HOW NOT TO COMMIT SUICIDE
5 of 9 pages 
The physical aftermath of a suicide attempt.
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Drug overdoses can cause inability to breathe, which in turn can cause brain damage. The immediate remedy, intubation, involves running an endotracheal tube through a patient's nose or mouth to their lungs -- thus clearing an airway. The photo above shows a "properly secured ET tube"; the diagram below shows the path the tube takes down to the lungs. |
Most suicides are drug overdoses, and many drug overdose patients reach the hospital in a coma. The danger in all drug overdoses is that the brain may not get enough oxygen. The airway to the lungs may get blocked off by the patient's vomit, or by the tongue falling back into the throat, or by drug-induced slowdown in the part of the deep brain that controls the rate and depth of breathing. Or the heart may seize and fibrillate -- all the heart muscle fibers quiver, but none in rhythm with each other. The blood doesn't move, so it doesn't take oxygen to the brain or carry away waste.
It only takes three to five minutes without oxygen to do permanent damage to the brain, starting at its most sophisticated sections. The memory is destroyed; the ability to read or speak is cut back. The longer it goes on, the more severe the retardation. So any poisoned patient is constantly monitored to make sure they can breath and their heart is beating. If they can't breathe, they are intubated. A physician slides a tube down the mouth or nose, through their throat, into the lungs for air to pass through.
Drug overdose patients are usually given sugar (in case they have low blood sugar), thiamine (which might have been depleted from the blood by alcohol) and Narcan, an antidote for opiates.
They're given because the deficiencies or drug effects they correct are
hard to spot right away and can be quickly lethal. Compared to the very
other antidotes that exist, these are considered low-risk. Patients are
often given Ipecac, which makes them vomit. Then they are given activated
charcoal, which looks like gruel and soaks up some of the poison in the
intestines before coming out in diarrhea induced by a cathartic, magnesium
citrate. The cathartic also increases the rapidity with which the poison
goes through the intestines, thus cutting down the amount absorbed by
the body.If the patient is in a coma a tube maybe run through the nose
or mouth and passed bit by bit down the esophagus in the stomach. A saline
solution flows through it into the stomach, and then is sucked back through
the tube with some of the poison. Emergency room staff call this "lavage";
in the street it's known as getting your stomach pumped.
"If you come in awake and alert you should not have your stomach washed
out," Bedard said. "But some doctors and nurses don't like to take care
of overdoses. They feel like suicidal people should be punished, so they
stick a tube down. It's not pleasant -- the tube is about the size your
thumb. Most people feel like they're choking to death."
The two most common types of drugs in suicides, McKinney said, are those
found around the house and those used in psychotherapy. Seemingly innocent
aspirin is "one of the messiest, most complicated overdoses you ever hope
to see," he said. People who swallow lots of aspirin react first by getting
sick to their stomachs. Beyond that, it affects nearly every system in
the body unpredictably, and two different people who took 100 aspirins
could get sick in completely different ways. Aspirin is an acid. It burns
the gastrointestinal tract from the inside. It changes the blood's pH
level which is normally at 7.4 (close to neutral). It sometimes makes
the blood acidic, but it also accelerates the brains' breathing control
center, which puffs out carbon dioxide twice as fast as it normally would,
and thus makes the blood alkaline. Either way, it throws off the metabolic
balance among kidney, lung and blood. "It produces fever," McKinney said.
"The fever, in turn, if it goes on long enough to overheat the brain,
can cause seizures. You can burn out parts of your nervous system." Aspirin
also carries a high risk of gastric hemorrhage. Occasionally people on
aspirin overdoses become deaf or develop a ringing in their ears that
doesn't go away.
The pain-reliever acetaminophen, sold as Tylenol, also makes people
sick to their stomachs at first, but then gets more deadly. The drug changes
into toxic particles that are usually neutralized by glutathione, one
type of coenzyme found in the liver. In overdose, if it isn't pumped out
in time, the toxic particles deplete all of the glutathione, causing the
painful death of an hepatic coma. Even relatively late in the process
surrogate glutathione can save the liver, but if the organ does become
diseased the results can be similar to those of hepatitis: jaundice, itchy
skin, depression, long-term listlessness, inability to eat much.
"The liver detoxifies poisons that build up in the body," McKinney
said. "If you destroy the liver it's like never taking the garbage out.
Specifically the most common build up is ammonia in the blood, which you
know if it goes too far will put you in a very deep coma, and then kill
you."
Both McKinney and Bedard told me about people who took Tylenol or
phosphorous, which also destroys the liver (and incidentally produces
phosphorescent vomit). In both cases, they slept off the initial sickness
and recovered for five days -- during which time they decided suicide
was a mistake after all and they wanted to live. But the liver had been
destroyed and after five days each of them started to feel very sick,
passed into deep coma, and died. "He knew it would happen and that there
was nothing we could do about it," Bedard said, "and his friends and family
knew it, and for five days they sat in the hospital together waiting for
it."