is the real problem with suicide. It may seem right to you, but even the most rational suicide harms those whom you leave behind. Death and grief go hand in hand, but sudden death leaves little time for the survivors to prepare or accept the loss. The thought that you would deliberately choose death over staying with people who care about you is doubly hard for the survivors to accept. It’s a very personal type of rejection and all the rational arguments about why you did it don’t change that.
As a trauma surgeon, I give families bad news on a regular basis. It isn’t something that I’m particularly good at. Although I try to put things in terms that are easily understood and give an honest assessment of the patient’s prognosis, I’m not good at offering comforting words or expressions of sympathy. Harder still is the discussion of brain death and organ donation. I believe in donation. I encourage everyone to become an organ donor. But I’m lousy at broaching the subject with families, even though it’s supposed to be part of my job. Thank God for the nurses at Donor Network who do that sort of thing very well.

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