when Caecina Paetus was condemned to death for his part in an unsuccessful conspiracy against emperor Claudius, he chose to commit suicide rather than face the emperor's wrath. but he was hesitant. so his wife, Arria, seized his dagger and stabbed herself first in order to give him the courage to do get through with it himself. she handed him his dagger saying "non dolet, Paete!" ("it doesn't hurt, Paetus")"
-"the enigma of suicide", p.151 & http://en.wikipedia.org/wiki/Caecina_Paetus
according to Mamoru Munakata, Hiroyuki Itaya & Yuichi Ono, "a cardiac stab injury is life-threatening and requires urgent surgical treatment"
-"cardiac stab injury by a bodkin", http://www.atcs.jp/pdf/2006_12_5/365.pdf
in 2006, they have satisfied this "requirement", by intervening in the dying process of a 48-year old, who "had a cardiac stab injury resulting in a cardiac tramponade as a result of suicide attempt using a bodkin, a sharply pointed instrument for making holes. the patient was transfered to our hospital about 12 hours afte the injury. pericardiotomy at the emergency operation revealed the penetration of the right ventricle and the hole was repaired following removal of the bodkin"
-"cardiac stab injury by a bodkin", http://www.atcs.jp/pdf/2006_12_5/365.pdf
the subject in question, after successful penetration, left the bodkin stuck (presumably due to a change of heart) in the 5th intercostal space, instead of pulling it out. stab wounds to the heart usually lead to death because of rapid blood loss, but for this to happen there must be an opening.
"a heart injury, in turn, causes internal bleeding and/or an inability to pump blood to other parts of the body. even a relatively small heart wound may be fatal if not promptly repaired, but the severity of a heart wound also depends on its location. if the cut is to the upper chambers, the right ventricle, or the major blood vessels, death is likely; a small cut to the left ventricle wall is sometimes survived, since the thick muscle there may seal the wound when the heart contracts.19 however, this is not something you should count on."
-"suicide and attempted suicide" by Geo Stone, p.193
now, let's take a look at a successful suicide case, the so-called "suicide by pencil" case, from 2005:
"with a common pencil. a 72-year-old male inflicted himself a penetrating thoracic wound
while being hospitalized for a hip prosthesis operation. although the patient was immediately operated, the cardiac injury appeared to be fatal. cases of suicidal penetrating wounds of the anterior chest wall are rare and they are mostly inflicted by knives, glass fragments, or other sharp instruments [...] after three days of an otherwise unremarkable hospital course, he was found lying on his bed with a pencil protruding from his chest. on the thoracic wall, left of the sternum and below the nipple, a small wound around the foreign object was visible [...] he was in cardiogenic shock [...] the anterior wall of the left cardiac ventricle had a penetrating lesion near the left anterior descending coronary artery, but the artery was intact. within the wall of the left ventricle, a small foreign object was found, which was recognized on gross examination as the tip of a pencil. the surgical intervention was completed by removing the foreign object and suturing the pericardial and myocardial ruptures. after the operation, the patient remained unconscious for several hours despite weaning from general anesthesia [...] septicemia developed, resulting in the death of the patient due to multiorgan failure on the 11th postoperative day"
-http://www.hawaii.edu/hivandaids/Suicide_by_Pencil.pdf
"with suicidal chest stabs, death is usually due to either (1) injury to a major vein or artery leading to fatal blood loss or (2) injury to the heart itself or to the sac surrounding it, the pericardium. If the heart is sufficiently damaged, it will hemorrhage and be unable to pump blood. but even if the heart itself is untouched, blood may fill the pericardium faster than it can drain out (or a blood clot may block outflow). this will eventually leave the heart with no room to expand, and thus keep it from filling (and thus pumping) properly ("cardiac tamponade")."
-"suicide and attempted suicide" by Geo Stone, p.200
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