code blog – tales of a nurse » Blog Archive » Some stories have no simple happy endings

W.B., paramedic, writes:

One evening, I went out on a call for a self-inflicted shotgun wound to the head. I arrived as the wife and children of the victim were hurrying to the door. They looked horrified and the wife asked me if her husband was dead. I told her that I didn’t know and that she should take her kids to the neighbors house.

It was dark out and the lights of the arriving emergency vehicles bounced off the house. I made my way down the hall, then down the stairs to the basement. A cop was holding the man’s shotgun and the patient lay in a pool of blood in the corner. He lay on his side away from me. An EMT was kneeling beside the man and told me that the patient had a pulse, so I decided that we would do what we could to preserve his life. It wasn’t a long thought out choice, it was just the obvious next move.

I instructed another EMT to set a back board next to the patient and we rolled the patient onto his back. I would later learn that the man was upset about his wife threatening to leave him for his drinking and temper. He knelt down and put the shotgun under his chin, his son ran down the stairs hearing a commotion and begged his father not to do it. Apparently, in kneeling down, he tipped his head back too far.

The patient’s face split open in two halves. His jaw was gone, nose off on one half, one eye gone, the other hanging into a socket on one side. I had help suctioning as I intubated the patient, secured the tube and bandaged the face. We carried the man out and as we placed him in the back of the ambulance I asked him to squeeze my hand. I was shocked when he did.

On the ride to the hospital the other medic began asking questions and worked out a way for the man to answer giving one finger for yes and two for no. We started IV’s and his vital signs stayed stable. He stayed conscious and alert the whole time and responded that he was not in pain.

At the hospital they determined the man’s blood alcohol level was over 0.20. A helicopter arrived shortly after to take the man to a trauma center. The man’s wife arrived and talked to the patient who chose to flip her off with his middle finger.

The man recovered with no neuro deficit. After a lot of reconstructive surgery the man returned home. I saw him once after. I go by his house a lot, but I never see him. The house is closed up, shades drawn. I want to talk to him and hear that I did a good thing, but I don’t know what I will hear. It was a call that was flawless in the way that the intubation went so well and the patient survived with no physical or mental deficit. Not so flawless in the aftermath when I think about the reality of who this guy is, what he did and what effect this all has on him and on his family.

I wonder how he feels now over a year later. I wonder how his family feels. I wish that stories had simple happy endings.

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When I was teaching first responders, I would show a training film of a attempted suicide very similar to this one. I wanted to show them that simply looking terrible and horrific doesn’t necessarily mean it’s hopeless, and to know the anatomy. I often wondered what happened to the man in that film, because I understand he too made a full recovery, even though he had no face.

The things we have to see in this job….

I still vividly remember seeing a man who did in essence the same thing when I was a volunteer at a hospital in high school (and that was 22 years ago). Sadly, (or luckily) this guy didn’t live through the night, and I can still remember the screams of pain until they managed to knock him out…

I too, wonder what effect that experience must have jad on the family…

When I was a teenager my brother was in a serious car accident and I spent a good deal of time in the ICU supporting him. There was a guy there in a situation almost identical to this — had shot his face off instead of making a fatal wound…

I once knew a woman who tried to commit suicide with pills in her garage. She was in her 60s, lonely, had a job in which she traveled constantly, her kid was living in a foreign country, and she just felt lost.

She had been unconcious for two days when she was found; she’d been lying in such a way that circulation had been cut off to one foot.

She lost part of her foot and spent many weeks in the hospital.

Later? She was glad to have survived it, even with the huge medical bills, but wished, instead, that since she owed all that anyway, that she’d spent the money on plastic surgery or a year in Europe instead of the suicide attempt.

I knew someone from high school who did almost the same thing; he recovered also. He’s doing well these days, and owes his life to people like you. :)

You did the best you knew how, in accordance with your training and experience. We cannot play God; it’s not our right. Long ago, I happened on a single car MVA; it was cold, dark and I found the car in drive. The only thing stopping it from going into an 8 foot deep pond was a single fence post jammed into the frame of the car. The older woman behind the wheel was apneic, but had a pulse. I directed the next (only) person to stop to go get help and stayed with my patient. I opened her airway and covered her with a blanket until EMS got there a few minutes later. For all my efforts, her family was rewarded with a 67 year old mother who remained in a persistant vegatative state for the next three years until she threw a clot and died. It took me a long time to get over what I had caused by my actions, i.e; another 2 minutes and she would have arrested, thus saving her family considerable emotional and financial pain. Would I do the same thing again if the identical situation presented itself? Absolutely and without a doubt; to do less would compromise everything we (as providers) stand for. Sometimes we don’t get rewarded with those simple happy endings, but the fact remains that your actions saved a life; his issues and actions are not your responsibility to determine, but doing the best you can in all situations as you trained for and performed certainly is.

Just another example how mean people never die.

Do I feel sorry for truly suicidal people? Yes.

Do I feel sorry for people who do it out of hate, revenge, and anger? No.

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Good site ! ;)

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