Friday, February 24, 2012

Patient Suicide: Part Five--Treat People Like They Matter

Between Light and Dark

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

My patient who killed herself told me once that when she died she wanted no obituary, no service, no tomb stone--no marker of any sort that made mention of her life. She wanted there to be "no memory that my sad life ever existed on this planet." She was a woman who was suicidal for more than half of her fifty some odd years on this planet. She was a woman who faced an unrelenting depression that possessed such strong gravity that it was hard for any emotion to break free of the soul-crushing grip of its power.

I've been thinking her wishes a lot these last couple of weeks. From time to time I think I might be comforted by visiting her grave. My experience of her death seems incomplete. She was alive one day, coming in for twice a week appointments, engaged in future planning, and talking about her beloved pet. The next day there was a phone call and she was dead. Gone. There was no space between life and death for me. I'm beginning to understand that one powerful thing rituals surrounding a death provide is a space to experience this moment in time--the moment between here and there, life and death. 

I broke my long standing rule of never using Google to search for a patient. It appears that her family respected her wishes. There was no public funeral. No obituary appeared in the paper. No record of a burial exists anywhere I look. A few of my patient's friends are looking for her, hoping she is safe. Beyond that, it as if she was never here. She got her wish and was erased from the record of this world. Or did she?

The anniversary of her death is nearing. I need not look at a calendar to know the time is close. As the weather moves toward spring we here in New England are inhabiting that place between the unrelenting dark nights of winter and the radiating light days of summer. I can feel my dead patient in the air around me. This time between light and dark will forever remind me of her lifelong struggle in that place. This time will forever serve as the marker of her life.

It's been nearly a year since my patient killed herself.

My patient is etched in the record of my heart. I wish I had thought to tell her this when she was alive. In her death, she taught me never to make that mistake again. This past year I've seen my own work transform. I find ways to invite my patients into this private space so we both can discover the ways in which we have impact on each other and etch our experience of each other upon the surface of our hearts and souls.

Maybe that's enough to save a life. Maybe it's not. It's the best I have. As I sit in my office chair and feel the pull of depression on all life and light around me I become increasingly aware this that is all I have. It's all any of us have.

My patient carefully selected the method of her death. After years of talking about suicide, and having therapists talk with her about the trauma she would cause others who found her, she selected a method that had the least impact. I'm sure she did this in an effort to begin the erasure of herself from the record of the world. She didn't want to hurt anyone--and she didn't want to be remembered.

The tragedy of this suicide--and any suicide really--is starting to surface for me in this space between light and dark. As this past year has elapsed I find myself overwhelmed by an understanding that the only tool left my patient had to make an impact--to show others how she felt and what she was experiencing--was to kill herself.

In her attempt to erase herself through suicide, my patient ended up doing something else. She seared a memory of her experience in those of us who knew her. She made an impact on us. The tragedy was that she never experienced that impact--and that connection--in her life.

Treat people like they matter. It's the most important thing you will ever do.


  1. With your help, your patient has impacted the lives of people who never knew her in person. She has affected more than your own practice and therefore the lives of many other patients. Her influence goes on and on in a ripple effect.

    1. Thank you! I've somehow missed responded to your comment. It means a lot.

  2. I understand her desire to leave nothing of her self behind. I've suffered a long time with depression and I've entertained thoughts of suicide.

    We're not worthy of being remembered. We failed at life in the most significant way possible. We literally failed to live. We hurt those in our lives. Let us go. Forget we existed. Be happy. We were only ever poison while we lived. We also do not want to believe there is anyone who would mourn our passing.

    We were never good at creating, maintaining, experiencing connections. We don't want to think that there may be more people than we know who's hurt by our death. It's bad enough to think of the few we know will hurt like parents or children. Knowing you really matter to someone does make a difference -as long as it is true and sincere.

    I wouldn't want a funeral or obituary or marker whether I died of natural causes or by my own hand. In my case, it would be a financial burden to those left behind. I'm kinda cranky though too -leave me alone in life and death. But, I also understand the need to grieve.

    I think, and I think your patient would feel this way as well, if you need to do something to honor her memory as a way to heal your own hurt, you should do something. Perhaps you could make a small donation to the local animal shelter, since you mention she had a pet she loved. I'm sure she would appreciate it.

    Take care,

    1. You know, I've learned from this experience that funerals are not for the one who has died: they are for those who are left behind. It becomes complicated territory, I think, respecting the wishes of the dead while doing what one needs to do for the living. These blog posts have been my funeral, my grieving (the public part, at least), and my way of saying goodbye.

  3. Reading about your experience with this patient has greatly impacted me. I think I first read it in November and since then I have started to ask for help. I'm so afraid to continue as I have been because I know it is leading me to end up as your patient's life ended. I never truly believed that treatment is possible. Listening to how much her life mattered even though she couldn't feel it, breaks my heart. I don't feel it either but now I'm at least open to considering that my thoughts may be distorted. I haven't yet seen a therapist but I have been talking to one through email and I'm feeling almost safe enough to go in. I never would have tried to get help if you hadn't reached me with this experience. I want you to know that your patient didn't kill herself because of something you did or didn't do. Its not that you weren't helping her because you were, and I think she hoped you knew that you made a difference in her life. I know my life isn't valuable in my mind and of course I wish she were here instead of me, but I am still here because of her story.

    1. So honored that reading these words have given you a little courage to move toward your own healing.