Search for a Silver Lining

         

The past week was a week of sadness and grief...

Less than twenty four hours after the death of my nurses' husband to cancer, my receptionists' grandmother was taken off of life support and pronounced dead. One of the deceased I knew well and the other I'd never met. My practice partner and I made it through the week without support staff the best that we could. I'm glad the week has finally ended. I wanted to find another topic to write on tonight but nothing seems to inspire me. We all wish we could avoid dealing with death and grief but doing so is the greatest form of denial, for death is fully guaranteed for every living creature. It is interesting that this thing we dread and hate so much is the very thing that gives life such value. Were death not a future certainty we would have no reason to be accountable for the life choices we make. It wouldn't matter if we selected a pathway of pure evil and destruction or if we selected the very same pathway we have chosen in our current life. Without death there would not be a past or a future and life would probably resemble that of Bill Murray in the movie Ground Hog's Day. Every day would be like every other day. In that movie, Bill's character eventually prayed for death but since death was impossible he was trapped in his own private hell where he was the only human with a sense of awareness of his reality. All others were only concerned with their own individual realities.

Hardly a day goes by that I don't speak with someone having at least passive thoughts of suicide. At this stage of my career I will ask someone if they want to die with similar casualness as I would ask them if they had any trouble finding the office. It is well known that talking about suicide does not increase the risk that a patient will commit suicide. Though impossible to prove it is probably more likely their suicide risk is reduced by you asking about such thoughts. If the examiner doesn't think to question a depressed person about suicidal ideation the examination is flawed and incomplete, not to mention the fact that if the patient just happened to kill themselves later that day you would probably be sued and would most likely lose the case. It is equally important to be aware of the homicidal potential of a patient since you could be held liable for people killed by an individual you may have recently examined. So I don't have a problem routinely asking people if there are thoughts of murder. It is not believed that doing so will contribute in any way to an individual becoming more homicidal toward anyone other than yourself, maybe.

Despite all the efforts of the mental health care community the suicide rate remains steady in the arena of 30,000 per year since records began over 80 years ago. The most predictable indicator of a rise in suicidal deaths epidemiologically has been the economy. The suicide rate tends to rise when the stock market falls. There was a marked rise during the great depression and a slight rise during the recession of the 1970s. Suicide has been described as a permanent solution to a temporary problem. The greatest deterrent to considering suicide I have found to be fear of going to hell. This question creates a theological dilemma for all after a suicide has occurred. I personally believe that if the persons' mental capacity had failed them then God would no more hold that against them than if their heart had failed them. The confounder that exists sometimes rests within the fact that a large amount of successful suicides involve self induced states of intoxication from alcohol or drugs. I think many of those people would have come to a different conclusion were they not under the influence of a mind altering substance. Alcohol is great at causing one to feel disinhibited and to do things they probably would not do in a sober state of mind. Theologically, I believe that what makes man God's greatest creation is our free will. Being equally able to choose evil is really what makes doing what is right so much more valuable. Usually, the pathway of least resistance passes through the temptation of doing that which is harmful or not right. In my humble opinion, I think that choosing to take life when in a state of mind that the individual clearly knows to do so is wrong predisposes that individual to whatever the consequence may be. That said, i believe that the vast majority of those intentionally killing themselves are totally out of their mind at the time. I believe God gives them a pardon.

Sometimes I feel I should go to rehab to address the hostility I sometimes feel toward most of the cocaine addicts I've encountered. Interestingly, when I treated them in the jail setting there was never a problem. Even now when that rare addict presents that admits to having a problem and is genuinely sincere about accepting help, I have no problem with them. But when I discover several weeks after seeing someone that everything they told me in their history was a lie and their whole agenda was to get a controlled drug I start to feel like Mel Gibson in Lethal Weapon. Over time I have learned to accept that they are very sick individuals who literally have damaged their brains so much that the parts responsible for good judgment, truthfulness, and any degree of common sense has usually been destroyed. Dead Man Walking is an appropriate description. It is often as if the trigger has been pulled and the bullet is on the way to their head in extremely super slow motion. It may actually take a few years for the metaphorical bullet to penetrate the skull and inflict the fatal wound. In the mean time they have an obligation to make everyone else's life as uncomfortable as possible. I don't mean to let those off the hook that prefer drugs different from crack but I have found there to be a significant difference. I am actually pleased to find an ordinary alcoholic to treat because I know what to do for them and what to expect from them. Pure opioid dependent patients can sometimes be perfectly normal and functional except for having that problem. I have yet to meet an individual smoking crack every day that has a normal life.

I know I have rambled and meandered a bit here but I think something useful may have been expressed. At the very least I feel that I have vented a little and feel better than when I started this entry. I suppose that's a good thing given that I have chosen to write about such a dark topic today. To me it proves that some humor can be found in the darkest situations even when little or no control is available. Maybe next week will be a better one.