I finally interviewed at patient at Osborne park today, she is an older lady and would still be very functional but was admitted after an impulsive suicide attempt by overdosing on her anti-anxiety medication. She is suffering from severe depression - loss of appetite, loss of weight, difficulty sleeping, feelings of hopelessness, no interest in the things she does, irritable and easily agitated, suffering a constant low mood and had constant thoughts of suicide and basically wants to die. She did not want to talk and was quite irritable saying she is sick of repeating all the same answers to the same questions when no one can do any good for her. But after a little persuasion that a new pair of ears may do good she agreed to have a quick chat.
We sat outside on a bench in the lovely warm sun, a small breeze blowing on our faces facing a small but pleasant courtyard. It was a picture of no reflection of what was going on in this lady's mind. Each question i asked turned into a negative reflection on her life, and it became almost predictable that every time there may have been the slightest chance of something positive, it was overridden by the one persistent statement - 'but i just want to die'. When she faced me as i asked questions and i looked into right her eyes you could almost feel her sadness and frustration. After a while she had a slight turn and this time said 'i want to die, but i don't want to die... it is this constant voice inside of me telling me i must die, my health is going down, i'm going deaf, i can't eat, i'm sick of people being positive, it's not helping i might as well just die'.
It was not the structured interview we as medical students are suppose to follow. Instead it was me trying to understand her and keep her calm. She told me about her birthday on Sunday just been and how her family came, they had a cake, but it was the worst day. She told me about her strong belief that she has bowel cancer and how worried and paranoid she is that she has it as though that is how she is going to die. She mentioned her first husband who passed away, her second husband is dependent on her and also has depression and her granddaughter who lives with her because she is addicted to 'pot' and has no where else to go and does nothing to help around the house. Can you blame this lady from having depression?
I asked about things she use to love, but it was as though from chronic depression she had nothing to enjoy. I asked about what she did in hospital to help her cope and lift her mood. She said all the activities and relaxation sessions she joined are useless. I told her i know i cannot understand how she is feeling and what she is going through, yet told small stories about me, how i cope with stresses in life. She then looked at me and said 'well you're lucky to have you mind to be able to cope with that' so i told her she can have that mind again too, but her next question directed at me with longing in her eyes i did not want to mess up. 'How? How can i be like that again? How will i ever get well again?' And i told her there is no direct answer, there is no direct way but it is by taking small steps. Each day you may find something that keeps you going and gets you better, one day something big may click that makes you take a leap forward. Sometimes we have to go backwards before we can go forwards. And although she said this is the worst she has ever felt, i hope that what i say is true.
When my colleague came into the court yard as well she panicked about having to talk to someone else so we stopped the 'interview' and she hurried inside. Maybe i can chat to her a few more times while on placement there, play a game or simply check up on her. If not i pray she will find some happiness again and that she overcomes her worry and her persistent thoughts of death. No one should be like that, not now and not ever, life is too precious and life is too beautiful to cut too short. All we have to do is make sure that even in the darker times we can still see it.
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