World Suicide Prevention Day can be difficult for those who’ve lost a loved one who suffered from a mental illness. It can also be difficult for psychiatrists, as I was reminded on the day after I participated in a Facebook event to provide information to parents on how to talk with their children about suicide.
My unease began in a CTV interview and stayed with me through the evening. The following morning I was working at my desk when tears began to pour down my face and I remembered three youth whose suffering affected me too much. Two died of suicide and one died because the injuries he inflicted on himself eventually caused his death.
Catherine is sixteen years old. That is the age of medical consent. She can say what she wants; I cannot tell her parents unless she is in physical danger. But I would like to say her mind is disintegrating. She cannot string two words together, let alone a sentence. I have to speak to someone and so I have conversations with my supervisor. My supervisor is focused on privacy and separation. I am focused on someone’s thinking dissolving in front of me.
The Teenage Mother High School Program wants me to see Lisa. Lisa is thirteen (thirteen!) years old and that is not usually the age of medical consent. Her baby is two months old and Lisa doesn’t get to school much because she’s tired from the night feedings. I go to see her at her parents’ home. She has a pink frilly bedroom and what seems like hundreds of dolls. But my eyes are glued to the real live infant in her arms…Lisa tells me that she’s fine, she doesn’t need to talk. I know that the child welfare agency wants to remove Lisa’s baby from her care. She tells me this would kill her. It does.
“…Lesch-Nyhan Syndrome is a X-linked recessive disorder of purine metabolism characterized behaviourally by self-mutilation…” There is a green room with large windows and four cribs – one in each corner – curtained off from each other. In crib No. 4004, there is a little boy with large eyes (haunted) with suspicious lesions all over his body. As I watch, he bites into the flesh of his hand before I can stop him and call for help. His parents are crumbling behind me in a corner. They watch as I put mittens and booties on him and then turn to their terror.
Every doctor has patients who die. I have been deeply affected whenever one of my patients has died and, even if there is not an official review of the patient’s care, I do that examination myself. As a doctor, I cannot help but question my care when a patient dies. I may come to a determination that everything possible has been done, and then I question my care once again. When I consider how much I am affected when a patient dies, I can only imagine what it must be like when a family member dies of suicide. I can only imagine.
(Note: These three children were my patients many years ago. Enough details were kept to sustain the reality of the difficulties they faced at the same time as the need for privacy was maintained.)