Sunday, July 10, 2011

Patient Suicide: Part Two -- 30 Minutes to Think

This is part of an ongoing story about a patient suicide. Click here for Patient Suicide Part One: The Phone Call, here for Patient Suicide Part Two: 30 Minutes to Think, here for Patient Suicide Part Three: Fully Present, here for Patient Suicide Part Four: What's a Life Worth, here for Patient Suicide Part Five: Treat People Like They Matter, here for Patient Suicide Part Six--Leftovers, here for Patient Suicide: Part Seven--Training Monkeys/Herding Cats, and here for Patient Suicide: Part Eight--On Scarves and Lessons Learned

Those of you who are therapists are likely well acquainted with just how much one can get done in ten minutes. Phone calls, a bite to eat, a quick trip to the restroom, and maybe a quick game of solitaire. I've done all of these in ten minutes--and sometimes more.

The day my phone rang and I learned that a patient of mine had killed herself I was "lucky". I happened to have a full 30 minutes free. Part of that time was spent listing to the voice mail a friend of my patient left. I just simply couldn't believe what I heard. It didn't compute. It didn't make any sense. I thought perhaps I heard it wrong. My patient had tried to kill herself and was in the hospital. That must be what I heard. I entertained the notion that maybe this was an elaborate practical joke. My patient had a wicked sense of humor. This wasn't funny.

In the end, I heard the message clearly. My patient used an extremely effective method to take her own life. She was dead and wasn't coming back.I had a very short window of time to get my act together--to figure out what to do.

I had of course no idea what to do. You would have thought I would. After high school I logged twelve more years of education. I had over 20 years of work experience in a variety of mental health settings. I logged well over 10,000 hours of supervised clinical experience.

I know exactly how to conduct a suicide risk assessment. I know myriad steps at reducing the risk of suicide. Not a single class, reading, or moment of supervision about what to do if a client took their own life. Whoops.

Maggie the therapy dog needed her afternoon walk. The friend of my patient, the person who made the call to me, needed a call back. My patient's psychiatrist needed a call. I figured calling the family of the patient was the right thing to do, too.

I made the phone calls. I don't really remember what I said. I remember saying how deeply sorry I was for the loss of this human being. I remember offering up my time. "Come in to my office, if you'd like." I figured the only thing I could do is that which I do best: listen to the experience of of those who were left behind. No one available, of course. I left a lot of voice mail messages.

The call to the psychiatrist was surreal. I've never had to be the first person to tell another person that someone they know was dead. How does one do that? After I hung up the phone after leaving and deleting the message for the psychiatrist. My fifth and final version came right from the role modeling I received after years of viewing ER and Grey's Anatomy.

Are you kidding me? Twenty years of experience and I'm using what I learned from prime time TV? Crazy.

Maggie the therapy dog knew something was up. I remember her pressed against my leg while I was making the phone calls. Still not sure of what to do, I figured I'd mobilize some resources. I called my partner, who was at work and of course not available. I called to friends who were psychologists. They of course were with patients. I called my supervisor I worked with when I was a post-doc. She'd know just what do do. She of course wasn't free, as she was with patients, too.

Maggie and I went for a walk to the river. I think it was raining, though I really don't remember. My half hour came to a close. I dried Maggie off from the rain and got myself a fresh cup of water. I sent Maggie out into the waiting room and she brought in my next patient. We saw five more patients before the day ended. I didn't think of my patient and her death again until I was walking out the door.

How did I manage that one? I don't know. Maybe it's a defense mechanism. Maybe it's mindfulness. Maybe it was shock.

As I walked to my car that evening I started thinking more about what I should do. Does confidentiality survive a patients death? Yes, it does. I could talk to her family, I figured. I could talk about my experience. I couldn't talk about the patient's experience. I didn't have a release. It seems like a human failure thought to not talk with the family about the patient. What was I going to do about that? At least I clearly knew I could talk freely with her psychiatrist: we had a release.

What about me? Who do I talk to? I thought about the law, the reason why we have laws about confidentiality, and what that confidentiality means. I also thought about the very human nature of this experience. What's the human thing to do? How do I balance the law with the humanness of this situation?

I thought about what the right thing to do was. My patient had a long term relationship with another psychiatrist and psychologist. We had many conversations together when my patient started working with me. I decided that the human thing to do -- and within the legal framework of confidentiality -- was to call them and let them know what happened. I called them, and left a message for both of them. I also knew I'd need an ethical consult. I made a note to call my malpractice insurance the next morning to schedule time with the JD/Ph.D. they have available to talk to in such situations.

30 minutes to think. That wasn't a lot of time. I was in shock. I was confused. I had more patients scheduled who needed my attention, time, and energy. The generous interpretation was that I was mindful. I set aside my thoughts and focused on what was in front of me. Part of what happened was mindfulness. That's for sure.

Part of how I made it through the rest of the day was the process of grief. It's what we do. We set things aside, we deny what has happened. We store it way for when the time is right to take it out again and look at what happened.

Walking out  my office I knew there was no denial strong enough to make this untrue. My patient was dead. I wouldn't see her again. I wouldn't be able to ask her about what happened. The place she sat in would forever be empty.

Months later I'm still reminded of her absence. Twice each week during her regular appointment times I notice the place where she sat. I notice it is empty. I notice the questions that will never be answered. I notice the life that no longer is.


  1. thank you for sharing. what a beautiful and honest rendition of this experience.
    Paula Young

  2. Thank you for telling how it was for you. I am a recent grad in professional counseling and a survivor. My brother completed suicide just seven weeks ago. I will have patients some day....lots of questions that will never be answered.....I am bookmarking your blog....

  3. Thank you so much Jay for sharing..I am finding the courage to one day share my story as well. Know you are not alone in your grieving process.


  4. @Paula. Thank you so much for your kind thoughts.

    @Lisa. You're welcome. The questions that will never be answered.... those are the hard ones. Grief has so many ups and downs.

    @jljones. I'm glad you are finding the courage to tell your story in your own way, too.

  5. Again, really grateful for your honesty and for sharing your pain and confusion as is. I find it personally very helpful and I am very glad you decided to blog/post about this.

  6. I am someone who struggles week to week with suicidal intentions and have always wondered how it would affect my therapist. I suppose the fair thing to do would be to quit therapy and wait a few weeks so he would not know so it wasn't under his watch. Right now he is the reason I still make it week to week.