The following post appeared in my blog on 8/29/06
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Warning! Those of you expecting a goofy and silly post, this is not one (in fact it is quite serious).
My nurse cried.
He was one of our favorite patients. He missed his appointment today, and since that was not his nature, I called to see what was up. I got his son on the phone who told me, \”He\’s dead. He shot himself on Sunday.\” I couldn\’t believe it and confirmed that this was, in fact, the right number. He left a note saying he was tired of being sick all of the time and he was sorry to do it this way.
The thing is, he would have been one of the last patients I would expect to do something like this. He was in his 70\’s and had been fairly sick over the past week, but I was doing what I could to get him better. He had multiple long-term illnesses, including diabetes, but they were generally well-controlled. He was very fond of me and especially my nurse. He seemed to truly enjoy talking and would make me laugh with some wry comment when he came in.
We first won him over when he transferred care from another doctor. He was surprised at how aggressively we went after his diabetes, but felt so much better for it that I had won a lifelong patient. Then we were able to get him his medications for free through patient assistance programs. After that, he started sending his friends (mostly women) to me to be their doctor. He was well-loved by the ladies, but not in a sensual way – they seemed to have a genuine affection for him. That affection is what we too felt for him.
He spoke slowly and with a gentleman\’s southern drawl. He was known to my staff by his first name, and he was one of those patients I was always happy to see. He gave us absolutely no warning about what was going on inside of his head. When I saw him last week I was concerned about his health, but he never told me how he was feeling.
This abrupt ending makes me take stock of my actions. I do my best to spend enough time with my patients, but tend to get behind and have to hurry to not get any later. I try to listen to what they are really saying (as the famous saying among doctors goes: the patient will always tell you what is wrong with them – you just need to listen to what they are really saying). I try to practice by that rule and listen to what they are really trying to tell me. Yet I get caught up in the rush, the phone calls, the drug-seeking patients, the anxious mothers, and the pile of forms that I have put off filling out. I am trying to manage their diseases by evidence – getting their numbers just right and making sure they have gone to the right specialists. That\’s good care, right?
There are other distractions too. I spend (too much) time blogging and reading blogs. I go around giving talks to doctors about computers. I am the senior partner of a business, so we have all of the financial headaches to worry about. Dare I leave out the fact that I have a wife and four kids at home who need me? Life is busy. Life is busy.
So what does it mean in this context that I laid my hands on a man who later in the week committed suicide? I was one of the last people to physically touch him while he was alive. Did I miss anything? I don\’t really think so. He wouldn\’t have wanted me to worry about him. But I am glad for all of the time I did spend with him. I am glad that I got to enjoy him as a person for the time he was on this earth. I am glad I was one of the good things in his life. I am strangely glad that I knew him enough to be so saddened by his abrupt end.
There will be no funeral. There will be no good-bye. We just have the memory of this gentle southern man who kept it all inside. Maybe I could have done differently, but I won\’t go there. I can\’t go there and keep from going crazy. I got to add more to his life than most did. I need to carry that fact into the exam room tomorrow when I see other patients. Yes, there is a lot to do. But there is really no greater honor to be allowed to serve these people. I can\’t forget that. We all can\’t forget that.
Good-bye, Jimmy. Thanks.
Unless they tell you, no one can know what’s going on inside of another. The only thing there might be to go by is the way they hold themselves or avert your eyes, or are unusually quiet…it could be anything. Sometimes they may appear down right happy, because they’ve already made a decision to say good-bye to it all. It sounds like he didn’t want to share what he was feeling. No one can help if they don’t share. How sad for all who knew him to have lost him this way. Chronic illness has to be a tiring weight. I’m sure if he could, he would thank you for all you did to try to help him. So sad, Rob. I’m sorry for the loss you, and others that cared about him feel.
Unless they tell you, no one can know what’s going on inside of another. The only thing there might be to go by is the way they hold themselves or avert your eyes, or are unusually quiet…it could be anything. Sometimes they may appear down right happy, because they’ve already made a decision to say good-bye to it all. It sounds like he didn’t want to share what he was feeling. No one can help if they don’t share. How sad for all who knew him to have lost him this way. Chronic illness has to be a tiring weight. I’m sure if he could, he would thank you for all you did to try to help him. So sad, Rob. I’m sorry for the loss you, and others that cared about him feel.
Right now, I’m shaken enough that I’ll have to write my post then go back and do the simple math spam protection. Six + eight is too hard. I wish I was being funny, I’m not.
I’ve read more about suicide and survivor notes than you could shake a stick out. All the stuff about “what to look for” is fine and dandy …assuming you’ve got a teenager crying out for help to stop them. It’s wonderful information …if the person is giving out any indication that they really are wanting to live at all. They’ll give warnings. Subtle though they might be …they’ll be there.
For a certain set of people, and it sounds like your patient is amoung them, and I know my Daddy was as well; there isn’t sign one that it’s coming.
You go away one day and they say “I love you” and you come home to find a note that says “You’ll be better off without me and I hope God forgives me.” (abrieviated of coarse)
Their pain, whether emotional or physical is beyond what they let anyone see. Their humor, their love, their grace …. and their gift to the world is so strong that they aren’t even aware of the fact that they still have so much left to give to the world and the weight of the pain they are caring just might be something that is not as permanent as they feel. But their mental strenth that allows them to share their grace and love and dignity with everyone they come into touch with …is the same dignity that keeps them from the ability to say “I can’t take any more”
And then it takes them from us.
I’m sorry Rob, so very sorry. I would give anything in the world for you and your staff to never have experienced this painful experience. He sounds like a man who’s life will have touched your heart forever. As painful as it is, it is a good thing.
Right now, I’m shaken enough that I’ll have to write my post then go back and do the simple math spam protection. Six + eight is too hard. I wish I was being funny, I’m not.
I’ve read more about suicide and survivor notes than you could shake a stick out. All the stuff about “what to look for” is fine and dandy …assuming you’ve got a teenager crying out for help to stop them. It’s wonderful information …if the person is giving out any indication that they really are wanting to live at all. They’ll give warnings. Subtle though they might be …they’ll be there.
For a certain set of people, and it sounds like your patient is amoung them, and I know my Daddy was as well; there isn’t sign one that it’s coming.
You go away one day and they say “I love you” and you come home to find a note that says “You’ll be better off without me and I hope God forgives me.” (abrieviated of coarse)
Their pain, whether emotional or physical is beyond what they let anyone see. Their humor, their love, their grace …. and their gift to the world is so strong that they aren’t even aware of the fact that they still have so much left to give to the world and the weight of the pain they are caring just might be something that is not as permanent as they feel. But their mental strenth that allows them to share their grace and love and dignity with everyone they come into touch with …is the same dignity that keeps them from the ability to say “I can’t take any more”
And then it takes them from us.
I’m sorry Rob, so very sorry. I would give anything in the world for you and your staff to never have experienced this painful experience. He sounds like a man who’s life will have touched your heart forever. As painful as it is, it is a good thing.
Thanks for sharing. That is such a sad situation, for everyone involved, partly because it makes people question their own involvement so much. He can’t thank you for what you did for him but we can.
Thanks for sharing. That is such a sad situation, for everyone involved, partly because it makes people question their own involvement so much. He can’t thank you for what you did for him but we can.
Being sick is not fun. Anyone out there with long term physical illness will have thought about ending it at one time or another. Sometimes we just can’t see a point to waking up every day just to have more pain and strife. Somehow it doesn’t all seem worth it. Maybe that was how he felt.
Being sick is not fun. Anyone out there with long term physical illness will have thought about ending it at one time or another. Sometimes we just can’t see a point to waking up every day just to have more pain and strife. Somehow it doesn’t all seem worth it. Maybe that was how he felt.
I know this is a little off-topic from suicide and I’m sorry for that. I certainly don’t intend to demean the grief and the impact it had on you and your staff. I have a question for you and I really have no idea who to ask.
You described this gentleman as one of your favorite patients. What is it that made him a favorite? I’ve been thinking a lot of about doctor/patient relationships lately. I know what it is that I look for in a doctor, both the bare minimum and the things that make them stand out. And I think I am familiar with some basic patient etiquette (be patient, be clear and concise without rambling, don’t expect miracles, pay your bill).
But what is it that makes a good patient into a great patient?
I know this is a little off-topic from suicide and I’m sorry for that. I certainly don’t intend to demean the grief and the impact it had on you and your staff. I have a question for you and I really have no idea who to ask.
You described this gentleman as one of your favorite patients. What is it that made him a favorite? I’ve been thinking a lot of about doctor/patient relationships lately. I know what it is that I look for in a doctor, both the bare minimum and the things that make them stand out. And I think I am familiar with some basic patient etiquette (be patient, be clear and concise without rambling, don’t expect miracles, pay your bill).
But what is it that makes a good patient into a great patient?
We cannot be all things to all people. We can only do our best. Seems as though you did yours.
So sad…
We cannot be all things to all people. We can only do our best. Seems as though you did yours.
So sad…
We live in a society that dictates us to not talk about our deepest, most painful feelings. We are taught to be the ones that give and not get. We are taught to think of others before ourselves. Eventually, that’s got to do a little “wear and tear” at some point.
Sorry to hear about your loss.
We live in a society that dictates us to not talk about our deepest, most painful feelings. We are taught to be the ones that give and not get. We are taught to think of others before ourselves. Eventually, that’s got to do a little “wear and tear” at some point.
Sorry to hear about your loss.
I am sorry for your loss. Honestly, suicide always seems to make survivors feel this way. I wish I didn’t know so well about that. They don’t intend it to. He didn’t mean to indict the care he got, either – it’s just the total finality of not being able to go back and ask to make sure.
You sound like a very good doctor. At least it sounds like you are interacting with the whole person rather than just their glucose level and cholesterol. That’s getting increasingly rare.
I am sorry for your loss. Honestly, suicide always seems to make survivors feel this way. I wish I didn’t know so well about that. They don’t intend it to. He didn’t mean to indict the care he got, either – it’s just the total finality of not being able to go back and ask to make sure.
You sound like a very good doctor. At least it sounds like you are interacting with the whole person rather than just their glucose level and cholesterol. That’s getting increasingly rare.