Life and Death

As nurses, there are some times that we all have to take care of patients who, due to circumstance, due to mental anguish, due to mental illness, or a combination of all of these things are desperately seeking ways to end their life. On the same shift, or in the same week, or in the same day we also are often taking patients who facing a terminal condition, are desperately seeking to live. How do we go from one extreme to the next and still feel intact? Nurses Announcements Archive Article

Life and Death

Suicide can be described as a permenant solution to a temporary problem. The most frustrating thing when taking care of a patient who is suicidal is safety, and if there is a plan, what is it? Patient's who are actively seeking to die have thought about this and planned this act with great care. Suicide by and large can also be described as the most selfish act that someone can complete. By and large, counselors and social work are large components of the plan of care of the suicidal patient. Sitters that not only watchfully sit and observe, but often need to start the process of de-escalation. The thing to try and remember is that the problem or issue that a person who is suicidal is overwhelming to THEM in that moment.

A number of nurses are bound by human nature. We are only human after all. It is most difficult when a person is suicidal over the break-up of a boyfriend, when your other patient is dying of pancreatic cancer and wishing for a miracle. At that point, we can often think "theraputic communication?!?!?! REALLY?????"

I am here to say, yes, really. Most patients who decide to end their life do not do so with a faint heart. Literally, they feel there is no other option, their life as they know it is unbearable, and they are no longer of "use" to anyone, including themselves.

Terminal conditions, on the other end of the spectrum, often strike when someone is vital, strong and in the prime of their lives. Most endure many treatments, most all of them painful, in a bid to prolong things in order to, well, get their lives in order. To complete a bucket list. To see their kids grow up. Because people need them. Because they have needs. And wants. And desires. And it is heartbreaking to see a decline and for a patient to lose control.

At that point theraputic communication can seem fruitless, and difficult. It is almost like trying to convince someone that it is OK, and that they need to try and let go. And in the next breath to say to the other patient that it is OK, but they need to hold on.

As a nurse, it is painful to be at both ends of the spectrum. A nurse can be as professional as they come, and still go home and try and file everything in their minds in a way that makes sense. That helps them to be in the present. That they can look to the rest of their day with a sense of purpose. To be determined that they can and will leave the problems of the world at work.

Sometimes that means looking to a power greater than yourself. Sometimes that means sitting in your backyard and letting the breeze blow through your hair. Sometimes that means the car ride home is singing to the oldies on the radio. Sometimes it is a good book, a better movie, or snuggle time with your loved ones--human or animal.

Nursing is really about human suffering. Of the mind, body and spirit. But to be mindful of your own body, mind and spirit can give you a greater sense of yourself, and greater good in what you do for a living.

Take time to smell the roses. Take time to just listen. Take time to breathe. And in your everyday life, take time to tell people that they are important to you. And most importantly tell yourself that you are important to you.

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jadelpn

About jadelpn, LPN, EMT-B

jadelpn, LPN, EMT-B

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Specializes in ER.

"Suicide by and large can also be described as the most selfish act that someone can complete."

If someone jumps to their death from a burning building, is that a selfish act? Or a desperate attempt to lessen their pain? Because suicide is an attempt to escape mental pain. It the patient has tried everything they know, and gotten no relief, then suicide seems like the only option. The nurse will be most effective if he/she is able to demonstrate that there are other coping mechanisms that WILL work, and life can be bearable, or even enjoyable.

If your cancer patient in the example finally said " this is too much pain, it's not worth it" they aren't selfish. Depression causes deaths just as painful, but without the attentive caregivers and strong pain meds. Part of the problem is that suicidal patients are assumed to be selfish. Let's change that mind set.

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"Suicide by and large can also be described as the most selfish act that someone can complete."

If someone jumps to their death from a burning building, is that a selfish act? Or a desperate attempt to lessen their pain? Because suicide is an attempt to escape mental pain. It the patient has tried everything they know, and gotten no relief, then suicide seems like the only option. The nurse will be most effective if he/she is able to demonstrate that there are other coping mechanisms that WILL work, and life can be bearable, or even enjoyable.

If your cancer patient in the example finally said " this is too much pain, it's not worth it" they aren't selfish. Depression causes deaths just as painful, but without the attentive caregivers and strong pain meds. Part of the problem is that suicidal patients are assumed to be selfish. Let's change that mind set.

And I personally do not disagree. However, jumping from a burning building when one has no other choice, with all due respect, is far different than planning one's self inflicted death. Again, personally dealing with 4 people close to me who completed the act of suicide, it leaves a hole that is difficult to comprehend. All young, vital, and awesome people that the expectation would not be that they would choose to end their life. The point is choice vs. no choice. Ultimate loss of control on both ends of the spectrum.

Cancer patients are different as well. Most would do anything to live until such time that quality over quantity prevails.

My main point was a sadness of human suffering that most all nurses can and do experience. To be able to rectify that when off the clock sometimes takes some work, self reflection, and a lot of self love.

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There are different views of suicide. You say that "Suicide is a permanent solution to a temporary problem." But the problem can be much larger than one low point in a person's life. It can be a daily struggle to find a reason to live. The hopelessness and pain that that person struggles with is just as real to them as it is to a person with a physical illness. And the medical community is very slow to respond to mental illness. I struggled with depression with suicidal thoughts and plans from about third grade into my forties, and have watched a son and daughter with their own struggles with depression. Fortunately they have been able to get treatment that helped them through low points, and after years of searching I found a physician who was able to help. Depression, like diabetes, requires self-discipline and medication. Yet I have often been told by RN's that depression "doesn't really exist". To think that just one disappointment in a person's life causes suicide may be true in some instances. For others, it is just a moment of weakness in a continuing battle to try to live a life that is filled with pain and hopelessness, often with no or ineffective medical intervention.

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I understand the point of the post, but I disagree with some of the fundamental assumptions made about people who are suicidal.

I lost a very close friend to suicide when I was 14. He was also 14 and was living in what I believe was a very abusive household. He attempted suicide and succeeded on his first attempt.

Surely, someone who believes that they are truly a burden to their loved ones or the source of their parents' arguments cannot be considered selfish. Eliminating the source of the problem when they think that problem is themselves might actually be the most incredible sacrifice imaginable. That suicide is selfish in its nature is a conclusion reached by a logical mind who views the suicidal person from the outside and is probably still mourning. Believe me, this is one thing I know and have experienced myself. But it is hardly the way most suicidal people see their lives.

It's true that many people experience debilitating or terminal illnesses young, but that doesn't mean that the elderly who are facing those same issues ought to be neglected because it's "normal" for their age. Illness is never normal no matter how old you are. My 95-year-old grandmother, who still lives alone in her house independently, taught me that.

I also understand the tendency to compare in disgust and disbelief the 20-year-old contemplating suicide over a breakup next to the terminal cancer patient, but again, this speaks greatly to nursing prejudice when it comes to dealing with mental illness vs. physical ailments. Just because you can't see the wound and bandage it doesn't mean that patient isn't deeply hurting. I've known many soldiers who would rather deal with physical pain than mental because at least their physical pain has a better chance of being treated!

To dismiss a person who is truly troubled over something we consider small because we are able to see clearly and logically over the situation does nothing but alienate the patient and perpetuate the problem. And if they could see clearly and logically, there'd be no psych field, yes?

Take care of yourself as a nurse--absolutely. Do it even if you're not dealing with life and death on a daily basis, because we as human beings can be a difficult breed as it is, suffering or not.

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"Choice vs. no choice." Hmmm. What do you do when you've tried so many medications you can't even remember them all? What do you do when talk therapy has done absolutely nothing? What do you do when everyone ignores your pain and calls you selfish? What do you do when you can't afford treatment at all and there are no public resources available to you and the only thing that happens when you're hospitalized is someone locks you in a room and watches you 24/7?

Is it really any surprise that someone will want to end their life when the pain doesn't stop and they have no way of fixing it? They don't think there's any choice. It's a last resort, and a desperate one, and the suicidal patient is often aware of that.

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I was speaking about one view of suicide. The aftermath of a successful suicide is beyond heart wrenching. I will say in my personal life I have heard more than one mother/sister/brother/friend ask why, and not realizing things had gotten so bad, think it a selfish way to die.

I have (as previously stated) 4 people close to me that chose death as the only option. It sucks doesn't begin to describe it for those they left behind. However, I absolutely 200% agree that the options are not ideal to say the least. The struggles are real. And difficult.

The only choice some see is death. And I do not deny that it is real. It is not an easy life for a nurse when dealing with death as a viable option as opposed to the only outcome of someone who is terminally ill.

We need to take care of us too. The feelings that need to be compartmentalized by a nurse who has these two opposites are real as well.

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it has been commonly expressed for a long time, that suicide is "selfish".

i never, ever agreed or saw it that way.

to call it selfish because the person does not think how their suicide will affect others, is secondary to me.

all i see are tortured souls that are acting desperately or stupidly.

my dtr's bff hung herself in 2009 and succeeded.

she had broken up with her boyfriend - the boyfriend killed himself as a result but left this girl a note, blaming the suicide all on her.

'heather' decided she couldn't live with the condemnation and guilt, and killed herself. (she was a teen.)

a few yrs later, her brother threw himself in front of an oncoming train when he was inebriated, and died.

rumors said it was because of a breakup with his gf - it was later discovered that he missed his sister.

bottom line, whether it seems petty/insignificant or not, these people were tortured or drunk/high enough to make poor decisions.

suicide is always so very tragic but i am always relieved for them as i believe they are now in a realm where enlightenment will occur.

jadelpn, you have experienced so much loss and i am sorry for that.

we truly need to all be proactive in getting mentally unwell people, the help they so desperately need.

we don't need "snap out of it", or "well, you don't know what I'VE been through", or any type of dismissive, superficial responses.

mental health is tragically low on the priority list in this country...

and it should be addressed as any other healthcare need.

in the meantime, jadelpn is right - we need to take care of ourselves.

unfortunately that will not happen until we learn to value and respect ourselves...

and only then, will we be able to effectively and compassionately reach out to others.

leslie

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Specializes in Critical care.

Some people are just so controversial I'm pretty sure you guys are reading way too much into this

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Some people are just so controversial I'm pretty sure you guys are reading way too much into this

Thank you Latroyashort for the kind words. The articles I write are meant to try and look at things in an alternate light. Good, bad, or indifferent.

I always like to write about "elephants in the room". My views and expereiences are not always (or sometimes ever) relective of anyone else's, sometimes spot on. But that is ok, as I really get very interested in what others experiences are that are different or similar to one's own.

As a nurse, I really do believe that unless we start a conversation(or 2 or 3) about the more difficult aspects of our jobs, and how it can affect us as people, we have nurses who are not sure what to do with all of the information in their heads when the day is done.

Sometimes what nurses need to do with the information in their heads is to write about it here. And I welcome the responses, no matter if one necessarily agrees with the article or not.

I am a firm believer in leaving things at the door on one's way in or out. But when dealing with the far ends of the spectrum that can prove to be difficult. We are in a career that isn't about us, however, how it can affect us is hard to fathom.

I can see truths in every one of the responses. And I am thankful that the article touched something in each of the responders that they cared to respond. Takes courage to lay it all out there.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I hear what you are saying that by the survivor point of view it appears to be a selfish act.

"What about those left behind?

Did they ever think about that?

Why couldn't they have thought about me!!!!

How much this would hurt me, their children, parents, friends????

How could they have been so selfish???"

I have heard these sediments from the surviving family and I think they are apart of the grieving process....that sense of anger at the senselessness of it all, anger they they died, maybe guilt thinking that they personally could have done something to stop them/change the outcome. Their grief is so raw...so painful to watch and there is nothing you can say or do to ease their pain.

I remember trying to save a successful suicide with dialysis and meds and life support in one LOONG code ......on someone very young. We Were not successful....I will never forget the parents reaction when we walked out of the room the hatred and anger as they said "Thanks for nothing I hate you". The look of loathing was difficult even though I KNOW they weren't REALLY mad at me, per se, that they had to be angry at someone to help them grieve. They hated the hospital forever and hate it still now they speak of the incompetent fools who can't fight their way out of paper bags...to this very day (my family is an acquaintance of this family). Do I realize it really wasn't me? YES...does it still hurt? Yes, some days it still does.

I am not sure those who commit suicide are being selfish.....I think their pain is so intense....so painful that they can't see past their pain....and they, like a terminal cancer patient racked with pain, they can no longer live with it. That their own survival is meaningless for they aren't worthy...sometimes their pain is so great they just can't see tomorrow.

I agree that we as nurses need to take care of ourselves, I think we need to care for each other. I think the lack of caring for ourselves causes burn out. We give it all to everyone and leave ourselves empty. I believe that nurses also suffer PTSD because of our jobs....which will never be recognized for that would means a work related condition. These nurses are sometimes referred to as "old bats who eat their young"....or "burned out"...when I think some of these nurses...they are emotionally drained and the profession has sucked their life from them leaving them high and dry. It's a crime.

I think we need to be kinder to ourselves and to each other.

I am sorry for your losses.....Thanks for sharing ((HUGS))

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The OP is writing from a surviving friend/family perspective; not from a suicide attempt survivor's perspective. Since nursing includes caring for the patient and their family, it's a valid, if incomplete perspective.

A close family member attempted suicide recently after months and months of debilitating depression. As she describes it to me, it wasn't about punishing anyone or about how awful it would be to her family and friends. She seriously was so severely depressed, she couldn't eat, she hadn't slept more than 3 hours a night for months, she said it was like this black fog followed her everywhere, engulfing her and sucking any joy and energy out of her. She said she attempted suicide after she'd tried to reach out and get professional help, but the help didn't make her feel any better. Her mental pain and suffering became too much to endure, and she literally could not imagine it ever getting better. She couldn't think about how her actions would hurt others, she really just wanted the pain to end.

I used to think suicide was selfish, but after her attempt, and my involvement with her recovery, and my own reading and research, I've come to conclude that it is not. It is an act of deep and utter misery and desperation. If I allow myself my own selfish moment, I think "how could she have done that to me and my family? Didn't she know how terrible that would be for us?" The answer is that,no she didn't. Just like someone with horrible physical pain can only concentrate on that, and can't (and shouldn't) be worried about the emotions of others, those with mental anguish truly cannot see beyond their pain. The family and friends of suicide completers are experiencing a similar pain and guilt that the family and friends of other people who have died, particularly those who died in a violent or self induced manner. It's not any better or any worse than the pain felt by the families and friends of the victims of the Boston bombing, of those who die in war, in car wrecks, of etoh poisoning, of drug OD. It's simply painful to lose someone you love, and when you feel like the death was senseless or preventable in some fashion, it hurts all the more.

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