I read something in the newspaper tonight that just makes me sick at heart........an elderly gentleman I took care of for three days last weekend was found dead at his home, apparently the victim of a self-inflicted gunshot wound.
The worst part is, I knew he was in danger, because one night he told me how he was thinking of "checking out". Then he began talking lovingly of his wife, and how proud he was of his four grown children, and about his faith in God. At the end of this conversation, we both agreed that he had a lot to live for, and that he ought to see what his upcoming lung biopsy said about his prospects. The very next day, his mood was much improved, and he practically raced me up and down the hall during our ambulation sessions, trailing grandchildren and IV tubing, and grinning the whole way.
I did make a note of this exchange in the patient's chart and a referral to the discharge planner, but he was so cheerful for the rest of the time he was in the hospital I figured he'd resolved his issues. Then last night at work, somebody mentioned that his name was in the death notices section of the newspaper........and while I immediately suspected it wasn't the cancer that got him, I prayed that he hadn't killed himself. And now, tonight's paper reports that he had "recently received a diagnosis of terminal cancer, giving him only weeks to live".
Ah, the guilt........I guess I *shouldn't* take any responsibility for this, but damn, the man TOLD me he'd been thinking about suicide, and then he went and did it. I feel like I should have done more than make a progress note and put a request in to the social worker to see him.......I knew even before the biopsy that the news would probably NOT be good.......but what else could I have done? This was an alert, oriented 80-year-old man who did things his own way, and he was determined that whatever happened to him, he was going to be in control of it.
And so he was.........I just wish I hadn't been fooled by his appearance of having worked through his feelings, and that I HAD been more aggressive about getting some help for him. I realize I'm not the only nurse who cared for him, nor am I probably the only person he shared his fears with; and who knows, maybe it was the diagnosis itself that tipped him over the edge.........or maybe what I saw the next day after our talk was just the calm before the storm, the sense of peace and relief that come when a man's mind is made up.
