Night Shift: Suicidal Ideations

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“Not another suicidal patient,” the charge nurse moaned as the chief complaint of a 14-year-old registering for the ER popped up on the screen. We have no psychiatric services at our hospital and we consider ourselves lucky to be able to disposition a suicidal patient within 12 hours. Doing so usually involves 20-30 telephone calls by a nurse in addition to completing and faxing sets of records to three to four facilities.

I try to take a bit of a different outlook on suicidal patients, especially after a patient that I still remember quite vividly from many years ago. That story began with a junior high school student who just didn’t quite fit in. She seemed nice. She seemed happy. She tried to get along with people. But her classmates would constantly tease and bully her. She wasn’t sure why. The “mean kids” would terrorize her in the hallways.


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She had a box full of notes that the bullies would leave in her locker telling her that she was “worthless” and that no one liked her. She tried out for the poms team and was the only one to get cut. It got to the point that eating in the school lunchroom became so stressful that she used to eat her lunch in one of the stalls in the bathroom.

She thought about committing suicide. Her mother brought her to the emergency department at one point. I didn’t think she was truly suicidal, she just appeared desperate. I encouraged her not to let these bullies get in her head. By reacting to their taunts, she was only giving them power. Instead of being hospitalized, she was referred for counseling.

Unfortunately, the bullying had done quite a bit of damage to the young girl’s psyche. Then God sent an angel to intervene. One of the teachers saw the girl crying at her locker one day. After learning about the young girl’s problems, she gave the girl a hall pass so she could come and eat lunch with the teacher every day. The teacher afforded the student that little bit of solitude the student needed to make it through the school day.


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Slowly, the young girl became confident to the point that she could ignore the bullying. She tried out for sports in high school and made the track team. By her senior year, she was one of two leaders for the pep rallies at the football games. She went on to college, was the president of her dorm one year and graduated with a business degree. One of her most tenacious bullies ended up in jail on drug charges, another dropped out of school and lives in her parents’ basement. I know all of this because I still see her as a patient every once in a while and I still get cards from her and her mother. It’s nice to know that sometimes little bits of advice can make a difference in someone’s life.

The overweight suicidal 14-year-old boy was a similar story. He was a lineman on the junior high school football team. Because of his weight, he was also the butt of his teammates’ jokes. When he entered the lunchroom, teammates would yell “Hide your lunch, Devin’s coming!” If he missed a block during a game, teammates would tell them that he probably wouldn’t have missed the block if he “wasn’t so fat.” He was seeing a counselor, but counseling wasn’t enough to overcome the constant taunting. The final straw came when a family member died and Devin left school early on Thursday to go to the funeral.

One of his classmates yelled out in class “he’s just going early so he can get the free food before everyone else gets there.” The whole class laughed. He felt humiliated. He didn’t want to go to school on Friday, but his father told him he had no choice. In desperation, he found some of his grandmother’s cholesterol medicine and took a few of the pills in a suicide attempt. He then told his mother what he had done. She called an ambulance, but by the time the ambulance was on scene, she had decided to bring her son to the emergency department on her own.

We watched as the triage nurse led him to the designated psych room. He trudged slowly down the hallway with his head hung low. When I spoke to him and his mother, he was calm, but obviously depressed. He didn’t feel suicidal, but just wanted a long weekend away from school so people might forget about what had happened to him in class the day before. Tears streamed down his face.


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The emergency department was busy, but I took a few extra minutes to just sit down and talk with him. I gave him the same advice that I gave to that other junior high student many years ago. You can’t let these dummies get into your head. If they don’t get a reaction from you, eventually they will leave you alone.

Find someone you trust and can confide in whether it is a teacher, coach, a pastor or another classmate. Don’t go through this alone. Your parents will always be there for you – don’t be afraid to talk to them. You will get past this and you will be better than those bullies. You have so much to look forward to in life. I’m not sure if my little pep talk helped much, but at least he seemed to listen.

I left the room to go see another patient as we waited for a social worker evaluation. While I was reviewing the next patient’s medical history, I got a text message from my oldest daughter. “When you have a second to breathe, give me a call!”

My oldest daughter is in her second year of law school and, after a bit of a rough start in her first semester, has done amazingly well. She also is by far the most empathetic one of our four children. She likes to engage in acts of random kindness to make someone else’s day better.

For example, one time I noticed a Starbucks receipt in the garbage showing that she had purchased 2 cups of coffee that morning. I asked her who the other cup was for.

She said that the line at the drive-up window was longer than usual that day. In her rear-view mirror, she watched the person in the car behind her become frustrated, yelling, waving his hands, and banging on his steering wheel. She laughed a little bit, but then thought she would “brighten his day,” so she paid for his cup of coffee before driving off. I don’t know what I did to raise such an awesome kid.

I called her to find out the good news. She was chosen to be a judge for an upcoming seminar for the first-year law students. Only a few students got that honor.

“Congratulations, honey. I’m proud of you.”

“What’s wrong,” she asked, “I can hear it in your voice. Did someone die?”

“No, just a junior high student that is getting bullied and who came in for depression. It makes me sad to see how mean that these kids can be sometimes.”

“Oh … dad.”

“Can’t talk about it now, sweetheart. It’s busy. Congratulations on your honor. I’ll see you when I get home tomorrow. Love you.”

I got back from seeing the next patient and there was another text on my phone. It was from my daughter.

“Now you have me crying. I just started to reflect how far I have truly come. Please tell your patient not to give in to the bullies! They probably see something in him that they know they do not have in themselves and are jealous. You have to go through some valleys before you can get to the top of the mountain you can touch the stars.”

I made a screenshot of her text message, printed it out, and gave it to Devin. He gave me a little smile, folded the paper, and put it in the corner with his clothes.

The social worker came to evaluate him and cleared him for discharge.

I went back to the room to make sure that Devin was OK and that he and his mother didn’t have any questions. His mother told me “I took a picture of your daughter’s message. I’m going to text it to Devin every now and then just so he doesn’t lose hope.”

Then I decided to take a few more minutes to tell them about that patient from long ago who was relentlessly bullied in junior high school in the same way he was being bullied now. I told him how she found a teacher that helped her work through it. I told him how she went on to do well in high school, did better in college, and how she just got elected to be a judge in an upcoming seminar for first year law students at her law school.

The patient and his mother both thanked me, but the best part of that visit was watching Devin walk out of the emergency department with a smile on his face and with his head held high.

There aren’t too many professions that allow you to touch someone’s life like that.

The “proud papa” bit is just icing on the cake.

ABOUT THE AUTHOR

SENIOR EDITOR DR. SULLIVAN, an emergency physician and clinical assistant professor at Midwestern University in Illinois, is EPM’s resident legal expert. As a health law attorney, Dr. Sullivan represents medical providers and has published many articles on legal issues in medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians’ Medical Legal Committee. He can be reached at his legal web site http://sullivanlegal.us.

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