SLIDER

Sunday, October 14, 2012

SI

Remember that day where I first had to escort a patient to the ER after demonstrating respiratory distress following an xray swallow study, and then later another patient of mine coded when I entered his room? Well this week wasn't all that far off, only this time it had to do with suicide rather than respiratory failure.

This week I had not one but TWO patients in a row express suicidal ideation - neither of them had "legitimate plans," as the mental health provider so graciously called it - but both expressed desire to end their lives, one via cutting and the other via gunshot.

Let's just say that I'm not impressed with how these cases were handled. Veteran suicides are a hot media topic, supposedly something this society takes very seriously. With the first veteran - a combat veteran in his mid-40s who had a history of suicide attempt - I informed my supervisor, who then contacted the neighboring mental health department. Where my supervisor was given a magnet. A magnet! Oh yeah, and a keychain. Both with contact telephone numbers should a homeless veteran need assistance. (Did I mention my patient did indeed have a home - and a family to take care?) And a recommendation from the LCSW for the veteran to visit the ED, should he have "legitimate plans" to take his own life. The ED that's in PORTLAND. And what constitutes a legitimate plan? I asked this patient if he felt hopeless. He did. I asked him if he had thoughts of harming himself. He did. I asked this patient if he had a plan and/or means. His response was more vague here, but I'm not the mental health expert, and I'm not about to take any sort of indication like this likely. Being that the magnet/keychain/ER solution did very little to make me comfortable sending my patient on his way, instead he agreed we could contact his non-VA psychiatrist via telephone and make a safety plan. The psychiatrist also agreed to check-in with the veteran the following day. As far as I was concerned, sending him back home with his family (who were all out in the waiting room) with a plan to follow up with his mental health provider was just barely enough for me to stop thinking about him when I was home with my own family.

The second patient was a bit more confusing. He was put on my schedule at the last minute because I was covering for my supervisor. He was a gentleman with aphasia (language disorder) who was supposed to be relatively straightforward. Instead, he was very agitated when I met him, escorted him back to my office, where he proceeded to complain (I think, again, he had aphasia, so his spoken output was limited to non-substantive words like "it" and "this") about not wanting to come to the doctor anymore and not having anything. He was pointing to his head and indicating "ever since this." I got a bit of a pit in my stomach thinking he, too, was trying to tell me he didn't want to live. I didn't have an easy means of communicating with him yet, and most definitely had not yet built a rapport - and then he gestured holding a gun to his his head and pulling the trigger. That was a pretty clear sign. He later said "I just want to die." Again, that doesn't leave much to the imagination. It took me touching base with several different providers before finally reaching his psychologist - who then told me, "He won't really kill himself. He always says this." We deferred speech-language therapy for the afternoon, and the veteran proceeded forward with his therapist.

Needless to say, when Friday rolled around and one of the new outpatients had a history of depression and suicidality, I told my supervisor that I was busy during that time slot because I did not want to make some sort of "third time's the charm" thing happen.

#dayswhenworkdoesfollowmehome

1 comment:

  1. UGH. Wow. What a day. That is so intense. You did exactly the right thing though Jo. It's so hard not to take your job home with you when you work with cases like that! Your dedication and how much you care is what makes you such an amazing SLP though. They were lucky to have you

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