The day before the last day of my last job, I reviewed my patient list. Five of my seven most disturbing teenagers were currently admitted to a psychiatric hospital for attempted suicide. It wasn’t entirely surprising. It is the fall. Teenagers notoriously struggle two to three months after starting school, getting into schoolwork, falling prey to bullying and stress, or failing to achieve their goals. But I was still pissed off. My most worrying patients are the 1% to whom I give 125% of my energy. When they show up, I give everything to them and their families. Now I found myself running on empty, knowing that I couldn’t say goodbye to those teenagers.
I found myself sitting at my empty desk, in my empty office, thinking about all the words spoken to these teenagers, all the seeds I thought I had planted in their minds, hoping to germinate in the bright future of their survival, and yet they were back in the psychiatric hospital. I thought of all the times I saw them with their parents together in my office, crying, arguing, shouting and not getting along. I would drag the parent out of the room to devote my attention and expertise to the teenager, to help him reframe his world, his words, and the expectations of his battered and bruised parents. The whole time I was reviewing coping strategies, again, for the 10th time. All the time I would go the extra mile to open a smile, a laugh, even an angry look – but the recognition that, yes, a painful truth has been brought to light and perhaps the key has turned to open the door of change. I felt helpless several times. More often than not, however, I felt a certain openness. I felt a little hope. I felt that I had catalyzed progress. And yet, my teenagers are currently hospitalized.
I dreamed of one of them. They came to me in a dream, distraught, scared and crying like a ghost. They asked me: “I no longer have a house. I have nowhere to go. Can I stay with you please? He shook me out of bed in a cold sweat. Every psychiatrist dreams of their patients from time to time, right? It can’t just be me. The next morning at work, I was alerted to his hospitalization in psychiatry. They had attempted suicide by drinking a bottle of red wine and swallowing three bottles of pills that I had prescribed.
I found myself wondering out loud in my empty room: what if I was focusing on the wrong person? What if I had taken the teenager outside and worked with the parents, helping them learn the tools and skills to calm down before reacting to their fiery teenager? What if I provided them with the questions to ask and the statements to avoid? What if I gave them the skills to work with adolescents in addition to my interventions?
And again, I remembered that the insurance does not reimburse parents’ psychoeducation. That it’s more lucrative for a company to see one more patient quickly than to spend a little more time with my worrying 1%. And again I reminded myself that this is why I can no longer work for managed care.
I wondered what goes through a teenager’s head when he writes a suicide note. Essentially, it’s the same as the notes I’m planning to write right now – one of the most final of the farewell notes – actually. Are these the same things going through my mind right now? How to enter the few words to describe what you represent for me? What are the top three things I want to tell you to burn me, or what do you mean to me in your mind? What is the mark that I hope to have left in your life and that I want you to remember? Does it really matter?
Handwritten notes are an archaic token of tender compassion. Displayed on coats or shoved in stuffed boxes under the dust in the attic. Most of my patients can barely write. But the image of my patients seeing a card I wrote, telling them that yes, they are special, and yes, they matter to me, and that I believe their life is worth living, obliged. So I found myself writing goodbye letters, writing them in my own grumpy handwriting, hoping that it would one day find its way into the hands of my patients.
One by one, I began to review the pearls of wisdom I learned from them and my hopes for their future. In each card, I found myself writing variations of the same message. Imagine your life in five years. Your vision can become your reality if you walk towards it and work on it a little. Your reality is in your hands. Your hands can be used both to hurt and to heal. Choose healing.
And then I paused, feeling compelled to write goodbye letters to their parents as well. One by one, I began to pass on to them the advice I had already given them. You are your teenager’s anchor and lifeline. You can fan or extinguish their flames. You are the adult. They are the child. It means they are still learning. Forgive them with their reckless and prickly ways. Apologize to them when justified. Love them with all their flaws. Show them why life is worth living.
In my office, on my wall, was a copy of the Serenity Prayer. I felt inspired to rewrite it for these parents.
Prayer for parent of suicidal child
To like,
Grant me
Curiosity
Question the content of my feelings and the origin of my reactive words,
Patience
To listen and receive the answer without judgment or self-criticism
humility
To forgive myself and my child for the past and for the present
and bravery
To act on the unfolding wisdom-
Turn hurt into healing
Create a future worth living.
I then came across the final note, the farewell note for the suicidal teenager in my dream. I wrote many things, but in closing I wrote, “You will always have a home in my heart. Promise me you’ll give your heart a chance to beat a little longer. I wish you the world.
To all suicidal teens and their parents reading this reflection, I urge you to find a way to make your heart your home. You can always go for it, no matter what happens or how hard life is. If we can all work towards this goal, it may be easier for our suicidal teenagers to find their way home. I wish you the world.
Shivana Naidoo is a child psychiatrist.
Image credit: Shutterstock.com
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