Last night was my last night on call in the Surgical Intensive Care Unit. At around 11 pm we recieved a page that there was a critical trauma patient arriving in the ER. The resident I was working with told me to go down and see what was up in case the patient was sent to our unit. I arrived in the trauma bay and was immediately shocked by what I saw: the 18-yr old boy laying on the gurney was missing almost his entire face. Apparently, he had attempted to commit suicide by placing a 12 gauge shotgun under his chin and pulling the trigger. He succeeded in blowing off most of his face include his upper and lower jaw bones, his nose, his eyes, most of his forehead, and part of the bone separating his face from his brain. As I took a closer look, I saw that he had a huge hole where his face should have been. Doctors from Trauma Surgery, ENT, and Neurosurgery all met with the patient's family and explained to them the gravity of the situation. Although he required a ventilator and a tracheotomy to maintain his airway, he was otherwise stable. However, he had no hope whatsoever of having any kind of a functional face, and more than likely his brain damage would be severe. The family told us that they did not want to keep him on support, that they knew how depressed he had been and wanted his suffering to end. As we sorted out the details, we brought him to the ICU and the family came in to say their goodbyes. I am left with an image of one of his teenage brothers, a tall blonde kid, who I saw on his hands and knees at the foot of the patient's bed wailing. As the mom left the room this morning after the patient died, she turned to one of the nurses and said, "I hope you never have to go through what we have just been through."

I can't understand what would make someone so unhappy that they would take their own life, nor can I comprehend the grief that this family must currently be dealing with. I am sure the events of last night will stay with me forever.