Suicide Attempt

Despite this gentleman’s best effort (he made an incredibly good effort- in fact, the most impressive attempt at suicide that I’ve seen thus far), we were able to save his life.  It is rare to see someone try to commit suicide by slitting his or her own throat, but it is even more rare to have someone that tries this hard.  I am amazed that this guy lived.  The true hero in this case was the paramedic who was able to find his airway and place an endotracheal tube directly through the gaping hole in his neck into his windpipe.  If it wasn’t for him, this man surely would have died on the scene.

When he got to us, he had lost a fair amount of blood, but had a stable airway.  After resuscitating him in the frontroom, we took him to the OR and did a formal tracheostomy below his incision.  This allowed us full access to the injury.  I have never seen anything like it.  He had cut through and through his trachea.  It was completely transected.  Not only that, but his esophagus (behind the trachea) was transected as well.  This picture is a view that I had never seen before.  You can look directly down his windpipe from above:

The most incredible part about this is that he missed the major vascular structures in his neck.  I’m not sure how, but he didn’t hit either of his carotid arteries.  We repaired his esophagus and trachea that day in the OR and he did pretty well afterwards.   He was able to talk in a whisper 1 week after the injury, but he still has an esophageal leak.  He's alive, but definitely not back to normal.

The question I get most often about cases like this is "why would you save someone that wanted to die?".  A good question with a simple answer.  We don't care.  It is not our place to judge.  We just do our best to save lives and fix the problems that are presented to us.  The most interesting thing about attempted suicides is that most of the patients are very thankful after we save them.  I can't remember any person that was angry after we saved his or her life.  The guy in the pictures above was one of the better patients I've had a Groote Schuur.  He was very appreciative of what we did for him.  Even though his life actually got a lot worse and a lot more difficult after his injury, he was able to see that life is still worth living.  This to me is inspirational.  Just when you think that life can't get any worse, it sometimes does.  But life is the most precious gift, and we all know that deep down.  At the end of the day, be thankful for the things you have.  Be appreciative of how good you have it today, because you never know what tomorrow may bring.