Suicidal character

DO you mean you want the ER tx for all four injuries? Are you trying to choose which or are you saying the char does all?

In the two cutting incidents, meds given are local anaesthetic prior to suturing the wound, possibly antibiotic and tetanus.

In the pill sit, depends on the pill if given activated charcoal, an emetic, a cathartic, if needing respiratory support. And the char did this in hosp? Did someone bring the pills? Are you saying he had them w/ him all along and they didn't discover this, take them away?

In the shooting, may well need exploratoy surg, beaucoup soft tissue repair, could well have a lung involved. Tx meds will include pain meds.

Psychiatrist will order a short term commital if it hasn't already been done; if the pt won't self-commit; or if the pt doesn't have a guardian who can commit. Long term, pt needs tx for the why and how to make other choices and for the clinical depression.

It's imp to distinguish between suicide attempts and gestures. A less savvy person may be making an attempt with the shoulder shooting and the porr wrist slice, but many, many people are only making a gesture there. Know which your char is.

Happy to help if I can but I don't think I adequately understand the sit your char is in...

The MC cuts his wrists (across) @ home.

MC shots self in shoulder (misses the hear).

MC slice wrists (long ways) @ school = blood everywhere.

MC takes whole bottle of sleeping pills and not discovered for an half hour afterwards (still in hospital after slicing wrists long ways)

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Forgive me if this sounds harsh, Jedimaster107, but something's wrong with that last bit. Your MC's in the hospital after a known suicide attempt and he manages to get a hold of a bottle of pills? Wouldn't he be under some pretty heavy surveillance to prevent another suicide attempt? Wouldn't the security measures to keep thieves out of the pharmacy keep him out as well? Unless he's in the same crappy mental ward that let Hookhand run around with sharp implements, you might want to rethink the pills.

Hope this helps and wasn't too harsh.

To continue what AZ said, the biggest difference between a psych unit and a prison is the smiley faces. They don't search people going to visit on the unit, which means someone (who would be rather crazy) could smuggle something in, but by and large, a psych unit tends to have rather serious (although maybe not obvious) security, especially for someone fresh from one suicide attempt and not judged to be stable by the staff.

I agree with AZ. I'd do some thinking on your last premise.

Best of luck,

Jim Clark-Dawe

I'm trying to find a way to say this that conveys the respect I have for you. I hope this works, and I apologize in advance for the bluntness of my reaction:

jedimaster107 said:

The MC cuts his wrists (across) @ home.

MC shots self in shoulder (misses the hear).

MC slice wrists (long ways) @ school = blood everywhere.

MC takes whole bottle of sleeping pills and not discovered for an half hour afterwards (still in hospital after slicing wrists long ways)

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If this is not a dark comedy, it's going to be very difficult to work with this in a way that feels realistic and believable.

Between the incompetence of the would-be suicide and the incompetence of the hospital that somehow lets him get his hands on "a bottle of pills" while he's in-patient for a suicide attempt, this sequence of events seems so bizarre and over-the-top that it reminds me of the opening sequence of the movie Harold and Maude.

Of course it may work much better in context. But I want to flag my reaction to the events considered out of context.

jedimaster107 said:

Nurse takes off the restaints just long enough to take vidals (sp i know) and to give him a sleeping pill. nurse hears someone yelling in a different room, goes to investigate, never restraining the mc or taking the pills with her. Basically the nurse screwed up. the mc swallows the full bottle of pills and isn't discovered until 1/2 hour later.

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In the US or Canada, at least, that wouldn't be possible--the way medications are dispensed in hospitals in these countries is never that people take bottles of pills into patients' rooms. Even if the nurse was the most incompetent nurse ever, the hospital procedures would guard against her making that sort of error.

#3
never say how he gets the sleeping pills. like a little mystery

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I would be cautious doing this. It is rather like saying 'it happened because I said so'. Sometimes this is necessary in a story, just as dues-ex-machinas can come in very handy when there's no other way out. However, the reader might be confused and/or irritated when something unlikely (i.e. a patient recovering from a suicide attempt getting their hands on a possibly lethal substance) happens with no logical reason.
JMHO, of course. I've used the 'don't explain, don't apologise - it happened because I'm the WRITER' argument for some highly unlikely things before ... but I wouldn't recommend it unless a. there is no other way to explain what happened, and b. what happened absolutely must happen.

One thing to keep in mind: what happens on tv or in the movies is not necessarily what happens in the real world of mental health units (psych hospitals) or crisis centers.

Pts in mental health units are closely monitored. BUT there are exceptions. I know of one psych hospital (also called mental health or behavioral health center) that is like what I call a "chain" (similar to Wal-mart) where records are lost, pts not observed closely, children mingle with adults. (Seriously. It was reported, but never closed.) That's rare. Otherwise, there's a unit for children, a unit for adolescents, and a unit for adults.

Nurses have meds just for that patient when they go into a room. Period.

If a patient needs restraining, they will sometimes administer Ativan or some similar drug to immediately sedate the patient. (Of course, this is on the charts by the attending psychiatrist.) They're put in a solitary-type room down in crisis--which is similar and near the ER-- if no one is with them, or they seem very agitated. Once upstairs, (or transported by ambulance to a facility that has beds--many times that facility is booked, like at the holidays) there are padded rooms, but hardly used. Restraints--hmmm...I've seen those jackets used, but so rarely. And wrist restraints are used more for those who are truly out of it. Or they now put on the patient's hands very soft boxing-type gloves.

They would never leave one patient with meds in his/her hand to go to another if screaming is heard.

Patients have been known to occasionally bang their heads into walls in the inpatient units. That's when the occassional use of a padded room is used. Or, again, meds to sedate them. Family is notified.

Committal: It's only called that when the patient refuses to be admitted and they have to call in the "team": social workers, psychiatrist. Otherwise, it's just an admission. Anyone over 14 in the US can sign themselves in or refuse admission.

Counseling is constant. Groups and individual throughout the day. Visiting hours are only for about two hours per day, usually evening.

Also, they take all belts, shoelaces, anything that can be used as a strangling mechanism. They do a body search each time the pt. comes back from a few hours leave (with a trusted family member) or is admitted. They're given back on discharge.

ETA: I can't see how the pt. would get the meds to overdose in the hospital. Unless someone who visits brings it to him. In a pocket. (All visitors pocketbooks and duffels and backpacks are searched in the inpatient unit near the lounge.)

KTC's right. Blunt force trauma to the head would be the only way, except the staff would be on him--the patient--in a flash, restraining him. I've seen someone try it. Didn't work.

Don't mind me; I'm on a roll.

Pills can be snuck in by a patient's friend or family member in a pant's pocket, BUT visiting hours in the lounge are very closely monitored. Suicide by overdose would be extremely difficult. Even someone slipping a knife in. The staff would be on them in no time flat. There are always a few staff members around.

And lounges don't usually look like what you see in the movies. They're many times nicer looking, and patients usually wear street clothes, minus the belts, shoelaces, jewelry. The occasional patient will wear the two johnny coats, one backwards, one forwards. And many patients aren't just sitting there, catatonic. Or talking to themselves. Or looking like Jack Nicholson. Many times you can't tell who's the visitor and who's the patient.

Again, movies and television don't truly show how a psychiatric inpatient unit really is.

I don't understand why your character has to try to kill himself multiple times, personally. It feels to me like you just want to try out different ways, I don't know, for the fun of it? But it doesn't strike me as realistic.

I would think (and bar in mind that I have no psychology training . . . yet) that if after his first suicide attempt the character was indeed still suicidal, he would be damn sure he was successful the second time. If it was another gesture, I can't imagine that it would occur in the hospital.

I know if it was me (please don't psychoanalyse), if I found myself in the hospital, miserable, after an unsuccessful suicide attempt, I would do my utmost to cooperate with staff. I would lie and cheat my way out of the hospital, and then find a way I knew would work. Otherwise, I would take the help I was given and not make a another gesture while I was already getting help.

But that's me.

You have a point, Daimera, but many times the patients aren't in their right minds. Meds are being adjusted or newly introduced; they can't think straight. They're frustrated, angry, feeling like they have to jump out of their skin. Or they're mildly docile from the Ativan or whatever sedative if one was needed. Co-operating in order to get out sooner is usually not in the front center of their thinking. Either they want to get better, or they want to get out.

That sounds like a better plan. Writing about what an inpatient unit looks like, functions like, is difficult if you haven't seen it.

Oh. But you'd still have to get him to a crisis center (which is a psychiatric ER) and have him admitted. You're still going to have to have him evaluated and they would monitor him. So reread the above descriptions of what an inpatient unit is really like. And ask if you need more help!

They'd watch him very, very closely.

If this guy really wants to kill himself so badly, why is he so incompetent at it? Trying to shoot himself in the heart is a bizarre enough choice (firearms suicides almost always shoot themselves in the head) but if he really wants to die, why are his next two attempts so lame? Why not throw himself off a tall building? Or shoot himself in the head? Or consume a common household poison?

And if his family "owned the hospital" (which is vanishingly rare these days--almost all hospitals are owned by large holding companies or religious and educational institutions), then the employees would take extra care with him, not violate all basic rules of hospital procedure.

I agree wtih ICE about shooting himself in the heart. In the 13 years I've been a 911 dispatcher, I've probably only seen 2 people that shot themselves somewhere other than the head. And both shot themselves in the stomach. One male who died and one very overweight female that did not die...not even close.

I have seen people that shot themselves in the head that didn't die though...which would probably be more realistic than the heart shot. Use a .22 and shoot in the temple rather than under the chin. Many times the bullet doesn't have enough force to pierce the skull and simply ends up under the skin. Or bounces right back off. It doesn't always work that way...many people have successfully committed suicide with a .22 but it's the one that seems to fail the most too.

KTC said:

I don't know if I would call this a roll or not... sounds like putting a murder weapon in the hands of a killer. Why in the name of God would any relative or friend bring meds to a suicider in a psyche ward? Why?

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You're right. I called it a night after that post.

I'm impressed with your positive attitude towards all us naysayers.

I think you're missing some of the oversight requirements with attempted suicides.

Your character arrives in the emergency room with an injury consistent with suicide. Doctor arranges a psych consult (which includes a look at the medical history which would disclose any past attempts). The shrink determines whether the patient is a danger to himself. If so, the patient is involuntarily committed, usually for 72 hours. A court hearing is set up to determine whether that time should be extended or the patient released.

Once the patient is involuntarily committed, several people have to sign off for him to be released. Lots of cover your butt going on unless it is a judge. Hospitals are sued with amazing consistency when they release a suicidal patient who then does manage to retire permanently.

If the patient isn't involuntarily committed, the patient can leave at any time.

Second is all hospitals have reviews of mistakes. Hospital releases someone who was suicidal who then attempts to commit suicide again. Person who signed him out the first time is going to get to explain his/her dumb decision to a review board. Even for a family owned hospital, this would be an issue as the state's certification board looks at this type of issue. Very, very difficult to bury unless someone is lying on the medical reports.

Your actually making me interested in this. I'm going to be interested in seeing how it turns out.

Best of luck,

Jim Clark-Dawe

kristie911 said:

I have seen people that shot themselves in the head that didn't die though...which would probably be more realistic than the heart shot. Use a .22 and shoot in the temple rather than under the chin. Many times the bullet doesn't have enough force to pierce the skull and simply ends up under the skin. Or bounces right back off. It doesn't always work that way...many people have successfully committed suicide with a .22 but it's the one that seems to fail the most too.

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Or there's always one-in-a-million . . . I don't know exactly what to call them. Anti-accidents? I knew a social worker who had a client (yeah, I know, word of mouth) who tried to shoot himself in the head and ended up with the bullet right between the hemispheres of his brain. And lived. With brain damage, but functional enough.

People survive crazy things. There was a nineteenth century railroad worker who got a spike straight through his head, and lived. If you're into psychology at all, you've heard of him, because the spike pretty much eradicated his impulse control. Still, he walked, he talked, he made sense, despite having a hole in his brain.

The upshot is, if you want to have someone survive a shot to the head, you've got a number of ways to do it. You just have to take into account what sort of permanent damage they're likely to suffer.

Izunya

Just one little correction, at least for US hospitals.

Emergency workers will do everything in their power to convince the person to be committed voluntarily. And most people can be convinced.

It's typically a social worker who does the suicide assessment in the ER. (If you need to know what s/he is looking for during the assessment, I've got that covered here: http://archetypewriting.com/articles/articles_ck/resources_psych_articles_suicideAssmt.htm.

Good luck!