I went out last night. It was cold, and just before I left the house I picked up my favourite scarf from the hat-stand. It’s my favourite for many reasons but predominantly because Miriam, who gave it to me, was wonderful.
Was.
She’s not here anymore. She committed suicide.
We were not best friends. We weren’t even really very close. She was my boyfriend’s best friend’s girlfriend. We would often be
at the same social events, would sometimes have tea together over breakfast, and spent a lot of time together waiting around for ‘the boys’. Miriam was a medical student. One day, in the run up to end of year exams, she left the library where she had been studying, went home and killed herself.
Her death was a huge shock.
For a long time it didn’t feel real. Even after the memorial service it still didn’t seem possible that she was really gone. I didn’t know how I was supposed to feel, what I was supposed to do or what I was supposed to say. I couldn’t work out how upset I was supposed to be, and what other people would think if I cried or didn’t cry. I couldn’t work out how upset I actually was. I was angry at her for not placing enough value on her own life. I was angry at myself for not having seen her distress. I wasn’t sure if I was close enough to her to have a legitimate right to grief. I didn’t want her close friends or family to think I was over- or under-reacting. I had no idea how to support my boyfriend or his best friend who had been the ones who had found her and called the police. All I knew was that this was all wrong.
My feelings were coloured by guilt. I am a doctor. Many of those close to her were doctors and medical students. Shouldn’t we have known? Shouldn’t we have seen the signs? Shouldn’t we have been able to do something? When I thought about it rationally I told myself that Miriam didn’t exhibit the classical warning signs. She was an outgoing, popular, successful, busy, kind, generous woman who appeared to be happy. How could we possibly have known? But rationalisations felt weak and pointless.
I recently came across a video in which Kevin Betts articulates some of these feelings better than I ever could. In it he makes “the toughest speech of his life” for World Suicide Prevention Day, reading a letter to his dad who committed suicide. Kevin’s message to his Dad is “I won’t stop.” He means it: to raise awareness about mental health and suicide he ran 52 marathons in a year. In his speech he says he loves his Dad, but also is disappointed in him as he “chose not to be here.” I struggle to know how I feel about this statement. Miriam “chose not to be here” but was it really a choice? How much control did she have over her thoughts and actions? I don’t know.
Estimates based on WHO data indicate that 1 million people a year die by suicide. The data is complex as suicides may not always be recorded as such due to social, cultural and societal reasons. Suicide attempts and suicidal ideation are far more common with 5% of people attempting suicide at least once in their life. The lifetime prevalence of suicidal ideation is estimated at 10-14%. Reports from the ONS and Samaritans show that in 2010 there were 5,608 suicides in people aged 15 years and over in the UK, with rates highest in those aged 45–74 at 17.7 per 100,000 for men and 6.0 per 100,000 for women.
These data show that suicidal thoughts and actions are astoundingly common. It is likely that we all know someone who has had suicidal thoughts at some point in their life. Yet stigma, fear and misconceptions mean few of us realise this, and still fewer ever talk about it.
Something I found striking from Kevin’s speech was that he felt let down by health and educational institutions. I have treated countless patients in hospital who have tried to kill themselves. I feel like I let them down every time as I am so helpless as a physician. I patch them up, make sure whatever poison they have taken doesn’t do too much damage and pass them onto the mental health team. I do not think I’m of any relevance to their life, and wish I could do more.
Kevin felt no-one wanted to talk about his Dad’s suicide. But he did want to talk, and continues to do so.
“Suicide is not shameful or selfish. It is just a way to die“
I think of Miriam often and can’t get past the feeling that if she could only have got through that day, and talked about how she was feeling, she would still be here. She taught me a valuable lesson: suicidal thoughts and actions are not something experienced by patients – they are experienced by people. I hope I never forget that.
If you are experiencing suicidal thoughts, or know someone who is, please call the Samaritans on 08457 90 90 90 (UK) or Mind on 0300123 3393 (UK). More information is available at Grassroots suicide prevention.
drlj 
Excellent post!
Excellent post.
When I was in medical school, a student in the year ahead of me ended his life by suicide. I didn’t know him very well, but I knew and was friends with the people he knew. It was devastating and like you, many went through the same kinds of emotions, particularly anger. It was a very sobering time for all of us.
Thank you. I think we share more common emotions than we realise in going through such tragedies.
“I have treated countless patients in hospital who have tried to kill themselves. I feel like I let them down every time as I am so helpless as a physician. I patch them up, make sure whatever poison they have taken doesn’t do too much damage and pass them onto the mental health team. I do not think I’m of any relevance to their life, and wish I could do more.”
You can make a lot more of a difference than you think! Have a look at this RCPsych survey- http://goo.gl/zBiVQ They found that from the patients’ point of view the most important thing affecting their experience of care in the emergency department when they had attended after an episode of self harm was the attitude and behaviour of the staff there. You sound like a very kind and thoughtful person and I’m sure that comes across to your patients.
Thank you so much for your comment and the link. This is really valuable feedback, and gives me great comfort.
I think it has to be acknowledged that some people just do not choose to go on living. They see a way to stop existence, stop the present and future, out of fear, out of despair, out of pain, out of weariness at carrying the load that they have carried. Those around do not have an absolute right to intervene. They can try. That is honourable. Some who have acted to commit suicide may be halted in their intention and find a new way of dealing with being human, being the person that they are. But in the suiciding person can be a longing to be ” under the ground” – as my mother said at the end of her painful life. That person checks out of the apparently impossible struggle.
I think we have to bow down to the mystery of our shared human existence in this universe at that point. And extend compassion. Non judgement. Bow together to the extraordinary price of consciousness that nature has crafted over all these millions of years… Because it sure did not and does not arrive out of nowhere. Pain that leads to suicide in some people is widely shared by many who do not suicide themselves. Consciousness comes with a price and a potential. Such extraordinary sensitivity combined with the power of thought can be VERY arduous. But the same sensitivity and power is also our means of fulfillment, of finding it all to be meaningful and beautiful.
Let them go, those who need to finish living on a knife edge which hurts too much. Let them go with our deep love and blessing.
An 84 year old patient who is mentally very active, but whose friends are dying at an alarming rate and whose joints are seizing up just as fast, said to me yesterday, “Old age is not for the faint-hearted”. Although she had made an appointment to discuss her arthritis, what she wanted to tell me, but couldn’t until after we’d used up our allotted time, was that in the last week she had joined Dignitas and Dignity in Dying. In trying endlessly to postpone death, doctors are keeping a distance from death that is not always in our patients best interests. Letting go, with love and compassion as Caroline says, is something we need to learn to do.
This is a really wonderful post – thank you for this.
Anna Taylor