17 March 2008

Completers

Suicidal patients are an everyday part of life in the typical American ER. For a variety of reasons, the vast majority of the "suicide attempts" are not particularly serious, by which I mean that the methods most commonly seen are not terribly lethal, and the patients attempting usually didn't actually want to die. For example, consider a patient who impulsively grabs a knife and makes a few superficial cuts in his or her wrist while arguing with their spouse, who then dutifully calls 911, or one who downs a whole bottle of prozac and then immediately calls a friend to tell them what they have done. These are the "suicide attempts" we routinely care for.

These patients are often a huge pain in the ass. They are usually intoxicated, often combative and agitated, may require extensive workups to ensure that no actual life threats exist, and wind up spending hours and hours in the ER, weeping and wailing, puking charcoal all over and annoying staff with their dramatic and manipulative behavior. Occasionally a non-serious gesture winds up being more dangerous than the patient intended. ("You mean tylenol is dangerous?") Many a time an irritated nurse has approached me and grimly suggested that we publish an educational flier titled "Suicide: getting it right the first time."

If this makes it sound like we don't take suicide attempts awfully seriously, then you're right. Mostly it's due to the preponderance of minor suicidal gestures over real attempts. Don't think we're not professional about it -- we know how to rule out the serious threats and make sure that a safe disposition is accomplished. But we are not overly impressed with the low-level stuff we usually see. I think the relative absence of "serious" attempts in the ER may be due to the fact that the numerical incidence of real suicidality is low, compared to the gestures, and the selection bias that those people who really do want to end it all tend not to make it in to the ER.

They are called "completers," in the jargon, as they "complete" their suicide attempt. When a would-be completer comes into the ER, it changes the whole tone of the evening. A pall settles over the department; the place is unusually quiet and staff uncommonly grave. This guy really meant it. It's a weird feeling.

Like the guy I saw the other day. A classic completer: middle-aged male, rather heavy drinker, recently lost his job and losing his marriage. His wife came home to find him in the garage with the engine running, unconscious, with an empty vodka bottle and pill bottles in his lap. Only she came home earlier than he expected.

He came in intubated with a carboxyhemoglobin level greater than 40%, which means that 40% of his red blood cells were saturated with carbon monoxide and incapable of carrying oxygen. This starved his brain of oxygen and resulted in a loss of consciousness, and would have progressed to death if not interrupted. The outcome in this case was good; we "dove" him in a hyperbaric chamber. Oxygen in higher-than-atmospheric concentrations can rapidly displace CO from the blood, allowing for full or near-full recovery if brain damage has not already occurred. This individual had a short stay in the ICU and was discharged to a voluntary psychiatric hospitalization.

This was an uncommon case with a reasonably happy result; many serious-but-unsuccessful suicide attempts wind up causing devastating consequences, especially when the method is violent: handgun, hanging, and certain poisonings can cause permanent brain damage, spinal cord injuries, or other organ failures. It's all very sad. I probably feel more empathy for these folks and their families than I do for almost any other patient. How terrible must their perceived suffering have been to drive them to actually pull that trigger?

I am glad we don't see them too often, because it's a hard thing to stare in the face:

This guy really meant it.

40 comments:

  1. Nice post on a truly difficult situation.

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  2. It sounds like that patient is getting some help now. He was one of the lucky ones.

    As for the gestures, TV shows don't help, what with giving the impression that a few slashes on the wrist can cause irreversible and fatal exsanguination within minutes, but gunshots to the center of the chest are well tolerated.

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  3. Your "completer" patient will have subtle permanent brain injury.
    My worst: a young husband/father of twin toddlers attempts three consecutive days. First day - pills. Second day - pills. Third day - GSW to the head with demise. The burden on his wife must have been unbearable.

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  4. I had a weird perspective. I was a small town family doc, who occasionally covered our local ER but was also the County coroner. I know, too many hats. Maybe that's why I'm no longer doing it...Anyway,I worked to educate the local EMS, especially the volunteer locals about responses. You mentioned the pall in the ER when one comes in. The EMS are conflicted about "saving" someone who wanted out. I acknowledged that that was a normal feeling, but a resusctation on a small caliber GSW to the head is a donor. Wonderful save. For somebody.

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  5. After 6 years in medicine I think the worst one I can recall was a young girl... 15 maybe? That was an "involuntary completer."

    You mentioned it already. She OD'd on Tylenol. I saw her in the ICU a time or two, her liver failed. Her family and friends came to visit her and you realized that she didn't intend for things to go this way. She died shortly thereafter. I just remember the look of her friends & family. Bummer.

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  6. No need to publish an educational flier titled "Suicide: getting it right the first time." Those already exist and aren't too hard to find on the Internet.

    I read them and so far every time concluded it was not worth the of-chance risk my attempt would fail and I would be ending up in the ER with fatal liver damage and die after a week of horrible pain.

    Now I'm older and I know the bleak periods usually go away after some weeks/months.

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  7. Yeah. Almost killed myself when I was thirteen. Researched. Planned. Almost completed except my mother came home early & found me. Spent a week on a vent, seizures, all that fun stuff.

    I still have my struggles with mental illness, but I've definitely never felt suicidal again. I look back on how much I would have missed (highschool, marriage, college) had I carried out my plan...and am so grateful that I'm alive.

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  8. I was one of those almost-completers when i was 17. I took 60 tablets of extra strength Tylenol (30,000 g APAP). Looking back, (I'm 24 now), I don't think I ever truly wanted to die, but it was a very desperate cry for help. I had severe clinical depression at the time, to the point where I couldn't attend school regularly.

    Anyhow, the nurse in the ER was horribly rude to me--she said some awful things to me, and the things that she said made me wish that i hadn't been brought to the ER. She also seemed to be trying to find excuses to do unnecessarily painful/scary procedures on me--the resident and attending had to keep on telling her that the things she was wanting to do were unnecessary. She still ended up rupturing a vein by trying to start an IV with an 18 g needle in my hand-unfortunately for her, my blood spurted up in her face.

    Anyway, I guess my point here was that even though most suicide attempts are not "genuine", the people who make them may very well be in genuine emotional pain. One has to have more than just a little wrong mentally to do this sort of thing, even if they are only doing it for attention. Just something for you and your staff to keep in mind when treating these patients. I understand the annoyance--after all the staff is having to divert attention away from the other emergencies. That said, I still remember the kindness of the ER and CCU docs that treated me--it was they who persuaded me that it was worth it to check myself into a psych hospital after being discharged.

    Sorry for the long post.

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  9. I had a friend who killed herself with tylenol. She was a lab technician, and knew how long it would take for the damage to be irreversible. She took the pills, came to work that night, worked and seemed to be her usual calm, happy self, went home and went to bed. Her husband came home and found her comatose and brought her to the ER. She died in the ICU a few days later when her liver failed. Her suicide note (which she apparently had written afte getting home from work, before she went to bed) detailed how much tylenol she had taken and how long she had planned and researched to do this. So very sad.

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  10. "But we are not overly impressed with the low-level stuff we usually see."

    Gosh, maybe people who are in emotional pain aren't looking to *impress* doctors or ERs with their attempts. What a horrible attitude to take.

    Yes, I get the day-in, day-out life of the ER is often monotonous and can lead to the staff leaving their compassion and empathy at the door. But seriously, if you think a suicide attempt is boring and not in need of real intervention -- e.g., mental health intervention -- then you need to find yourself a new profession.

    So sad to see your attitude here... And a perfect example of why mental health concerns remain stigmatized in America.

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  11. Re: "checking empathy at the door"

    That's not quite accurate. First, as I stipulated, I am a professional and do my very best to display empathy, real or feigned, to all my patients. But truth be told, I have only so much emotional energy to invest in patients -- you have to remain detached on some level -- and that gets parceled out to those who really need it.

    A half-hearted dramatic gesture does not rank very high up on the scale, not in contrast with the real tragedies unfolding in the rest of the ER.

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  12. But the message you're sending to patients (yes, people can pick up when a person is feigning empathy pretty easily) is that they don't matter as much as the "real" tragedies taking place daily.

    Which is precisely why they're in the ER in the first place -- people don't care about them. You're just reinforcing that message by your saying, "You're not real or important enough for anything but the most minimal of care and attention. I save my real empathy for real attempts."

    I mean, wow. That's just an amazing attitude to have toward people in serious emotional pain. Like somehow emotional pain that isn't serious enough to be successful in a suicide attempt isn't serious enough for the same level of care and treatment by the staff...

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  13. These "near-completers" take huge amounts of time and resources in the operating room environment: middle of the night x 8 hours of facial/skull debridement following self-inflicted shotgun blast. Many many hours of ENT/plastic/OMF and anesthesiology time for subsequent reconstructions. Only to be discharged home a couple of months later, where the completion event occurs "successfully". Truly sad all around.

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  14. "I mean, wow. That's just an amazing attitude to have toward people in serious emotional pain."

    The problem being that many, many people who continue to make one parasuicidal gesture after another are in *chronic* emotional pain. Their life is one crisis after another for years. Some people thrive off of the attention and drama; some people simply don't know how to say "I'm in pain" without the accompanying tylenol OD. For whatever reason, it's emotionally and financially draining for those around them. And it never ends. No show of compassion (whether by friends/family or medical staff) is ever enough; because they're essentially searching for something to fill an emptiness that can't be filled with by-proxy love & support. It's always: *this* OD will be different, it'll really show them how much pain I'm in. This psych hospitalization will be different. If only people cared enough about me, then I could learn to love myself. But it's never enough.

    I think what motivated me to change was when the reactions of my parents and friends quit being surprised. I'd do X stupid thing and it's like everyone expected that to happen. Everyone was resigned to the fact that I might accidentally manage to kill myself. My psych history went from family & friends rallying around me with balloons and gifts and support -- to being stuck in a psych hospital, in a gown, because no one would bring me any clothes.

    When I quit expecting other people to fight for me, I learned to fight for myself.

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  15. Great post, Shadowfax.

    Trauma service can be very draining due to the patients who have been admitted for suicide attempts. These are usually the ones who "meant it."

    My most memorable case was of a gentleman who had tried to stab himself. He'd done considerable damage to his chest and shoulder, and had needed significant intervention. He'd picked off part of his brachial plexus. We knew he was getting better when he realised (and got upset about the fact) that he could no longer move his thumb properly.

    It was hard to know what to say to him at that point. Small wonder the psychiatrists hated to answer our calls.

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  16. As a psychologist and also the older sister of a depressed teenager who recently attempted suicide, I am angered by what I read. My brother stabbed himself several times. And as he lay bleeding in his car, decided that this was not right and called 911. Since he found a reason to live, should he have been treated like scum when he arrived at the emergency room? It seems to me that the general feeling is that he wasn't worthy of care. Thankfully the ER docs treated him differently. Every patient I see deserves compassion, especially those who are so depressed they feel there is no way to dull the pain short of death. Why not try to show a little care to someone rather than compounding their already depressed mood with treatment as someone "not worthy" of your time or empathy.

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  17. The author demonstrates a willful ignorance about mental illness and effective treatment. There is no such thing as pretend empathy. Either one is genuinely empathic or is not. One can feign concern.

    In my view, the approach to patients which is described for what is described in the post as "noncompleters" is malpractice on the part of physicians and nurses.

    Show me any evidence where the AMA, ANA and State Boards of Medicine and Nursing approve of that behavior.

    Wow, just wow.

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  18. Well, doc, you have no idea what you're talking about. Any mental health professional can tell you that you have to take suicidal ideation seriously, especially when someone actually goes through some motions of self hurt. I've been suicidal most of my life. I told my therapist that I thought it was such a waste that I'd inconvenienced all these people--from policemen to medical personnel to co-workers--and then not actually gone through with the suicide. He said, "Didn't you actually read that book you recommended to me?" [It's Out of the Nightmare by David Conrad] 95% of all suicide threats don't end in suicide. 95%. That doesn't mean that in 4 years, when my kids are finally out of high school, I won't implement my carefully thought-out plan. It means that people listened; they intervened; they saved me, even though I don't want to be here. That's probably benefited my kids, who would have been traumatized by my suicide. Your attitude reminds me of the articles I read at the turn of the century about a young man who was found in the basement of a pharmacy. When the "chemist" asked him what he was doing, he said, "I'm looking for something to kill myself with." The chemist replied, "You won't find it here" and chased him away. The young man later ran into a policeman who said, "What's wrong with you?!" and the young man said, "I'm just going down to the river to kill myself." The policeman told him to go on, and the newspaper article reported that no one had heard from him since. Intervention saves lives. You're an intervener. It's your job. Sorry to hear that you think you can judge the actual intentions of the suicidal.

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  19. Well, that kicked over an anthill, didn't it?

    I can assert that I am well able to feign empathy without patients detecting falsity. Maybe you want to quibble whether I am in fact feigning sympathy, empathy, compassion, interest, or simple courtesy. The semantics of that debate do not interest me.

    What I do is this: I listen to the patient's story, ask open ended questions followed by more probing questions, and perform whatever examinations may be needed. I am polite and respectful and try to make the patient feel that I listened to what he or she had to say, and that I cared. Then I explain the process to them: medical screening and treatment, followed by mental health evaluation (which is not performed primarily by me, but a psychologist).

    What I do not do is allow them to weep on my shoulder, nor do I rend my clothes and weep for them. I don't give hugs, nor do I express affirmation or validation for their subjective feelings of despair, abandonment, etc. It would be accurate to describe me as "reserved" in this respect. I think it is correct to say that my approach does not differ whether I perceive their attempt as real or not.

    I will, if necessary, be stern or authoritative to control behaviors which are unhelpful or disruptive, and I am not above telling excessively dramatic patients to cool it.

    Despite this, I can and do make a clear distinction as to whether the patient was "really" suicidal or, as hannah put it, "parasuicidal," or somewhere in between. Some people -- many -- are clearly full of shit, and I can tell. Some people are for real, and they are sobering. Many are indeterminate, and I am humble enough to admit that they are hard to sort out.

    So don't project your biases or past bad experiences onto me, folks.

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  20. An impressed reader3/20/2008 10:48 PM

    I want to say that I was very impressed by the original post. I am someone who has shown up in a Psych E.R. because I no longer trusted myself, but also to be sent as a teenager.
    Sometimes, yes, people need a reality check, not a fluffy pillow and a shoulder to cry on. I deal with many things with humor. If it is intense, it is often easier to laugh than cry. I am more effective if I am not burnt out.
    Thank you for recognizing the tendency of suicide attempts as a dramatic gesture that some "attempters" will indeed be embarrassed by and making jokes about in the future.
    Please get the word out that just showing up at the E.R. for help without the drama is much more effective and efficient.

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  21. Well, that's certainly different than your original post where you said,

    "These patients are often a huge pain in the ass. They are usually intoxicated, often combative and agitated, may require extensive workups to ensure that no actual life threats exist, and wind up spending hours and hours in the ER, weeping and wailing, puking charcoal all over and annoying staff with their dramatic and manipulative behavior."

    Anybody reading that sees exactly how you feel about people who are suicidal and present to the ER for their concern. They are "a pain in the ass."

    Most people who present to your ER and attempt suicide are, according to you, "dramatic and manipulative" as well as "intoxicated."

    You really could use a class in compassion, and your chief could sure do a better job in training such abhorrent attitudes out of you. What you have is called "prejudice" against people who have what is called "emotional pain." But because you can't see it and it's not your specialty, you minimize it, insult the people who have it, and suggest most of them are just obnoxious drunks looking for attention.

    Before admitting your prejudice in the future, and your ugly dislike for certain types of people, you really should think more about the hate you spread and the harm your words carry.

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  22. I didn't want to jump into the fray here, but I'm going to.

    I understand that there ARE, in fact, many people who use bullshit "suicide attempts" as the equivalent of a toddler holding his breath: because it's dramatic and attracts attention. And yes, that is annoying and a huge pain in the ass.

    That being said, I get the impression from this post that everyone who gets close to suicide but doesn't follow through is lumped into this category, in the eyes of medical personnel.

    That's actually not true. There are people who are seriously suicidal but have a flash of last-minute survival instinct, for example.

    Also this post makes me squirm because it conveys the impression that there's something noble about "completing" a suicide and something weak and pathetic about changing your mind and deciding to live. And wow, I don't even know what to say about that. I'll shut up now.

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  23. You wrote: ". . . we are not overly impressed with the low-level stuff we usually see."

    What if one day one of your sons or daughter was in the ER for a low-level suicide attempt? Seriously think about it Doc. What kind of ER staff would you want helping him/her?

    ER staff have saved my life on few occasions. Once it was for a drug-induced psychosis. You know how humiliating it was for me EACH time I visited the ER?

    Medical staff cannot predict the future or look into the hearts or minds of their patients. Every suffering patient is an opportunity to touch his/her life. Everything you say and do matters.

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  24. Wow, a different view that I have wonderd about. I am extremely depressed and suicide is never far from my thoughts. Even suicide prevention tells you to go to ER, which I have considered for help. Guess not anymore.

    My husband died next to me while I slept (heart attack) at the old age of 43. I have been a recluse for a year now and things just get worse. So where do I go for help? No tight family, I've managed to lose friends due to me being a shut in, I'm not driving, not going outside, so I just waste each day away...could be a fate worse than death.

    Much to think about, and it's ok, as there are lots of people who sadly don't understand depression. But I do thank you for the honest post.

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  25. Me again, the depressed one. OK, I've done more digging and I do understand somewhat. Mental illness is not what the ER staff is trained for. The traditional physical treatment is what ER was set up for.

    Sadly now suicide is the #11th cause of death in the U.S. and anyone dealing with depression (or someone who is) is having to deal with this...and we are not set up for it. Never have been, even when there were State funded Mental Hospitals, it was not the best. Yes, it helped with the homeless by giving the mentally ill a place that was safe and off the streets, but the means of treatment were barbaric. Sadly, I do know of examples first hand, as my mother was a committed patient in one of these.

    Sadly, I don't have any answers to these problems but hopes there is, otherwise, why hope? Oh and Doc, just so you know, it's frustrating as hell for us depressed people too.

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  26. "What if one day one of your sons or daughter was in the ER for a low-level suicide attempt? Seriously think about it Doc. What kind of ER staff would you want helping him/her?"

    As the chronically para-suicidal daughter of an ER doc;

    I mean, seriously, what a stupid question. At the most, my "status" saved me from having my stomach unnecessarily pumped. (I'd be found hours later, mostly just very very dehydrated.)

    Nobody prostrated themselves over my body. Nobody ever said: "But why? You have so much to live for!" Nobody tried to act like a therapist. Nobody ever tried to do any more than shadowfax has admitted to.

    The rest of you are idiots.

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  27. Wow, some some of the depressed people who are posting here must have gone to ERs and acted like assholes when feeling suicidal or why would they be so defensive and feel like the doc was talking about them personally?

    Not all people who make suicidal gestures are depressed. Some people are and need sympathy and support.

    Some people who make suicidal gestures and threats and do it repeatedly ending up in the ER so frequently that the staff recognizes them by name do it because they're manipulative and bored. People with personality disorders have low boredom thresholds and it frequently drives them to act out by by taking pills and immediately reporting it to someone or making slash marks on themselves or other such "suicidal gestures."

    Patients who use destructive behavior to garner attention do not benefit from positive reinforcement for the behavior. There is no therapeutic model for rewarding a patient for hurting themselves.

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  28. Some people might die who otherwise would live, as a result of this post.

    Even people who fully intend to die can sometimes screw it up and wind up in the emergency room, get effective treatment, and live. Publicized scorn for people who don't successfully kill themselves is an incentive to make absolutely sure your friends and family will be dealing with your death.

    Before being effectively diagnosed and treated, I was suicidal on a number of occasions. I visited the emergency room once because I was very, very close to attempting, with full intent to die. Luckily, they did not respond to me as though I was wasting their time because I had not quietly and effectively killed myself elsewhere so that they didn't have to deal with me. (And yes, avoiding "being a burden to others" by ensuring that I tidily knocked myself off somewhere out of the way was on my mind.)

    I wish I didn't have to deal with difficult people either; unfortunately, your clientele are as they are, not as you wish them to be.

    To others: please do not take this doctor as representive of all ER personnel, and please do go to the ER if you are immediately suicidal, or need medical attention (for god's sake don't avoid going to the ER if you need stitches, regardless of why you need stitches), and especially if you realize before or after starting a suicide attempt that you want to live. Your life and the wellbeing of your friends and family is more important than a doctor's convenience.

    To the doctor: if you don't want parasuicidal patients showing up in the ER, it would probably be more effective to work to get such patients into DBT therapy. If you truly think that some of your patients deserve to be dead (yes, this is what your post is implying), then please, please take a vacation or switch professions to one where you are not responsible for others' lives.

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  29. I am not a doctor, nor do I claim to know more than one. I can, however, completely relate to this person's perspective.

    In the past 2 years, I have found myself dealing with multiple suicide attempts by many people I am close with, including my ex husband. Quite frankly, I am tired of this total bullshit.

    I agree that, of course, there are genuinely people out there with mental disorders and/or absolutely unbearble life situations (loss of child/husband/job) that result in a total loss of control and a serious desire to end one's life. I have also witnessed half-assed attempts by multiple people who want someone to coddle them and feel sorry for them.

    I used to be the first person to the rescue. I'd ask how I could help, what made them feel the way they did, what could help prevent this in the future. The fact of the matter is, I cant take these "attemts" seriously anymore. These attempts ARE a pain in the ass, and they are, above all, the most self-centered thing you could possiby ever do.

    I had to file a police report with a blood-soaked letter in my hands, while my future ex-husband's parents and brother could do nothing but pace and cry. What these people crying for attention don't think about is: what happens if you succeed? If you accidentally kill yourself, you don't just leave your loved ones with fond memories of you. You leave them with questions. And those questions are something they'll have to deal with for the rest of their lives: Why did they do this? Why couldn't we stop it?

    By taking your own life, you take the lives of everyone else you care about with you. If you can't get it together for yourself, seek help so you can get it together for them.

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  30. The part about the "incompleters" being overly dramatic and loud, intoxicated, etc, is interesting to me. I've been to the ER twice for attempted suicide (and I assure you, I meant it - things happen), and both times was dismissed out-of-hand because I was very calm and courteous to the medical staff - apologetic, even, for taking up their time.

    Eventually someone would come back to the ER's "nut room," where I was stashed, waiting for the on-call psychiatrist, and tell me with new concern or maybe just interest that I was in fact in need of immediate blood transfusions or charcoal/antidote. They were surprised that I'd done exactly what I'd told them I'd done, because I wasn't wailing or crying. One doctor was quite angry with me for not making the emergency clear. Um... in the ER... told you what I did... ??

    Can't win for losing, I guess.

    I appreciate your honestly, and you seem a decent sort. At least you're courteous. Puts you head and shoulders over far too many docs out there. Do they beat the compassion out of you people in medical school?

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  31. It makes me angry that those who should be there to care for and help those who are in pain, mental or physical, show such contempt for those who don't fit their criteria of 'seriousness'.
    Whether or not they want to die (and I don't think you can know with certainty that they don't, if not now, further down the line when they have been sufficiently rejected and marginalised by attitudes such as yours), they are coming to you with a need for compassion and humanity. If you can't give them that, maybe you're in the wrong line of work.

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  32. My husband's ex is in the hospital now as a result of an attempted suicide. They have three children, 13 yr. old twins, boy & girl and a 17 yr. old boy. I am furious over this. She lived through a kolonipen overdose w/alcohol I presume. This woman has tried every trick in the book for attention and she certainly succeeds. She was in ICU for two weeks in a coma and is now in the hospital and is displaying some kind of mutism. I tend to think it's put on but I know I could be wrong. She looked at me as if she wanted to hit me when I went in to see her with my husband and then she started crying. I don't know the ends and outs of her condition but I do know she has succeeded in upsetting the lives of her kids as well as mine. I have to watch my husband pet her hands and face and tell her everything is going to be all right and frankly that just pisses me off. I don't have sympathy for people like this at all. She is a drug abuser and all of us have choices in this life and she chooses to be what she is. Am I a bad person? I don't think so.

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  33. "So don't project your biases or past bad experiences onto me, folks."


    It sounds as if you have already projected your biases and past experiences on anyone with a mental illness presented in your E.R. Thanks for the honesty, however. It lets patients know that they need to bring someone to the ER with them to protect them from the staff.

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  34. "Why would they feel like the doc was talking about them personally?"

    He's not. He's standing in for all the docs with similar attitudes, just as the suicidal people he sees represent to him all the other "incompleters" he's seen.

    A look from the other side: http://lunarrose.wordpress.com/2007/05/14/worst-doctor-ever/

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  35. I work in an outpatient setting where we see "drama" on a daily basis. I am not an effective clinician unless I can relieve my annoyance at this behavior and remember that what we do to help heal even these behaviors makes just as much difference as setting a broken bone. The clients/patients are not in our care to annoy us...

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  36. Wow, this post saddens me. I have survived two suicide attempts that were most definitely serious. I admit that I was ignorant of how much pills and alcohol it would take to do the job, but it wasn't for lack of intent.

    The first time a friend made me vomit & kept me awake. The second time a friend found me & I ended up in the ER.

    Thank God the doctors there took me seriously. I was as quiet & polite as possible telling them I'd made a stupid mistake, I was acting impulsively, it was just a cry for help, etc, etc. I was trying desperately to appear remorseful so they would release me and I could go home and finish what I had started, now realizing I needed to do some research on dosing.

    The doctor in the ER saved my life by not dismissing me as a pain in the ass, but by taking what I'm sure looked like a pathetic gesture seriously, and putting me on a psychiatric hold.

    I know that your job is stressful & you have to deal with many unpleasant people, but PLEASE never assume you know a patient's intent. Looking back my attempts were not physically serious, but I truly thought they were. I am so thankful the doctor did not dismiss me as an attention seeker, because I would have done my research and completed as soon as possible.

    Mental illness & depression may be a pain in the ass for you to deal with, but it is much worse personally struggling with it day in and day out. I say this not with anger, but with utmost sincerity - please have compassion for the suicidal (whether or not you think they are serious) or find another profession or practice where you do not have to work with them.

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  37. Hi Everyone,
    I'm finding the post and subsequent comments very interesting, and extremely timely. I can't even remember how I found this blog in my web surfing tonight so I'll share the events of today.
    I'm under psychiatric care and have been for many years due to recurrent major depression and Borderline Personality Disorder. I'm sure the docs here all know about BPD and I believe we have additional, and probably deserved, stigma beyond the stigma attached to other mental illnesses.
    I'm 46, single mom to 2 teens. Today, my thoughts of suicide reached a breaking point. I guess I can share progress (?) in that from age 17 until a few years ago, I almost always attempted suicide when I felt like this. Some times were more serious than others. Some I intended to die (laid in middle of highway, CO2 [found by accident], and another too complicated to share).
    I will try to focus on today, though. I truly did not know what to do. I know that I want to die. I know my method of choice and it would be final. BUT, I also know that my kids adore me and need me. It should be a no brainer and there are lots of "shoulds". But, I didn't know what to do. I wanted to get help but honestly I feel that without an "attempt" no one will believe that I am suicidal. In fact, if I don't kill myself, am I really suicidal?? Because, shouldn't I "shit or get off the pot"? Isn't it time for everyone to know I mean business? Do I want to keep feeling this way? No. But I do think suicide would be selfish of me. But I also think at long last I deserve peace of mind, aka death. But, that would destroy my children's chance of having peace of mind. I look forward to nothing. I exist for my children only. Should that be enough? I can't say it's not or I will be labelled a cruel, unloving mother. I did talk to my psychiatrist today and he increased my anti-psychotic to a level that will greatly sedate me. He said there is a shortage of psych beds right now and I would have to wait a day and a half in the ER "cell" before being admitted so sedation is the route right now.
    I long to go to the ER because I feel so unsafe, so frightened and the thoughts of suicide FILL my mind. I went to the hospital but after sitting outside for eight hours pondering my choices, I chose not to go to the ER. I didn't feel important enough, I knew I would not be taken seriously and I knew that if I were "dismissed" it could send me over the edge to "completion".
    There are no right or wrong answers. The human psyche is complicated. I have been one of those manipulative, charcoal-puking, half-assed-attempters. So, how do I tell someone that this time I'm so scared not to be taken seriously due to my wolf cries of the past? Thanks for listening.
    CH

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  38. CH, your story illustrates why this doctor's attitude is so toxic.
    I hope you find safety and help. I am saddened that the system is such that it is so hard for you to find them.

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  39. An attempted carbon monoxide suicide may look like they failed when in reality the survivor goes on to experience all kinds of health and neurological problems because of it.

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  40. I'm glad I don't remember anything after taking enough pills that I truly thought would kill me (this was before the internet.) All I'll say is that I hope the doctor and staff were not like this guy (who can "fake empathy"). Empathy isn't crying over someone or holding their hand; it is putting yourself in someone's place for a moment. I really hope the doctor who treated me was more like this: http://edwinleap.com/blog/?p=65

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