Tuesday, May 12, 2009

More Trauma


A 17 year old boy was transferred to us after an attempted suicide. Family said he was outside playing football with his friends. He came home....was drunk...told everyone he knew they didn't want him alive...and went into his parents bedroom. Next thing they heard was one shot of a rifle. He put the riffle under his chin and tried to kill himself.

He didn't die...but he pretty much blew off his face. It was one of the most unbelievable sights I have ever seen...and I mean that in a bad way. He aimed the gun up instead of back, and the riffle destroyed his chin, mouth, facial bones, eyes, forehead, etc. Amazingly he was intubated at the other hospital. I don't know how. You could see parts of his brain from the open bony defects. His face was basically a big crater gushing blood. Neurologically, he was intact. When sedation would wear off, he would reach for his tubes and move his arms. Cat scan just showed a small bleed in his brain from the skull fragments.

There are so many points we could discuss here. What could drive a young normal kid to this??? Why was he drinking??? And of course...gun control! I will let you guys discuss these in the comment section. Right now I can't. After spending hours trying to tie off all the bleeding vessels in his crater face...I just need this image out of my head so I can sleep.

-ER Doc

28 comments:

LivingDeadNurse said...

holy crap...it would be hard to sleep after seeing that...

Anonymous said...

Somehow, I imagine that a kid with this violent/ sudden of an urge to commit suicide would not let the absence of a gun (rifle) stop him. He could have just as easily used another method (pills, slit wrists, taking a walk in traffic, etc). The gun was a means to an end; controlling the object does not control the behavior. I believe that to truly dissuade those committed to doing harm to themselves or others you have to start with the person. You also have to acknowledge that the only person you can control completely is yourself and that bad things will happen, regardless of how hard you try to prevent them from occurring. I wish this wouldn't have happened, but I don't see where stricter gun control would have saved him from himself; it may only have allowed him to choose a method that kept his face more intact and even then, who knows.
*sheepishly steps off the soap box*

PurpleRN said...

For the kid's own sake, I hope he doesn't make it.

If you feel your life is bad enough that you want to end it, surviving the horrific process sans face is not going to make you any more grateful for your life.

Poor kid.

Liz said...

Ok, hope not to lessen my cred by referencing an Oprah show, but she did one about young people who survived serious suicide attempts. Each and every one featured on her show was so grateful to have survived and now were able to value having life. Some were permanently paralyzed, some permanently, horribly disfigured.

They each stated that the 'instant' the gun went off (or their feet left the bridge or whatever), they regretted the action.

My one thought while reading this entry was whether or not this kid could/would be grateful for surviving. I pray so.

Shane said...

I'd comment that the kid should not have had access to the gun, but he was 17. I had friends who had total access to their hunting rifles by that age, since they'd been hunting since they were 12.

So I have to agree with Anonymous, the gun was merely the tool of choice to enact his will to self-destruct. I'm thinking the circumstances of this tragic youth are more complicated than, "was playing football, got drunk, wanted a pity party, and blew his face off"

Starry Night said...

I saw an interview one time of a person who survived after jumping off the Golden Gate bridge. He said that on the way down he was telling himself, "Why did I do this, this is stupid". He survived with severe back injury but is able to walk and , yes, alive and grateful. He is now working with an organization to prevent others from making the same mistakes he made.

Are we to ban bridges now because of this? I agree with prev post, controlling gun will not prevent this from happening but getting more involved with what our kids are doing (without being intrusive) and having a good line of communication might. I know, it's easier said than done.

Maybe "unglorifying" the event, i.e. no media coverage showing how families and friends are suffering for the loss might do something to the psyche of people contemplating suicide.

After all, most people agree, suicidals are mostly trying to call attention to themselves, a cry for help of sort or in some cases, done to supposedly punish a loved one.

tracy said...

That is absolutely heartbreaking...having been to that very dark place myself, i think maybe i can imagine a little of what that poor kid felt. God bless him and all those who tried to help.

Mejis said...

I agree with the comments about gun control. He would have just found another way. I do feel sorry for him. He won't be able to see, smell or taste anything ever again. He won't have a face...I really don't think he'd be grateful to be alive. I know I wouldn't be.

Por2gee said...

god bless you, I feel bad for his family. When I was in EMT school we were shown a video of the same effect, they had to intubate the patient through the gurgles of what was apparently his trachea. Very sad.

Nurse K said...

I like the misspelling of the word "sites" when referring to a rifle [also misspelled] wound. Are we referring to the site on the rifle or the mangled face?

If the child's family knew he was suicidal or seriously depressed and at risk for suicide, they should have stored the guns somewhere other than the house, but, if they didn't, well, it's just an unfortunate event.

Walt Trachim said...

I went through the CCEMT-P course at the Medical College of Georgia in October of 2007. One of the rotations I had was in the Shock-Trauma unit and, as it happens, there was a patient there - a 27 year-old male - who took most of his face off with a 12-gauge shotgun full of .00 buckshot.

When I was in the unit he'd already been through 3 surgeries to correct all of the structural damage he'd done. There were at least 4 more scheduled, plus an unknown amount of work to replace his face. He was neurologically intact and able to move without a great deal of assistance. And - this was only the beginning. He was also getting fairly intensive psychiatric care; apparently he was bi-polar, and "the voices" told him to kill himself.

As bad as this was, the worst part was watching his family with him. His mother and his wife were both wrecked. They thought it was their fault that he'd tried to kill himself. Apparently, the shotgun he used belonged to his father, and it was up on a rack, so he had access to it.

He had no children. Personally, I was glad; as bad as it was on his mother and wife, I can only imagine how this would have affected his kids.

Anonymous said...

My niece killed herself two weeks ago -- she hung herself in her closet. Suicides will happen despite the availability of weapons.
Classof65

Anonymous said...

I think that every hospital has seen these poor people who can't aim well enough to end it. Why were you tying off all the bleeders instead of the ENT's/trauma surgeons/plastics team? I didn't think that ER residents got to do much after stabilizing the patient...? maybe things have changed...I do remember the days before the 80 hour workweek :)

Silje said...

He might just have found another tool, but he wouldnt have been able to do it there and then, if he was drunk it would have been much more complicated to do it by other means and he might have decided to sleep on it and do it another day, and maybe, maybe his parents would have interweened. Or maybe he would have felt a tiny bit better the next morning and have picked up the phone to a suicide help line...



(sorry about the bad spelling im from norway so my english isnt great)

Trust us....we're doctors said...

RE Anonymous:
We do a lot more now....jack of all trades if you will. Especially in the middle of the night when it takes ENT or plastics at the fastest 20 - 30 min to get out of bed (and that's assuming they are in house). Stopping exsanguination is part of the ABCs...but the real fixing happened in the OR of course

-ER Doc

tracy said...

Anon #2 i am so very sorry about your niece...that is just soooo very awful. i knew an e i g h t e e n year old girl who also hung herself...in a treatment facility...
Bless you,
tracy

GuitarGirlRN said...

Will he get a face transplant like that lady whose husband shot her in the face?

Trust us....we're doctors said...

The thing that nobody talks about is the fact that the kid was drinking alcohol at the time.
People do stupid stuff when their judgment is impaired by drugs.
I just treated a guy, almost exact same story except it was a .45 revolver and he had worse aim. It blew half of his jaw off. Now his fibula is his jaw. He was drunk too.
Another classic example is Kurt Cobain. People talked about gun control then. People talked about him being bipolar and whether his meds caused it. What nobody wants to emphasize is that the guy was high on heroin.

Drugs will mess you up, people. You think you're in control, but you're not. This includes alcohol.

-Psych Doc

Trust us....we're doctors said...

RE Guitar Girl:

-No transplant. Our plastic surgeons did an awesome job. He had reconstructive surgery 3 times 3 days in a row. They used metal plates and other things i have never heard of for the facial stuctures. then sutured him up with his skin. 1 eye was salvaged. Gonna need more work on his oral cavity before the trach can come out. He looks unbelievably good considering his injuries. now time for his psych consult...

Anonymous said...

Yeah I know the person my wife has him in her ER first, very sad and his family has ties to our ER community, never really saw this coming... Pray for him and his family....

Firemedic said...

As the primary medic on this scene I can honestly say that this was one of the hardest intubations I have ever performed. This was an unbelievable story of survival during such a tragedy. I pray for the pt. and the family to have a successful outcome. I dont believe that gun control is the issue here as much as learning the signs that someone is deeply depressed and is considering suicide as an out. I could never imagine what he was thinking prior to the event to push him over the edge.

Firemedic said...

As the primary medic on this scene I can honestly say that this was one of the hardest intubations I have ever performed. This was an unbelievable story of survival during such a tragedy. I pray for the pt. and the family to have a successful outcome. I dont believe that gun control is the issue here as much as learning the signs that someone is deeply depressed and is considering suicide as an out. I could never imagine what he was thinking prior to the event to push him over the edge.

tracy said...

The saddest and hardest part is, one can never really know when a person is truly suicidal...not even a Psychiatrist or other Mental Health Worker...

Anonymous said...

With all the publicity about health care reform, unsustainable costs, and so forth . . .

It is YOU AND ME who are going to pay to patch this guy up and support him in some pathetic semblance of a life at a cost of, let's be frank, millions of dollars.

Can you (doctors) really be sure that this is ethical??

Are healthcare professionals really the best ones to make the decision to treat in these cases? After all -- this kind of thing may disturb you for a few days, but it's always possible to ignore that when they pay the bills. It's called conflict of interest.

Trust us....we're doctors said...

Dear Anonymous,
Believe it or not, we do our jobs to help people, and sometimes we even get to save lives. We are medical residents. We get paid jack squat. The amount we get paid does not change whether the patient lives or dies.

There is no decision to treat. Everyone is treated regardless of payor status. When your family member comes to the emergency room with their face blown off, having a heart attack, etc., do you think we care how they will pay? Do you want us to call the insurance company and get prior authorization (which may take days or weeks) while your loved on dies on the gurney?

Don't project your question of ethics onto the physicians. It is you, not us, who is asking us to let this patient die, because you are worried about who will pay.

It seems that you are the one with the ethical challenge.

-Psych Doc

Anonymous said...

>Do you want us to call the >insurance company and get prior >authorization (which may take >days or weeks) while your loved >one dies on the gurney?

But don't you see, the whole reason that the insurance companies are involved is that physicians are unwilling and/or unmotivated to get involved in this issue. I would have no problem with some sort of sensible rationing for ED care based on quality-of-life guidelines.

You may not be paid more or less depending on whether the patient survives, but the system as a whole as well as (maybe) your employer definitely has an financial incentive to treat no matter what the probability of a good outcome.

Unless we assume unlimited resources we can not be 100% ethical, that is a chimera. We do appreciate that you guys may be more ethical than the rest of us on an individual level. I just don't know if it us useful to extrapolate that to the whole system.

Tony Harrison said...
This comment has been removed by the author.
JonnyHo said...

It's terrible. There have been a surprising amount of suicides around home.
I have heard stories of people being upset over relatively minor things, having a bit to drink (not a lot) and then deciding to end it.

Think the moral of the story is, dont drown your sorrows, sorrow is an excellent swimmer.