So today my patient told me he wants to kill himself and how. I had a lot of lead-ins to that, but I'm too tired and overwhelmed. Nobody paid much attention. In fact one nurse laughed and said "he can't do that here". Duh. But he won't be in the nursing home forever. And when he goes home it will take 30 seconds to do what he's planning.
I know professionally how to handle this kind of thing. I did what I could. But nobody seemed to get it, that first of all if he has a plan he is serious, and second of all that if he feels like that he needs HELP. He needs to go to psych like 8 hours ago. Instead they are ignoring it, saying "he's just like that". So HELP HIM.
I never realized until today how desperate I felt those last few months. I knew how scared I was, especially on the day that I knew I would do anything to hurt myself if I only had access to more than a paper bag and an ink pen. But it had been a long time since I went through a long period of feeling suicidal, and probably this was the first time I was actually feeling suicidal and really thinking of it. Before it has always been either short-lived or in one time that scared me into treatment, I realized I was completely serious in my intent to kill myself the next time I became more than mildly depressed. At that time I knew only that I had recurrent depression, so I knew it would happen and that when it did I would not be able to handle it again. Telling someone I felt like that was awful, and over the next few months I swung closer and closer to hospitalization. Then the clinical trial happened and I made it to the next hurdle. From then until these last months I've been suicidal and I've even been suicidal for days or weeks, but never with the same steady intensity that it was this time; before it always came and went. This time I thought about it plenty and knew what would work. That's how my patient is. And everyone blew it off as he's safe where he is, he's just feeling old, maybe he's having family issues. OK, so why doesn't someone besides me see that it might be a good idea to HELP him with these things??????????
I'm so angry, and so confused because after all this is a touchy subject for me and I can hardly run around work yelling about how they don't know what they are talking about and that from someone who just got way more suicidal than anyone who knows her inside and out thought she could, it should be taken seriously. And that if he's thinking this, whether he is safe or not, he feels horrible.
I'm going to just go to sleep and try to forget. I woke up at 4 am this morning, I think from a nightmare maybe, and got up and started doing things. I got home at 8:45 or so. I'm worn out and tomorrow is a nice early PT day. Bleck.
I need a day off to process this........
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3 comments:
Once again, you are able to make good use of your experience to help another person when those around you seem ignorant and callous. You are a beacon of light in a dark place. Don't the others know that the elderly, especially men, are in a high risk group for suicide? Do they really value his life this little?
Your co-workers don't need to know that your knowledge and compassion spring from your personal challenges. If you have to explain the reason for your well-founded concern, and I don't believe you do, you could inform them that "someone close to me has dealt with...xyz..." I think you could call upon the general knowledge that they should have as professionals. Is there a higher authority you could inform? At a minimum, they should be concerned as a matter of liability. They know the danger signs and are cold-hearted bystanders. H(eck), even postal workers save lives on their rounds in the neighborhood when they happen upon someone in danger!
You know the gentleman is hurting and you know he needs HELP! He needs someone with a brain and a heart...that would be you. I know you can't do it all but you are the one who can be the megaphone for his cries for help.
I read this quote the other day:
"To this world you may be one small person, but to one small person you may be the world!"
(anonymous )
I would never wish this dilemma upon you but here it is. You are a very important person in a very significant professional role. It seems to be another place for you to minister out of the experience and the help that you've received.
"Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort that we ourselves have received from God."
2 Corinthians 1: 3-4
I hope you can find the right person to contact about this. It's pretty awful that no one was more responsive about this. I would like to think that a nursing facility would have a mechanism in place to deal with the mental health needs of its residents, but I'm probably dreaming.
At my work I tell the charge nurse, and I tell the doctor, and I say that I'm documenting it and that I'm documenting that I told them. There's protocol that the doctor has to follow and by saying that I'm charting it I feel like I kind of passively force them into following it. Of course, we have our docs around regularly so I can always pull this out if I need to.
Alternatively, can you use your expertise (from your prior position in a psych facility- not from your personal experience- if anyone asks) to lead the way in addressing it? Talk openly with the patient about managing, make a contract? You probably know way better than I do what kinds of things I'm talking about. Sometimes I feel that other staff blow it off because they are uncomfortable and feel unqualified to address it. I find that if I come in assertively (but polite and deferential- it's hard to find a balance...) and say something like: "back when I worked at... we addressed this kind of thing as follows..." I often can get other staff on board with my plan.
Finally- The facility's got to have an anonymous hotline, or social worker, or- failing that- an ombudsman that you can go to if you feel certain that there will be an unsafe discharge because of this.
And Michal Ann, yes- they do place a (slightly) lower value on his life- but they probably don't mean to.
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