Indiana Poison Center Nursing Position

I just finished a 12-hour shift. Maybe it’s the cold, cold weather, maybe it’s the post-holiday let-down, maybe it’s the phase of the moon… but there were an unusual amount of suicide attempts for the day shift today. Most intentional ingestions happen on evenings and nights.

(All details below changed to protect confidentiality.)

I talked to two concerned moms with distraught daughters. One was a 13-year old girl who took 10 Ibuprofen after her boyfriend broke up with her. The other was a 24-year old lady with a history of bipolar disorder and post-partum depression who took a double-dose of her Elavil®, “but wanted to take the whole bottle.” Fortunately, mom had wrestled the bottle away. I also spoke with the ER nurse caring for an 18-year old girl “whose parents are out of the picture” and who was brought in by her live-in boyfriend after they had an altercation. She had drunk half a bottle of Nyquil® and taken four tablets of Benadryl® – because she “wanted to go to sleep.”

Now, none of these sound like very serious ingestions to most people – they aren’t ingestions of hundreds of pills, they aren’t particularly toxic substances in the amounts ingested, and none of the patients were having significant symptoms when we were called. Still, each patient was referred to the ER for (or the ER was advised to provide) a thorough medical evaluation – on the general theory that a person who is upset enough to intentionally take an overdose can’t be relied upon to be the most accurate historian. Psychiatric evaluation was also recommended.

At some point you may encounter a friend, relative or acquaintance that has made a suicidal gesture. The circumstances (a teenage romance, the baby blues, a squabble with a boyfriend) may not seem very significant to you. The exposure itself may not seem particularly toxic. Of course, we recommend that you call Indiana Poison Center and let us help you determine what to do in each circumstance.

I encourage you to treat these events EXTREMELY SERIOUSLY for these reasons:

1. Although the “motive” may seem “insignificant” in your eyes, if the patient has judged it to be an adequate reason for an attempt, disastrous results may occur.
2. You don’t really know what has been ingested or the quantity involved and you shouldn’t wait to find out what may develop.
3. If initial suicidal attempts are ignored or minimized, subsequent attempts may be more aggressive.

What happened with these three young ladies? All three were medically evaluated and medically cleared. All were evaluated by the respective Crisis Teams at their facilities. Two were admitted for in-patient psychiatric care and one was referred back to her current therapist for on-going out-patient therapy. Were these ER evaluations worthwhile? Absolutely. They were a very effective method to establish physical stability and acquire an entry to the mental health system.

Someone may call on you for help. Be sure you are listening.

Gwenn

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