“Do you know what you do when you get this nervous? Go fishing.” The “advice” was not given by a clueless relative, but rather by a doctor in the emergency area of a public hospital in the east of São Paulo. Seamstress Suzane Barbosa, 32, had to hear this after having attempted suicide by ingestion of medication in 2019.
“When I entered the hospital room, I immediately heard the nurse: ‘right now that my shift was over!’ She barely looked me in the face, asked what I had taken and said she was going to wash my stomach. I was scared and I said I didn’t want to. Then she asked: ‘Did you really take something or are you just doing it to get attention?'”.
During the procedure, Barbosa stayed in the room for two hours, very cold and alone, she even heard the nurse saying again that she just wanted to draw attention. “I couldn’t stand it, I pulled the probe and took the needle out of my arm. It squirted a lot of blood and my mother had to put on a coat to stop it.” Barbosa was taken to a stretcher in the hallway and only left the hospital after passing by the doctor who ordered to go fishing.
In Curitiba, Vanessa*, 24, went through a similar situation. After taking medicine, he ended up in the hospital and “hell began”. “Two nurses asked my mother to leave because, according to them, ‘it was going to get ugly’ and started the washing procedure. They forced the probe into my nose while mocking: ‘look, I just found out that you have a deviated septum’; ‘that’s shit, it can take it now’ and they pushed the probe more and more. I saw the blood flowing and the look of contempt of those women. Finally, I heard, between screams, that the probe needed to be swallowed ‘just like to the pills I took”’.
Vanessa was smeared with blood, feeling the taste of plastic in her mouth and a new trauma. “I felt humiliated and violated by professionals who, for some reason, wanted to make me suffer”. When she was discharged, one of them even said “I’m glad you’re fine. Due to the amount of medication you took, you won’t have a headache or an infection anytime soon.”
The report heard 10 reports of patients who attempted suicide and were ill-treated in emergency hospital care. On social networks and in conversations with professionals in the field, it is also not difficult to come across testimonials like these. The psychologist Janaína Catolino claims that this is a recurrent situation. “I saw a patient who, during the discharge procedure, a nurse said that, next time, she could look for her, as she would find a medicine that would be a ‘shoot and fall’ to kill herself”.
Why does a healthcare professional act this way?
One article Rosana Machin, professor at the Department of Preventive Medicine at USP (University of São Paulo), discusses the influence of the “disease intelligibility model” — present in the training of health professionals — which, based on the idea of the body as a privileged place of care, and illness as an event of an accidental character, prepares to save lives. Thus, situations of self-inflicted injuries — which include abortion and alcoholism, for example — are considered events charged with intentionality, resulting from a choice, which does not generate the identification of their authors as patients or victims.
According to Machin, there is a judgment and a difficulty in understanding the reasons why a person does not want to live. “They are there to help a person who has suffered an accident or a type of violence. In this way, those who cause a self-inflicted injury are seen as someone who is creating a problem. This distinction is still very present in the formation of the health area and blurs the emergency care,” he says.
Student Caroline Assis, 24, from São Paulo, is an example of how this judgment is present. She went to the hospital with a stomachache, but when she took an IV, when they noticed the cuts on her arm from previous suicide attempts, they made unpleasant comments such as: “since you like being pierced and cuts so much, I’ll apply it several times to satisfy you” and “this is lack of God”. “I went in feeling sick for a common reason and came out worse. They applied the medication wrongly and when I said it was hurting, they laughed: ‘but you like to feel pain, don’t you?'” he says.
Physician Isabela Pina, a psychiatrist at the HC-UFPE (Federal University of Pernambuco), believes that there is a certain gap in the undergraduate curricula. She cites as an example that, just last year, the mandatory rotation in mental health was added to the medical course at UFPE. “This attention to learning and experience with patients in a state of mental illness is recent, which explains, in part, this inadequate way of dealing with suicide attempts”.
Alexandrina Meleiro, vice president of ABEPS (Brazilian Association for the Study and Prevention of Suicide), highlights that emergency room professionals, in general, are overloaded and burnout by the precarious structure, even in private hospitals. “It’s like there’s a censorship, ‘we’re here trying to save lives and you’re trying against yours.’ In addition, there is a lack of knowledge that suicide is a medical emergency for a psychiatric condition. There is a taboo with death self-inflicted as if the person had to always be well to face any situation”, he comments.
How to approach patients
Hcor, for example, created a Assessment and Care Protocol for Suicide. “We trained the team as a whole. The PS doctors brought us a very great difficulty in knowing how to approach these patients. The professional cannot judge. We have to be impartial”, says Cury.
She highlights the importance of the presence of a psychologist or psychiatrist in emergency care to bridge the gap between the patient and the team. However, this is not always possible. “The important thing is to enable professionals to understand why the person tries to commit suicide. Her suffering is so great that it becomes unbearable. So, in her mind, it is easier to die than to seek help”.
For Pina, it all starts with training, with training in communication and empathy skills. Machin corroborates this. According to her, when the health professional is in care, moral values will not disappear, but they need to be suspended in that context, as there are other priorities, such as saving the patient.
Barbosa left the hospital traumatized, the poor treatment, according to her, “made her want to die even more”. Some patients run away before they are even discharged, like Tyler Silva, 27. The telemarketer says he heard the nurse saying: “yes seeing? Did it work? Now you have to go through this”, while he was shoving the probe in with everything.
“Every time someone would come and look at me with contempt or make some comment like: ‘so many people fighting for live and others doing it, taking places from those who need it’. Another said that if I did it again, they wouldn’t see me anymore.” After staying three hours isolated, he fled.
According to Silvia Cury, mental health manager at HCor, in recent years, it has become increasingly common for patients to attempt suicide inside hospitals. “When a person realizes that he couldn’t kill himself, he feels that he failed and was still mistreated for it. So, he can become more frustrated, bringing a greater inner need to die,” she says.
While the necessary changes are not implemented in all hospitals, patients continue to be affected. After hearing that “if I wanted to die, it was better to do it right” and that “I should stay in bed to learn to value life”, Isabela*, 21, felt much worse and just wanted to have “done it right” not to be too much trouble. Meleiro emphasizes that it is important to approach without sermons. “Only the person knows the pain, suffering and anguish they are feeling. Any word can make the situation worse. It is necessary to listen with compassion and do our best to help,” he says.
If you are thinking about committing suicide, seek specialized help such as CVV and the CAPS (Psychosocial Care Centers) in your city. CVV works 24 hours a day (including holidays) by phone 188, and also answers via email, chat and in person. There are more than 120 service stations throughout Brazil.
*Fictitious names to preserve character identity