Suicide methods: or How to come off
‘No weapon…kills immediately’.
Internal sources and ability of a human organism is almost unlimited, which is obviously shown under the stressful conditions, and attempts of suicide are among it. It is very difficult to murder a person (and even oneself) and to survive after it without making harm to the organism. In most cases, the attempt of suicide resulted in heavy trauma and further disability.
Partly it occurs because the attempts of suicide are based on the information from the mass media, films and literature, but not on the basics of anatomy and physiology of the organism of a human being. On the other hand, even knowing the physiology, the reaction of the organism on this or that influence could be unpredictable.
This is very true for the attempts only to ‘scare’. Under such actions, where the main goal is to imitate the suicide, but not to self-murder with the hope for timely disclosure and rescue, it is not possible to foresee everything. People around could find late or to react inadequate. But few more minutes in loop or cut veins could cause the heavy trauma and death.
For people survived after suicide’s attempt the being in the resuscitation department is not the picture from the movie, when supporting relatives are near the patient and medical staff is running around. The picture will be very opposite: one nurse serves few patients. Because she is not able to control all people after the suicide’s attempt, who may behave inadequate, these people are undressed, fixed (tied) to the bed by hands and legs. In order to prevent aspiration (patients could choke with their vomit masses, because they lay on the back without ability to turn), the special tube, allowing to breathe, is put into trachea of the patients. Of course, meanwhile patients are not able to ask for something or complaint. Because person is tied and is not able to eat and to go to the toilets without assistance, the catheters are put into urinary bladder, probe – into stomach and rectum. So, tubes are almost everywhere in natural openings of the human body, which gives the very unattractive view for a person. Relatives are not allowed into the resuscitation department, therefore there is no chance to expect their support.
After the status of patient becomes stable, he or she is moved from the resuscitation department not to the standard one, but to the department for the psychosomatic patients. Hospital rooms there remind the cameras for pre-trial prisons with relevant contingent of the patients.
Suicide methods: Poisoning
Those, who decided to suicide by taking ‘200-300 of some pills’, should be prepared for very unpleasant detoxication therapy procedures. Detected bodies of such people are in the pool of won excrement and vomit masses (by doing so, organism tries to bring poison out of the stomach and bowels). For a start the emergency team will make the gastric lavage by putting the rubber tube (probe) via mouth into the stomach and slowly 10 liters of water at the same location (apartment) and relatives, neighbors and idlers who happened to be standing by at the same time. This procedure could be repeated few more times in the hospital. Poisonous action of the medicine causes people to remind ‘crazy old people’, who are not able to tell about themselves, remember nothing and behave like animals. In case person was not able to become conscious for a long time, the prolonged laying on the back is resulted in bedsores of areas of scapulars, buttocks and heels, when skin, fatty tissue and muscles under the weight of own body are necrotized (died). Subject to duration of the unconsciousness, such bedsores may have 10-20 cm in diameter and could reach bones.
Suicide methods: Fall (jump) from a height
Fall from a height (even from building in 9 or 16 levels) does not result in immediate death for sure. Multiple extremities, pelvic, spine and head fractures do not allow independent movements and ability to ask for a help. Such victims could lie without moving for few days before death and have all painful sensations, thinking about their action. The aggravating factor is that person is in full conscious, could see road and people in few meters, but could not ask for a help or to creep.
Treatment of extremities’ fractures takes a long period of time, up to couple of months, while this person lies without any movement, weights of skeleton extension are hung up to person’s hands and legs. Under heavy damage of extremities, extremities are amputated, which makes person as invalid for the rest of the life. Under damage of internal organs the complicated surgeries take place; the damaged organs are removed, which also has the influence for further life of the person. Scars after such surgeries are almost impossible to remove and it is kept for the entire life.
Spine fractures are very often under the fall from a height and are accompanied by damages of spinal marrow. While it, apprehensibility and movement in hands and legs are disturbed up to its full absence. Because of the spinal morrow damages, person is not able to control own physiological needs (urination and defecation). Nowadays it is not possible to suture the spinal morrow, therefore such damages stay until entire lives and make invalid from the person, connected and defecating their bed.
In case of immediate death of a person, the death is only caused by the heavy traumas, which makes difficult to ‘connect’ each parts of the body. Multiple fractures and tears of tissues, traumas of head (where head reminds the inflated balloon), cut off hands and legs, all these result in burial with closed coffin, because it is almost impossible to make more or less proper view of the body.
Suicide methods: Shut into head
Shut into head does not mean damage of brain and fatal outcome. Some people, who are not over blessed with intelligence, brain could hide among immeasurable area of a brainpan, which even for the machinegun is difficult to strike a target. Resuscitation departments of the research institutes names Sklifasovski and research institute of neurosurgery named Burdenko are overloaded by such victims. In case of no fatal outcome (which takes place very often), the heavy damages of the brain stay for entire life.
Suicide methods: Shut into heart
It is not easy task to strike a target even for a professional. First of all, people are different and to determine by sight where heart is located is not always possible. In addition, heart, in some way, is a moving organ because of its systolic beats; heart not only changes its shape and volume, but also the three-dimensional configuration (location). But it is elementary to damage lungs or spine. Is it attractive perspective to lie with paralyzed lower extremities in nursing pending fire? Let’s go further. Let you shut the heart by bullet of 9 mm. No one could guarantee the fatal outcome. Tremendous experience of military surgery shows that such wounds have not been resulted by death even that level of medicine and complications of the military time. Currently, such wounds under timely hospitalization are healed up successfully. But cardiovascular and other problems stay. I do not want to say that all wounds of heart are not dangerous and could be healed up, but that there is no 100% of guarantee – this is true. Another point. Have you ever thought that under ‘lucky’ shut into hearth, the death could not come immediately? Brain could function for few more minutes. But you would not be able to help. It is scary to realize what is going on. ‘Expectation of death is worse than death’.
Suicide methods: Poisoning by gas
Propane (‘kitchen gases) is almost not toxic for the human body. But there is another danger. First of all, there is the danger of firing, where inhabitants with children of the stair landing and may be of the building could get damages or die. This is not suicide, but this is the act of terrorism, where you act as not self-murderer but as suicide attacker. The second danger of the action is in displacement of oxygen, because it is heavy then air and person suffers due to hypoxia. The fatal outcome is not high in such cases, but cases of post-hypoxemic encephalopathy with behavior reactions damages and personal changes are more often. If to say the same by easy words you will become moron.
Suicide methods: Veins cut
The attempt to cut veins also is accompanied by the damage of tendons. This causes the breakage of movements of fingers with further disability. Because of the veins damage and dirty wounds, gangrenes could take place. Normally under such actions, the damage of arteries does not occur.
Suicide methods: Cut of carotid artery
Organism of a human being is created in order to protect the most important organs for its survival to the prejudice of less important. Therefore in order to reach carotid artery it is necessary to know properly topographic anatomy of neck’s vessels and to do the best. Even if you totally cut the carotid artery, the emergency has time and to provide medical care.
But further the interesting mechanism starts to be effective. Brain needs the remaining second carotid artery and vertebral artery to support essential functions (stem cells). As a result drop of blood pressure causes hypoxemia and this could be fatal for the brain cortex. I would not describe in details all pathophysiological mechanisms. Result could differ from the planned one. Damage of half of the brain cortex (and accordingly half of the personality of a person) causes moron.
Suicide methods: Hanging
While hanging, the essential functions of organism damage in certain succession. During 2-3 first minutes breath-holding, chaotic movements and anxiety occur. After it, cyanosis of face and neck develops, impairment of consciousness (like torpor) reveals. In the sequel, these developments increase and convulsions show up. Often there are involuntary discharges of saliva, excrement, urine, sperm (for male) and cristeller mucoid impaction (for female). There are convulsive ‘sighs’, often with wide mouth opening. Further breathing stops, but heartbeats continue for few extra minutes. After loss of consciousness convulsions develop. For strangulation of 6-7 minutes, repeated and full-blown convulsions, patients become more aggressive; it is necessary to use soporifics and fix them to bed in order to prevent damages. Such condition normally takes normally 4-6 hours. Protrusion of tongue and nipping it between teeth is one of the features of neck’s compression by loop while hanging (during autopsy this feature is observed in 44,8% cases).
Often there is nipping of fingers by loop on the bodies of hanged people. This features show the attempt to self-rescuing. When person realizes all honor of all taking place, he or she are trying to get out of the loop by doing their best but without result. If dead body hung in the untight loop for a while (more than half day), especially without compression of vascular fascicles, soft tissues of head could be pail and weakly bloody due to movement of blood down. Cyanosis and swelling of penis are also related to this process. Long stay of dead body in the loop under full hovering brings to decrease of circle and substantial elongation of neck. There is a possibility of separation of head from body by loop under sharp putrid changes and skeletonization.
In case the attempt of self-hanging has not been resulted by death, rescued people have various damages. Fractures of larynx’ cartiladge, trachea tearing off, paresis of vocal ligament are also possible. Often loop damages vessels of neck, which is accompanied by its thrombosis and malfunction of cerebral blood flow. Bit wounds as damages of tongue are local changes for dead bodies of hanged people. The most important and regular long-term effect of strangulation are derangement of memory: during first months after hanging it is sharply reduced, in time it improves, but full restoration almost never happens. For a long time victims have undue fatiguability, headache, giddiness, which cause disturbances of working capacity for many months. In case of incomplete restoration of central nervous system, disorientation and derangement of memory could stay permanently, which cause stable incapacitating condition of various degrees. Practically half of rescued people have changes of the temper: they become hot-tempered, do not understand jokes, and do not bear loud noise. After long strangulation organic dementia could develop as well. More often there are decreases of eyesight, ear, stammering and epileptic attacks.
Under accidental discovery of person in loop, people have such confusion, that they are not able to act or, vice versa, become imprudent. While head extractions from the loop, safety measures are not followed, and, as a result, victims get various damages: nose fractures, brain, face, back and etc. contusion.
Suicide methods: Caustic poisons or self-immolation
The attempts of suicide with the help of caustic poisons (acids and alkali) by its painful sensations could be similar with attempts of self-immolation. I would like to explode the myth that person after self-immolation dies immediately or at least very quickly due to pain shock. In reality, few hours and even few days are required in order to develop shock; while this period person suffers on terrible pain, which are very difficult to soothe (even by narcotic analgesics). In case person survives after such massive burns, he or she has big scars on the skin covering few areas of the body. Such scars complicate movements in joints, because of its density and inability (unlike skin) to stretch. Now I’m not talking about cosmetic aspects of this issue.
As for people who drink acids or alkali, terrible burns of gastrointestinal tract are accompanied by evident pain and vomiting. In addition to the afore-said, I need to indicate the effect of chemical burn of esophagus. Such damages bring to spread scary stricture of esophagus, which does not allow person to eat food by mouth, as all people do. In order person not to starve to death, the special surgery and gastrostomy is one (‘hole’ on the stomach, with the help of it food floods directly into stomach). Such food procedure does not give neither moral nor aesthetic satisfaction to the patient and to people around. Only after few months (once organism is restored in full) the plastic surgery on esophagus could be made. Normally the fragment of own esophagus of a person is used for this purpose. But nobody could give 100% guarantee of this surgery, therefore the possibility to use the food by the afore-said method exists until the end of the life.
Suicide methods: Drowning
Drowning is often used as method of suicide. But not always because of drowning death comes immediately. Often the period of drowning continues for 5-6 minutes and is very significant. Under submersion of the body under the water, reflex breath-holding of different duration takes place. Due to the increased lack of oxygen in the organism, involuntary respiratory movements appear. This moment water starts to actively move into respiratory tracts, causing cough reflex. Forming escaping mucus mixes with water and air and forms foam mass of grey-white color, which fills lumen of respiratory tracts. At that moment person tries to come to the surface of the pond. Increasing oxygen starvation brings to loss of consciousness. Then respiratory movements temporary stop, human body sinks into depths, where water under pressure enters into depth of respiratory tracts, fills bronchial tubes, water via broken capillary enters blood vessels. Blood, thin by water, goes through heart and later spreads by other organs. Thereupon final respiratory standstill comes.
External checking of a dead body shows persistent fine foam around nose and mouth in the shape of lumps, reminding cotton wool (‘foam cap’). Foam forms in a result of drowning when mucus mixes with water and air. While drying up of foam, its marking stays near nose and mouth. Normally foam disappears in 2-3 days. Sometimes there is puffiness of face or defecation. When body is in the water, specific changes of the cutaneous covering occur; this process calls as maceration (softening). Over water influence, skin loosens, shrinks and gains white color. Epidermis, more swelling, comes off as layer. Skin on the wrists with nails comes off in the form of gloves. The same happens with skin of foot. As a result of skin loosening, hair falling out starts. In contracts to lifetime alopecia, skin of the dead body head contains obvious sockets of falling out hair. At the same time with maceration there are processes of decomposition. Due to putrid gas, unit weight of dead body decreases and it comes to the surface of the water.
Almost all people have haemorrhage of muscles of neck, chest and back – as a result of strong tension of muscles, which appears when drowning man tries to escape. This obviously confirms the horror of a dying person. It also should be noted that dead bodies extracted from the water, are affected by the putrefaction, especially in summer time.
Extracts from in-patient cards
1. Mr. À. of 25 years old got into hospital with diagnosis ‘Complicated compressive-comminuted fracture of 7th cervical vertebra’, he died in 78 days. He was delivered to the hospital by the emergency team, when found on the street near the entrance door of a building. He got the trauma 2 hours prior the arrival by leap out of 11th level of a building.
He had poor condition upon entering the hospital. Breathing was independent. Urinary bladder was catheterized; it was received 200 ml of light urine. While checking, it was noticed paresis of upper and lower extremities. Next day, during the psychiatrist’s checking the patient was in clear consciousness, does not have the suicide thoughts and tries to hide the attempt of suicide. The spinal column surgery with installation of titan plate has been made on next day. However after the surgery patient has been in poor condition, but in conscious, artificial pulmonary ventilation and lower tracheostomy surgery have been made. Paresis of extremities exists. In one month cicatricial deformity of trachea in the area of tracheostomy with lumen decreasing has been developed. Bedsore of gluteal and sacrum region has been developed; the surgery of necrotizing tissues of bedsores has been made. Because of the absence of equipment for artificial pulmonary ventilation at the neurosurgery department, patient has been transferred to the general resuscitation department. In two months after admission to the hospital, urethra of the patient broke; catheterization of urinary bladder via front abdominal wall has been made. In 77 days of being in hospital, there is a note: ‘according to the words of the resuscitation specialist on duty…Z, mother of the patient… A refused to take her son away from the hospital to home (in case of his recovery) and also asks the resuscitation specialists on duty to turn off the ALV (artificial lung ventilation) equipment connected to her son and to stop all possible efforts of his treatment’. After it in a day the patient died.
The external checking shows the dead body of a man of standard constitution with malnutrition, the length of a body of 160cm, delivered for autopsy without clothing. Cutaneous covering is pale with pink shade, cold in all regions to the touch. Eyes are closed, corneas are transparent. Pupils of the eyes are round of 0,5 cm in diameter. The openings of nose, mouth and external acoustic meatus are clear and free. Mouth is closed. Borders of lips are dark red, slightly dry. There is the round skin defect of 1,5 cm in diameter with round edge, entering into lumen of trachea (tracheostome) on the anterior surface of lower third of neck. On the right and left lateral surfaces of the neck there are round wounds of 0,2 cm in diameter with dark-red dry borders (marking of needle pricks). There is round defect of soft tissues of 1,0 cm in diameter with round brown-red borders entering into interstice of urinary bladder in public region. External genital organs are formed and correctly developed without sores, scars and discharges. Anus is closed, skin around is clean. There is round defect of soft tissues of 14,0 cm in diameter, 3,0 cm in depths with wide borders of grey-blue color in sacral bone. Bottoms of the defect are: in central areas – sacral bone, of periphery – muscles of dull dirty grey-red color with grey-green fibrin (bedsore). The same bedsores are in the area of both buttocks of 8,0 cm and 10,0 cm in diameter; and of 3,0 cm and 4,0 cm in the area of heels.
Autopsy showed comminuted fracture of 7th cervical vertebra with disruption of intervertebral disks and compression of spinal substance at that level, purulent tracheobronchitis and pulmonary edema.
2. Mrs. Ê. of 26 year old got into hospital with diagnosis ‘Poisoning by psychotropic medicine’, died in 6,5 days. Before 17-18 hours prior to admission to hospital she drank unknown number of medicine.
The emergency team made intubation of trachea, rinsed the stomach via probe and started the therapy. Upon admission to the hospital the condition of the patient was poor, but no complaints because of the severity of a condition. The patient is in coma, artificial pulmonary ventilation started. In 2 days after start of the treatment, the patient came to consciousness and moved for independent breathing. But next day her condition became worse and artificial pulmonary ventilation started again, the low tracheostomy was made and drainage has been installed into abdominal cavity. In spite of the made treatment, the patient condition became worse and later she died.
The external checking showed the dead body of woman of standard constitution with malnutrition, body length of 155 cm, delivered for autopsy without clothing. Cutaneous covering is pale, cold in all areas to the touch; cutaneous covering of torso has pink shade with many minor edematic and spotty, partly confluent blue-red hemorrhages. Eyes are closed, corneas are transparent. Pupils of the eyes are round of 0,4 cm in diameter. The openings of nose, mouth and external acoustic meatus are clear and free. Mouth is closed. Borders of lips are grey and soft. There is surgical linear incision of 1,5 cm in length with round edge and sharp ends, entering into lumen of trachea (tracheostome) on the anterior surface of lower third of neck. Mammary glands have the form of hemisphere, without focal indurations, nipples are isolated without discharges. Front abdominal wall, above navel, contains vertical linear surgical incision of 1,0 cm in length with drainage tube. Virginal membrane is fleshy and of middle height. Mucous membrane of vagina is blue-pink, dull, without stitching and bleedings. External surface of left heel and internal surface of right foot have areas without epidermis of 4,0 and 4,5 cm in diameter. Its surface slightly falls back, is dull and of brown color (bedsores). The round wound of 0,2 cm in diameter of dark-red dry borders (marking of needle pricks) is in right infraclavicular region. Similar wounds are on external surfaces of third bones. Cutaneous coverings of wounds are of 4,0 cm in width with blue shade.
Autopsy showed bilateral pneumonia.
3. Mr. M. of 26 years old got into hospital with diagnosis ‘Multitrauma’, died in 22days. He got this trauma more than 1 hour ago, thrown from 3d level.
Upon admission to the hospital the condition is poor. Catheter is put into urinary bladder; 200 ml of light urine is taken. Intubation of trachea is made and artificial pulmonary ventilation is started. It is made drainage of right pleural cavity and air is received. In 6 hours upon admission to the hospital the condition of the patient has been improved, he has recovered consciousness, but during next hours the condition became worse and biological death has been certified.
The external checking shows the dead body of a man of standard constitution with proper nutrition, the length of a body of 193cm, delivered for autopsy without clothing. Cutaneous covering is pale, cold in all regions to the touch. Eyes are closed, corneas are wet and transparent. Pupils of the eyes are round of 0,5 cm in diameter. The openings of nose, mouth and external acoustic meatus are clear and free. Mouth is closed. Borders of lips are blue-grey and soft. On the right and left lateral surfaces of the neck there are round wounds of 0,2 cm in diameter with dark-red dry borders (marking of needle pricks). Similar wound is located at right infraclavicular region. There is surgical linear incision of 3,0 cm in length with round edge and ends, entering into lumen of trachea (tracheostome) on the anterior surface of lower third of neck. There is horizontal linear incision of 1,5 cm in length with drainage tube from it at the external surface of chest, at the level of 2d intercostal space of middle collarbone. There is linear incision of 1,5 cm in length with drainage tube from it at the right surface of chest, at the level of 7th intercostal space of axillary line. External genital organs are formed and correctly developed without sores, scars and discharges. Anus is closed, skin around is clean.
Autopsy shows multitrauma of head and chest, necrotic suppurative tracheobronchitis, pneumonia, purulent pleurisy.
It is also necessary to note social consequences of the suicide attempts, not only its organic and mental consequences. This mostly relates to people who tried to frighten the people around (to reach other goals) rather than the suicide attempt. After suicide attempt you will have the ‘label’ for the entire life. You will never have the same attitude from other people, the attitude as for 100% normal (mentally sane) person. Upon admission to the hospital, patient’s life history will contain the information on suicide. The attitude towards such patients by medical staff will be, to say the least, very specific.
But even without knowing about the suicide attempt, people around will avoid you subconsciously (and most of people consciously) after they see scars of the forearms (after veins cut); you should be prepared for this while communicating. In addition it will create problems for the recruitment process and further marriage.
Peter Rozumni, expert in forensic medicine
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