A Bittersweet Ending

Just when I thought my days of dealing with multiple emergency cases per day were over...

I'm currently rotating in general surgery I, which deals with soft tissue diseases, plus diseases of the gastro-intestinal tract from the esophagus down to the stomach. For some reason, we have been admitting a lot of patients with caustic ingestion these days--- you know, those people, often females, who drink toxic fluids, most often non accidental, allegedly to kill themselves, but most likely just to gain some attention. What is with these people?! where did they get the notion that drinking toxic substances is an effective form of suicide?! Honestly, I'd like to make an advertisement everytime I see such cases in the emergency room to dispel that notion. Yeah, these substances can cause death if they are concentrated enough, but death is often delayed. Often, they just damage your gastrointestinal tract, and you'll either wish you'd die after several days of not eating, or a lifetime of not being able to taste and swallow food--- blended nutrients just passes a tube that goes directly through your intestines. Often, you'd see that these people just crave attention. Drinking a teaspoon of bleach? a sip of insecticide? even an overdose of cough syrup?! How can anyone think such weak concentrations can end their life... and with the slim chance that they did drink enough to cause major damage, they cry--- proof enough that they didn't want to cause major damage in the first place. How can you have pity on these people?!

One patient who took a lot of our time these past few days was a patient who drank sulfuric acid--- just because she had an argument with her husband. Pathetic. The acid was strong enough to burn her esophagus and stomach--- her stomach was bleeding non stop. We first tried to manage her conservatively... gastric lavage, then when that didn't work, we proceeded to cauterize the bleeders with argon. That didn't work either, so we had to operate on her. There was no way to stop the bleeding, so gastrectomy was done--- her stomach was removed. After a few hours, fresh blood was seen in the drain, so we opened her up again and saw bleeding from the suture sites. crap. Her normal looking tissue was actually friable due to the acid, that the suture sites gave way. The same thing happened after a few hours that we had to operate on her again. Afterwards, she asked for pen and paper. She wrote something like we experimented on her. I guess for an ordinary person, waking up with a tube in your mouth to aid in your respiration, with another tube coming out of your skin to drain saliva from your esophagus, and yet another tube going through your skin into your intestines which would be your way of eating from now on...it would really looked like you were a subject of some horrid experiment by mad doctors. I explained what was done to her and her prognosis, and she had this look of disbelief and sadness that I couldn't quite explain. Even her husband was not aware of how his wife would be living in the future, if she were to survive. I felt some pity as they cried, but I can't really emphatize with patients who commit suicide and then cry and shout words of regret afterwards. I mean--- they asked for it. There's nothing to blame but themselves... yet some of them act as if their physicians didn't do everything they could to treat them.

She's currently in the intensive care unit, and... I dunno. It looks like she won't make it. I guess she'd be happier that way, as I remember the way she looked when I said there's the possibility that if she were to survive, she would not be able to eat anything again, nutrients would just pass through a tube in her tummy. A few days back, She wanted to receive the gift of death. too bad death way playing coy. He gave his gift a few days later, when there was time to think things through, when there was time for regret and common sense to rematerialize.

In the end, she'll most likely get what she wished for... I just wonder if it's the same thing she's wishing for now.