Saturday 1 April 2017

Look of disappointment

Clara looked at me with sad, red eyes, tears welling up and starting to run down her flushed cheeks.  I've seen that look before, many times.  Many, many times.  Usually the look comes when I've told someone her son was just killed and I couldn't save him, or someone whose wife has a terminal cancer that I just can't cure.  But not this time.  Clara wasn't related to the patient, she was the patient.  Her look was indeed one of deepest disappointment and sorrow, but it wasn't because she was sad, and it wasn't because she was hurt.  It was because she wasn't hurt.

If it doesn't make sense yet, it will soon.  I promise.  

My trauma shift starts at 8 AM, and it ends exactly 24 hours later.  Full-day shifts are torture; they are antiquated things that should have been retired long ago, but they persist in many places because we haven't come up with a better system.  The worst part of the shift is theh 7 AM - 8 AM portion, because it's right at the time when most people are driving to work and car accidents are likely, and it's right at the time when I'm counting the minutes until my shift is over.  So when my pager went off as I was making rounds at 7:35 AM and looking forward to my first cup of coffee, I was unsurprised but thoroughly disheartened.  What did surprise me was the mechanism of injury:


Wait, what?  Who the hell gets shot at 7 o'clock in the morning?  I quickly trudged down to the trauma bay, my mind running through all the possibilities.

None of them, it turned out, proved to be correct.

Clara (not her real name™)  rolled in looking even more disheartened than I was.  That was . . . strange.  Most trauma victims look in pain, angry, half dead, or giddy (in the case of Drunk Driver type 5), but not Clara.  She just looked . . . blank.  She was staring straight ahead at nothing and no one in particular, her face slack and emotionless.  Then she slowly turned her head towards me, and while I expected a smile, a frown, a scowl, or something, her expression did not change one bit.  She simply looked at me.

"Hi Doc, this is Clara.  She's stable, oxygen sats 100% during transport.  She tried to kill herself this morning by shooting herself in the chest with a hunting rifle."

Ah.  That explained her look of sheerest despondence.

Clara dropped her head and stared at the gurney, her face still impassive.  I was half expecting her to either complain, deny, or cry, but she did none of those things.  She just sat.  While I felt terrible for her and her obviously hopeless situation, it was also a very troublesome situation for me, because I then had to say something that I knew damned well she did not want to hear.

"Hi Clara, I'm Doctor Bastard (not my real name™).  I understand you were trying to hurt yourself, but I need to make it clear to you that it is my job to make sure that you do not succeed."

She merely glanced at me briefly, nodded once, and returned to staring at her lap.

The entry wound was in the upper outer portion of her left breast, and the exit wound was on the outer portion of her left back.  Based on the trajectory (and the fact that her lung sounds were clear and equal), it didn't look to me like the bullet had entered her chest, but obviously I needed to be sure.

Her chest X-ray was completely clear (except for a few small bullet fragments in the subcutaneous tissue), an ultrasound of her chest was normal, and a CT scan confirmed that no major damage was done.  No fractured ribs, no pneumothorax, no injury to the heart.  As soon as I saw the pictures, I walked into the scanner to tell her the good news, which (I realised as I was saying it) she would take as bad news.

I put my hand on her shoulder and said simply, "Hi Clara.  I just looked at your scan.  I know you don't want to hear this, but the bullet did not enter your chest.  There's no major injury."  Before I could even finish, her emotionless expression started to break down.  "It's ok.  You're going to be ok.  We're going to get you the help you need."

With that, the flood gates opened, and Clara started openly sobbing.  "Oh no!  Oh god, no!  I can't do this anymore.  I'm 53 years old, I've lost my husband and both of my kids, and I just can't do it.  I can't do it any more.  I just can't!"  She continued to sob as I tried to figure out what to say next.  What could I say?  Is there anything that could make this hopeless situation remotely better?

Ultimately I decided that there was nothing I could say to her that would assuage anything.  I simply gave her arm one final friendly squeeze, smiled meekly at her, and walked out, while I looked up the name of the psychiatrist on call.

Yes, today is April Fools' Day, but this is not a joke or a hoax.  This is a 100% true story.  Clara is a real patient, a real person, with real problems that are clearly worse than I could possibly imagine, bad enough that I had a great amount of trouble empathising with her.

I'm posting this purposely on April 1 to give everyone a break from the silliness that reigns on this date, simply to remind everyone that life isn't a joke for everyone.  


  1. I have known too many people who took that way out. I've also met some for the first time when they took that way out. one close enough that I heard it happen, though I didn't connect it until the tones came in.

    sometimes I think we could do something about it if we just had the social will.

  2. Sometimes in our lives we are confronted with a situation that we have no way of knowing how to handle the situation, and situations like this because we have not been to he place they have- the abyss. A month or so ago I had a much darker situation- a revelation that a friend of mine, a guy, had been raped by another man some years ago (note he wasnt gay) The other person in the room had had a suffered similarly and they comforted each other. All i could do was leave the room as how could I possibly comfort either one.
    I may have been in a dark place in my life before, i contemplated suicide at one point in my life, but the sorrow i faced pales in comparison to those two who I know so well, or to claras.
    If anyone whose reading this blog or this post ever contemplates ending it all, know that theres always another way. Things can get better. You just need to reach out to get the help you need, whether from loved ones or a proffessional or anyone.

  3. Thank you for this post, Doc. I lost my sister to suicide almost two years ago to the day. How I wish she had not succeeded.

    1. I'm so sorry for your loss, Robin.

      My husband has been in and out of hospitals through the years due to threats of suicide so I have an inkling of how hard this is on you. I sometimes wonder if his ticket gets punched one more time we'll get a fruit basket or something. <---- Weak attempt at humor in what is a shitty situation.

      Wednesday (who still can't find her password)

  4. I thank you as well for this post, Doc. Although the details of Clara's story were scant, I hope those who read about her, and those who know her personally, will understand that people who try to take themselves out of this world are not selfish cowards who succumbed to an impulse. Even if your efforts fail, it takes tremendous courage to be willing to jettison your life when living becomes unbearable.

    Others, no matter how much they care for you, cannot live inside your pain or carry it for you. And it's terribly mean-spirited to judge someone who felt compelled to end their own suffering.

    1. It is not so simple or straightforward as you think. every person's situation is unique.
      and it is terribly mean spirited to judge another, AT ALL.
      the only generality one can apply is that most people who try to take their own lives don't see any other valid options; and the service we can do them is to try to help them find more options.

    2. Unfortunately, options can be very subjective. The question then becomes at what point do we respect another person's evaluation of his or her life instead of trying to judge it by our own perspective?

    3. when they can demonstrate that that they have objectively evaluated all of the available options and made an informed decision.

  5. A couple years ago there was a news report of a tragedy: a young family went hiking. The older kid (around five if I remember correctly) slipped on the path and under the railing and plummeted to his instant death down a cliff. The dad, who had the younger kid in a back carrier, bent over the railing, trying to grab the son. He lost balance and toppled over the railing, he and the younger kid also instantly died on the cliffs below. The mother was right beside them, helplessly watching as her happy little family was erased within moments.

    When I read this report, my immediate thought was: had that been ME in that situation (and as my kids were almost the same age, it really hit home), I wouldn't have hesitated even for a second. I would have dived right after them. That is one situation I would not want to survive.

    So, I sympathize with Clara, even though I thankfully have not been in that situation and my family is currently happily asleep beside me. And I think I'll make sure to hug them extra tight today.

    1. I was already in tears from Doc's post. Now my heart is just absolutely broken.

      Fucking hell, life can be absolutely terrible.

      It makes me want to refuse to let my future offspring out of the house until they're 18. I cannot imagine the pain that woman felt. I'm disgusted by the underfunding that impacts nature reserves and parks... a solid railing somewhere so dangerous could have prevented that easily.

      Going to go back to crying like a baby now. Holy shit.

  6. Nothing can be said, the best I have found to say to comfort someone is- "you may feel alone, but you are not alone in your feelings". In her situation not knowing if husband left with kids or they simply died, if the kids are alive- I would make her look at me and repeat my words, "if I do chose to end my life I will make my children wonder what they did to make me kill myself".
    I know it sounds cold hearted but we aren't alone, others have and will continue to experience those tremendous feelings of no self worth, failure, giving up..
    I was a counselor for many many years, I seen a lot.
    At the end of my career I held someone while they died, held their funeral, but the day after they died I came home to a letter- Dear Ms. Cali, we regretfully have to inform you this way that you have cervical cancer, we have tried to contact you for two weeks.. .. .
    I was taking care of my grandfather to give him his final wish to die at home, he died in my arms, and I didn't sleep but a few hours every other day, I fell asleep driving home on the highway, my cousin seen it and laid on her horn and put her car between mine and oncoming traffic..
    I came home to that news, I felt I came home to my own death sentence..
    Biopsies and tests and invasions of my body and more tests and then the funeral, at the funeral my kids guinea pig died and a month later my aunt died.. I had enough, grabbed a shotgun and was going to make it stop..
    I had a nervous breakdown, it was to the point I couldn't remember simple tasks, I didn't even remember where I had just sat down my cup as I sat it down..
    My husband started to set alarms so I could do simple tasks; shower, use the restroom, get kids from school.. I sat on the bed with this shotgun, cried my last cry and raised the gun and put it down, raised the gun and tried to figure out the best way and put it down, raised it again and cried harder and put it down.. My alarm went off, he set it on my side of the bed and my cell phone, so when my bedside alarm went off I knew I had something to do and checked my phone for the reason for the alarm, it was an I love you alarm it's time to get the beastlings from school note attached to my phone alarm.
    I would have left my kids at school alone and afraid, I would have created a panic for my husband and the three of them would have found me together dead.. I wasn't alone at that point, I would have destroyed their lives.. The self realization was punishment enough for my thoughts..

    Sometimes Doc there is never words, that's when all we have to give is to listen..

  7. I have lost 3 people to suicide and one to literally suicide-by-cop. All involved guns. Every death tears a bit of your heart (and whatever it is that we call the "soul") away, but these deaths do so much more damage than any other loss I've ever experienced. It's not just the shock. I understand desperation and misery and wanting to escape the pain of life. I have been on that precipice. I sincerely wish everyone who is contemplating suicide could be saved, but at the same time, there really is no way for them to live without constant agony, be it physical or mental, I wouldn't want them to be forced into that living hell, either. For most people though, suicide is a permanent solution to a temporary situation and reaching out for help will make things better.


  8. My coworker successfully did what "Clara" set out to do on April 2nd. It has been devastating. I'm glad she got a second chance.


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