Sharing my video journey with you!

It’s a very simple fabric tote bag. Nothing fancy or designer,  a freebie that came with my cosmetic purchase. But I bought the cosmetics for the sake of this bag. On this bag, it says in pink alphabets, “Your best days are ahead”. I could not resist. I was about to lose my hair and was to start chemotherapy soon. I was nervous about my new look and did not know what to expect. So the cosmetics and the words convinced me, that I could still look beautiful. Perhaps it was an empty promise of a retailer but in dark times, even small hope is worth falling for.

That tote then became my “chemo bag”, a bag that would hold my lemon heads, my essential peppermint and lemon grass oils, my warm socks, a small copy of the Quran and a book that I was currently reading. Sometimes I would take some snacks or crackers along. I carried this bag, back and forth to the cancer center sixteen times, fifteen times with anticipatory nausea and anxiety but then I would read the words on it, “Your best days are ahead” and I would fall for the promise every time.

Doing sixteen rounds of chemotherapy for Stage 3 Breast cancer requires a lot of inspiration and motivation. Week after week, presenting yourself willingly to get infused and injected by drugs that make you deathly ill and not complain about it requires one to immerse herself into motivational and inspirational mode. Challenging but it felt doable; I habitually looked on social media for quotes and memes about life and difficult times. I bought inspirational books and collection of quotes. I would read and re-read quotes that connected with me emotionally and post them on my face book wall. These small doses of inspiration along with support of my friends got me through. Words do matter, they matter a lot and when everything else seems to be falling apart, holding on to a few strong words can help you conquer much more than you think you ever can.

Here is a list of my most favorite inspirational quotes:

1.      Life live as if it is rigged in your favor

2.      Although the world is full of suffering, it is also full of overcoming.

3.      Stop watering the weeds in your life and start watering the flowers.

4.      Don’t believe all the things that you tell yourself late at night.

5.      Scars have the power to remind us that our past is real.

6.      Don’t think about what can happen in a month, don’t think about what can happen in a year, just focus on the 24 hours in front of you and do what you can do to be closer to where you want to be.

7.      You are a perishable item, live accordingly.

8.      Never be afraid to fall apart because it is an opportunity to rebuild you the way you have always wanted.

9.      Nothing makes a woman more beautiful than the belief that she is beautiful.

10.   Today may suck but it doesn’t mean tomorrow will too.

11.   Feel the fear, do it anyways.

12.   No pressure, no diamond, no grit, no pearl

13.   Life is a balance of holding on and letting go

14.   Stay away from people who make you feel that you are hard to love

15.   To realize one’s destiny is a person’s only obligation.

16.   The thing about life is that while it disturbs us, it too, forces our hearts to roar in a way that is secretly fluid.

17.   When something goes wrong in life, just yell “plot twist” and move on.

18.   Life is a roller coaster; it has its ups and downs. But it’s your choice to scream or enjoy the ride.

19.   Disease is somatic, suffering from it is psychic.

20.   You don’t die if you fall in water; you die only if you don’t swim.

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 29,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 11 sold-out performances for that many people to see it.

Click here to see the complete report.

I have been thinking about the New Year. Although it is nothing more than a mere change of date on the calendar, it gives everyone a little nudge for introspection and self-reflection. Life isn’t so generous that you get to completely start over but with a new year, a small window does open to changing things perhaps so that it feels like a new start.
We all secretly hope to start over, sometimes so we can be free of our past mistakes and errors, to set the record straight or to reclaim what we have lost. That is why resolutions are made. To start with a clean slate, clean of the markings from our pasts that we desire no longer to acknowledge and admit. Somethings cannot be undone. A lost love, a lost opportunity, a lost moment in time, sometimes can change the trajectory of one’s life. But there is always hope. A hope to start over and get things right or at least in the right direction.
I want to start my new year with hope. Hope for better things, better times, better moments. I hope for less fear and more love. I hope for more affection and less heart ache. I hope for more kindness and less cruelty. I hope for more wisdom and less foolishness.
I want to start my new year with caring. Caring better for myself, so that I can care for others too. I am nothing if I don’t care, for myself and others. Caring gives meaning to life and makes life worth living.
I want to start my new year with passion. I want to feel the intensity of wanting to do something so badly that it hurts when I can’t. Knowing what you are passionate about is a gift. I want to unwrap this gift over and over again. I want to connect and reconnect with my passions.
I want this new year to start with mindfulness. Mindfulness of who I am and how I belong in the world around me. I want to understand my deeper desires and interests and things that keep me alive.
I want to stay alive. As a cancer survivor, my first and foremost resolution is to stay alive with utmost honesty to the gift of life that I have been given.
I need to enter this year with a continued commitment to help others who suffer and with a wish to help alleviate their suffering with the gifts and insights I have to offer.
I want this new year to allow me to maintain my spirit of giving throughout the year and not just around holidays.
I want to enter the new year with an open heart and an open mind. Open heart for forgiveness and healing and open mind for growing and expanding.
I hope for the opportunities to learn more about the world and people around me and what makes them click. I hope for more patience and willingness to understand who they are. I hope for more ability to accept others as who and where they are.
I hope for the better judgement to walk away when need be but also to hold my ground when it is necessary.
I hope to honor myself by remaining happy with the choices I have made and to work on being happy every day. I hope to be accepting of things that weren’t my choice but I still have to withstand them.
I want this new year to remain a year that I find myself full of gratitude and to nurture practicing gratitude every day.
I want to be true to myself and to others to the best of my ability.
I resolve to be me just a little better, just a little stronger, just a little more hopeful, just a little more open. The weight loss, exercise, money and vacations will all happen if I am truly happy with who I am and what I do!
Wishing all of you a very happy and blessed new year! Happy 2016. May you have a year where you get to be who you are and whom you love.

Wishing you lots of days of health, joy and self renewal in 2016.

Congratulations, it’s a girl!”

“I like the name, Uzma,” I imagine my mother saying with joy, holding her baby girl.

Thus started a long association between us.

You and I.

A relationship decided and sealed at birth, my X chromosome, a tiny strand of DNA, picked my destiny. A daughter, a sister, a woman, a wife, a mother, all these roles woven sequentially in the microscopic double helical protein within my cells.

Dormant inside of me were two tiny organs holding within my fertility in form of finite number of eggs.

The chief conductor of the orchestra of womanhood, the maestro, “You,” the Estrogen and “I,” the human female.

After a quiet phase, you started to conduct music, slowly and gently. Your ebbs and flows, coordinated meticulously with your accomplices, the progesterone, luteinizing hormone and follicular stimulating hormones.

As I started to mature physically, my chest would feel tender and sore and I couldn’t understand why. Running through my blood, you slowly started stimulating the growth of my breasts and catalyzing numerous changes all over. Then, around my 13th birthday, you roared, you, the mighty hormone Estrogen surging through my thin and petite body. The first crescendo and decrescendo of estrogen and the event called “menarche.”

“Mummy, I have blood on my underwear!!” I yelled, scared that something awful has happened to me as I was getting ready to take a bath.

“Finish your bath, we will talk later,” my mother, failing to hide her horrified expression peeking inside the bathroom, reassured me in her usual contained manner.

I wasn’t quite prepared for “it,” neither the “periods” nor the “talk” and she didn’t seem ready either.

Raised in an Islamic conservative culture in Pakistan, where the whole society is an overt denial of sexuality, puberty is neither a welcome transition nor an exciting discussion. It usually triggers discussion about marriage, saving money for marriage and dowry and other expenditures. In summary, myriad of worries and stress for parents. Mothers don’t engage in discussion with daughters about sex and sexuality. It’s usually the older sisters or friends that enlighten the dazed young woman. Most sex education comes from foreign movies and literature.

“We didn’t even have pads, my mom washed an old cloth and cut it into pieces and we used those, you are lucky to have sanitary pads.” My mother reminisced.

I didn’t feel particularly lucky but I listened.

End of the “talk.”

My life was no longer simple as I dealt with the necessity of bleeding every month for no “real “reason. I had been delivered nature’s gift for womankind. At 13 years, it was hard to wrap my brain around the fascinating intricacies of a female body and looking back, I was a very naïve 13 year old. I didn’t have much exposure like a thirteen year would in this day and age. My ninth grade biology book however was quite helpful in understanding because it was a “foreign” edition and actually had the chapter on “Sex and Reproduction” unlike the state-censored text books.

“My periods hurt a lot, these cramps are awful!”

“I get diarrhea with my cycle!” they said.

“I can’t wait to go into menopause!” I joined in.

We all giggled, silly teenagers, finding comfort in conversing and longing for menopause. Together we celebrated our arrival into womanhood, our newly acquired bras and secretly talked about boys.

My body was changing in so many ways. My boy-like flat chest was getting curvy. I was no longer allowed to play outside with boys albeit it gets hit with a cricket ball somewhere “sensitive” (Read as “chest”).

Stepping into womanhood also meant facing stereotypes and sexism. The “PMS” jokes and misogyny of my native culture gradually was evident to me. Slowly, I understood I belong to a “minority” group being a woman. I became aware of gender based quotas in educational institutions and the limits on the sport activities available to women, the estrogen-laden female gender.

Perhaps it is you and your impact that makes a woman unpredictable, your play with the serotonin and endorphins in my brain, the highs and the lows. Scheduled yet unpredictable. No wonder you remain the topic of research for scientists all over.

It’s not just about uterus and ovaries for you, unlike most believe. Your charming presence stimulates everything from the brain to the bones, from the pelvis to the heart; you remain vital to so many body processes. You are part of the miracle of conception and procreation. You took charge and moved things forward. Just like all relationships, it was so exciting in the beginning. You transitioned me into the magical world of womanhood with femininity, intimacy, sex and love. You made possible the funny tingling feelings that one feels in love in places you don’t expect.

“How often do you get migraine?”

“At least once right before my periods.”

“You have premenstrual migraines. May be you can chart your migraines on a calendar” my doctor suggested.

You, thus, brought your own share of medical problems. Sometimes, I wished for menopause just so I could rid myself of those throbbing, lingering headaches. The migraines remained the bane of my existence through medical school and then residency. The night calls particularly made me vulnerable to severe episodes but as a young resident, new in the US, the land of opportunity, I didn’t care.

A different and a liberated culture where dating and male companionship is the norm. I hesitatingly adjusted and very quickly he took a liking to me.

“I love you.” He said.

“I love you too.” I replied.

A wave of funny sensations spread all over my body, in parts, known and unknown to me. We hugged. We blended into each other. Yet another aspect of womanhood, entered my life.

“So you didn’t have a period this month?”

“May be I should do a pregnancy test or see the doctor?

“Congrats, you are going to be a mom! “The doctor smiled.

Oh, the joy I experienced that day. As your levels rose within me, nurturing the tiny little being inside my body. High on hormones, I waddled along in life. The headaches disappeared for a full five months.

“He is so beautiful!”

“Look at his hands, they are so tiny, my precious little baby!”

A new mother, although with a picture perfect life, I was quite lost in the first few days . I remember how much I missed your might after I had my son. Sad and anxious, so unsure of myself. For nine months, your mighty presence propelled me. Now the high was gone, leaving me with the post partum blues. At times, I thought I am just not a good enough mother and taking care of a newborn isn’t something I can ever do. I felt inadequate. Gradually, as I found my bearing, I started to recover and life continued.

I was blessed with another child. Not so hard the second time around, I coped with the hormonal decline better.

Two years after her birth, I was told “You have breast cancer!”

Things between us changed that day. It was shocking to hear but I was told that you were in cahoots with the cancer and because of you the cancer in my breast was thriving and growing.

“The pathology report shows that your cancer is Estrogen Receptor Positive , which essentially means that estrogen in your body helps the cancer grow “

I felt betrayed.

I needed you and you took care of me. You nurtured me through two pregnancies. It was your glow on my face; it was your gloss in the thickness of my hair, it was your presence. You sustained me.

And now? You left me ambivalent and my trust shaken. I want you to stay, believe me I do. But my options are narrow.

Our relationship has run its course. It is time for me to move on.

It’s time for me to let go what is no longer meant for me.

Cancer has made me wiser. I have learned to gracefully let go what isn’t sustaining me.

You still are important to me.

I will miss you tremendously, down to my bones. As my blood robs me of my calcium, I will no longer have a trusted friend, making sure my bones stay strong.

As I sweat through every hot flash, I will think of you.

My heart will ache for you as my coronaries with thicken and stiffen without your protection.

My brain will miss the shield you hold against memory loss.

I will miss being a complete woman without you.

“So have you decided what are we going to do about your ovaries? You are too young to have a natural menopause. Your Estrogen levels are too high!” my oncologist nudged me gently.

I need to let you go. I do. If I don’t, there is a chance that I may not make it. I may not live to see my kids grow up. I may not grow old with my husband. I may not be there for my friends. I have come to believe that I have greater purpose in life. I want to write and reach out to others. I want to travel. I want to share my experiences and live life fully.

With you, it may not be possible.

It could have been that we parted ways naturally, slowly and gradually you pulling back and I accepting this with grace and grey in my hair, the natural menopause, but the time to separate came so much earlier.

When I let go, maybe I will get depressed like my mother did, during her menopause, maybe I will get osteoporosis at a young age. The risk of heart disease will be higher for me and I hear that the hot flashes will melt me every time I get one but I have to accept all of this. For the sake of surviving cancer, I must part with you.

I am so sorry.

You have helped me so much.

Reluctantly and with a heavy heart, I made the appointment.

“Uzma, here is your Zoladex shot. It’s going to hurt a little. This medication will put you in a medical menopause. By suppressing your ovaries and stopping estrogen production, there is a good chance of reducing recurrence of your breast cancer. This is a wise choice!”

Yes, un-woman me now. It’s over, Estrogen, it’s over between us!

Today might be the day.
Today might be the day, my life could change again,
Today might be the day; it starts all over again,
In a different way,
Its hard to say,
May be worse,
Much more worse,
May be not.

You hold my hand,
And tell me,
It will be alright,
I accept reluctantly,
My fate, my share,
My vessel of anxiety,
In which I float every day.
Some days I see the surface,
And glance like a master,
Some days, I struggle.
I struggle to breathe
the breaths
that may be numbered
To take in gingerly
What may be pre-determined.

Today I might find out,
How many?
How many breaths?
How many days?
How many years?
My fate, my share!

Yes, take a look
One more time,
At my rebellious body,
With your fancy machine
Look!
Look closely!
Do you see ?
Bits of happiness on the film?
Or shreds of my mental peace?
Or perhaps all my feelings?
In black and white
While my life is grey forever?
Tell me what you see?
Tell me what is likely?
Tell me what cannot be ruled out?

What does it say today?
How many more?
Scans, days, moments,
Can you see what I have lost?
Can you see what I have gained?
Can you see it all?
Or perhaps repeat in six months,
A twisted sense of time
very long and very short.
Until another six months,
While I remain suspended
in my vessel of anxiety
in my vessel of hope.

This year for October, I was planning to write a well researched thought over article about Breast Cancer. I was aiming to get the statistics and figures, do some fact checking and present varied point of views regarding money spent researching cure for Breast Cancer. Cure is what all survivors want. We are desperate for someone to tell us that its actually all over for us.We never get to hear that. We don’t get a conclusion to our misery unless death bails us out from this chronic uncertainty.

So we party at the end of chemotherapy or the end of radiation or just because our life was spared, we celebrate “remission” or “NED” ( no evidence of disease status). We grieve the loss of our health, we endure the “collateral damage” and we keep moving while science slowly inches to this hope we have called “cure”. We are willing to walk , run , race and gallop to it. The society getting drowned in pink in October is being told that a cure is coming. But is it near?

We ,survivors , want to hear, “Go live your life, you are cured!”. But cure remains elusive. We have the monster of Breast Cancer but no hero to slain it and show us the head severed  from its body or strangulated by the very same pink ribbon that is all around.

We want the pink ribbon to be the noose around the neck of Breast Cancer and leave it gasping  for air just like every woman who hears for the first time” You have cancer” . We wish for the eradication of the disease that takes mothers, sisters and daughters away. We want to life without fear and apprehension and insurmountable stress.

All the pink walks combined have not paved the pathway to cure. It still remains a dream, the fantasy of every  breast cancer patient.

I was planning to write about all of it. The funding, the controversies, the pink washing and the sisterhood.

I wanted to get my thoughts together so I can write a refined and polished piece. And then I got a migraine headache. A headache that lasted 5 days which didn’t respond well to the migraine medication I usually take. This lead to a neurologist visit which lead to a Brain MRI which lead to finding of a spot on the brain that no one knows what it is. Alarming as the finding is, it is just another day in my life . So I get recommended  ‘the wait and watch ‘ approach. Wait to see if it grows, wait to see if its cancer.

This is what living with cancer is , Wait and Watch. Do all treatments recommended and hope for the best while doctors watch over you and you wait anxiously to get through the first five years. Some get through, some don’t. No one knows, which group you fall into. Unknown and unpredictable, that’s  the gestalt of life with cancer.

Every symptom occurs after cancer needs to be assessed for the possibility of it being a cancerous lesion. And it will remain so until we have a cure.

And a common side effect of having had cancer is losing time. Weeks to increased surveillance after having a new  symptom, waiting in doctors offices, anxiety , fear, frustration and sadness , therefore that spot on the MRI  took away from me the time I had set aside for my article.

The loss of time and money remains enormous in the life of a survivor.I can only imagine the actual cost of these life time of investigations and scans done on every single breast cancer patient. The PETS, the MRIs and the CTs. My insurance told me that the MRI of my brain was 2,500 dollars. I will need a repeat in 6-8 weeks. So far in the last 2 years, I have had one PET and probably a dozen MRI’s and CT scans combined. And this will continue for the rest of my life.

Because we have no cure, we wait and we watch. We watch 40, 0000 women die every year from Breast Cancer and we wait. We wait and we watch, we watch and we wait.

We are all aware, I am not sure there is anyone who doesn’t know what the pink ribbon stands for. Come October every thing from soup cans to cement mixers, turns pink like it was submerged in a giant vat of peptobismol.

Breast Cancer Awareness. Everyone is attune to the presence of this deadly cancer amongst us. But this awareness leads to at the most, early detection.

We are not preventing cancer by spreading awareness. Get your mammograms isn’t the answer. The mammogram awareness can lead to early detection, it doesn’t not stop a cancer from growing. We are to a point where we can diagnose breast cancer very early with mammograms.However, we also know now that we are over diagnosing and aggressively treating DCIS( Ductal Carcinoma in Situ), more than it needs to be.Thought processes about management of Ductal Carcinoma in Situ are changing.

Mammography has significant limitations most notable being increased breast density. Women with dense breast are repeatedly failed by mammograms and their cancers can go undetected for a long time unless an Ultrasound is done in conjunction with a mammogram to achieve better imaging. Sometimes both can miss the cancer, which in my case was about 7 cm when first detected on an MRI.

Young women tend to have more aggressive cancers, young women tend to have dense breasts. Therefore, we are not gaining much edge here with mammogram screening. The 3D mammograms seem to offer better resolution but currently aren’t being used extensively.

MRIs that offer very high resolution remain reserved for those that are high risk and insurances fight tooth and nail in approving those even for high risk patient.  They ,of course , carry risk of false positives and over investigation and therefore are not considered good screening tests. Having had breast cancer, I do  get a breast MRI every year.

In the U.S., breast cancer is the second most common cancer in women after skin cancer. It can occur in both men and women, but it is very rare in men. Each year there are about 2,300 new cases of breast cancer in men and about 230,000 new cases in women.

We don’t know what causes breast cancer. Certain risk factors are known.

National Cancer Institute’s web side states the following

“Studies have identified numerous risk factors for breast cancer in women, including increasing age, personal history of certain benign breast diseases or breast cancer, early menstruation, late menopause, never having been pregnant or having a first pregnancy after age 30, use of oral contraceptives, family history of breast cancer, presence of certain inherited genetic changes, history of radiation therapy to the chest, long-term use of combined hormone therapy, use of diethylstilbestrol (DES), increased breast density, alcohol use, and obesity after menopause.”But they are risk factors not direct causes. Breast Cancer is likely multi factorial in causation.

We do realize that there has been significant advancements in treatments and management of Breast Cancer in the last 100 years. Women are no longer subjected to elaborate surgical procedures  that donot help increase the survival rate. Gone are the days of Radical Mastectomies and the accompanying  disfiguiring complications.. We now have data that lumpectomy can improve survival similar to  a mastectomy in cases of early disease. There are more choices available to a woman today surgically than before.

Recently a very rare gene identified in women of Polish and Canadian French descent that increases Breast Cancer risk. A few other mutations are now known to increase the risk but their clinical application remains limited.

We also understand that all breast cancers are different from each other based on their cell type and receptor status. There is significant variations among breast cancers. We are just entering the world of genomics in medicine and are at the brink of utilizing how to target cancers with more precise treatments and immunotherapies.

We maintain the insight  that cancer is a hard disease to beat since it has high ability to change and mutate. Mutation is  the biggest challenge in treating any kind of cancer. Breast cancer thus is no exception. It changes , it morphs , it hides. It can recur and metastasize to other organs. Metastatic Cancer is the kind that kills by spreading into the other organs out side of the body. Women who die of breast cancer die of Metastatic disease in their other organs.

Not having a cure means 1 in 8 families will suffer at the hands of this disease for the rest of their lives. Some will go bankrupt because of medical bills. Some will have the children suffer and live without a mom. Some will leave grieving families with elderly parents. Not having a cure means, all survivors live in the fear and anxiety of having no cure. Once diagnosed with cancer, the uncertainty is ever present.

Not having a cure means, going through scans and tests for the rest of your life. Not having a cure means living in the shadow of mortality.

Cure, a hard reach. Cure our utmost desire. Cure

But I also grasp as a physician that finding cure is a high aim. In medicine,  we don’t have cures for many chronic illnesses. Cancer is a chronic illness. It can be managed and treated like Diabetes and HTN.

Medicine is most effective in curing infections. We do not have cure for Diabetes or High blood pressure , we have ways to manage them and we can attempt to prevent them. We have lots of research available to link the high risk factors leading to these particular diseases and devise a plan of action.

To cure , we need more understanding of the risk factors, the process of the cancer proliferation and spread and ways to stop the cells from becoming cancerous and eventually  effective treatments to eradicate all cancer cells from the body, active and dormant. We are getting better at all of it  but at a pace that is disproportionately slower than the fatal wrath of this illness.

So here we are in October , the breast cancer awareness month. Aware that one in eight women will be diagnosed with breast cancer in their life time. Aware that once cancer is diagnosed, there are very harsh treatments for it. Aware that there is an alternate life path after cancer peppered with  fear and residual damage, should we be luck enough to survive. Aware that a significant number of women will die of  breast cancer despite early detection and treatment.

I am aware that two years ago, I was diagnosed with a potentially fatal illness that has no cure. There are millions like me. We will live our lives worrying about new symptoms, recurrences, getting scans and seeing oncologists. If our aim was to eradicate breast cancer, we continue to fail miserably. The gap between awareness and cure remains wide.

Despite extra ordinary advancement in the field of cancer and having even the first anti cancer vaccine, we are away from the cure of breast cancer. We all have pink t shirts and pens and bracelets and egg cartons with pink ribbons on them, we need a cure. Until then, we wait and we watch.

It’s a story I feel compelled to tell. It may be therapeutic for me and possibly others. It’s a story that need to be told. But I hesitate. I fear the stigma. I am afraid of being judged. I fear breaking the silence. I ruminate about the potential repercussions.
What if I, a psychiatrist, wrote about my own emotional conundrum after a patient chose to end his life?
Can I open the private vault of personal grief that filled me with his untimely and unnatural departure? I want to narrate the tumultuous aftermath of patient suicide, the distressing combination of grief sans closure, perilous self doubt and professional impotence to undo it.
Suicide is the tenth leading cause of death in America and every 40 seconds someone commits suicide. It happens and it happens a lot. But it’s hardly talked about by the “treating survivors” of patient suicide, the psychiatrists, therapists and others mental health care providers who cared for them, the ones that lost their lives via suicide.
The hesitation and the apprehension is real. Suicide is also the number one cause of lawsuits brought against mental health providers.
Should I take a chance and disclose this vulnerability?
Should I disclose that I had played our last appointment over and over in my head to look for clues for what I could have done differently? That I had stressed my brain to recall all details of that half hour in the office. His mannerisms, what I had said, what he had brought up, my responses, the color of his outfit, the time of the day, the pauses between his sentences.
Is it okay to say that I had questioned my ability to assess suicide risk despite all my training and experience? Could reveal that I had reviewed quietly in my head, standard of care that I had provided?
Should I say that I cried? Should I say that I mourned?
It is customary in a psychiatric appointment to ask an individual about suicidal ideations and thoughts. This is especially true when treating individuals with depression. Suicide is often a complication of depressive illness. Depression which envelopes an individual in a cloud of darkness that swirls around them day and night, with no access to the light of the outside world. It’s visible through the eyes of the depressed and you look for that glimmer of hope to reassuring you that they will hold on to life. They , sometimes, verbally reassure you, ” Doc I am not going to do anything, I won’t be the patient you will get the call about”.
You reassure them that they will get better, the appointment ends and they leave with another appointment card.
Then, you pick up the next chart and get busy with another life and another story.
But then you do get the call one day.
The call that is mechanical yet doom-ridden. It can be from an ER or police department asking if you knew this person. The past tense in knew, makes your heart stop and sink. Your mind flashes to the last appointment.
The film reel starts to run. Beginning to the end. 30 minutes that get burned in your memory for you relive them so much that they singe any other comforting thoughts trying to crowd them. Despite everything you did, you keep asking yourself, “Could I have done more?”
You experience sadness and loss but you can’t disclose why. You feel anxious, isolated and apprehensive. You are engulfed by grief and fear simultaneously. Grief of the loss and fear for you couldn’t stop what you think you were hired to prevent.
It’s a grief that must be felt in private just like those sessions are, private and confidential.
May be your own family understands your dilemma but the confidentiality of your profession stops you from openly talking about it. Sometimes the malpractice attorney tells you to stay silent. You think about calling the family or going to the funeral, you try to do the right thing.
What if I admit that I have doubted my professional abilities after since I heard it had happened? I even wondered if I am in the right line of work.
Is it okay to say that I took a week off after it happened to regroup? Can I justify in writing those pangs of anxiety I had felt every time a depressed patient left the office?
Losing a patient to suicide affects how one treats subsequent patients. The perceived “reasons” of what might have caused it remain at play.
Sometimes there is the overcompensation to ask each and every patient depressed or not , if they are feeling suicidal at every appointment even though it annoys some of them. Sometimes its avoidance of patients with suicidality.
” Are you having thoughts of harming yourself?”
” I told you, suicide is not an option, I don’t want to go to hell.” or ” I would never do that to my kids”.
But in your heart do you really trust the monster of depression not take the best of their fragile frame of mind? Those few moments before they actually do something, they aren’t rational. When they pull the trigger or take the pills or take that knife to their wrist, their decision making is impaired , that’s what the research says.
You focus on the trivial.
May be the number of suicide hotline should be enlarged more and put at more places in the clinic? May be the waiting room needs more literature on this topic? May be I should attend another training on “Suicide Risk Assessment”?
You question your treatment choices. May be they never filled the prescriptions.
May be the medications taken did not work? May be they worked too soon.
The risk of suicide with antidepressants in highest in the initial two to three weeks, when treatment improves energy enough to follow through with a suicidal plan but the mood is still profoundly sad.
Can I say that I had a hard time sleeping in wake of such an event? Is it okay for a physician to accept their vulnerability and write about it?
What if I wrote his story? What if I wrote about how it changed my own story?