I was informed by my specialist that a patient who I saw one month ago had committed suicide at home. He killed himself by hanging.
I was shocked.
“Afiza yang last jumpa dia. Bulan lepas. Tapi sebelum tu ada banyak doktor lain lagi yang jumpa dia. Nasib baik Afiza ada tulis yang ‘patient denied suicidal ideation’.”
I felt terrible almost immediately. I have never lost a patient to suicide before. No patient on my regular follow up has ever committed suicide before.
Medical Officers don’t always see the same patient each time the patient comes for follow-ups. Patients are seen by any medical officers according to which medical officers are available, unless the patient specifically requests to see a specific medical officer. I have a few patients who will only see me but most of the time I see general patients who are not on follow-up with any specific doctor.
When my specialist told me the name of the patient, I just could not recall who he was and how he looked like. It made me feel even worse. He died and I could not even remember who he was.
I asked my staff to trace his OPD card.
Sure enough, that was the first and the last time I had ever seen the patient. I gave his next appointment in one month time.
God, maybe I should have given him an earlier appointment date. (Regret number 1)
I looked at what I had written in the card, hoping it might help me to remember. But all I saw in my mind was a blank picture. (Regret Number 2)
I looked at what I had written in the card and I felt sick that all I had written were only five lines of documentation: (Regret Number 3)
-Mood is much better
-Appetite still low
-Sleep requiring Stillnox
-Denied suicidal ideation
There are not many times that I feel like kicking myself. But this is one of those times. Ya Allah… Afiza, couldn’t you have written in greater details? My only saving grace is the fact that I had actually documented that the patient had no suicidal ideation, which only meant that I had asked about it.
But did I ask earnestly enough? Did I see his face when he denied having suicidal ideation? Or was I busy writing, rushing to call out another patient on a busy clinic day? Maybe if I was not in a rush, he might feel encouraged to say something that would clue me in on his suicidal ideas. Maybe if I had watched his face carefully as he was denying the suicidal thoughts, I might have seen something.
A flicker of sadness in his eyes… maybe.
A sad, wry, self-deprecating smile… perhaps.
A finality to his demeanour…
Just something! Something that would prompt me to explore more, dig deeper.
The problem is, I couldn’t remember a damn thing! And that might be a good thing. If I feel THIS devastated for losing a patient I could not even remember, maybe I would feel a thousand times worse if I could actually remember the whole interaction. By not remembering, God spares me the regret I would feel if indeed I had done a sub-par job.
On a busy clinic day, I might have spent 15 minutes talking to a patient. But I might only scribble a few lines of simplified documentation because I am in a rush to see the next patient. Or I might only see the patient for a few minutes and thus the documentation was brief. So the length of my documentation does not always reflect how much time I have spent exploring his issues.
The problem is I cannot recall anything, including how much time I have spent with him and whether or not I spent any minutes exploring his issues properly.
I went home on that day with a feeling of something deuced uncomfortable in my chest. Not exactly like sadness. But more like a heaviness…. that I associated with a feeling of regret.
If I feel this bad for losing a patient I have seen only once, I cannot imagine how shattering it would feel to lose a patient who is on your regular follow up. You couldn’t help feeling that you are responsible somehow. That you have missed something. Was it something you said? Was it something he said that you did not pick up? Was it just fate and happenstance? Or are you just a crappy doctor?
I packed my things and stayed with my parents that night. I need my mom’s comfort food. I need to see her face. I need to hear the sound of her voice telling me things that I already know. That I couldn’t have predicted these things. That things happen. That there might never be anything different I could do that would change the outcome. That many psychiatrist have had patients who had committed suicide.
That I am not to blame.
Now, I know….this is how it feels.
So I followed Julie Andrews famous advice in The Sound of Music: When the dog bites, when the bee stings and I am feeling sad. I simply remember my favourite things….and then I don’t feel so bad. (Don’t you just love how Julie Andrews and the kids look so adorable and happy in that song?)
So I did my favourite things.
I started writing in my blog,
And then, I lie on my bed at my parents’ house, reading my novel and start losing myself in the story. Getting drunk in someone else’s journey.
Thank God, for favourite things! It soothes the blow of this crappy feeling!