S is for Suicide: A Paramedic's Perspective

It was a typical evening downtown for my partner and me. Running a paramedic unit in an urban area is an exhausting job, and this night was no exception. The normally high call volume was even further burdened by an incessant downpour, broken only by spontaneous lightening flashes and deafening claps of thunder. Hollywood couldn’t have produced a more appropriate setting for the call we received shortly after midnight. We were dispatched to “one unresponsive” on the outskirts of town. Unfortunately, all units were busy that night and even though we were a good distance away, we were the only unit available and had to take the call. We were wet and tired, and the extended response time put us on edge, so we weren’t in the best of moods as we turned into the gravel driveway leading to the darkened address.

Set far off the road in a grove of trees, the monstrous old mansion stood three stories high. Adorned with gables, eaves and a rounded tower jutting off the northern wall; it presented an eerie picture as we approached. The house looked abandoned. There were no street lights this far out, and the interior was totally dark. In fact, there were no lights on anywhere, and I figured the storm must have knocked out the power. As I climbed out of the ambulance, I noticed that I stood in a parking lot. I then saw a sign at the bottom of the front porch steps. My initial assessment of the house had been colored by the gothic atmosphere. It wasn’t the sinister home of some eccentric old spinster. Instead, the Victorian structure had been renovated and sectioned, and was now home to several small businesses.

First responders and police were already on the scene. I approached the fire captain and asked what he knew. He told me a man had come to check on his father, an architect, who had not been heard from since the day before. His office was housed in the building, but when the son arrived, the place was locked up tight. Not having access to a key, he climbed the porch railing, followed the broken roof line, and looked in his father’s office window. He thought he saw a pair of feet sticking out from behind a partition, so he called 911.

I asked the captain if he had gained access, but he informed me that the place was a fortress. It would take a battering ram to enter through the front door, so his men were trying to gain access through the man’s office window. “So, where is the office?” I asked. The captain turned toward the northern wall of the house, and that’s when I saw the two fire-fighters perched on the narrow ledge outside the tower window. It was clear we were going to have to access the most treacherous part of the building. I asked my partner to get the cot and equipment ready and wait at the front door. I took a jump kit and headed for the ladder that the fire department had set up. At least I didn’t have to climb the porch railing.


I tightened my rain gear and started the climb. I don’t usually suffer from a fear of heights, but as I picked my way across the rain slick roof, I felt the unmistakable paralysis of acrophobia trying to needle its way into my brain. I somehow kept it at bay and when I reached the tower, the fire fighters had pried the window open about twelve inches, and were standing there looking at me. It was clear that this was as good as it was going to get. I looked at the two Charles Atlas types and quietly handed one of them my jump kit. Dimensions and logistics had silently voted me most likely to fit through the window. As I squeezed through the foot high opening, I suddenly had a strong urge to backtrack down the roof and return to the safety of my ambulance, but I didn’t.

Once inside, the men handed me my kit and a flashlight that had seen better days. I trained the light on my surroundings and it took me a minute to get my bearings. The high ceiling room was a jumble of drafting tables, easels and partitions haphazardly placed in a makeshift attempt to create separate work areas. I concentrated on the partitions since one of them reportedly sported a pair of “feet”. After what seemed like an eternity of following the weak beam of light as it attempted to slice through the darkness, the beacon passed over a pair of Nikes, toes up, protruding from the corner of a cubicle.

I turned to the fire fighters for support, and all that I could see were two hulking silhouettes in the window, occasionally being framed by flashes of lightening. I took a deep breath and turned toward the running shoes. After all, I am a professional…this man needs my help. I sensed the futility of calling to the man, but I tried anyway. Silence. As I made my way across the room, I was thinking of the possible directions this scenario could take, but I was totally unprepared for what was hidden behind the carpeted particle board.

He wasn’t exactly old. Well maybe, it was hard to tell. He had that trim, well preserved look from the neck down. Designer jeans, new athletic shoes, he was definitely a man who kept up with the times. The flashlight beam traveled the length of the man’s body. When it finally illuminated his head, I stumbled back, almost knocking the partition over.

His face was barely visible through the plastic bag. His lips were retracted, leaving his mouth in a gaping, half-grin. The eyes were open, staring through a milky film. His entire face was engorged, swollen, filled with blood. Blood that was frozen by the tourniquet effect of the wide rubber band that was buried in the man’s neck, holding the bag in place. The rubber band that created the vacuum that caused the man to die.

When you are a paramedic, you think you are immune to the horror of death, then when you least expect it, all the elements come together and your entire death repertoire seems to culminate in one call. Not the specifics. Pictures of blood and gore didn’t flash through my mind. Instead, I found myself longing for a time when I thought of death in abstract terms. That romantically frightening journey that we all are destined to take at the end of long and happy lives. Blessed ignorance was gone forever, and I was overwhelmed with the inevitability of my own death and the death of those closest to me.

I shouted to the waiting firemen that we had a 10-67, “one dead one the scene”. The silhouettes left the frame of the window and I was totally alone with the victim. I was suddenly frightened. Though the man had obviously been dead for quite some time, I hastily scanned the room to insure that I was truly alone. My light revealed several drafting tables in various stages of disarray…except one. The table nearest the dead man was completely clear, save one small piece of paper. I looked. It contained only three short lines…

the pain
the pain
I can’t take any more pain

The man had taken a plastic bag, placed it over his head, and secured it with the rubber band. With his succinct note in place, he had lain on the floor and allowed his lungs to slowly be deprived of oxygen until his body could no longer function, and he died.
At that moment the door opened and a bevy of people entered the room. The man’s wife had arrived with a spare key and the police had come upstairs to investigate. I addressed the sergeant in command, pronounced the man dead, and returned to my ambulance.

I never heard what had happened to him. Such is the nature of my job. I shared with him the few private moments between his desperate and lonely act, and the shift in the universe that undoubtedly happened as the reality of his decision hit the ones who loved him. I left just as that universe was unfolding and went on to the next call and went on with my life, but I have thought about him often since that night. The note he left raised more questions than it answered. Was the man ill, his pain so great that he chose death over tolerance? Or, was his pain in his heart? Had he suffered a loss too great to bear? Perhaps he just didn’t want to live with himself any longer. This possibility disturbs me most of all and causes me to reflect on the many times I have indulged in self-loathing.

I know that his life was not in vain. Though our encounter was brief and long after he had drawn his last breath, I learned a lot from this man. This happened over twenty years ago and I carry those lessons to this day. Of course there is the obvious. There is nothing romantic about death, especially death by one’s own hand. But more importantly, I learned that no one has the right to place value judgments on another person’s feelings. To claim the ability to measure the depth of someone else’s pain is the ultimate form of arrogance. Please God, don’t ever let me be that arrogant.