Thursday, July 20, 2006

Good for her

Doctor, my eyes
Cannot see the sky
Is this the prize for having learned how not to cry

I got called out this evening to see a patient who was obtunded and vented, according to the report. I get there, only to see a gaggle of nurses giving report to each other. Then I hear one nurse say, "oh well, good for her." They part for me, and the nurse sitting at the nurses' station says, "Oh, (my OPO's name) is here. Listen, when I called she had nothing. I swear." I look in the patient's room and she's kicking her legs lustily. Apparently, in the interim, she woke up from whatever she OD'd on and is now kicking and fighting the vent, the staff and the restraints they've put on her. So, she's not dead. Good for her.

I sit down to write a brief progress note and call my office to tell them I'm leaving. Something from the front of the chart catches my eye. It's a suicide note. I tell the person on the other end of the phone and they make the typical, ER comment, "Well, let's hope next time she gets it right." I cringed.

Now, I've had my share of whiny, puking, usually teenaged suicide attempts. There may be some half-hearted scratches on the wrists. Or maybe they took some pill they found. Very often there is charcoal to be administered, then puked up, then administered again until you both look like you work in a coal mine. And the drama. Always the drama. I understand why health care workers have this jaundiced view of near suicides. Once I had a young woman with cystic fibrosis who was trying to live until her 30th birthday. In the next bed was a 20 something drama, who felt she would show her boyfriend by taking 5 tylenol and calling it a suicide attempt and was now generally being a pain in the ass. You just wanted to strangle her, or at least show her the woman in the next bed who would give anything to live to grow old.

When I hear that someone has tried to commit suicide I think of two patients, both women, who really touched me. The first was Patricia. Spanish-Pah tree see ah, not Pa trish ah. Patricia was how I learned that rat poison is basically coumadin, cause she felt the pain of living, made herself a rat poison shake and drank it down. She was basically okay but had to be watched for bleeding and given Vit K to help her blood clot for a few days. Don't ask me why, maybe because she had some things in common with me, but she struck a nerve. With my little Spanish and her little English, we talked about what happened. She was glad she didn't die and she wanted to get help. She was the first person I took care of in the ER that I ever visited upstairs. We couldn't really talk, but we communicated and she was glad I came to see her.

I can't remember the name of the second woman. Zoe? Zelda? She was also my age. She had been fired from her job and was driving back to live with her sister. While passing through my state, she pulled her car to the side of the highway, slit her wrists and jumped off a bridge. Some fisherman were in the water and pulled her out. She managed to escape serious injury. I remember being in xray with her while they cleared her C-spine. Her sister was in the waiting room. I asked her if she wanted to see her. She said, "do I have a choice?" I said, "you always have a choice." We locked eyes for a minute and she was crying and I started to tear up. She was the second patient I went upstairs to visit. Her mother was with her, high powered and full of money, taking charge and ordering the staff around. She demanded to know who I was. I looked at Zoe(?) and she looked just like a butterfly that's about to be pinned to a board. So scared and fragile.

How can you judge someone who wants to end their life? I wanted to take these women and hold them close and tell them that someday life will be worth living again. That they don't want to die, they just want the pain to stop. I don't think my coworkers, then or now, are cruel as much as they're in denial. Who hasn't had a dark thought, a secret urge to hit the reset button? I think they're whistling past the graveyard. By being cynical, they can convince themselves, "I'm normal and they're not." And if you haven't ever had that thought, then good for you. And my now awake patient, she doesn't need me hovering at her bedside, so good for her. I hope she wakes up and gets the help she needs.


PJ Geraghty said...

Good post. It's important for us to remember that our patients do things for a reason, even though we may think it's a wrong reason, and that they're still human. Many a time I have stood over someone's bed and roundly cursed him and my own fate for being on call the night he decided to end his life one way or another, and every morning after doing so I have felt guilty.

Great blog, by the way. I'm going to forward the link on to my staff, so you're about to get a bunch of new readers from AZOB...

TC said...

Cool. Thanks.

Grace-less said...

What does charcoal do? I don't get it. Nice post. You're a lovely writer.

Moreena said...

I am so very much enjoying reading you. Thanks.

may said...

call for most suicide attempts are. and just like you, i don't know if the cynicism will eventually get into me..for now, itmakes things so sad.

denyse said...

I have just discovered your blog and as I am a donor coordinator in Western Australia it is great to read that things are no that much different for other coordinators. as an icu nurse of longstanding i can say that yes some attempted suicides piss you off and some do get to you, especially the families left behind.

DeLita said...

Being a Recipient Liver Transplant Clinical Coordinator, I think that it is good to see the otherside of transplant. Donor families are loosing a loved one and rarely do you see or hear about the donor and the donor families.

The gift they are giving to a stranger is the greatest gift one can give, but the public usualy only gets to see the recipients.

Not to say that they are not thankful, still the donor and the donor family needs a stronger voice and I think that you are giving them that voice.

Keep up the good fight.

Jenny Cracker said...

At Grace-Less-
Charcoal absorbs toxins. So if some one drank a poison and then ate charcoal the charcoal would soak up the poison. The person might not be completely fine but they would be much better off then before.

TC said...

Hmmm, thanks Jenny Cracker. But how did YOU know that!?

Jenny Cracker said...

I don't know, you probably told me at one time.
Or it could be my large and super cool brain.

Keith, RN said...

You are a special and compassionate individual, and it's a pleasure to share the blogosphere---and this planet---with you.

drytears said...

Wow, moving post.

After my suicide attempt it took me awhile to realize all the people I had hurt.

I never thought about what the nurses thought or said about me. I had one nurse I really liked who wanted to talk to me about it while I was in the ICU, but my parents were there when she asked so I turned her down, plus I was still shocked.

BTW, I was also restrained because I was trying to pull my ventilator out, only I don't recall it.