Self

There are lots of ways that I could have ended up my month on trauma. I suppose this one was as appropriate as any.

She was 67, thin, and otherwise healthy. She was a week away from her 40th weeding anniversary. And late that evening she took the family gun, held it to her temple, and pulled the trigger. The bullet passed clean through her brain and out through her skull on the other side. The cops found it lodged in the wall of her house, amidst a splattering of blood.

Amazingly, she wasn’t dead. Her blood had spread all throughout her head, but the two holes left by that bullet served to decompress her skull and stave off the high intracranial pressures that are usually fatal in this sort of instance.

We worked very hard over the next two days on this lady, while her family gathered at the bedside and slowly came to grips with what had happened and what the likely future would hold.

In medicine we often end up prolonging life under dubious claims. But it struck me that there could not be a clearer instance of someone telling us that she did not want to live. If you believe the statistics, women attempt suicide much more often then men do, but because they often choose less violent methods (e.g., overdosing on pills) they are less successful than their male counterparts. Needless to say, out patient chose as violet a way as possible to try to end her life, and so sent a powerful message as to her wishes. It didn’t dampen our efforts, but I’d be lying if I said it wasn’t on my mind.

We often hear suicide described as a selfish act. And this became obvious as I stood in that room and saw a husband, a brother, and a friend gather at her side, speaking words that fell on bloodied ears – who knew if she could hear? – the only response being the methodic beeping of the monitors and the eerily empty breathing of the ventilator. The police would pull them out one by one to question them – a final insult to the torture of the whole process. Who was suffering the most at that instant?

And what could have been so bad as to bring someone to that point? How do you get there? How is that even possible? How can you be that self-absorbed?

I started to write my explanation, but I erased it. Why even pretend that I really understand? Besides using the clichés of hopelessness and alienation, I would write only from speculation. And anger. I’m not suicidal and I never have been – I don’t have it in me, and for that I am grateful.

We see a lot of horrible things in surgery. But suicide, for me, is the worst. Nothing turns my stomach or puts me more on edge than an attempt at one’s own life. We are hard-wired to survive and preserve our life against all odds. There is nothing so unnatural as self-destruction. Maybe it’s because so much of what we fight is accidental, or by fate, or at least out our hands – suicide is just the opposite. It is intentional. Deliberate and purposeful, it is precise in its perverted meaning. It messes with my emotions more than I care to admit.

Ask anyone who’s worked in a hospital, and they’ll tell you that death has a certain look. She wasn’t dead when I walked out the door, but you see that it was coming. Just as she had wanted.

And that’s how my month ended.