Self-harm from the doctor’s point of view

Edit added at the bottom.

First of all, this is going to be detailed, and if it might upset you, please do not read.

I’m going to leave the details of the story pretty generic to be sure to protect patient identity, though it was a pretty typical self-harm story, I guess, the kind that is seen in emergency rooms ’round the world every shift.

As I said in the last post, the subject of scars has been going around the internet, how people feel about them, having them for the rest of their lives, after they have stopped. So that was very much on my mind when she walked in – that I wanted to leave her the minimal scars possible, so that when she gets older and better, she won’t be disfigured.

I have no idea what her actual psych problem was. She was quiet and pleasant, hardly spoke, probably some depressive affect in there. She was brought in by her mother, technically being a minor. She looked much younger than her age. She had, by the record, been in a few weeks before for the same thing.

My only hint as to what I would find was the fact that her arm was heavily bandaged from the hand all the way up to almost the shoulder. I think (though I’m not basing this on anything) that more common is maybe 5-10 cuts on a forearm.

I took her into the stitching room and set her on the table, ready to unpeel the million layers some nurse somewhere had wrapped on. I asked her her name. She made one request before I started, was very childlike in speech and mien: “I don’t want my mom to see it.” The mother was there, knew full well what had happened. I thought it was actually a sign of maturity, wanting to deal with her problem herself, to not upset her mother. I was fine with that, I mean, if she’s old enough to request, and to be in this kind of trouble, then she’s old enough to deserve some privacy. But then some ER manage walked through and heard and flipped out that she is a minor, the mother has to be in there. I got kind of pissed off at that. My patient, my call. I now wonder if I was mad for the sake of her autonomy, or for having my authority undermined.

So I sat the mother down in the room and closed the curtain around the table, leaving the mother “in the room” but not visible. I started to unwrap. The nurse who had dressed it somewhere had slathered TONS of iodine all over everything.

It was a tremendous mess of dried blood, fresh blood, and the fucking iodine. (Which is not shown to prevent infection any more than washing with saline.) It was impossible to work. We had to wash it all off. She didn’t want to come over to the sink, so I let her lie with her hand and arm hanging off the bed and started to wash with bags of saline. Plenty of the wounds were full of clots and dried blood, some were actively bleeding, and the iodine was everywhere.

And as I unwrapped and cleaned, I realized the extent of what I was seeing.

From what I had read on blogs and their accounts of the emergency room, I assumed that self harm was usually around 1-10 cuts in various shapes or lines, usually on the arms.

This girl had perhaps fifty or sixty slashes to the subdermis, about 5-7 cm long, in parallel, parallel to the wrist and elbow creases, on both the wrist and back side of her arm. She went past the elbow, halfway to the shoulder, and some of the cuts higher up had actually had skin removed. They weren’t just slices, but rather ellipses – but not the lines of ellipses, ellipses with the skin inside removed. I couldn’t imagine actually sitting there and doing that. Plastic surgery creeped the hell out of me, the lifting of skin from its bed. She must have done that alone somewhere.

Washing up took at least half an hour, digging out the mess in each wound. I told her to tell me if it hurt, or if there was a spot where she’d rather clean herself. She did but ultimately was too tired or depressed to do much of it. By the end, my feet were soaked in fluids and blood. I hoped she didn’t have any blood-borne disease.

Then just finding enough Dermabond was a nightmare. That shit is expensive, so I had to raid the whole place to find some – each cabinet had one or two vials only. This also took a long time.

Just for public record, since I guess many people might not know this, stitching or closing a superficial wound is not to stop bleeding or prevent infection (closing actually increases the chances of infection). The idea is to bring the edges of the wound as close as possible for the smallest possible scar. It is a cosmetic technique only.

Putting it back together was another story. There wasn’t enough skin between the cuts to really stitch anything, there was no room to land a stitch that wouldn’t tear. She was sliced to ribbons. The The hand ortho guy decided to try to glue them. Some of the defects were clearly not fillable and would have to be left open, invariably leading to horrible scars. I kept thinking about when she was older. In just one cutting episode, she’d probably achieved arms that some people achieve in a decade.

I also wondered: it seems like most forearm cutters make slices in that direction, in a “slitting the wrists” way. Unfortunately, to me (not sure on this, but it seems like) that seems like the way that goes exactly against Langer’s lines, probably the worst way to scar, because every time you flex or extend your arm, that skin is getting pulled. It probably is better to do with the line.

We started gluing, but discovered the same problem. You couldn’t glue one closed without pulling the one next to it. There just wasn’t enough to anchor anything to. And to glue, everything has to be dry. Blood from upper wounds kept dripping down into the field. It was just not possible.

The plastic surgeon was called; maybe there was a special trick here that we didn’t know. No, she said. Leave it alone, bandage it up. There’s nothing to do here.

So we wrapped the girl up and sent her on her way. I made sure to tell her goodbye, using her name. Throughout the whole thing, I kept thinking of people’s stories that I have read, about the various versions of both good and asshole ER docs who have stitched them up, and I didn’t want to be this girl’s terrible story. She didn’t seem too chatty, so I didn’t push, just asked her often if something hurt, didn’t make a big deal of it. Tried to treat her like a person. Offered to try to set things up so her shirt wouldn’t get wet or ruined.

I wanted to tell her this, but I didn’t think her mother would be too happy, so I didn’t. I don’t feel bad about putting this out there, because it is a basic harm reduction principle, which I believe in.

Instead, I’ll tell all of you now: I know that it is a hard thing to stop. I know that nothing I can say will stop you, and that sometimes, that is the safest kind of relief available. I get that while you are doing it, you are kind of in a trance, and probably not thinking too clearly. But you will have to live with the scars one day when you are better. Try to space them so that they can be aesthetically closed. Try not to cut in areas where the skin, during natural movement, is pulled – this will widen your scar, instead, go with the grain of the skin, in a place where it isn’t pulled tightly. Try to stay as superficial as possible, the less deep you go, the better it will look.

We might consider some of our scars, both physical and emotional, badges of pride. But these are different, because they are so public. Someday, you will feel better, and you won’t want to be reminded of such a bad time every single day.

* * *

Edit: a point I wanted to make originally, and somehow forgot. I wanted to explain how I felt toward her, what she evoked in me.

I didn’t feel pity or sorry for her. I didn’t feel annoyed at her like a lot of medical personnel do at self-inflicted problems (and this means all kinds of lifestyle problems, not just psych). I didn’t overly “feel her pain.” I felt, at the time, that it may as well have happened by falling through a glass door or something.

This might come off as cold, but I was glad. I think this is actually a sign of medical maturity, I didn’t have any superfluous judgments (good or bad) about who she is/was, what she did, etc. She needed medical attention, period. Also, my own life and pain didn’t carry over in any way to how I felt toward her, positive or negative. She was just another case. And that was good.

As to a more thorough psych evaluation at the time, I’m sure I could have pulled more out of her if I had tried, but what would be the point? Obviously, plenty of people with lots more experience than I have are involved with her and not succeeding. Everything about her said she didn’t want to talk. She wasn’t silent in a “just-ask-already” way. There were no signals that she wanted to talk, she didn’t make eye contact, nor actively avoid it in an obvious question-seeking way. She was just silent, alone in her thoughts. Right to privacy is important. This gets lost in psychiatry a lot – especially after suicide attempts. Every doctor that comes through thinks that he or she has the right to ask, “Why did you do it?” They don’t. She doesn’t have to be “grilled” by me just because I happen to be treating her arm.

If I could have gotten the mother out, I might have tried to talk more openly. But I knew nothing about either of them, nor of the relationship between them, other than that the mother seemed kind of abrasive and gave me the impression of looking for someone to blame or sue, so I didn’t want a complaint later about how I told her daughter it was ok to cut. There wasn’t enough context, though, for me to be sure. Maybe it just sucked to be in the ER at that hour and she was tired. Neither spoke much. I only asked about what she used, to think of things like infection and tetanus.

Talking more during the hour I spent on the wounds wouldn’t have been helpful. It would have been for my curiosity or to satisfy my need to “help.” As much as we want to “help her,” she doesn’t have to justify or explain her injury any more than someone with pneumonia does. And I’m glad I didn’t feel an overwhelming need to ask or try to “empathize” or anything else, for any reason. I treated her with respect, like any other patient, and I am proud of myself for that.



  1. Before I respond to your interaction with the patient, I’d like to ask a favor:

    Please don’t assume and refer to nurses as anonymous entities – neither human nor professional. If, in this case, you know that the poor initial wound care was performed by a registered nurse, you should preferably speak directly with him or her to discuss where the problem were and collaborate on how to correct them in future. Many institutions use protocols for wound management, and the “iodine” you reference, may not have been used by choice. There may be other system problems which come to light that are at the root of the problem. Perhaps, for example, the wound care was performed by an unsupervised nursing assistant or patient technician, or by a student in a clinical rotation. It’s too easy to “blame” the generic, ever-present nurse as stock actor villain.

    Plus, you discovered suboptimal care, and this should be addressed in some fashion. Perhaps generating an occurrence report so that the specific incident and the institutional policy, standard and practice are examined and improved.

    Thanks for considering my digression.

    Now to the interaction:


    Besides the therapeutic communication techniques you used as well as the protection of her dignity, how was she cared for from a psychiatric point of view? Were the aftercare instructions inclusive of her mental illness needs and management? How did her mother relate throughout all of this?

    Was your patient able/willing to communicate beyond simple binary answers? Was she living at home with her mother and other family members? What social roles did she have – daughter, yes, but worker, student, etc.?

    To be honest, I don’t think it would have been inappropriate to frankly discuss management and self care around future cutting behaviors. They are risk behaviors, and so a rough (very rough,m I admit) analogy might be to think of the teaching needs around sex: protection against communicable diseases, wound care, safety contracting, etc.

    This isn’t my field, so I don’t want to jump off the cliff and speculate any farther. But it would be interesting to read the psychiatric nursing standards of care and practice around patients who self-harm.

    Excellent case presentation. Excellent care by you. Kudos.

  2. I really valued being able to read that and I hope that I’ll come back to it next time I think of doing myself significant damage.

  3. How heartbreaking for both of you. I cannot imagine how difficult it must have been to want to help so much, yet realize there wasn’t anything you could have done to help. I am sure your caring manner hyelped her.

  4. I wonder why she didn’t want her Mom to see it. hmn. I wish self harmers who cut had more support.It must feel like you are the only one in the world who does this. Seems no one ever wants to discuss it either, glad you have.

  5. chowchow – it was really pretty gruesome. I got the feeling she didn’t want to put her mother through that. I think that was fine. It wasn’t like she didn’t know what had happened. Why make her see how bad it was?

    I asked who had dressed it, and she said, “The nurse.” I don’t know anything else about her, not if it was a nurse at some facility, or where she lives, or what. It was not a nurse in the ER. I think you are missing what emergency medicine is really like. It is dealing with emergent problems. I have no idea if the psychiatrist saw her. I assume she was already in intensive treatment by her med list, and obviously had access to “a nurse” in the middle of the night to fix it.

    As to a more thorough evaluation – what would be the point? Obviously, plenty of people with lots more experience than I have are involved and not succeeding. Everything about her said she didn’t want to talk. Right to privacy is also important. She doesn’t have to be “grilled” by me just because I happen to be treating her arm.

    I think that was something I wanted to say in the post – what she evoked in me. I didn’t feel pity or sorry for her. I didn’t feel annoyed at her like a lot of people do at self-inflicted problems (and this means all kinds of lifestyle problems, not just psych). I felt, at the time, that it may as well have happened by falling through a glass door or something. I think this is actually a sign of medical maturity, I didn’t have any superfluous judgments (good or bad) about who she is/was, what she did, etc. She needed medical attention, period.

    If I could have gotten the mother out, I would have talked more openly. But I knew nothing about either of them, nor of the relationship between them, other than that the mother seemed kind of abrasive and gave me the impression of looking for someone to blame or sue, so I didn’t want a complaint later about how I told her daughter it was ok to cut. There wasn’t enough context, though, for me to be sure. Maybe it just sucked to be in the ER at that hour. Neither spoke much.

    But at that point, talking more during the hour I spent on the wounds wouldn’t have been helpful. It would have been for my curiosity or to satisfy my need to “help.” As much as we want to “help her,” she doesn’t have to justify or explain her injury any more than someone with pneumonia does.

    I think I might move that thought up to the main post. It was something I wanted to convey and sort of missed.

  6. Uh oh – I guess I better self disclose some: I am a nurse with critical care, level I trauma ctr ED. clinical, academic and adminsitrative experience. I have undergraduate degrees in psychology and nursing and masters and doctoral* degrees in nursing administration (ABD at the doctoral level). I didn’t mean to infer any lack of clinical assessment, treatment or care on your part, and I apologize if I wasn’t clear or if I indeed did do that.

    You presented an interesting case, my usual performance improvement, systems analysis antennae went up, and that’s the frame of reference I was using.

    I’m not clear where you are in your own education and clinical experience. You write about cases with so much insight, sensitivity and therapeutic mien, that I may be overestimating your expertise – or you may be undervaluing it *grin*.

    Experts tend to become skilled at continually assessing and interacting using “more circuits” as it were – more comprehensively, while not necessarily more conscious of doing so. Many of the assessment parameters become automatic and integrated into normal function and so become sublimated to the interaction.

    You seem (from what I rightly or wrongly infer) to be able to meet patients where they are in their emotional, cognitive and judgment spheres, and that’s a rare skill. I hope you continue to model it for other staff, regardless of what patient population and clinical specialty you eventually settle in.

    As to a more thorough evaluation – what would be the point? Obviously, plenty of people with lots more experience than I have are involved and not succeeding.

    How that was obvious? In my own experience, errors and gaps in care happened when that assumption was made, and so I wonder how you and fellow staffers know in that venue, who and what services are active on the case. I realize that ED care is compartmentalized, but please don’t revert to treating “a wound” or “an arm” or “the cutter” etc. just because it’s the sad norm to depersonalize and orient to task. That’s a symptom of system failure and patient case load burden – it’s nothing to accept simply because it’s the status quo.

    Quite possibly, your interaction with her will have lasting meaning and impact.

    Have you been exposed to the research about patient trauma and intentional self-harm/suicidal ideation? There is quite a bit of research which looks at the relationships between risky behavior (driving while under the influence of substances, speeding, driving without restraints, in the beds of pickup trucks, riding motorcycles helmetless, taking the safety mechanisms of PTOs on farm equipment, etc) and self-harm/suicidal intent and behaviors in the ED. In critical care units, more than half of patients had illnesses and injuries that were a result at least partially of behavior which was incompatible with health and well-being.

    It seems to me to be more a matter of degree than of crazies versus the rest of the ED patient population. πŸ˜‰

    But that’s just me – “a nurse”.

  7. Hey

    Discussing harm reduction is a judgment call. In theory it means that the cutting is safer, but it can also inform the patient how to do more damage without hitting something serious say.

    Closing wounds though primarily cosmetic does have some added benefits in that scars can be tight and hurt to move so the smaller the better really.

    Regarding talking to her. The three/ four questions I would ask are, is she seeing someone? when did she last/when will she next see them? does she want to talk to someone now?

    As for whether she will regret it? Almost certainly but she will probably have known that going in.

  8. This is an amazing piece. Your compassion and empathy and ability to assess this situation on every level – medical, social, esthetic, psychiatric – leaves me stunned.

    While you weren’t able to speak the words you wished to say, I am quite sure that your presence was healing for her, at least for those moments in which you were joined. That was a laying on of hands.

  9. In critical care units, more than half of patients had illnesses and injuries that were a result at least partially of behavior which was incompatible with health and well-being.

    That’s not surprising, nice to hear it as a statistic…does that include smoking related stuff and weight and so on?

    It is obvious that the ED, and even hospitalization to some degree, is highly dependent on behavior and socioeconomic factors. Diseases that just don’t need to end up in the ED if the patient has normal health care…do. Hospitalization is often for outpatient-treatable illness in patients who don’t take care of themselves.

    It was obvious that she was in treatment by her medication list – although it seemed to me excessive for a kid…one of those “throw everything at it” type lists, antidepressant, antipsychotics (old AND new), some benzo or other…

    I thought you had a public health background (for about 10 years now I’ve been waiting for the time for it to be right to do an MPH, never is). I think it was the thing you said about sentinel problem and root cause.

    I also wondered at the time if it really was a “nurse” who did that. It’s a small community, I wondered if it wasn’t really some neighbor with some kind of clinic training or something, an ambulance volunteer, or something like that. Or maybe a psych nurse – here they are usually not very well trained in anything.

    Harm reduction – in her case, I don’t think it would be possible to do more damage than she did or cut more than she did. If it was going to be that extreme, well then at least so that it will be with reparable wounds and later, less scars. The scars she will have are probably going to limit movement someday.

    And my point was that as a “cutter” or wound, she has the same right NOT to talk as anyone else. I treated her with basic respect that is often denied in that kind of situation. Somehow most people think that they have to or should interrogate psych patients, or they are just curious. Does a morbidly obese person have to explain WHY he is that way, or a smoker WHY he doesn’t quit? I’ve found that too often, there is an element of judgment in asking about psych patients’ behavior. (Same for obesity but to a lesser degree.) She has the right to have her injuries treated with no further comment. She has the RIGHT to be just an “arm.”

  10. Hello Sara,

    I write and teach about self harm from time to time and I found your comments on harm reduction interesting. Although I did not understand them all.

    I do understand your comment about not having the cuts too close so that they cannot be closed asthetically. I also understand your comment about keeping the cuts superficial.

    The grain of the skin I assume means where the lines in the skin naturally are already there. Right?

    What did you mean by those areas where the skin during natural movement is pulled?

    Also any ideas on harm minimization for burning the skin with cigarettes of some kind of hot metal .

    Interesting post and statement on your relationship with this person. I worked for a number of years in a prison where my main job was the management and assessment of self harming and suicidal inmates – all 750 of them!

    Over time I evolved a way of relating to the self harming inmates in what sounds like a similar way to which you did with this woman. I understand why they did what they did and so it was a bit business like really at least in relation to their cutting. I felt for them and understood the angst they felt from time to time. But the actual self harm sort of almost became irrelevant over time. They were going to do what they were going to do and so I focused more on how we related.


  11. Thank you Sara. For being there for her…and for all of us. I wonder how much detail i want to go in to here…suffice ti say i am a self-mutlator and have m a n y scars,from cutting and burning, some much worse than others, all over, especially on my forearms, from cuts-long, kinda deep ones that have landed me in the ED for
    sutures or staples….yep, those scars are there to stay.

    Tony You sound very knowledgable and understanding about the topic.

  12. Hmm, I never thought it would be unclear about stress lines. You can look up “Langer’s Lines” – it is the grain of collagen fibers in the skin.

    What I mean about not on an area that “has pull” means not on an area that pulls the wound apart. A sort of example would be a cut on the knee perpendicular to the floor. Every time you bend your knee, you pull apart…this widens a scar. You don’t want to cut in a direction or area where there is “pull” on the skin.

    I don’t know about burning because I’ve never seen that. Honestly, I never would have thought of this advice about the cuts if I hadn’t seen it either. Not sure how it could be done badly or well.

    Harm reduction is a public health concept that people will do what they do no matter what, so you try to make the damage from it as minimal as possible. The classic example is needle exchange programs.

    And yes, although self-harm is flashy, it is a symptom, not a problem.

  13. That’s something i never really thought of, at least consciously…self-mutilation as “flashy”. Not taking offense…just wondering when that term came about…or actually ,what it means…’cause the definition here probably doesn’t match mine.

  14. I meant by that “dramatic” or “attention-getting.” Parents really flip out when their kid does it or whatever. Visible, as opposed to all the crazy inside. Not “glamorous” or anything like that.

  15. Crikey.

  16. I went to the emergency room a couple of years ago to get stitches, and was really surprised at how nice everyone was. They weren’t intrusive and they weren’t judgmental. Nobody, as you mentioned, decided to chat me up on why I had done it. When I asked what they thought of me, a nurse explained that lots of folks came through the emergency room with self inflicted injures, and they understood it to be a coping mechanism.
    Somebody even made a joke while I was there.
    It was such a huge relief. I was afraid they’d sneer at me or withhold anaesthetic.
    In any case it’s really important to come in and go out feeling like a human being, and I think privacy is certainly a part of that. Thanks for posting this.

  17. I have also self harmed, and infact still do. I was taken to hospital 2 years ago after cutting my wrists up and taking an overdose. I recall one nurse asking me if I wanted to die or just wanted some help. Again, no one asked me why, and no one seemed interested why. I got a few looks by nurses as I wandered around in my bloody clothes. I was sent to a psychiactric unit and then put through therapy and ended up discovering I have a mental disorder.
    I am sad that people feel they will be judged or treated differently if they see a doctor. I am still frightened to ask for help with my depression and other mental problems because I feel there will not be enough understanding from my GP.
    Thank you for sharing your story.
    – Z.

  18. Best of luck. I’m glad to know that might help someone. I hope you are doing better and that someday your scars will just remind you of something from a long time ago.

  19. when i od on paracetmol i felt that the nurses were avoiding me or would say summet cruel one nurse that tried 5 times to get a sample of blood said to me is ure fault for doing this to yourself i found this to be very unperfesnal this mayy sound stupid but i hate needles so having one stuck in my arm 5 ttimees in a row made me cringe

  20. I am a medical student. I also self harm. As a patient, I have been met with variable reactions, from pity to obvious contempt. I don’t know what the best way to dEal with people like me is. To be honnest by the time I rock up in A&E the crisis has past and I just want someone to clean up the mess I have made and let me go.
    I really like your comment that patients, even psychiatric, have a right to privacy. Most A&E doctors I have come across didn’t grill me about what I had done, probably because they didn’t have the time, and I am glad. But the psychiatrists/mental health nurses certainly do and it’s pointless and intrusive. I feel deeply humiliated when I go to hospital and having all my feelings and thoughts coaxed out of me and analysed only makes it worse.
    There is nothing anyone in A&E could do to make me better at times like that. Just treat me with a minimum of respect. Don’t judge because you don’t understand. And just get on and fix what I did to myself.
    I think the way you dealt with this girl was the best you could have done and you’re right, it is a sign of maturity and professionalism. You should be very pleased with yourself that you can do that.
    I wish I could behave like that when I see patients too. Unfortunately, given my background, it’s difficult. I feel helpless to help myself and completely at loss when it comes to other people. The few times I have seen self harm patients, I am overwhelmed by memories of what it is like to be in their place.

  21. Hi, I’ve been away doing residency interviews, so haven’t followed this email, but thanks for this comment.

  22. I just wanted to say that I loved this post. I have to go to the doctor soon for an unself-harm-related reason, but I know that she will recognize my scars as self injury. I think the way you delt with this girl was great. You gave me some confidence that I will be treated without judgement. Thank you.

  23. AC, As a medical student who self harms, I wonder if you could offer a little more of your experiences?
    I am a 7 year ‘recovered’ self harmer, and am applying to medical school this year. Having worked my backside off for 5 years to allow myself this opportunity, I am deeply concerned about how patients, peers, doctors and consultants will react to my forearm scarring. I am not sure where you are, but in the UK we operate a strict bare below the elbows policy.
    Thank you for any advice you can provide

  24. Thanks for this. I only hope people in the UK are as non-judgemental.

  25. Natalie, just came back to this page after a long time but I hope you will get this answer. In my case I started self harming after I started medical school, not because of things relating to my studies, but things in my life outside of work. My tutors became concerned when they saw my injuries and I got sent to occupational health and then on to a psychiatrist. I was told to take time out and I had to stop my second year half way through. I was then told they had a policy that people who had previously self harmed had to have been free from self harm for a year before being allowed back. In reality, they have been a bit more relaxed about it and when I prooved that I was being coopertative with the psychiatrist, took the medication he gave me and engaged in psychotherapy, they let me go on. They never said it as such but the kind of unofficial aggreement is that I don’t hurt parts of my body that patients can see.
    I think you should be fine. You will certainly have no problem with OH if you’ve stopped (otherwise it’s classed as discrimination). As for peers, patients and consultants, I guess it depends. I have a few scars on my arms (most are on my tummy) and the only people who have asked about them really are close friends. It’s up to you how you deal with questions. Personally, I don’t feel like talking about it so I make things up. But I think you’ll find overall that people don’t comment about it and will see beyond that. I hope it goes well!

  26. I am a swlf harmer and never been 2 my doctora about it cos i np thay will just be rude but if i had a doctor like u i would be so open and reading ur storie has helped iv self harm for 11 years ans when c my scars i do it more

  27. Thank you so much for sharing your story with us! I’m making flyers for SIAD (Self Injury Awareness Day) to hand out to hospital ER’s, hoping that some of the staff will read them. I’m researching facts on Self Harm and especially how the medical staff should treat the patient when they come in for their wounds to be treated.

    I think you treated your patient with much respect, and as a self injurer in remission (I haven’t harmed myself since April 2011), I’ve been met with a wide variety of treatment regarding probing questions, disrespect, and a nurse even asked me, “Why do you do this to yourself? The only person you’re hurting is yourself!” I found that to be an ignorant statement for many reasons. First of all, I hid my wounds; they’re mostly on my thighs, and second of all, it DOES hurt others who know about it: your loved ones. But I did not do these things to hurt anyone BUT MYSELF so I found her statement to be uninformed regarding self injury. My hope is to spread facts about self injury itself and awareness as to how to treat the patients from the standpoint of the medical professional, since that is the idea behind SIAD; to end the stigma that prevents so many from seeking the help they desperately need. I cut myself so badly once that I super glued it shut because I did not want to go to the ER in fear of how I was going to be treated and met with hostility. It’s embarrassing enough to have to go to the ER to seek treatment for something you intentionally did to yourself, but it’s made worse by those medical professionals who are unaware of how their response to their patients make the whole experience worse. It doesn’t stop the cutter or self harmer. Like you said, the patient will do it again anyway. Being rude to them or disrespectful only makes the patient reluctant to seek proper treatment. By the way, I had to go to the ER anyway after super gluing my cut; it became horribly infected, and I had to be put on a very strong antibiotic because of it, and it was too late to suture it since it was well past the 24 hr mark of suturing injuries, all because I was afraid to go in to the ER when I should have.

    Thanks again for sharing your story, I think your response to your patient was right on the mark. Keep doing what you’re doing, and hopefully more medical professionals out there will learn how to respect ALL of their patients.

  28. I’m a self harmer luckly to not that extent, and I feel you reacted in the correct way and protocal to your job which what you wittness you get used too. My heart went out to you and you must be a very kind and professtional doctor I feel you did the right thing into not pushing her to talk because as a self harmer sometimes it can worsten the feelings. I myself have relapsed after 12 years of not self harming and its a battle as I’m 30 and now more difficult by medical mental health standards as its more complex. There should be more men in the world like you I hope you have an amazing career in your professtion. Excuse spelling x

  29. im a self harmer to a terribly wrong extent. I am 13 years old and i have been cutting, scrating, burning, and biteing since i was 11 years old. I have a lot of family issues. I could basically write a trilogy on my life. I really have no one to talk to. my friends look at me as if im a psycho. I constantly am, picked on and nagged about my choices. i wish people would leave me alone. I dont talk to barely anyone and i am always shut out. Im lonely, why does all this have to happen to me. Im not saying my lifes the worst, but it surely isnt the best.

  30. Thank u for this article! We don’t want people to see these injuries. They r private and embarrassing.

  31. Hello

    I realize that this is an old entry, but I’m glad you posted it. The sheer volume of patients who self harm and come into the ER, and the derision they’re treated with, is staggering. I try to take as many as I can myself, because I’ve discussed this particular lack of sensitivity with my seniors and residents (politely though. Bottom of the food chain n all, yknow?) but they’re in no way inclined to show them any soft corners. In the end, I gave up and just try to take self harming patients meself.

    I used to self harm. I had an extremely difficult and suffocated childhood and adolescence, and I know what it’s like, to want to self harm. I toughed it out and taught myself how to stop, but obviously, it’s an uphill battle for most everyone, one that we don’t often win. And I also know how much a kind word from the treating doctor, even a gesture in silence, can mean.

    Thank you for taking care of her the way you did. And, thank you for writing it all up and putting it out there.

    I would love to talk to you more, if you can find the time. I know how crazy our schedules are, lol.

    Hope you’re having a great day. πŸ™‚



  32. Hey there! My nbames Ruby, and I’m doing an assignment on self-harm for my english, so I was wondering if I could use some of this to put in it? it would be great if I could πŸ™‚

    This is really sad though 😦 I feel so bad for all self-harm victims 😦

  33. Thank you for such a sincere telling, you really touched my heart there πŸ™‚
    As a final year medical student still wobbly balancing empathy and detachment, the respect and maturity you show is the very soul of medical care and one I would be honoured to display one day.
    The respect and humility you show is very inspiring truly.
    Years ago I used to bang my limbs or bite myself, snap rubber bands etc sometimes to avoid leaving scars and I am glad I made that choice when I was young. The same non-intrusive kindness you have is the very thing that eventually pulled me out of the abyss. You left a mark on that girl that night, you know – a good, kind one πŸ™‚
    I am especially touched by the empathy and practicality you have.
    I was unpleasantly surprised by a super professional expert nurse / degree collector Annie down there who for some reason thought you were doing a case presentation, and somehow managed to miss the whole point of front-line medical care, and instead depersonalized the whole incident to something about admin work and the Swiss cheese theory and stuff, and *cough* holistic care. Were I the girl there I would be glad that it was you I met and not that nurse with all her big words. Because at the end of the day after all her theories, you guys -the silent clinical doctors and nurses- are the one who are there to clean up the mess. You guys don’t have to say anything – you just *are*. And every nameless patient you help is more precious than all the degrees she proudly proclaimed.
    Thank you for being a professional, and thank you even more for being a empathetic person.

  34. I only read the first few verses however I think it’s unprofessional, I can’t believe it honestly and I think those who do self harm don’t need to see this

  35. I know this is years (9 years! xD) after this post but I found it so want to share this as others may, and maybe you will read this too.

    I have several -about eight?- scars on my left upper arm. Theyre only about 4mm thick each but 5cm long. They are keltoid/hypertrophic scars (I don’t actually know much about scars) but the ones that just won’t fade. Other have faded. I regret it. It reminds me of my bad times.

    This was interesting to read. I have never been treated during an emergency (my interaction with mental health services is quite limited-I have only gone to a therapist for two sessions before) but still found this very interesting to read. Your dissociation from the self harm is really strange. I guess it’s pretty professional and it would just happen if it’s your job to regularly see and treat the injured but to me it seems strange since I would immediately empathise.

    I regret that my scars will be with me forever.

  36. I have self-harm before and im worried the doctor will take me away from my mother when I go to a check-up. Is this in anyway possible?

  37. I’m sure a lot of people will disagree with how you handled the situation. But I feel as though you made a good call. I think it may have been good to find out if she has current psychiatric help just in case (maybe you did, I don’t know) just from my own experience, I have found it a lot more calming when doctors are more non judgement when it comes to self inflicted injuries. I’ve had paramedics tell me how horrible I am but I’ve also had doctors treat me just like I was human, and I really appreciated that.

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