A Letter to the Suicidal Patient
Before I get into this post, I wanted to give you a little insight on what my plans for this new series on my blog will entail. As a nurse working on an inpatient unit, I come across different patients with similar diagnoses. Though they are not managed in the same manner nor do they have the same exact stories, a lot of their stories are similar. There are many patients that I have cared for that I wish I could say certain things to but is not appropriate to say to them at that time.
So, this new “A letter to the _______ patient” series will basically be letters to these patients that I wish I could give to them so that they can see what goes through my mind and what I wish I could express to them as a nurse. Although these letters may seem as though they may be directed to one patient, they aren’t. They are directed to the general population of that type of patient based off of my experiences. I hope you enjoy this series and learn more about how much of an impact that not only we have on these patients, but how they impact us as well.
The first letter of this new series is a letter to the suicidal patient. I’m not sure if you know, but September is Suicide Awareness Month so I wanted to help raise awareness to this public health issue before the month ends. At the end of this blog post, I will include resources on suicide for you or for anyone you think may need it.
A Letter to the Suicidal Patient
Before you were admitted to the floor, I had enough time to look over your chart and see why you are being admitted to our unit. As I read over your admitting diagnosis, I can’t help but get a sinking feeling as I read it. The diagnosis shows: Suicidal Ideation.
(For those of you that aren’t familiar with medical terms, according to the Centers for Disease Control and Prevention, suicidal ideation means “thinking about, considering, or planning a suicide.”)
After I read the diagnosis, I take another look at your age. Although I had already reviewed it, it’s just hard to believe that such a young person could have suicidal ideation. I know suicidal ideation can occur in any individual and that there’s no age limit to when you can begin to start thinking about it. So, I don’t know why it still comes as a shock. I just think it’s because I hope someone your age doesn’t feel so strongly about something that you feel the need to take your life. I don’t understand how those thoughts can occur because when I think back at when I was your age, I didn’t have thoughts like those. Will you help me understand?
Even though your diagnosis shows suicidal ideation, usually an attempt was already done. So I move to the ‘Notes’ tab to see the story behind why you are here.
As I skim through the notes, my heart sinks. I read sentences that begin with: “Unknown time of suicide attempt…”, “Found unresponsive by sibling…”, and “Brought in by emergency personnel…”
As I read the details of the attempt, I feel my eyes get watery. I can’t imagine what you must have been going through to feel this way. It makes me wonder what events or interactions must have occurred in your life for you to feel that this was the only way. All I know is that you must have felt VERY strongly about it to attempt suicide and it breaks my heart. How can I, a nurse of only 2 years, provide the care YOU need to get better?
The nurse down in the emergency room is calling to give report so I pick up the phone. They give me the same details on why you are here as I have already read in the notes. They tell me that you are on suicide precautions and are on 1:1 observation. This means that you must have a sitter with you at all times to make sure you don’t have another suicide attempt. So in other words, that person has to have their eyes on you at all times and be within arms reach of you, no matter if you’re just eating, using the restroom, or showering.
After I get report from the ER nurse, I set up your room. You are not allowed to have any cords in your room or anything that you can use to end your life.
When you arrive, you don’t make eye contact. You’re wearing a special gown that isn’t capable of being ripped just in case you decide to attempt again. I explain to you who I am and that you will have a person with you at all times. I also let you know that all personal belongings will have to be put up and kept at the nurses station until you are off suicide precautions. As I assess you, I see evidence of the suicide attempt on your body. I quickly look away because I don’t want to make it seem as though I’m staring at them.
Honestly, what I want to do is hug you and tell you that everything will be alright. I want to tell you that things will get better! That these times will pass and that even though it seems like you can’t see the light at the end of the tunnel, there is one. But the truth of the matter is, I don’t know if everything will be alright and I don’t know what new obstacles you’ll face in the future to be able to tell you that. So I keep it to myself and I don’t hug you because I don’t want you wondering why a stranger is hugging you. But, I can’t help but think, should I have given you a hug? Should I have said those words to you?
In nursing school, they don’t teach us how to comfort a suicidal patient. There’s no guidelines to follow and even though I’ve had other patients like you, I’m still unsure on what you need from me. And that bugs me. I’m a nurse and I’m there to help you. I want to help fix any problems you may be going through so I hate that I don’t know how to help you with this major one.
So how do I help you through this time? Do I seem insensitive to you because I merry-go-round the topic of why you’re here? Is it something you want to talk about? Does it bother you when I have to tell the new sitter that you are here because you attempted suicide? These are all questions I wish I can ask you because I want to know how I can better my care for all future patients with the same diagnoses.
The days pass and it seems as though that you are getting better. You talk more and interact with the staff a lot more. You even crack a joke here and there. Even though it seems as though you’re doing better on the outside, are you really doing better on the inside?
After you’ve been with us for some time and your team of providers determine that you are mentally healthy enough to be discharged, you get to go home. Except when you go home, you go home with a reminder of what brought you into the hospital in the first place- that are now healing wounds on your body.
After you’re discharged and I go home, I can’t help but think about you. I hope you’re in a better place and I hope that you received the help you needed while you were admitted. They tell nurses to try and leave things at work so that you’re not bringing it home with you. But there are some things that are impossible to leave at work. At night before I go to bed, you come across my mind. This usually happens for the next two weeks. I wonder what you’re doing and I hope you’re not having suicidal thoughts. Are you receiving the support you need outside of the hospital to be able to get away from these thoughts? If not, did we do a good enough job educating you on where to find those resources?
But most importantly, I hope your still alive and I hope that you have found that living isn’t so bad after all. I hope I don’t have to see you again at work because you’re doing well. But if you do come back, I hope it’s because we made a difference in your life and you wanted to show us how well you’re doing. Either way, we will always be here for you and I hope you know that.
A Nurse that cares
Suicide Warning Signs (as listed on suicidepreventionlifeline.org)
- Talking about wanting to die or to kill oneself.
- Looking for a way to kill oneself, such as searching online or buying a gun.
- Increasing the use of alcohol or drugs.
- Acting anxious or agitated; behaving recklessly.
- Sleeping too little or too much.
- Withdrawing or feeling isolated.
- Talking about feeling hopeless or having no reason to live.
- Talking about feeling trapped or in unbearable pain.
- Showing rage or talking about seeking revenge
- Talking about being a burden to others.
- Displaying extreme mood swings.
** If you you or anyone you know are experiencing any of these signs, please get help with any of the resources listed below.
National Suicide Prevention Suicide Lifeline: 1-800-273-8255 (Open 24 hours a day, every day, free & confidential)
Suicide Prevention Lifeline Website (click link)
Suicide Fact Sheet by the CDC (click link – includes statistics)