One of my patients came with history of falling from height 3 days ago. He told me that he worked as a laborer in a constructing site, and he fell from the third floor during working. His friends were there also and they said nothing. From physical examination and x-ray, he had fractures at his forearm and heel. We setted OR schedule to do internal fixation of the forearm today.  

This morning during I was doing morning round on the ward, I heard someone screamed. Shortly after that, a nurse came and told me that the patient jumped out from the terrace (the ward is on the fourth floor). She tried to grabbed his leg but she could just reach the pants which were torn in a few seconds. We hurried to the ground floor where he lied unconsciously with some amount of bleeding from his head. After stabilized his spines (neck and back), we sent him to the ER immediately. From the primary survey, he couldn’t breathe by himself so we inserted endotrachial tube to help him breathe. His vital signs was stable after that so we sent him for CT scan which showed comminuted fractures of the skull and massive bleeding in the brain. After consulting the Neurosurgery staff, I had to came back to work on the ward like usual.  

The patient died at 10.30 am from brain death.   

One thought keeps bothering me … who to blame …

- Nurses for being careless? Isn’t it their responsibility to take good care of the patient?

- The hospital director for not planning some policies to minimize suicidal risk like placing steels at the terrace so nobody can jump out?

- The patient for having so low EQ that he chose the way out from whatever problems he had by committing suicide?

- His friends and family? They should have been close to him the most and told us if he had depression and chance for committing suicide.

- Or it was me … 

He told me it was the accident during working that made him fall from height. His friends said nothing. It all sounded logical for me … just another occupational-related accident which happen almost everyday in this area. I didn’t even think there might be any other reason that could make him fall … I didn’t even think it could be a suicidal attempt …  

If only I had a clue that he had suicidal risk, I would have warned the nurses to keep their eyes on him all the time. If only I got the right history … if only he told me … if only his friends said something … if only I took a few minutes to think about other causes besides occupational accident …

May you rest in peace. Your doctor is begging for forgiveness …  

ahhh.... cheers up... its hard but try... dont blame yourself too much..

Well, the story sounded plausible. From your description, it was obvious that you did not have knowledge of his suicide risk hence not put him under constant watch.

I would not blame the nurses. There is only that much of them compared to number of patients.

Nor the hospital owners.

Most important is to figure out in the orignal moment that what caused the "accident" or whatever and act properly ie. the suicide risk watch thing.

Sure, ok, the hospital windows could be made so that they do not make it possible to jump from. And all unnecessary doors to outside locked. But thats about it. Yea, the windows should not be made so that it is possible to open and jump from /or fall from by accident either...

But, tragic story indeed.

Blame Thai politician now... :)

RIP... sad jung.

neither you nor the hospital is to blame for his suicide. As a doc you can ct his head but you cannot look into his thoughts. To find out about the reasons that led to his suicide you need to examine and ask his family, colleagues and friends..

I don't why i was crying while i read your journal.. This is so sad but please don't blame yourself. We sometime could not help anyone else... Dn't know what to say more... Just feel sad inside. Once i used to see one lady suicide from 22 fl.at my bf old place.. That was shocked me too.

It's not your fault. You've done your best saving people's lives in your area of profession, and that doesn't include mental health. Nobody could have predicted it, and it's not within your control. It's a tragedy, but you have to be fair to yourself.

Don't be sad you have already done your best....bless you !

You assessed the situtation with all the facts you had

His work mates didnt give you any indication

His family and friends, You can only act on the facts you have at your disposal

You did all you could So did his nurse

The blame if any should be all his. He lied to you. He put himself in your care

then jumped out the window. How were you to know he needed to be protected from himself.

Your patient lied to you and apparently his friends conspired to help him with that lie. When someone commits suicide it's hard to blame anyone else for it. Having felt suicidal, I find it hard even to blame the person who killed himself.

It must be hell to lose a patient and go through all the second thoughts and self doubts that follow, but from the facts you presented, you certainly have nothing to feel guilty about. Try to be detached but still care. You have chosen a very difficult profession.

If anyone is to blame, it might be the friends and family who came with him, but I'm sure they wanted to help him save face and not be too embarassed by his suicide attempt. He probably assured them he was okay and wouldn't try again, and maybe he believed that himself. For that matter, if no one saw his first fall, they may not have known it was a suicide attempt and assumed his story was true.