Suicide is painless--not so much

Working shifts in the hospital, I have gotten called to the emergency department several times to see patients who have attempted suicide. These are draining situations for all who deal with them, for a lot of reasons--sometimes the staff members have lost relatives or friends to suicide or have histories of depression, as I do. The situations that give me the coldest chills are the truly lethal ones, where it is possible to piece together the story and realize how intent the patient was on death. Each story is different but every one involves careful planning, concealment, deception of family, all in the service of a drive to death. The patients arrive at the hospital only because some strange fluke resulted in discovery of their plan; but they don't always survive. Depending on the means they've chosen to kill themselves, or the amount of time elapsed before they are found, it may not be possible to save them. If they do live, it may be only a matter of time before they try again. I suppose that what makes these calls especially creepy is that the drive to live which often helps other patients survive extreme challenges of illness or injury is, in the lethally suicidal patient, locked in combat with a relentless drive to death, and it is truly--truly--unclear which drive will prevail. Very scary stuff. And the families--no idea the patient has had this in mind, it hits them straight out of left field. The first priority is survival of the patient but even when that happens the story is only beginning. I don't think things ever go back to "the way they were" after a lethal suicide attempt. Treatment for the patient might or might not help--not every person responds to medicines for depression--sometimes the suicide attempt itself leaves disability--the lack of parity for mental health treatment means that medicines and therapy may be out of reach--and the stresses, losses, pain that may have interacted with the patient's depression may be irreversible. It is very hard to find hope, to encourage families to have hope, when the obstacles are so formidable. It is hard for me to stand at a bedside with family members, watching the numbers on a monitor, hoping against hope for signs a patient is going to survive the physical consequences of a lethal attempt. I know in those moments that the family can't completely comprehend what lies ahead and that they will be desperate to find a fixable problem, to ensure the horror won't happen again. But what is true is that when the drive for death overwhelms the drive for life, there is no way to prevent a suicide. And that is a sobering reminder of finitude, of how utterly limited we are as human beings.