Please back away from the steak knives…

I saw about 12-14 patients last night on new year’s eve, but two stand out as being eerily similar…

Patient number one was a woman in her mid-thirties, first seen at a community hospital for two stab wounds to the groin. The bizzare part is that they were self-inflicted. Drinking combined with marital strife caused her to grab a kitchen steak knife and plunge it into her right groin…twice.

WHY WOULD YOU DO THIS TO YOURSELF???

She lost 2-3 units of blood, but no obvious arterial injury. Bleeding had slowed to a trickle by the time I saw her. We did an angiogram to assess vascular damage and petitioned an involuntary psychiatric admission for self-mutilatory behavior.

The frustrating part was giving her the option of signing in voluntarily…her argument was that she needed to go home and take care of her kids (her husband is currently taking care of them). How can she not realize that if the knife had struck a centimeter more to the right…that her kids would have no mother???

In the big picture, a day in the hospital is small payment for a little professional help to keep you from killing yourself.

PATIENT #2

This young man arrived about an hour after the first. He had been celebrating New Year’s (i.e. drinking). He went home and found his fiance inbed with another man. First he punched a wall, breaking his hand. But then he got a better idea. He went to teh kitchen, grabbed a steak knife and plunged it…not into his lover, not into HER lover, but into himself, right into his abdomen!

Let me reflect one more time…WHY WOULD YOU DO THIS TO YOURSELF???

I probed the wound with a sterile glove & a sterile Q-tip, and met resistance at about 1 1/2″ deep…my guess was that he did not penetrate into the abdominal cavity. But guesses aren’t good enough, so trauma surgery came to see him and ultimately scanned his belly. The funny part about this guy was that he had been admitted in the past involuntarily to the psychiatric floor for somewhat less dramatic behavior. His mother’s comment to him when she left his bedside was, “Well, if they don’t admit you to the nuthouse, give me a call and I’ll come and pick you up.”

I put him in the nuthouse.

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