With slim cuts to her wrists, she came into the emergency room and said she wanted to die.
“This is clearly a cry for attention,” others said. “Send the new doctor to stitch her up.”
I sat by her bed with a 30-gauge lidocaine-filled needle and 4.0 nylon sutures, and began unravelling home-made bandages. The cuts were superficial, far from life-threatening. But when she looked at me, agonized eyes imploring me to understand, and said, “I want to die,” I believed that she did.
I had seen suicide attempts many times before, as a student, but this was my first time as a doctor. I was newly struck by the frailty of being, not just the vulnerability of our fleshy human bodies but the fragility of our desire to be, to exist.
Squeezing the tiny lidocaine needle under her skin and watching the bleb of freezing lengthen along the edge of the wound, I began with a slow question. Why did she feel she wanted to die?
I tried a few more – direct, factual questions this time. Was she on any medications? Had she taken any drugs or alcohol? Monosyllabic daggers, (“no! no! no!”) flew back at me. Eyes shying away, I kept my gaze on the skin edge, only flicking occasional glances upwards to make sure I was not hurting her. We immersed ourselves in a very awkward silence.
At family dinners, relatives debated about medical school curriculum: “You can’t teach someone to express care! The right words come easily for compassionate people!” But as my grandmother died, I discovered that I was silenced in the presence of suffering. The right words did not always come easily, despite authentic care. This trend to muteness followed me into other intense moments, to trauma bays and operating rooms. Now I found myself again with nothing to say. Here, with my first suffering suicidal patient, my words sublimated and I scanned through silly medical school acronyms for appropriate questions to ask.
I think that it all must have been very strange for this woman. She had been to the emergency room, this exact one, many times before. She had been peppered by questions. She had been efficiently stitched, deemed medically safe, and sent on from the emergency department to the psychiatric ward many times. But this time she got stuck in the stitching phase. Her doctor was slow and, for the most part, silent. Within the flimsy, curtained-off cubicle, this young doctor tried out painfully awkward questions flavored with florid self-consciousness, followed by apologetic glances.
After nearly forty-five minutes of stitching amidst this embarrassing newbie circus display, the woman was merciful, offering up a non-question question, an opening disguised as closure.
“I do actually want help, but there’s no point here because no one has time, no one cares. I can tell by how they look at me.”
I paused my needle and looked up into her eyes. “I really do want to try to help if you let me.”
“It’s a long story.”
“That’s ok, I have as long as you need.”
Given the afternoon swell buzzing through emergency room, my error of imprudent time allocation should have prickled at me. Instead, I became ensconced in her words. Time seemed such an easy thing to give at that moment. I dawdled at bandaging and she told me her story.
It was the first time she had ever told her story, and sure enough it was disorganized and run-away, convoluted and lengthy. Naturally I will not repeat it here. What is important is that this woman was afraid she had done something wrong, something of a medical nature that might have hurt someone. Hearing it, I knew that what she was afraid of could not have happened – it was biologically impossible. Moreover, she knew it might not be real. Only, she was not certain. And she did not know anybody with medical knowledge who she could trust enough to ask. Thus, the existence of this fearful possibility – what she might have accidentally done – continued to haunt her. She despised herself for the undone act and each day, with deepening intensity, hated the haunted being that she had become.
It was a real bind. How can a person confirm that something is not real if they come to mistrust their own eyes?
Put in that way, her situation seemed algebraic to both of us. We supposed that to break out of this bind she had to trust someone, someone with knowledge enough to accurately repudiate this fear.
I do not know what made her trust my nervous, new-doctor eyes. I did not always trust them myself. But she asked me to use them; to look through my worldview; to tell her if her fear could be real and to tell her the whole truth. Her trust clarified my vision. I considered her situation – carefully, solemnly – and when I looked back into her eyes I told tell her the truth. She had nothing to fear, she could not have been the cause of the event she described, she was not to blame.
She took a long time to respond. I think she suddenly realized the possibility of a future existence in this answer. I think this, because when she did finally speak what she said was that she desperately wanted to live.
Years later, as I look at the sea and think about existence and this woman, I wonder how strange it is that she only declared that she wanted to live because I had believed her when she said that she wanted to die. Weaving a tenderly-woven thread of trust, we roped ourselves back from what felt like a critical brink back to a place where she desired existence.
With experience, I am not like the doctor in this story anymore. I generally do not spend an hour and a half with each patient. I stitch quicker and ask questions more confidently. Suffering does not shake me into silence in trauma bays or operating rooms. I am glad not to feel a nervous shock when introducing myself as doctor anymore and I realize how important it is to make time to come home for dinner now and again. Perhaps this early time in my career was an important transition phase and perhaps I am better for being beyond it, but I would be lying if I said – sitting by the beach and thinking about this woman – that I am not terribly afraid that I have lost something.
KATRINA SAMARA GENUIS is an anesthesiology resident doctor in Vancouver, Canada, with a special interest in chronic pain medicine. She believes the care of those who are suffering has artistic, philosophical, and religious dimensions, and recently completed a Master’s degree at the Institute for Theology, Imagination and the Arts at the University of St. Andrews. Armed with theological, philosophical, artistic, and medical training, she explores modes of incorporating the humanities in the holistic care of those who are suffering.