A Sin, A Crime, An Occupational Hazard

Joshi, Sapna

The phone call came as I was going through my routine “condoms, condoms, condoms” talk for a patient who was busy swallowing azithromycin pills for chlamydia. My receptionist said there was an important, confidential call on the line. After wrapping up the visit with my patient, I picked up the phone.

It was an ER psychiatrist on the line. The call was about Vivian, one of the university student patients I saw regularly at my clinic in the small “college town” where I worked. Vivian was my success story: severely depressed when I met her four years ago, we had started her on medications, and she had engaged in cognitive-­‐behavioural therapy with me. My work with Vivian largely involved helping her find coping mechanisms for difficult situations – situations that had caused her to feel suicidal at times. I last saw Vivian one week ago for a mental health check-­‐up, when she had shared every embellished detail of how her boyfriend had proposed to her. Her engagement ring was dazzling, almost bright enough to compete with her smiles. At that clinic visit just a week ago, Vivian had not shown the slightest hint of wanting to harm herself, but we had done a suicide risk assessment to be thorough.

The ER psychiatrist somberly told me of Vivian’s suicide attempt that morning, only a week after she had seemed so well in my office. She had taken all of her anti-­‐depressants, plus a handful of Tylenol. My eyes stung, my breath was shaky, my hands and feet felt clammy. I could not believe it – we had done a comprehensive risk assessment just a week ago, and I thought I knew Vivian so well! I told the ER psychiatrist about my visit with Vivian last week, including her reassuring suicide risk assessment. The ER psychiatrist assured me that my assessment was appropriate, that I had done nothing wrong. Yet after hanging up the phone, so many thoughts swirled in my head: How could this happen? Does her fiancé know? Do her parents (also my patients) know? What did I miss? Did I do something wrong? Have I failed my patient?
I shut myself in the clinic room and locked the door. My computer screen displayed the long list of patients left for the day: five patients already in the waiting room. I wondered what to do. Would my staff understand if I left work at this time? Would my patients understand? Would they all think I was a terrible doctor?

I took a deep breath, swallowed, said a quiet prayer for Vivian, and moved on with my day.
That day, and the days that followed, felt simultaneously slow and hectic. Vivian’s parents came to the clinic to discuss their daughter’s suicide attempt. A devout Catholic, Vivian’s mother was astounded: “How could my own daughter attempt such a sin?” Both parents shunned the act and disparaged Vivian for the suicide attempt. While struggling to make sense of my own thoughts and feelings, I listened to Vivian’s parents and provided as much emotional support as I could.
However, my own suffering and confusion made me feel a sense of inadequacy as the parents’ physician, so I offered them additional therapy and support through our clinic’s counseling services.

Two weeks after the suicide attempt, Vivian came in for a follow-­‐up visit. She had been admitted to the hospital for an entire week. Her father had called 9-­‐1-­‐1 when she had told him that she had taken an overdose. Vivian shared with me that being escorted to the hospital by both the police and paramedics made her feel “like a criminal.” I learned that the overdose had been triggered by an argument with her fiancé, which had ended by Vivian heatedly telling him that the engagement was over. Vivian’s suicide attempt was her effort to cope with her deep feelings of sadness, anger, and regret.

With the help of our clinic’s shared-­‐care psychiatrist and Vivian’s counselor at her university, we were able to create a more robust safety plan with different coping strategies. Vivian later told us that the suicide attempt was perhaps a blessing in disguise: the subsequent mental health treatments gave her the skills to cope with a stressful year of wedding planning and adjusting to married life.

Were it not for the support and empathy I received from my colleagues in family medicine, psychiatry, and counseling, I may not have been able to cope with my patient’s suicide attempt. The shared-­‐care psychiatrist at our clinic was especially supportive. She told me, “Sometimes you do everything possible to prevent a suicide. Despite all that, suicide attempts or even suicides can happen. In mental health care, it’s kind of an occupational hazard.”
Vivian continues to learn and use new coping skills as a suicide survivor. Similarly, I too continue to learn and grow as a clinician survivor of my patient’s near-­‐suicide. 
Theme: Teaching and Learning | Enseignement et apprentissage
Theme: Physicians | Médecins
Theme: Patients | Patients 
Theme: Health Care Delivery | Prestation des soins de santé 

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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