Highly commended in ‘The patient that taught me’ category, Dr Amrit Kaur Khara writes about an encounter with a suicidal patient
Whenever clichés happen in clinic, we click open the notes and with a wry smile prepare ourselves for what is to come. The few words under the patient’s name telling us the brief reason for the appointment act like a teaser for a film you don’t particularly want to watch. The ‘Friday afternoon suicidal patient’ bounded around in my head as I heaved a heavy sigh and steeled myself for the inevitable long consultation that was to follow that winter’s afternoon.
As I scanned across the other GPs’ lists, I was envious of their ‘cough not getting better’ and ‘diarrhoea since Monday’ patients. I did remind myself that although it was likely to be a late finish for me, the patient probably didn’t particularly want to spend his Friday night feeling like jumping off a bridge either. I felt a sense of guilt for fleetingly wondering how serious he was; I had dinner plans that evening and was hoping to have time to get ready before.
As I called him in, I was struck by how he was squinting his eyes, averting his gaze, looking down at the floor as he slowly entered the room. ‘My head’s banging doc,’ he started, grimacing in pain. I could believe he was in the throes of an acute migraine looking at him hunched up in front of me. I soon realised he was very serious about jumping off a bridge that evening. The physical symptoms were exacerbated by his mental state – as is so often the case with our patients – and although there were plenty of pills I could prescribe to help with his pain, his mind was less straightforward to treat.
Money issues, family, and work difficulties had all led to this point and he could see no way out. Sometimes with patients we hear the demographics to be wary of echoing in our minds as they sit in front of us. The ‘infrequent male attender who is likely to mean what he says’ was persistently in my thoughts as we spoke. I knew he was serious, he knew he was serious, and when the psychiatric liaison nurse asked if I felt he was safe to leave the clinic for home, I genuinely did not feel he was.
No amount of training can really prepare you for trying to make a judgement call on someone who no longer wants to live: when the heart is starved of oxygen, the pain is intense and forces us to seek help; strokes may render us unable to move; but when the mind stops working, it is quieter and more subtle – there is a kind of defeat in someone’s eyes that we may sometimes miss. We sat together in an unusual but special companionship, understanding the gravitas of the situation and waiting for the psychiatric team to confirm they could see him that evening.
The rain was beating down. The evening darkness had literally (and figuratively) arrived, and in that quiet space the clichés faded and it was just us two. He nodded at me as he eventually left, the only kind of acknowledgment he could muster at the time. I reflected as I cancelled my dinner plans how, in the quietest of ways, perhaps a life was saved that day.
Every so often, there is that one patient who stops us in our tracks. And so they must, so we never forget that once the systems are closed down and the clinic doors shut, the lives we learn about continue… or don’t.
Dr Amrit Kaur Khara is a locum GP
