A 23 year old woman was transported by EMS to the ER. According to her, her neighbors found her somnolent and difficult to arouse. After awakening her, they asked her why she was so sleepy and she replied that she had taken some pills. I think they did the right thing by calling EMS, as this woman had some psychiatric history. She reported that she had taken pills about a year earlier and that was a suicide attempt. Her mother strongly felt that this was a suicide attempt, although she couldn't tell us why. There was no note or comments by the patient.
However, as with Maria's patient, she denied suicidal intent or ideations. She stated that she was "stressed out" and that she just wanted to get some sleep. She reported that she took a 10mg Hydrocodone (she didn't say Hydro) and 5 Vicoprofens. This was fairly consistent with the meds remaining in her prescription bottles.
There were plenty of pills left in her bottles that she could have taken if genuinely suicidal.
She had a low potassium, don't ask me why, and needed to be admitted. All other labs, including acetominophen levels, were normal. In our hospital, most suicide precaution patients go to the ICU because the nurses don't feel they can watch them closely on the floor. So, if she had been admitted without suicide precautions, she could have gone to the floor.
What do you think? Do you believe her story? Or the story of Maria's patient? In our community, if this patient's potassium had been normal, I would have consulted Crisis Response and they would have come to see her. When they see a patient with this type of story, specifically denying suicidality, they will usually send them home with a no harm contract and scheduled follow-up.
Of course, if you wanted to commit suicide, and knew that if you admitted it you would be locked away where you couldn't kill yourself, wouldn't you lie and sign the no harm contract?