“How would you do it?”
“Oh, I think I’d take a whole bunch of pills.”
“Have you actually poured ‘a whole bunch of pills’ out into your hand?”
“No, never… it’s just something that’s crossed my mind.”
“Do you have access to a gun?”
“No—and even if I did, I wouldn’t use a gun. It’s too messy. I wouldn’t want to leave a mess behind for them to clean up…”
(Tangent: Some people seem to believe a bloody mess is more distressing than self-destruction. To me, this is a distortion of logic: When we learn of people killing themselves, are we more disturbed that they killed themselves or that the surrounding environment required disinfection? Seeing a pool of blood on the floor can be sickening, yes, but seeing a dead body due to a self-inflicted injury is horrifying.)
“… I just want it all to go away. You know, there’s no pain this way; just take a whole bunch of pills and fall asleep, never wake up.”
While it is occasionally true that swallowing a “whole bunch of pills” may induce immediate loss of consciousness (which is not “sleep”) and, eventually, death, this is not always true. People seem to believe that upon swallowing a large number of pills, their bodies will immediately shut down (within minutes, if not seconds, of the ingestion), thus resulting in sleep, and then they will die shortly thereafter. They romanticize suicide by pill overdose.
In fact, the following events are what may actually happen after swallowing a large number of pills:
>> Nothing. People often start checking the clock, wondering why “nothing is happening”. They start to feel frustrated that their efforts did not produce any results. A few people have told me that, after attempting suicide by overdose where nothing happened, they never attempted suicide again: “It didn’t work, so why bother?”
>> Cerebral edema. This is the fancy term for “brain swelling”. Because the skull holds a fixed volume, a swelling brain eventually ends up oozing out of the base of the skull, which can end life. This, however, is not a rapid event; it can take hours. People may be awake while their brains are swelling; they may notice that their breathing rates are irregular (which is psychologically distressing; think anxiety and panic). Sometimes they notice that their muscles get tight, thus making it more difficult to move. Their pulse rate may also drop, which can lead to dizziness and chest discomfort. Brain swelling is not a comfortable experience.
>> Renal failure. This means that the kidneys are either significantly impaired or they stop working. This also does not occur immediately; it usually occurs on the order of hours. Again, people may be completely awake and alert while this is happening, though they may start feeling nauseated and begin to barf. (Though nausea is not a type of pain, many people find nausea less tolerable.) Their appetites may drop, as well as the amount of urine they produce. If one is not peeing, one is not getting rid of body water, which means one may start bloat. The areas around the kidneys (”flanks”) may begin to hurt. Failing kidneys result in a miserable experience, which is why so many patients who do not attend their dialysis runs regularly often show up at the emergency room when they are “overdue” because the nausea and other sensations are simply intolerable.
>> Nausea, vomiting, diarrhea. This can occur independently of renal failure. The stomach lining may be irritated upon digestion of the large number of pills. Again, nausea isn’t pain, but it still sucks.
>> Tinnitus. (Debate rages whether this is pronounced “TIN-uh-tis” or “tin-EYE-tus”.) This refers to “ear ringing”. Not painful, but pretty dang annoying.
>> Hypokalemia. This is the fancy word for “low potassium”. This, too, does not occur immediately (there is a pattern here)—our bodies are amazing machines that try to adapt to physiologic stressors as effectively as possible. If the body does not have enough potassium, muscle function is compromised: One may start to feel numbness of tingling in various places; this can ultimately lead to paralysis. The diaphragm, which facilitates breathing, is a muscle. When one is not in control of one’s breathing, one freaks out. Choking and suffocation are both psychologically and physiologically distressing events. The muscles of the gastrointestinal tract can also be affected; see “nausea, vomiting, diarrhea” above. The heart, too, is a muscle; irregular heart rhythms can lead to chest discomfort—sometimes pressure, sometimes pain, but always uncomfortable and distressing.
>> Hyponatremia. This is the technical term for “low sodium”. Again, not immediate. See “nausea” above. People also experience headaches, body aches, and possibly seizures. People can eventually succumb to comas… unless they stop breathing first (see “when one is not in control of one’s breathing, one freaks out”).
>> Hypoglycemia. “Low sugar.” People with diabetes are often more familiar with this symptom than any of us would like to admit. This, too, is not an immediate event. When hypoglycemic, people report feeling hunger… and irritability. They also start to sweat, feel anxious, and experience unusual heart rhythms. People can also develop “neuroglycopenia”, which is the ornate name for “changes in thinking because of low blood sugar to the brain”. People can get confused and behave strangely… and, ultimately, if the blood sugar is not corrected, will pass out.
>> Coagulopathy. “Bleeding abnormalities.” Not immediate. People don’t melt into pools of blood, but if they bonk an elbow—or even firmly touch something with a leg—they may bruise significantly. Maybe their gums will start to ooze blood. If they’re endlessly oozing on the outside from minimal trauma, that also means it can happen on the inside, like in the gastrointestinal lining, in the lungs, in the spleen… and those have associated, uncomfortable symptoms.
Overdosing on pills is not a guaranteed method of painless suicide. In fact, the event may precipitate more problems than it solves (like a trip to the emergency room, hospitalization, an interview with one of those weird psychiatrists, a five-digit financial bill, and disruption in social support). Although suicide is always an option, it is one that we hope that people do not elect to pursue because, like overdosing, suicide may precipitate more problems than it solves—and is quite possibly the ultimate act of avoidance.
UpToDate provided the information to help me review the physiologic consequences of toxic ingestions.
2 May 2007 |
What do you think about websites that offer instructions on how to use drugs the “right way” for suicide? You’ve probably seen them, but they usually include information on which drugs to use, how much, and how to get your doctor to give you a prescription for them.
On the one hand, they can make the process (should it result in death either way) quicker and more painless, while on the other hand, they could result in a higher success rate.
As for the mess, yes finding someone dead is disturbing, but I have to agree that saving someone the trouble of cleaning bits of your brain off of the wall or floor (rather just having to put you on a gurney and roll you away) is probably a worthy consideration.
Comment by Brock Tice | 3 May 2007 @ 3:29am
The point being living is painful but dying is not necessarily painless.
You’ve been writing quite a bit about suicide lately, last month posting about hospitalizing suicidal patients.
I was wondering what you thought personally about forcing people to stay alive. I think the general public believes if someone wants to die, by all means hospitalize them and once there the doctors will magically take the self-destructive impulse away with potions and such and poof, all better.
The reality of what happens to a person who is committed against their will to a psychiatric ward is far grimmer.
Do you believe that anything and everything should be done to a suicidal person in order to keep them alive? If they refuse medication, is it okay to physically assault them and inject them by force? If they refuse to eat, is it alright to tie them down and tube feed them? Can any of these interventions be called abusive or does the end always justify the means? Is forcing a suicidal patient to stay alive always, without exception, a good thing?
What is the limit, if any exists, to what doctors should be allowed to do to patients who are determined to die?
Comment by Jane | 3 May 2007 @ 1:07pm
reminds me of a chapter in atul gawande’s book about the conflicts between states requiring physicians to be present during lethal injections and the AMA’s forbiddence of physicians attending such executions. a good run down on the grisly details, thanks for it.
Comment by drcharles | 3 May 2007 @ 3:22pm
I saw a patient several years ago who seemed to know what she was doing.
We didn’t know what she had taken when she came in. Drug screen showed benzos, nothing else. She was put to bed with supportive care — IV’s, etc., in the ICU. Bloodwork initially looked OK. Some hours later she wasn’t looking good (I think pupils became fixed or something). Blood sugar was found to be about 10 or less.
As we retrospectively put it together, she not only took Valium, she also took Inderal (not hers), which doesn’t show on a drug screen, and gave herself a big dose of insulin (which also isn’t going to show on a drug screen — she wasn’t diabetic but someone in the family was).
So she came in obtunded due to the Valium. The Inderal masked the autonomic signs of hypoglycemia, and a regular IV running D5 and whatever was no match for what the insulin was doing.
By the time the profound hypoglycemia was discovered it was too late to save her brain cells.
Comment by Greg P | 3 May 2007 @ 6:00pm
Suicide is not painless, period.
Comment by Fallen Angels | 6 May 2007 @ 7:36am
I am depressed.
Comment by r | 5 Sep 2007 @ 6:29am
Didja say all that to discourage me from thinking about it? Or possibly trying it AGAIN? Didn’t work.
Comment by Anita | 18 Sep 2007 @ 3:39pm
im sure if enough opiates are taken the fear of a painful death is nonexistant. you go to sleep your breathing stops and thats it
Comment by scott | 18 Sep 2007 @ 8:37pm
Anita, and anyone else who is contiplating suicide
I don’t know what is going through your mind, or how you even feel. I have at one point been depressed, and suicidal. I can tell you from personal experience… IT IS NOT WORTH IT!!! You don’t know what is coming around the corner in your life. It took the conception of my daughter to even realize, it is not all about me. (I am not saying getting pregnant is the cutre all, it could in someone who is not ready for the responsibility, make it worse) There are others I need to consider before I give the ultimate F*** You… My daughter is now the most important thing in my life and I have her and only her to thank for my recovery. I am now happier than I have been in years. If you want to know how long I was depressed, from 1986-2001… I know that if you don’t seek medical treatment for your disease, it will not get better, only to fester until oneday you ultimately give up or give up again. Fighting suicidal thoughts is not easy. You probably don’t want to talk about your thoughts or feelings to family or friends, I understand. I was once a person who put on a front, so that no-one knew what I was feeling… how detrimental to my health that was. I didnt realize that keeping it all bottled up was worse for me, than talking to someone about it. There are alot of organizations out there who can help you. There are free counselors who can lend their ears. Why end your life? I can’t answer that for you. Only you can find the single most thing that makes you happy and build on that. That is what I did after I found out I was pregnant, I was very scared of being a mom, but elated. When she finally was born all signs of depression and suicidal thoughts were gone, I revolved me around her. But, I knew it couldn’t just stop there, now that I had one source of happiness, I needed to build upon it. I began counseling, I begun doing things that made me feel good about myself. I no longer felt sorry for myself, I no longer had self hatred. I now LOVE myself for the first time in years. My daughter is now five, and I have not had a single thought of suicide. I am no longer depressed. I only have lingering effects of the past through stress induced anxiety disorder which I am being treated for with Xanies and Zoloft. I am not perfect, I accept that. The world in which I live is not perfect, I accept that. I accept it and I make my life as I want to, I make everything adapt to me. Recovery after depression is a time of self centeredness, you have to be self centered because you have to heal, and in order to heal you must find love for yourself. I have, and I found it not only through my life title, but through my strength. Bless you child, I hope you find a way to love yourself.
Comment by sherry | 8 Oct 2007 @ 9:32pm
I recently broke up with my boyfriend, I lost my baby when it was born due to a breach. The two main reasons, but only 2 out of a hundred reasons why I cannot be convinced not to commit suicide. I came across this site looking for information, I have a few obstivles I must overcome before i commit suicide;
1) I want it to be perfect, and I want everyone to remember it.
2) I want no one to blame themselved or feel sad.
3) I want to make sure all my affairs are in order.
Three almost impossibel goals, but I will find that perfect way to leave this world, tell the world why, and what my life did consist of, and make sure no one blames his or her self.
There may be hell after death, there way be just a box where I must see myself wither and die forever, or there could be a dozen other things. The only one I hope does not come true is re-incarnation, how horrible it would be to swiftly leave this world and say adu hoping never to see it again only to be born into it again anew.
I am Lleu, and although i will destory this vessel I will be a legend never the less.
Comment by Lleu | 13 Oct 2007 @ 8:52pm
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