The vast majority of folks I see want to kill themselves

I love football.

There is one thing that I absolutely believe to be true about the sport I love.

Any given team can beat any other team on any given day.

Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well.

At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of the consults I worked on and completed that day. I list the initials of the patients and the demographic information about them for the bean counters who hang out in Columbia making sense of what we clinicians do every day. I add a few diagnostic codes, and then I also look at a little drop down menu that allows me to describe in a few simple words why they needed to see me in the first place. The reason for the consult.

On any given day, the pattern that jumps out at me is something like this:

Danger to self.

Danger to self.

Danger to self.

Danger to self.

Danger to self.

In other words, the vast majority of folks I see on any given day want to kill themselves. They are suicidal. They have tried to slit their wrists or overdose with pills or drink bleach or hook hoses up to car tailpipes or shoot themselves in the chest.

Now, most days I am pretty circumspect about my job. I know that it is stressful. I realize that it puts me at risk myself to hear story after sad story about the woes and trials and tribulations that my patients bring and leave at my feet. Anyone who knows me, has had a conversation with me or reads me knows that I am a person who loves stories. I love to hear them. I love to tell them. I love to write them. I will go back to work at the clinic this morning because I know today, through stories, I will learn something that I did not know yesterday, something that I can use to help someone else tomorrow.

On any given day, however, the stories can be so bad, so terrible, so hopeless and so horrible that they try their very best to not only beat me up, but to beat me. Finish me. Pummel me. Make me quit. Send me packing. Some days I feel defeated by them. Some days I am flat out of answers, suggestions and positive statements. Some days I slink out the back door, swiping my little electronic card to get out, half hoping that when I come back the next day it will malfunction and not let me back in.

But you know, if this list of woe, this chronicle of misery can beat me yesterday, then today is a new day. It can be my time to come back, march down the field, score a last minute touchdown and win the game. On any given day, I can be the one who comes out on top, not the misery that the world would throw at me by way of my chosen profession.

I saw a lady yesterday who is very, very ill. She is sick physically as well as emotionally. She knows this, and it torments her. She cannot do what she used to do, no, she will never be able to do those things again. She is depressed, sad, sometimes hopeless, sometimes suicidal. She has been in counseling. She has taken medications. She is only marginally better. She is worried that nothing is going to work, that she will never feel good again.

I could sit there with her and commiserate, feeling sorry for us both, the defeated patient and her defeated doctor, helpless in the face of one of the illnesses that lead to more than thirty thousand suicides a year in this country. I could write her off as just another very, very difficult case that I don’t know how to solve, how to fix.

That’s not why I went into medicine.

On any given day, my job is to be there for her, this lady who came shuffling in with braces and cane and aches and pains and depression to see me when she’d rather have stayed at home hidden away from the world.

On any given day, my job is to be there with her, to listen to her story, find something in it that will guide me and teach me how to best help her.

On any given day, my job is to try, and try, and try again, until there is no more time on the clock.

That is the only way to win, in football, medicine and life.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

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  • FugaziedUp

    Ever feel like you are trying a lot harder than your patients to make them well?

  • meyati

    I think that some of the mentally ill are the bravest people in the world.

    I had a schizophrenic student that was put into detention at the end of the semester, so he was put into ISS, In School Suspension. He nagged and begged the ISS teacher that he needed to take his math finals. He had asked me if he could take them early. He knew that he was slipping into that abyss. I was suspicious that he might give the test answers to the others. The ISS teacher came down with him to see if he could get his finals. She was surprised that I handed them to him. I told her that if he had any questions, they could call me. She smiled and said that wouldn’t happen. She brought him and his test back. She couldn’t help him, she didn’t understand it at all, and what teacher gave students 10 page finals? Dr. Gregg, he finished the test, I graded it right there, so he knew what he did- 3.6. He left the campus and checked himself into the juvenile psych unit for about 2 weeks.

    About the possible cheating for the other students? He had the same type of questions, but different variations.
    For me, it has been a privilege to know some of these students and vets.
    Did you make a difference to your patient with the braces? Yes. If your true care and personality didn’t make any difference, she would have blown you off, but she was there because you help her to give meaning to her life.

  • Richard Willner

    I listen to Physicians and Surgeons who have gone thru Sham Peer Review, State Board Abuse and has issues with credentialing. Yes, many of those want to kill themselves.

    But, there ARE solutions…

    Richard Willner
    The Center for Peer Review Justice
    “Doctors Are Our Patients”

  • Rob Burnside

    There’s a difference between Greg Smith and other QMHPs I’ve known. I’m not sure if it’s in the Q (“qualified”) or the P (“professional”), but I suspect it’s neither. Rather, it’s in the MH (“much heart”). Makes all the difference in my book: Ask Not for Whom the Clock Ticks. Roll on, Doc!

  • ValPas

    I wonder sometimes, with all the mental illness in our country, if we shouldn’t take a look at the Buddhist understanding of the world and its pain. Our culture certainly seems to generate a lot of despair and psychopathology.

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