HOW NOT TO COMMIT SUICIDE
6 of 9 pages
|
|
A chest X-ray of someone who came into a large city hospital unconscious
and aspirating after a drug overdose. The X-ray looks into his front,
so the lung on our left is actually the patient's right lung. That's
where the trouble is. What looks like grey and white bubbles floating
inside is vomit that dripped down from this throat. His left lung
(on our right) is comparatively clean. In a normal X-ray both sides
would look like that. At the top of the throat is the bronchial
tube through which they are trying to help him breathe. The sharp
white dots (electrocardiogram probes) and the thing that looks like
a telephone cord (part of the intubation machine) are both outside
of his body. |
Probably the most painful form of suicide attempt, whether
or not it ends in death, is swallowing lye, Drano, oven cleaner and other
household caustics. Most of us know how painful these are because scare
stories have been passed down in household lore from 100 years ago, when
caustics were the preferred suicide method. Unlike suicides today, who
visualize themselves slipping off into oblivion, people who killed themselves
in the 19th century expected to suffer along the way.
Very few people that ingest caustics die," McKinney said. "If they do die, it's days, weeks or even months later, of infection. I'm pretty immune to most gore, but the draw the line at the burn unit." Caustics scar the mouth and tongue, puncture holes in the esophagus, burn the chest from the inside and block the gastrointestinal tract with scar tissue. Even the process of treating inner burns is painful; surgeons drop an endoscope, or fiber-optic camera, down the person's throat, unavoidably scraping it against the raw nerves there, to see what the damage is. Repairing an inner burn can take 15 or 20 years worth of surgical operations, plus fluid therapy and antibiotics to keep infections from growing. Swallowing can be painful for the rest of a person's life and some survivors of such attempts have to be fed intravenously for years afterwards.
Psychiatric drugs -- phenothiazines like Thorazine or Haldol, tricyclic antidepressants like Elavil - cause what are probably the most morally offensive overdose cases. "It's a built-in irony," McKinney said. "The very population of patients currently under therapy to supposedly avoid suicide are often handed enormous quantities of medication. You might as well give the guy a gun.
Except in child abuse, nothing outrages the emergency room staff as much as when someone comes in with an overdose on Thorazine and you go through the pockets and see the same doctor has prescribe three or four hundred tablets in a two-week period. Those are the doctors who get a phone call at three a.m. saying, 'You better get down here now and see your patient.'" (Hardly ever does the psychiatrist show up, McKinney and other doctors told me; it's more common for the answering service to find out who's calling and why and then say the psychiatrist is out of town.)
Tricyclic antidepressant patients are in a particular high-risk situation,"
McKinney said. "Typically a person is depressed over a long time; he goes
to a psychiatrist and after some psych workshop procedures it's decided
he needs an antidepressant. Classically, Elavil is prescribed. Elavil
takes three to eight weeks to work, and an average of four weeks. The
person may not be told clearly enough or may not want to hear that the
drug takes a long time. Two weeks later he bolts upright and says, 'This
is the biggest crock of shit,' and swallows the rest of them."
The phenothiazines, or major tranquilizers, are used to calm down psychosis
or extreme anxiety. The tricyclic antidepressants are chemical mood elevators.
Both work by somehow altering the minute bursts of chemicals which neurons
send across the synapses, or gaps between nerves, to carry impulses from
one nerve to another.
Because they affect the nervous system which in turn reacts with every
other system in the body, psychiatric drugs have lots of side-effects
- dilated pupils, dry mouth, feverishness, speeded-up heartrate, slowed
down digestive muscles, breakdowns in coordination, rolling eyes. Overdose
can accelerate these in any part of the body. I once met a man whose hand
muscles had contracted violently after a phenothiazine overdose, leaving
his fingers permanently warped. Tardive dyskinesia, a Parkinson's-Disease-like
condition caused in some patients by long-term use of the drugs, can be
accelerated by the overdose. Probably the most common permanent damage
from overdoes is brain damage, caused by seizures and fibrillation.
The exotic drugs of mystery novels, strychnine and cyanide, are painful
and deadly, but rarely show up in emergency rooms. What shows up all the
time are sleeping pills and mood pills -- the sedative hypnotics -- barbiturates
like Seconal, mild tranquilizers like Valium. Typically, a sedative overdose
will do nothing more than put you to sleep for a day or two, and leave
you with a bad hangover and a case of the slows when you wake up. But
like many other overdoses, sedatives are often taken with alcohol, which
makes people nauseous. Anyone who vomits when they're passed out risks
sucking some of the vomit into their lungs, which is called aspiration.
It's as dangerous as it sounds disgusting. Vomit contains enzymes from the stomach that destroy tissue, and those go to work on the lung walls. It also contains a rich broth of food, perfect for pneumonia bugs to grow in. People can also drown in vomit, which keeps air from getting to the brain, which once again causes brain damage. As aspirating patient goes into intensive care; a device called a bronchoscope is used to look into their lungs and pull out whatever pieces of vomit it can.