I noticed that my comments on Narcissism being removed as a diagnosis from the DSM, seemed to get more attention and comments than my previous blogs. The other four blogs: about a tribute to a friend, writing with compassion, my experience writing my first novel and my fantasy books I would like to write, didn't get any comments. I need to look at them for spelling and improve them if I can. I also had the chance to look at other blogs and some of the subject matter, I found really interesting. Lots of good ideas and writing going on. One of the blogs talked about suicide. It gave me the idea to write everything I know about suicide. I am not suicidal. In fact I am kinda freaked out by death.
So here it goes. Everything I know about suicide. Hmmm. Cam. I had a friend named Cam who made beautiful handmade pen and ink birthday cards with intricate drawings of hearts and women. She only charged five dollars, yet I could easily now imagine that one of these cards would take an entire day. She was on social security disability for Crohn's disease and had a colostomy. She had had over 18 abdominal surgeries to remove pieces of her intestine or revise her stoma over the years. In addition she suffered chronic abdominal pain from nerve dammange. I got to know her by buying her cards and we had mutual friends. She mentioned that every single person in her immediate family had committed suicide except her, both her parents and both her brothers. She died of natural causes a few years back, which to me seems like such a victory. She offered her story to me little by little over the years, and I was always stirred by her life.
She was sexy. Slim, due to the Crohn's but it was more than that, also just always kept her hair nice and was small. Wore feminine smock type shirts and slim fit bell bottom jeans. She had three children. One daughter was an artist like her. Strange when I want to blog on everything I know about suicide and the first thing that comes to mind is Cam, who didn't commit suicide, although was a huge risk for it. Her father had been a doctor and her mother an artist. I never asked or learned the details of her parents suicides. She did tell me the details of her brother's suicide, also a doctor. His wife was divorcing him and he hung himself in the garage so that she could find him. I also heard another story like this from someone else, this last summer. Cam's other brother, I didn't know what he did for a living or how he suicided. Cam told me that she went to a psychiatrist for seven years and that she traded pieces of art for the therapy. Then one day she was finished and she knew she wasn't going to suicide. Whenever I would pass that doctors office I did a silent cheer.
Sylvia Plath seemed to have some underlying mental troubles. I read that her son also killed himself a while back after a long struggle with depression. He seemed have built a decent career and had people who cared about him. I think family history leads to two points. One that there might be a genetic link with depression or personality disorder and two that we look to our relatives for how to behave. Although I have known a few people over the years whose parents had suicided and made some kind of deal with themselves that this was not going to be their story. So, we always have some choice when confronted with our family histories. Although, it is less likely to have these sorts of issues if isn't modled.
My observation of suicide working in a mid sized southwestern city ER, more like a big cowtown, with three Emergency Rooms, was that there are patterns to suicidal behavior. One large group of people we saw in the ER were what we referred to as "bread and butter". People who got drunk, fought with their significant other, took pills or brandished a knife with some superficial wrist cuts, immediatley called for help and were fine once sober. We saw about 5 of these every night day in day out in the ER. "Notha bread and butta", I remember this one tech from the east coast,who was really good at plastic surgery level stitch work, would mutter. Usually that would be their one and only suicide attempt. After the ER bills and the self awareness that comes with a suicide attempt is often enough, first and last timers. Unfortunately, sometimes people from this group did die. Sadly, most because of various forms of judgement against therapy and antidepressants would have benefited from these low cost and effective treatments.
We saw the ones that made it. Not the ones that went to the OMI office next door. Which were relatively few when you juxipose this to all the people attempt suicide. When people impulsively decide to try to kill themselves. They often just take whatever is around the house. Sometimes that will be 8 motrin. Other times it would be more drastic. The most poisonous are Tylenol and antidepressants when taken in significant doses. The Tylenol because of the kidney dammage and antidepressants because of it causing heart beat irregularities. I have heard of a few Tylenol overdoses who lived and ended up on dialysis. Drinking household poisons is another thing that can end up being very devestating.
Another group, with more serious underlying problems and issues, kind of chronically complain of, or attempt suicide or come to the ER with other physical complaints. This group would be the ER regulars. They would even nurse and doctor shop, and go away if someone they didnt like was working. To me, I think it fed some kind of old need they had, the attention, the drama, even the rejections and humiliation. Sometimes they died after many attempts. Than the next group, the serious people who meant to kill themselves. Often over a specific reason or acute stressor. This group is the ones we tried hard to find and admit. Lots of people going through divorce and even several cases of people needing to show up to prison in the morning and didn't want to go, social issues of various kinds coming to a head. So, although much is made of suicidal ideation, not all suicidal ideation is treated the same.
First we would look at lethality of means. As women tend to attempt suicide more often, they use less lethal means, so are less successful. Women tend to take pills or cut on themselves superficially. You can die by these means but you have time to seek help first. Hence, the lower success rate as people have time to think about it. Men attempt suicide less often, but use more lethal means, such as hanging, gunshot, jumping in front of trucks on the highway. Our job was to find out if they indeed were serious and if they had a plan, a serious lethal plan.
Many people suffered from an almost intermittent chronic suicidal ideation and only harbored vague intent and plan. We used to ask them when was the last time they didn't have suicidal ideation. Sometime these people would seriously answer that when they were 8 years old. In other words they thought of suicide but would never do it because they had strong reasons to live, and never took it to the actual intention and plan level. To be honest, these people we all found terribly annoying. It was like suicidal ideation as a lifestyle.
Sometimes when people would overdose on antidepressants they would come to the ER and die shortly after, because they had waited to long and absorbed to much medication. I remember one terrible experience where the guy got drunk took all his antidepressants, that he hadn't been taking, and when he woke up two hours had passed. He came to the ER walking and talking and he wrote a nice letter to his mother and died. It was terrible. We tried to get her on the phone but nobody answered, that is why we had him write a letter. He wrote half of it and dictated a few other things to me. I mailed the letter and put a copy in his chart. He was blond. He looked like a cowboy construction worker type. I blocked his name out. He reminded me of John Voigt character in the movie Midnight Cowboy.
I liked the doctors because the rule of thumb, if any doubt admit. They always assessed for a family history of suicide and acute stressor. Than would ask if they had a specific intention or plan. I remember one guy was in his thirties came in and this other nurse named Patricia saw him. I have no idea what was said or not said as I never had the courage to look at the chart after. That night he ran in front of a truck on the highway and died. When I got to work the next day everyone was talking about it. I think of him from time to time. Always wish we had kept him. I wasn't involved in the decision. Just felt we failed him. I do regret not getting involved because I had this strange intuition he was serious. Just by how distraught he looked in the waiting room. In ER's there is a little bit of a culture of not butting in unless it's for a good reason. My idle comments would likely not have been appreciated or more likely brushed off.
We used to have this lady who would lay in traffic and would get brought in once or twice a month, and sure enough she eventually got run over and died. Her speciality was laying in front of police cars or business trucks. I used to wonder if she was bucking for an insurance settlement. If I could tell you the number of times these terrorized cops would come in with this itty bitty lady in their back seat or follow the ambulance. Only to find us all looking like, here we go again. Explaining to the cop that she did this all the time. She was in her fifties and had been doing that one and off for years. Poor person who ran her over. Also a lot of people came in after shooting themselves and living. One guy I remember lost his palate and in the following months during followup visits, I would see him outside smoking and the smoke going out his ears as he hadn't got his artificial palate put in yet. The people who had lost eyes, lost jaws, to self inflicted gun shot wounds, mostly men.
The suicides that bother me the most are the ones that were people I knew. This one guy when I was in nursing school killed himself over a girl, we guess we really don't know why. To this day although it has been over twenty years, I still think I see the back of his head in a crowd. Another one that bothered me was this woman who never did seem to get it together and had a teenage daughter. That happened recently. I don't have any close friends or relatives who have killed themselves. Although I am very saddened by a second cousin, who sounds like impulsively overdosed during college and got treated at a student health clinic, but still died. Just very sad and is dreadfully missed by her large and supportive family. A terrible loss.
With the new awareness of mental health issues and less taboos around it, my hope is that impulsive suicide attempts can be prevented. I think crisis call lines really do serve a good purpose. I think most people stuggle with how to handle things. I didn't really go into the underlying mental illness and mood disorders, drug and alcohol addictions, that are common amongst suicides. I am also a big proponent about therapy and reaching out for outside help when necessary. My hope is that anyone thinking of suicide or has attempted it would be treated by a doctor or in therapy. I got on this topic as a result of reading a blog here about a book someone is writing were the main character attempts suicide. I found the blog very sympathetic and kind spirited.
These observations were in just one ER in this in one mid-sized city. I think the other two ER's were less busy as we were the county hospital. I sometimes tried to imagine what it would be like in bigger cities like Chicago or LA. Sometimes when I left work I would imagine all the ER's in all the cities all across the USA churning out the nightly bread and butters. I used to think that a TV series about Psychiatric concerns would be interesting and I think there is a therapy show on these days. I am not up on my USA TV living in France although read some about new shows in the New Yorker or New York Times. Strangely in all my novels I would like to write I don't really imagine any suicidal characters, probally because it freaks me out. If I did write about a suicidal person it would be the middle crazy group. The title of a chapter could possibly be, "Notes Under the Door".