On the day before the last day at my last job, I reviewed my patient roster. Five of my seven most worrisome teenagers were currently admitted to a psychiatric hospital for a suicide attempt. This was not completely surprising. It is the fall. Teenagers notoriously struggle two to three months after starting school, getting into academic work, falling prey to bullying and stress, or not meeting their goals. But I was still upset. My most worrisome patients are the one percent that I give 125 percent of my energy to. When they show up, I give them and their families my all. Now I found myself running on empty, knowing I would not be able to tell these teens goodbye.

I found myself sitting at my empty desk, in my empty office, thinking about all of the words spoken to these teenagers, all the seeds I thought I had planted in their minds, hoping to sprout into the bright future of their survival, and yet they were back in the psychiatric hospital. I thought about all of the times I would see them and their parents together in my office, crying, fighting, yelling, and not hearing each other. I would pry the parent out of the room to spend my focus and expertise on the teenager, to help them reframe their world, their words, and expectations of their battered and bruised parents. All of the time, I would go over coping strategies, again, for the 10th time. All of the time, I would go the extra mile to crack a smile, a laugh, even a look of anger — but the recognition that, yes, a painful truth was brought to light and maybe the key turned to open the gateway to change. I felt helpless several times. More often than not, though, I felt some opening. I felt some hope. I felt I catalyzed some progress. And still, my teens are currently hospitalized.

I had a dream about one of them. They came to me in a dream, distraught, scared, and crying like a ghost. They asked me: “I don’t have a home anymore. I have nowhere to go. Can I stay with you, please?” It jolted me out of bed in a cold sweat. Every psychiatrist dreams about their patients once in a while, right? It can’t just be me. The next morning at work, I was alerted of her inpatient psychiatric admission. They had attempted suicide by drinking a bottle of red wine and swallowing three bottles worth of pills I prescribed.

I found myself wondering out loud in my empty room: What if I focused on the wrong person? What if I had taken the teenager outside and worked with the parents, helping them gain the tools and skills to calm themselves before reacting to their fiery teen? What if I empowered them with the questions to ask and the statements to avoid? What if I gave them the skills to work on with the teenager to complement my interventions?

And again, I reminded myself that insurance does not reimburse for parent psychoeducation. That it is more lucrative to a company for me to see one more patient quickly than to spend a little more time on my worrisome one percent. And again, I reminded myself that this is why I cannot work for managed care any longer.

I wondered what goes on in the mind of a teenager when they write a suicide note. In essence, it is the same as the notes I am contemplating writing right now — a most final of goodbye notes — in fact. Are these the same things that are running through my mind right now? How do I capture the few words to describe what you mean to me? What are the top three things that I want to tell you to etch me, or what do you mean to me in your mind? What is the mark I hope I have made in your life that I want you to remember? Does it really even matter at all?

Handwritten notes are an archaic token of tender compassion. Displayed on mantles or pushed into boxes stuffed under dust in the attic. Most of my patients can barely write at all. But the image of my patients seeing a card that I wrote, telling them that yes, they are special, and yes, they matter to me, and that I believe their life is worth living, compelled me. So I found myself crafting goodbye letters, penning them with my own crabby handwriting, hoping it would find its way into my patients’ hands one day.

One by one, I started reviewing the pearls of wisdom that I have learned from them and my hopes for their future. In each card, I found myself writing variations of the same message. Envision your life in five years. Your vision can become your reality if you walk towards it and work a little at it. Your reality is in your hands. Your hands can be used for both hurting and healing. Choose healing.

And then I paused, feeling compelled to write goodbye letters to their parents as well. One by one, I started imparting the advice I had already given to them. You are your teenager’s anchor and lifeline. You can flare or extinguish their flames. You are the adult. They are the child. That means they are still learning. Forgive them with their rash and prickly ways. Apologize to them when it’s warranted. Love them with all of their flaws. Show them what life is worth living for.

In my office, on my wall, was a copy of the Serenity Prayer. I felt inspired to rewrite it for these parents.

Prayer for the Parent of the Suicidal Child

Love,

Grant me

The curiosity

To question the content of my feelings and the origin of my reactive words,

The patience

To listen and receive the answer without judgment and self criticism

The humility

To forgive myself and my child for the past and for the present

And the bravery

To take action upon the wisdom that unfolds-

Turning hurt into healing,

Creating a future worth living for.

I then came upon the final note, the goodbye note for the suicidal teen in my dream. I wrote many things, but in closing, I wrote: “You will always have a home in my heart. Promise me you will give your heart a chance to beat a little longer. I wish you the world.”

To every suicidal teen and their parent reading this reflection, I urge you to find a way to make your heart your home. You can always go there no matter what happens or how hard life is. If we can all work on this goal, maybe it will be easier for our suicidal teens to find their way home. I wish you the world.

Shivana Naidoo is a child psychiatrist.

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