01 March 2007

coffee and suicide

On my way into work Tuesday night, I was trying to resist being overwhelmed with dread. I had to be in charge and, if you don’t understand what that means, let me just say that I feel unqualified at best to fill these shoes. There are two full time charge nurses and when they’re both off, I’m the only idiot that doesn’t refuse the charge hat (there’s not an actual hat, but I suppose if there was, it would be a bit more fun).

There were three nurses on and we worked as a trio last week as well. With one of the nurses having recently fractured his pelvis dirt biking (a pass time sent, I believe, solely for the purpose of population control) and the other nurse having JUST gotten off orientation, I felt I was boarding the Titanic.

That night last week didn’t play out very well at all so I was pretty despondent about having these same deck of cards. I did my usual prayer time before I go to work begging God to keep me from killing anyone (this includes co-workers. In fact, they are more in danger than my patients, at times.)

A little bit after 9, I got a guy in from a psych facility in need of medical clearance. He stopped taking his methadone about a week prior and was experiencing withdraw symptoms and a great deal of pain.

“Why did they baker act you?” I asked.

“Because I told them I’m going to kill myself. They don’t like that for some reason,” he responded.

“Why did you want to kill yourself?”

“I didn’t say that I wanted to kill myself,” he said. “I said I AM going to kill myself. It’s not a choice of whether I want to or not. I have to now. I’m not going to live this way any more. I refuse to. I’m in so much pain every moment I’m awake I can’t stand it. So, when the time is right, I’m going to end it. But don’t worry, I’m not going to do it in here [he saw me eyeing his shoe laces]. This isn’t the right time or place, but mark my words, it will happen.” Hearing the certainty with which he spoke gave me goosebumps.

I continued triaging him and gave the chart to the doctor. I kept thinking about what he said and thought about suicide. I was brought back to the time in my life a little over a year ago when I thought about suicide on a regular basis. I remember seeing images of guns to my forehead like a flash from nowhere – this would startle me to the point of flinching and I’d be left wondering, ‘where did that come from?’. I’d decided that, if it was going to happen it wouldn’t involve a gun. That’s not my style. But still, the images of the guns would visit me while I was busy at work and sometimes while I was dreaming.

I remember one morning I got up at about 4am and was supposed to run about 8 miles that day. I dreaded the running schedule and hated life so much. Before I was supposed to leave the house I sat on the edge of my bed and wrenched in tears until my body physically hurt. I’m surprised that I didn’t wake up my roommates who, at the time, were quite worried about me. I knew that I couldn’t run in that state and so kicked off my shoes and fell back in bed. I continued to cry for maybe an hour and finally begged for God to take my life as I slept. I thought that would be the perfect out to my problems. I wouldn’t have to cut myself, my family wouldn’t have to deal with the issue that I ended my life – it would be natural (as natural as a 23 year old dying for no reason could be). I just didn’t want my own blood on my hands, figuratively speaking. When I finally fell asleep, I dreamed that I walked into a live power line that was down from a storm. I felt my body surge with energy and then everything turned white and I looked up (kind of like that guy did when he was being sucked up by the UFO in ‘Fire in the Sky). God said “I can take you now, in your sleep, or you can stay. Your choice.”

“I’ll stay,” I repeated a few times. And I did. I woke up. I got up and shortly thereafter began the slow upward climb out of darkness.

I could feel this patient’s pain and I wanted to connect with him, but he didn’t seem to want to connect with me, so I let him rest in his bed. I went about my business and busyness putting out fires wearing my little charge hat (again, not an actual hat.)

When it was getting close for him to leave, I went and told him about the transfer back to the psych facility. Noticing that he had been keeping his eyes closed, I asked him, “how’s your pain. Is it any better?”

“Are you fucking kidding me? Is it any better? No it’s not better because you’ve not given me anything for my pain. I’m just sitting here like a number – like a part of a herd of cattle just waiting for you to push me to the next place. ‘Is you pain any better’ – you’ve got a lot of nerve you little punk. I told you when I got here that my pain was excruciating every hour of every day. But you can’t comprehend that and so you think that I’m a medication seeker. You think that everyone who comes in here is after narcotics so, because I look like I’ve had a rough life, you think I want Demerol or Dilaudid. Well, I don’t. How about a fucking Tylenol? Something to ease the pain… you people, man. All you do is see people as numbers.”

The whole time while he was talking I was sitting on the edge of his bed looking directly in his eyes thinking, “God, use me.” Every word he said (and I’m sorry if my candor offended you) was dead on. He had no reason to live, no reason to believe that I was anything more than the sum of my surroundings. I failed him.

I brought in some Tylenol (the only thing the doctor would order for him because he was a ‘seeker’ [his word]) and I sat the med cup and two juices on the edge of his bed.

“Here’s two Tylenol if you want them. I’ll leave them here,” I said quietly as I left the room. I could sense that his eyes never left me when I was in his room… He wasn't somebody i wanted to loose the approval of.

After leaving his room and for reasons I don't quite understand myself, i sat down and wrote him this note:

"You’re completely right. Most patients are seen as numbers and with that I cannot contend. What I am about to say I mean with all of me: I am truly sorry that your life is so miserable. There’s little more I can say that that. I’ve not had to deal with chronic pain and I cannot empathize with you, only listen and try to understand. You may not believe that what you said made it in my brain, but it sank in so much deeper than that. You think that I see people as numbers and I have no desire to try to change your mind, but please know that not everyone sees people that way. My heart’s desire is to try to love people like God does and many times I fail. I did today. My role in the ER today was to evaluate weather or not you were in a medical emergency and clear you for transfer. often empathy is lost in the mechanics of a job I’ve done for years. Sometimes its impossible for me to treat everyone holistically. That is where I fail, and for that I am truly sorry."

After he read the note, he asked me to forgive him. I said ‘ditto’ and we started talking. He wanted a ciggy and some coffee, so I brewed my special Starbucks Casi Cielo and bummed a pote from my co-worker. We sat outside in the 3am fog and he told me why he wanted to die so badly. He told me of the jobs and the money that he’s had the privilege to have in his past. He told me the horrific story of the car accident that preceded his life of pain. His wife that tried to run him over.

“Wives don’t try to kill their spouses for no reason,” I said, trying to be the devil’s advocate.

“You’re right, they don’t. But she's in prison now and I'm sitting outside drinking coffee.”

I shared with him the story of my depression. Sure, it didn’t seem as made-for-TV-movie as his did, but he listened all the same.

“So why didn’t you?” he asked.

“Well, at first I didn’t have the balls, but just when I was getting the courage to follow through, God opened my eyes to the truth of it. That it never ends pain, only starts it. So, I stopped wallowing in my own selfishness and here I am talking to you… there’s a reason I’m your nurse you know. You’re not supposed to go through with it. You know that. You just have to believe it and I’ll pray you do – sooner rather than later.”

To that he smiled and finished his cigarette. His paddy wagon arrived to cart him off to the pscychiatric ward. A place that he no more belonged in than you or me. Before he got in the van, he shook my hand and said, “Thanks for everything. You know, when you hit the fuckin’ bottom, you’ve only got one place to look.”

And having said that, he pointed upward.

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