What’s the point?

The radio at the desk carried the same story as always, in faintly static words, as if to echo the faintly static thoughts of everyone involved:  ‘25-year-old female patient with suicide attempt.’  She had ingested a bottle of something that wasn’t quite dangerous enough; or maybe she superficially applied a razor to her wrist, in such a way that everything important beneath her pale skin remained intact, properly flexing and pulsatile.  I don’t remember which it was, or if it was anything other than ‘I want to drive my car off a bridge’ or ‘I just want to go to sleep and die’.

What I do remember is that the excellent and caring nurse who took the report turned around and said what many physicians and nurses think at some point: ‘Why don’t we let her?  Who cares?  If she wants to die, we should let her!’

I thought about that later; thought about all of the time and money and effort.  About the miles of stitches and staples placed in wounds that men and women inflict on themselves.  I tried to imagine the uncounted tubes of charcoal we pour down thousands of feet of nasogastric tubes every weekend, every year.  I remembered the many interactions I have had with psychiatric facilities in the night, all to rescue the people who said they wanted to die.  Why do we do it?

Maybe physicians and nurses and paramedics do it because it is expected. After all, if we don’t do ‘the right thing’, there is the threat of malpractice suits and the stigma of not meeting the ‘standard of care’. Or maybe we just don’t want to feel guilty, as we know we will, for letting another human take their own life.  Those are all parts of the puzzle.  But I believe there may be more.

I hope that most nurses and doctors recognize that the minds of those patients are diseased, and that suicidal thoughts and actions, like hallucinations or delusions, are the symptoms of diseased brains.  The psychic equivalent of jaundice or murmurs or deformed limbs.  Even as these patients drive physicians to distraction, even as we struggle with the ethics of self-determination, on some level we know that a brain is an organ, and all organs are potentially diseased.  We work pretty hard to save those with heart disease, emphysema, diabetes and terrible injuries, so maybe we know that diseased minds deserve the same effort.

But everyone can have a hard time with that.  After years of controlling our lives, working hard, suppressing emotions and personal interest, it seems a little ridiculous that someone else couldn’t do the same.  That someone couldn’t see tomorrow as a little brighter.  It seems odd to physicians and nurses, secure as we generally are in position, influence, financial security and respect, that someone else could see the world as simply unmanageable and intolerable.  How could they think life was less than wonderful, good and full of meaning?  Maybe that’s why they can be so frustrating to our ‘type A’ personalities, what with their empty pill bottles and lolling eyes, their tearful families and crumpled, dirty suicide notes, with their bleeding arms and botched gunshot wounds.  We think, ‘I would never do that!’  So too many doctors and nurses wonder why bother to try at all.  The world of the suicidal is too far removed from most of our lives.

Beyond the fact that most of us just can’t relate, and beyond guilt, malpractice and ‘duty’, there lies another reason for we try to reach the suicidal.  A reason born in the lives of the ones who try to cut and ingest their way to the morgue.  After seeing enough people in my 13 years of practice to date, I have a few ideas about why we struggle year after year with so many patients’ attempts to end their lives.  It’s because I believe that maybe we can sense, if we pay close attention, just how very much pain they are enduring.

The truth, that hopefully most of us see, is that our patients are suicidal because they were abused physically and sexually, as adults and children, and no one has ever told them it wasn’t their fault.  The only way they see to end the guilt, and oblate the re-entrant path of painful images, is to die.  Our patients are suicidal because their families gave them diseases of the mind that passed through the confluence of DNA, through the womb, and through the families where they grew up in constant chaos.  Many of them can’t afford medication or psychiatric care.  Death is an escape from diseases they inherited like the mark of Cain, and from the ties that bind them to others just as diseased.            They are suicidal because they lost parents or children, spouses or lovers, friends or even pets who were the only things that gave them any hope or affection in a cold world.  They want to die because tomorrow only seems more bleak than today, and because with no hope of vacation or shopping trip, no hope of education or achievement, death seems as good as life.

The suicidal come to us because they are slaves to drugs and alcohol, slaves to sex, slaves to food, society’s expectations, cruel families and misery.  They know that death is a kind of liberation from the chains that bind them in every way.  And the suicidal come to us because no one has ever said to them, ‘Whatever you do or don’t do, or did, you still have worth to me.  I love you.’ The suicidal are suicidal because they either have no one to love them, or because they cannot believe that they are worthy of love.

Why do we do it?  Now I know why we do it.  In the end, even the most committed suicidal patients are seldom really suicidal; they’re only desperate for some anesthesia of the heart, and death is the only permanent sedative they know. We know that all of the thoughts that tell them to kill themselves are lies and deceptions of disordered minds and broken hearts.

As for me, I’ll keep pushing the charcoal and talking to the counselors and sewing the wounds.  And God help me, I’ll try not to act angry or annoyed.  Because if my child ever reaches that place, and I can’t be there to fight for them, I want someone to ask, not ‘Why do we do it?’, but rather, ‘Why would you do it, my dear?  Let me pull you back from the edge and we’ll talk a while.  There are other ways to take away the pain.’

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