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Two Attempts, Two Ways

Author: Abdul Hafeez Asyraf Bin Abdul Mohsin Rejaludin

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Abstract

Abdul Hafeez Asyraf Abdul Mohsin Rejaludin¹, Nor Shahida Abd Mutalib¹, Nurul Syeha Abdull Rasid¹, Sakina Saad¹

The COVID-19 pandemic is a global challenge, in terms of physical consequences and also mental health catastrophe. Segregation during quarantine period may serve as a strong motivation for a person to inflict such self destructing act. We are presenting a case report of a young man with two attempts of suicide in two different methods. The highlights of this case are the importance of family support and to encourage people to help each other in difficulties regardless of race and religion. A 38 year-old gentleman ex-IVDU, known case of HIV and Hepatitis C was referred to orthorhinolaryngology (ORL) team following open tracheal injury secondary to suicidal attempt in August 2021. Airway was successfully secured with an endotracheal tube placed through the exposed airway at the emergency department. Imaging studies showed extensive tracheal injury, segmented fracture of lower half of cricoid cartilage and crashed fracture of multiple upper tracheal rings with intact trachealis muscle. Isthmus of thyroid gland and infrahyoid muscles were also cut. Miraculously, there was no vascular and esophageal injury. Neck exploration, reconstruction of tracheal and tracheostomy was performed immediately under general anesthesia.

It was learned that this was his second suicidal attempt. His first attempt, just one month prior, was driven by low mood, loneliness and feeling helpless during quarantine period due to close contact with a positive COVID-19 person. He cut both wrist using a sharp knife and sustained tendon injury required repair under general anesthesia. He was then diagnosed with Major Depressive Disorder. Unfortunately, he contracted COVID-19 infection (CAT 2) during the admission. He had no suicidal ideation during hospitalisation, and subsequently was discharged well. Sadly a few weeks later, he was found at his neighbourhood lying unconsciously with bleeding from the open neck wound.

Once suicidal attempt was made, the second one is more easily triggered and the act will be more severe as stated by Beck’s Theory. As for this case, the second attempt is causing very severe injury nearly cost his life. Patient’s mental health and wellbeing were relentlessly affected as such in that he refused to talk about the real event.

Keywords : laryngeal injury, suicide, COVID-19

¹Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Sultan Abdul Halim, 08000 Sungai Petani, Kedah, Malaysia. 

 

Correspondence to : Abdul Hafeez Asyraf Abdul Mohsin Rejaludin, Medical Officer, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Sultan Abdul Halim, 08000 Sungai Petani, Kedah, Malaysia, [email protected]


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