“This is not happening” I muttered under my breath as I hastened towards the female ward. I could hear the commotion halfway to the ward from my call room and people hurdled in groups on the corridors.
“Is it true?’’ I asked the nurse closest to me as I entered the ward. She was a very attractive woman, slim and curvy, and she always had a smile on her face, something that made me take a liking to her. But her face was grim, and without a hint of a smile. She nodded.
I heard excited noises coming from the side room, and I moved towards the source. The sight that I saw rooted me to the spot. A patient had committed suicide. Not just any patient but my patient. I had reviewed her yesterday and she had betrayed no ideas of wanting to kill herself.
She was lying on the bed in the middle of the room, a dark complexioned woman, on the plump side wearing a gown made with Ankara and with her eyes closed like she was sleeping. At first, I thought it was all a joke but my expert eyes have picked the absence of respiratory effort and knew that this was real. She really had killed herself.
There were several nurses by her bedside, all talking and shaking their heads. Sorrow and apprehension reflected in their faces. Suicide in a psychiatric ward was not a small matter. It usually leads to an inquest and it is not something to look forward to.
‘’But how should we have known?’’ one of the nurses lamented. “She appeared cheerful and full of life and displayed no suicidal tendencies!”
“She only said she was feeling tired and couldn’t attend the occupational therapy session” added another.
As the conversation swirled around me, I recalled my interview with the patient the previous evening.
“Mrs. Ibe, how are you? You are looking good today” I enthused “that is one nice gown you are donning”
She had smiled. “Thank you doctor. I really do feel better today”
I had noticed that she was making eye contact with me, which was remarkable. Ever since her admission four weeks ago for a major depressive episode, she had been withdrawn, talking with a low tone and sparingly and never maintaining eye contact while talking with anyone.
“I am happy to hear that” I said and made some notes in her case note. “Can you rate how happy you are today?’’
‘’I would say 50%”
I scribbled some more. “Do you enjoy any activities on the ward now?”
“Yes. Playing Ludo with the nurses and patients”
I looked up at her and smiled. She really had made remarkable improvement. She smiled back and I noticed she had dimples on her cheeks. I wondered what kind of person she was before she became depressed. A lively one, I concluded, and from her history, she had been described as a jovial person.
“Do you think about dying?’’ I asked, looking her in the eye. I remembered the consultant had said that asking about suicidal intent should be done in a matter of fact manner. If the patient should sense that the doctor is uncomfortable with the question, then it’s likely that they would not want to talk about it.
“No” she replied, without hesitation.
“When did you decide that life was worth living again?’’ I probed.
“About two days ago. I realized that none of what had been happening to me was my fault and that I had no control over it. I had only been looking at it the wrong way. It wouldn’t hurt to give life another chance’’
‘’ And what about your work and the future?”
She smiled and looked away. “Well, sometimes things doesn’t go as planned but I am a chartered accountant with ten years of experience, I am sure I won’t be in the job market for long”
“Have you been thinking about harming yourself in any way, or killing yourself?’’
“Not anymore. Not in the past two days’’
But here she was, dead. I replayed the interview several times in my head. Did I miss something? Had she been giving any signs that I failed to pick? Any non-verbal cues? I couldn’t place my hands on any. But she looked away when I asked about her job, did that mean anything?
The matron noticed my presence then and her voice intruded into my thoughts.
“Doctor, you are here’’ she said
‘’How did it happen’’ I asked, my voice a bit lower, and raspy.
‘’She just said she was feeling a bit tired and not up for the occupational therapy session’’ she looked at the dead body before continuing “we told her to get some rest before dinner was served’’. She sighed “So when it was dinner time, we came to her bed to wake her and found her like this” gesturing towards the bed.
‘’How did she do it?’’
“She took an overdose of her antidepressants”
“Where did she get them?” I was shocked.
‘’apparently, she had been cheeking her drugs’’ she shook her head disbelievingly, “we did not suspect her at all. She was always taking the drugs with no persuasion whatsoever. We found a hole under her mattress where she has been storing them. As if she was reading my thoughts ‘’we saw a tablet left, she probably missed it’’
It was hard to believe. She had been deceiving everybody and had been planning her death for a long time.
‘’we need you to certify her before we can transfer her to the morgue’’ the matron’s voice broke into my thoughts.
I went about the motion of certifying her; checking and confirming the absence of a heartbeat, and absence of the light reflex.
‘’clinically dead’’ I wrote in the case note and signed her to be taken to the morgue.
Next, was making the call to the senior registrar informing him on what had happened. Something I was not looking forward to doing. So much for a calm call, I thought despondently. Not only had a patient committed suicide but one from my unit, and I get to face my consultant tomorrow at the rounds.
feedbacks are always appreciated. please drop your comments in the comment box.
share with friends too.