Final Jeopardy
(Please note that identifying information about the case described here has been changed to respect the privacy of all involved)
Let me just get this out in the beginning, because as much as it hurts to write this, it will hurt more the longer I wait: a patient I admitted broke a window in her hospital room and jumped out, plummeting five stories to her death.
I’m going to let that sit there for a moment while I digest it.
Now, suicide is unfortunately a relatively common problem, but what is likely much rarer is suicide done within the confines of a hospital. And it hurts. Real bad. But what hurts more is that, in retrospect, I cannot think of anything in that individual’s hospital course that could have changed what happened. Let me explain:
I was actually at a Costco, bargaining with the cell-phone people about switching to a new phone at around 2 PM, when I was paged by my boss, informing me that my services were needed at our county hospital. As one of four “jeopardy” residents, I am spending this month perpetually on-call, required to fill in at a moment’s notice for sick or absent residents, or when there are an overflow of admissions that require a warm body to assess them. On this day I was being called in because the primary team was full at an early hour and there were patients waiting to be admitted in the emergency room.
When I arrived at the hospital, I was immediately handed the admission pager and the names of two patients who needed admission. While catching up with those, I was called about a young woman in her 30s who needed to come in after being diagnosed with alcohol-related liver disease. Upon meeting her one hour later, she quickly explained the circumstances of his current state. A chronic alcoholic, she descended further into abuse after losing her job months ago – we’re talking pints and pints of the hard stuff daily. She was a classic “medical student” case, ripe with physical exam findings to demonstrate the characteristics of liver disease. This, however, was hardly interesting to any seasoned medicine resident.
What was so fascinating about this patient was that, in talking with her about her disease and alcohol abuse, she seemed so genuinely interested in quitting. For herself, for her health, for her family. For life. In fact, upon signing this patient out to the resident who would inherit her the following morning, I vividly recall saying “You know, among the hundreds of alcoholics I’ve admitted over the last two years, this lady may actually be the one person who might listen to us and quit.”
A striking statement, if only for its baseless irony. Looking back, I wonder whether the realization of her damaging addiction was too much to handle. Or whether the sudden cessation of alcohol, combined with the shocking settings of a poorly-funded county hospital, was too much for this brain to handle. Or any number of other issues below the surface that we just were unable to uncover before the end. Then I think of more practical things: why was the window break-able, why was there no gate, and why didn’t the other person in the room scream for attention while there was still time? Why didn’t I pick up on this earlier?
Why didn’t I pick up on this at all?
Excuses, but there is no blame here.
I know that none of that would have affected the outcome. I can only hope that I can learn from this experience, never discounting the torture that may be occurring inside a patient’s mind.
It is truly a cruel lesson.
Let me just get this out in the beginning, because as much as it hurts to write this, it will hurt more the longer I wait: a patient I admitted broke a window in her hospital room and jumped out, plummeting five stories to her death.
I’m going to let that sit there for a moment while I digest it.
Now, suicide is unfortunately a relatively common problem, but what is likely much rarer is suicide done within the confines of a hospital. And it hurts. Real bad. But what hurts more is that, in retrospect, I cannot think of anything in that individual’s hospital course that could have changed what happened. Let me explain:
I was actually at a Costco, bargaining with the cell-phone people about switching to a new phone at around 2 PM, when I was paged by my boss, informing me that my services were needed at our county hospital. As one of four “jeopardy” residents, I am spending this month perpetually on-call, required to fill in at a moment’s notice for sick or absent residents, or when there are an overflow of admissions that require a warm body to assess them. On this day I was being called in because the primary team was full at an early hour and there were patients waiting to be admitted in the emergency room.
When I arrived at the hospital, I was immediately handed the admission pager and the names of two patients who needed admission. While catching up with those, I was called about a young woman in her 30s who needed to come in after being diagnosed with alcohol-related liver disease. Upon meeting her one hour later, she quickly explained the circumstances of his current state. A chronic alcoholic, she descended further into abuse after losing her job months ago – we’re talking pints and pints of the hard stuff daily. She was a classic “medical student” case, ripe with physical exam findings to demonstrate the characteristics of liver disease. This, however, was hardly interesting to any seasoned medicine resident.
What was so fascinating about this patient was that, in talking with her about her disease and alcohol abuse, she seemed so genuinely interested in quitting. For herself, for her health, for her family. For life. In fact, upon signing this patient out to the resident who would inherit her the following morning, I vividly recall saying “You know, among the hundreds of alcoholics I’ve admitted over the last two years, this lady may actually be the one person who might listen to us and quit.”
A striking statement, if only for its baseless irony. Looking back, I wonder whether the realization of her damaging addiction was too much to handle. Or whether the sudden cessation of alcohol, combined with the shocking settings of a poorly-funded county hospital, was too much for this brain to handle. Or any number of other issues below the surface that we just were unable to uncover before the end. Then I think of more practical things: why was the window break-able, why was there no gate, and why didn’t the other person in the room scream for attention while there was still time? Why didn’t I pick up on this earlier?
Why didn’t I pick up on this at all?
Excuses, but there is no blame here.
I know that none of that would have affected the outcome. I can only hope that I can learn from this experience, never discounting the torture that may be occurring inside a patient’s mind.
It is truly a cruel lesson.
posted by Admin at 9:24 PM
49 Comments:
I can definitely feel your pain through your words. No words could probably make you feel better, so I'm just sending you hugs.
I wrote about my first encounter with a dying patient on my blog. Someone asked whether I thought that with time and repeated exposures to such horrific experiences would numb one to their effects...
From what I read I see one doctor who's still very much sensitive to this. Or is suicide a different story, I wonder.
A sad story.
You definitely shouldn't blame yourself for not picking up on this. It is impossible to determine what is going on in a person's head within 15 minutes of meeting them. However, this is a terrible tragedy, hope you are doing okay. This makes me realize how precious a stable life can be and how things can dramatically change in an instant.
you always ask us if we feel safe at home.... how about one more question so you can get a better idea of our mental health?
Suicide always seems absurd. Also if a person decides to kill himself he will sure kill and nobody will be able to prevent it.
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You definitely shouldn't blame yourself for not picking up on this..
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wow.. i was thinking the same questions myself as i read this article. im not a medical student-yet, so i dont know if i have any inclination to give advice but from the sound of it, there is not much you could have done.
it is unfortunate these things happen. :/
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great post very nice thanks a lot.
a very difficult situation. Of people are surprised what to do in this case. No one wanted to be in this case.
Well Nice Blog and Very Informative ..
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It's a terrible thing to have happen in a hospital, but as you say there is no reason to blame yourself - perhaps systemic issues should be looked at by the hospital though.
Very useful piece of writing, much thanks for your post.
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