What a Way to Die

I walked into the Accident Room of Charity Hospital in New Orleans. A young man sat in one of the old, wooden, high-backed wheelchairs they used at that time*. He was thin and pale. His shoulder length hair was greasy and unkempt.

He sat still and showed no emotion. His left eye was covered with a large paper cup, which had been taped in place by emergency staff. Under the cup was the wooden handle of an old ice pick, the point of which had been thrust into his eye. The cup had been placed over the handle to prevent it being bumped, possibly making his obviously serious injury worse.

I asked him what had happened. In very flat and unemotional words he told me he suffered from psychotic depression and had wanted to die for a very long time. He recounted how he had seen a show on public TV that showed cross-sectional images of the brain. This made him realize his brain sat immediately behind his eyes. He reasoned that poking an ice pick into his brain would clearly kill him. So, he planned to drive an ice pick through his eye and into his brain, in order to die.

He denied being in any pain unless he moved the eye, which he found difficult to do. He said, as far as he could tell, his vision was OK.

When I gently lifted the eyelid open, I could see an old, dirty, rusty ice pick entering the lower part of his eye. The rest of the eye, above the ice pick, seemed to be working fine.

I had three problems. The most immediately life-threatening was brain injury. He was right in recognizing the brain does sit behind the eyes. The bones of the orbit, which surround the eyes, are thin and could easily be pierced by even an old, dull ice pick. From the looks of how far the ice pick seemed to have entered his head, it looked like he probably had stabbed himself in the brain.

My next worry was his eye. Though his vision seemed to have been unaffected so far, I was concerned that trauma and potential infection might threaten his vision.

The third problem, very real but not so acute, was his depression and suicidal ideation.

There was no good way to fully evaluate either his brain or his eye with the ice pick in place. I was afraid to pull it out without addressing the possible brain injury, so I called the neurosurgeon who went with me to the CT scanner. The neurosurgeon placed one hand on the patient’s forehead, grabbed the ice pick handle with his opposite hand and gently pulled, twisting slightly to get it to let go.

After the ice pick was removed, the CT scan was done which showed no bleeding or other problem in the brain that required neurosurgery.

I then made arrangements for ophthalmologists, the eye doctors, to see the patient. They took him to the operating room where they cleaned out the wound. They found only a small nick in the lower part of the globe, which they cleaned and repaired. The patient was then admitted to the hospital for a few days to make sure no complications arose. Afterwards, he was transferred to the psychiatric ward.

This poor man must have been at the end of his rope to get the nerve to do such a horrible thing. He really wanted to die and, by all rights, he very well could have.

However, when he stabbed himself, he hit just low enough that, rather than puncturing the eyeball, it was displaced upwards. The ice pick passed under the globe, missing the vital parts of the eye, so his vision was not affected.

A small hole in the bone of the orbit would heal with no treatment. Ironically, the part of the brain he punctured, the frontal lobe, is probably the most forgiving part of the brain to damage. So, rather than dying, he ended up fine with no permanent damage done at all.

I certainly hope his psychiatric care ended with the same good results as his medical care did. I think that was not too likely, as this sort of depression is very hard to treat.

*

I found this in Google images. It is exactly like the wheelchair my patient was sitting in that sad  day.