Head impalement - An unusual form of suicide.

An 80-year-old man with pancreatic adenocarcinoma and depression was found with his head impaled on a bolt that had been screwed into a hole that had been drilled in the floor of a shed at his home address. Once the bolt was in place the decedent had winched a heavy weight above it, using a pulley that he had attached to the metal roof frame, and the front fork of a bicycle frame. The latter had been bolted to a nearby work bench as a winching device. After the weight had been positioned, he had placed his head over the bolt and cut the rope with a kitchen knife. The impact of the falling weight had forced his head onto the bolt with penetration of the cranial cavity. The complexity of the design of the suicide apparatus is exceedingly rare in our experience and the time taken to set up the device indicated that there had been a considerable degree of premeditation. The finding of complex apparatus at a death scene may provide useful information in ascertaining the manner of death and also in providing some indication as to the decedent's level of determination to succeed.