Is this patient suicidal?

  1. Patient admitted with blood ETOH .8, unresponsive progresses to need for intubation/ventilation......for the 3rd time in 2 weeks!

    Doctor was asked for 72 hour hold and direct transfer to detox with inpatient treatment to follow upon patients stablization. He "could understand how this overindulgence could easily happen with someone who is truely an alcoholic used to drinking huge quantities" (whiskey is poison of choice). When asked when this might be considered a suicidal gesture, he responds, "I hate to antagonize him and he will do much better in treatment if it's voluntary".

    This topic is under much debate (he has been with us for more than a week now) and I wonder how this is viewed in other places. We have more leaning toward suicidal gesture requiring mandatory intervention than a mistake. What's your take?
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  2. 27 Comments

  3. by   sharann
    Well, you are right to be concerned. The end result however, for this patient will ultimately be death. One way or another. Is it not suicide if you do it slowly? If this person doesn't admit to a problem they will never be free of said problem.
  4. by   KarafromPhilly
    I would say DEFINITELY suicidal. After all, alcoholics don't want to go to the hospital to get intubated, dried out, or whatever--they want to stay home and drink. How could someone with that much experience with alcohol be so incompetent? I don't buy it.

    And that is a truly weird response from the doctor. After all, would he be concerned about "antagonizing" a patient who is having a heart attack and insisting he is fine? What does that have to do with anything? Besides, I would guess that, even if the patient might appear to be angry, he would secretly be very grateful that someone is taking him seriously and cares enough to hospitalize him even though he resists.


    Yes, in the final analysis, the patient is going to die. We all are. There's really no need to be mean about it. IMHO, alcoholism is its own punishment.
  5. by   Nurse Ratched
    Depending on the patient's age and length and intensity of drinking hx, he may well be suffering the beginning of alcoholic dementia. May not have sense enough to know when to quit (or less sense than average!)

    There is an option that he can be committed to tx AND can be committed to tx AFTER discharge as well. Nearly dying 3 times in two weeks is evidence enough that he is a danger to himself. If your psych doc has the inclination, he can make it stick.

    Just tell one of the suits how much money this guy is sucking up in health care costs and they'll make *sure* it happens .
  6. by   OrthoNutter
    This is why I wish there was a course entitled "Suicide....Getting it Right!". I had this frequent flyer try to suicide 5 times over the course of 2 months....he tried a different method each time. He genuinely wanted to kill himself....this was no cry for help. First time it was Tylenol, so we parvolex'd him so no harm done. Psych's reviewed him, said he wasn't acutely suicidal and sent him home. Three days later, he closed all the windows and locked the door to his bathroom, filled the bathtub up with water and drank copius amounts of whiskey. That just resulted an overnight stay in our unit, just to make sure he was going to come out of it okay. After that time, they took it as serious suicidal intent and had him regulated. While he was in the MHU, he stabbed his arms repeatedly with a 14G cannula and succeeded in making nothing but a huge mess and a reason for MHU to send him back to us. While he was with us, he tried to hang himself on the buzzer cord after he knocked out the MHU staffer who was supposedly on the suicide watch. He managed to behave himself for a month after that, he did his time in MHU and got discharged. We didn't hear from him in over two weeks and we assumed that he'd either finally done it or had been 'cured'. Two weeks later, he was found by a friend in his bathtub, slit wrists, an empty bottle of his antidepressants and an empty bottle of bourbon. He left a note for us - "to any would be do-gooders, all I can say is good f&^%ing luck". He got what he wanted....sometimes there's just nothing you can do...
  7. by   micro
    tough subject and tough to see somebody dealing with.......
    does this person realize that they are maybe trying to commit suicide.....maybe yes, and probably no.....
    to the original thread question.......

    "Yes, in the final analysis, the patient is going to die. We all are. There is no need to be mean about it. IMHO, alcoholism is its own punishment."

    We see so much in nursing and health care..........and then you add to that just what we see and deal with in "this thing called life".

    Be well,
    Micro
  8. by   teeituptom
    Howdy yall
    from deep in the heat of texas

    Now whether its a drunk who imbibed too much. or an addict who ODs. Stupity and addiction are not SUICIDAL, they are self destructive in nature but not suicidal. There is a fine point of difference there. We have heroin and other substance abuse ODs all the time. And once they are physically stable, AOx3, etc if they deny suicidal ideation and there is no evidence to suggest a suicide attempt then they are free to get up and leave. You can not hold them against their will if they dont want help. If they are suicidal, or left a note or something then you have the evidence to hold them.
    So ceecel if the patient wants help. you can help them. But you try to mandate sending a drunk to rehab against his will. Doesnt work. Once there they will ask him if he wants help and if he doesnt, they will allow him to sign some papers and just walk out.
    I ought to know I am a recovering alcoholic of 27 years sobriety, now.
    Dont try to force your beliefs on to someone. you will only get a headache from tryimg.
  9. by   ktwlpn
    Originally posted by OrthoNutter
    This is why I wish there was a course entitled "Suicide....Getting it Right!". I had this frequent flyer try to suicide 5 times over the course of 2 months....he tried a different method each time. He genuinely wanted to kill himself....this was no cry for help. First time it was Tylenol, so we parvolex'd him so no harm done. Psych's reviewed him, said he wasn't acutely suicidal and sent him home. Three days later, he closed all the windows and locked the door to his bathroom, filled the bathtub up with water and drank copius amounts of whiskey. That just resulted an overnight stay in our unit, just to make sure he was going to come out of it okay. After that time, they took it as serious suicidal intent and had him regulated. While he was in the MHU, he stabbed his arms repeatedly with a 14G cannula and succeeded in making nothing but a huge mess and a reason for MHU to send him back to us. While he was with us, he tried to hang himself on the buzzer cord after he knocked out the MHU staffer who was supposedly on the suicide watch. He managed to behave himself for a month after that, he did his time in MHU and got discharged. We didn't hear from him in over two weeks and we assumed that he'd either finally done it or had been 'cured'. Two weeks later, he was found by a friend in his bathtub, slit wrists, an empty bottle of his antidepressants and an empty bottle of bourbon. He left a note for us - "to any would be do-gooders, all I can say is good f&^%ing luck". He got what he wanted....sometimes there's just nothing you can do...
    Oh my---the note is a nice touch....A very large amount of our valuable resources were utilized to no avail on a pt. that did not want them....and others can not afford the care they desperately need...Ironic
  10. by   canoehead
    You guys are real crapheads. There are lots of suicide gestures that should be dumped back out on the sidewalk but is there any compassion for the truly depressed? It's the "suicide- getting it right"attitude that keep the people that need and deserve help from going out and getting it. They encounter that attitude in the ER- they figure may as well go home, I really am a piece of poop. But the ones you really want to get rid of don't care WHAT you think, they have their own personal drama happening and the cranky ER staff feed right into it...

    I have seen people coughing and "vomiting" spit get more TLC than someone near death from a high lethality suicide attempt. Why? Have we just picked that particular patient population to vent our frustrations on?
  11. by   joenp
    I think that alcoholics do not stop when they have had enough, because they probably have little concept of "had enough." He did drink too much and did he do it because he did not know when to stop, or was he trying to make an attempt at stopping himself in the only way he knew how? The last question I would pose: Why does he drink? Is it because he is depressed? If so, then it may very well be trying to hurt himself. joenp
  12. by   Nurse Ratched
    I do think that people may overestimate the negative reaction to a 72 hour hold. While many of my patients may have little insight into their addictions, they comprehend the concept that there are consequences to overdosing and being brought into the ED by police, for example (a fairly frequent occurence.) They are usually relieved that they woke up in the hospital instead of jail.

    I don't think 72 hours out of the man's life to reflect on his situation is unreasonable. Pushing to get the hold placed would be advocating for the patient's well-being, in my mind.
  13. by   zumalong
    QUOTE]This is why I wish there was a course entitled "Suicide....Getting it Right!". I had this frequent flyer try to suicide 5 times over the course of 2 months....he tried a different method each time. He genuinely wanted to kill himself....this was no cry for help.[/QUOTE] Orthonutter


    I slept on this quote all night last night. I needed to cool down. I must say that if this is the attitude you presented to him--I am not surprised he left the sarcastic note. Suicide is not a joke. It is not funny--people who truly want to die are so deep down in that dark well that they can see no why out. The pain is emotional--but it is as bad as the worst cancer pain. Would you treat a terminal cancer patient with the same disrespect that you cared for this person??? I doubt it.

    I have been touched by suicide two times in my life. Both my brothers. (the one's anniversary date was yesterday). The 'help' they received was little. When they did reach out--they ran into people who made comments like yours. "why can't you get it right the first time' etc. Isn't nursing supposed to be about compassion. Neither of my brothers would have hurt a fly--so I cant speak for your patient who acted out--but the ignorance about suicide is unreal.

    I would have felt the same way as some of you did on this board before this happened to me. But if you were to ask around you would be surprised at how many people's lives have been hurt by suicide. All I want to get across is that most people who are sucidial have reached the end of their tolerance for that emotional pain. Many times there is no way to help them. But we don't have to treat them like crap because we can't seem to see things from their point of view.

    In memory of Doug and Danny:kiss :kiss
  14. by   teeituptom
    Howdy yall
    from deep in the heat of texas

    Zumalong, I understand your pain in regards to this. Bur one thing, I have never seen depressed patients get treated like crap in any er, except when their behaviour mandated it. Such as combativeness and other untoward behaviours.
    And Xena, have you ever followed up on 72 hour hold patients. Most are turned loose in the morning once they have chilled out or sobered up. Only a small percentage actually make the full 72 hours and even a smaller percentage end up under court ordered hospitalization. Largely due to lack of funding and space availability. I have sat on a mental health review board. Its sad what goes on once they are out of the ER.
    And Joenp alcoholics do not drink because they are depressed. They drink because they are alcoholics, study the disease process for alcoholism. Or attend some AA meetings. I am an alcoholic, been there.

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