Psychiatry – Day 5

This post includes discussion about suicide. If you or anyone you know is struggling with thoughts of suicide the National Suicide Prevention Hotline is 1-800-273-TALK (8255).

New week and with it an attending change. Of course the day I run out of scrubs and come in business casual is the day with the one psych attending that wears scrubs. If the attire and long flowing hairs wasn’t enough of a tip-off, his practice style was very chill. The way he talks with patient’s is very familiar (in the sense that the way he present himself is very down to Earth and comforting).

At this point I’ve gotten a couple opportunities to talk to patient’s struggling with suicidal thoughts. Today was my first time talking to a patient who was feelings actively suicidal. From my perspective, what was difficult about the conversation was it felt like talking to a wall. This person had been struggling with depression and suicidal thoughts for several years. They had tried various treatment options without any respite and they just want it all to end and they resent the world/ society for not allowing them to follow through with. As heartbreaking as it was to hear them speaking, I also thought what they were saying is reasonable. I can’t feel what they are feeling, but I can only imagine if I were going through years and year of torment and people saying they can help me or that they want to help and nothing changing that could drive me to contemplate suicide. So often we invalidate patients experiences, even when we don’t mean to. We’ll get you better. Just keep an open mind. Trust us. Why? Why should they trust a system that has historically failed them and only led to disappointment? Why are we acting like they are the one that is broken and they are only one more trial of SSRIs, one more session of group therapy away from being whole again? Yes these are proven therapies and in many case do work to help people manage their depression, but pills and therapy can’t fix the life circumstances that may have brought them there in the first place. This is just a half-baked thought and I’m not sure how to reconcile this. The way I approached it for myself today was essentially selfish and also in acknowledgement of the reality: I don’t want this person to die and we as a medical facility for better or worse have an obligation to keep this person from dying by whatever the means, i.e. we aren’t going to help them end their own life nor are we going to send them home in the state where they are likely going to end of their own life, even if it means holding them in the hospital against their will. So in the face of those realities, we might as well try something to see if it helps, and maybe keep expectations low.

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