The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This time, forensic psychiatrist Sohom Das remembers a patient who took her own life.
If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com
As a psychiatrist, the potential of patients ending their lives is part and parcel of my own. It’s not common, thankfully, but it is frequent enough, unfortunately, to lurk in the back of the minds of myself and my peers. In fact, the career of almost every shrink is blighted by a couple of patient suicides. It’s inevitable, yet nonetheless shocking. And you don’t need umpteen years of psychiatric training (or the obligatory beard and pipe they give you at the end) to imagine what it’s like to process this tragedy. How could I have missed this? What should I have done differently? What do I say to the family? And of course, the ultimate insomnia-provoking: Was it my fault?
I’ve had this egregious experience only once, and it still stings. It happened to be early in my career, when I had been a junior psychiatrist for less than a year, working in Scotland.
A middle-aged woman, who suffered from psychotic depression, was found hanged in her room on a psychiatric ward. She had been her normal self only a couple of months earlier, though had deteriorated rapidly. She had developed somatic delusions: unshakable, incorrect beliefs about her health and she was absolutely convinced that she had cancer and was going to die a horrible, painful death. Reassurance from a number of doctors, specialists and her husband made no difference. Even being shown her normal scans didn’t help. Instead, she was inexplicably convinced that we were all part of a conspiracy, hiding the truth from her.
She had made vague statements about how she “didn’t want to live like this,” and that she was petrified of dying painfully from cancer. But when we asked her directly (and believe me, different members of the team, myself included, asked her several times), she denied actual suicidal intent. Looking back now, I still don’t know if she was hiding her true intentions, or if it was just an impulsive decision. I guess I will never know.
Either way, her final act must have been planned. She was on 15-minute observations in a ligature free room, so she must have waited for the right window of opportunity.
I happened to be on-call in the hospital that night, and the consultant psychiatrist in charge, lived quite far away. So it fell to me to break the news to her husband. I still remember the conversation word for word, and I think it will always haunt me. I had reassured him (in retrospect, a very arrogant move) only a week earlier that his wife would definitely get better. Not possibly. Not hopefully. And that phrase kept circling through my head as I spoke to him. I felt like a fraud. Afterwards, all those doubts, those aforementioned questions tormented me. I even temporarily decided that psychiatry wasn’t for me.
But I stuck it out (more due to inertia, rather than bravery) and have now worked in psychiatry for almost 15 years, and have risen through the ranks to become a consultant myself.
I’ve come to accept that the nature of working in mental health means my patient group will always be high risk. For every tragic suicide, there have been dozens of patients who have some of the risk factors, yet managed to pull through. Even the best mental health professionals in the world are not psychic. We cannot predict the future. It would be unethical, as well as logistically impossible, to lock up everybody that we are worried about, indefinitely. We have to use our clinical judgement on a case-to-case basis, and accept that we cannot get it right every single time. We need to remember the many patients we do actually manage to treat, and support to get better.
Having said that, this is a very easy aphorism to write in blog. It is much harder to accept when sat face-to-face with a relative, having that dreadful conversation, feeling like a fraud.
Suicide is a serious issue, and remains the single biggest killer of men under the age of 45 in the country. Funding has been promised for mental health services, £2 billion, according to the last budget. I am interested to see if this trickles down to the front line and makes a real difference to the ever-growing crisis of deliberate self-harm, and suicide.
The Case I Can’t Forget is a weekly series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com.
Useful websites and helplines:
- Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
- Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
- The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk
- Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on www.rethink.org.