Extract from issue 146 July/ August 2007, 'Managing risk, recognising strengths'

Peculiar grief by Jessica Evans

Do you remember those watersheds in your life when your sense of who you are becomes changed for ever? At those moments innocence is lost. Something that has been seen can never be unseen.

I remember a time when the future opened up before me like a foreign land to explore. As I prepared for the expedition, I thought that my education, a pleasant manner and a belief in success would see me through. It has, funnily enough, but not in the way I thought at the beginning.

On a nondescript week day about two months ago I received a call on my mobile. I was with a colleague in the car park of a small, rural psychiatric hospital, planning the delivery of a presentation to nursing staff and making all the usual goodbye noises.

It was a senior colleague who told me simply that one of my patients had died and that she had hanged herself. She had been found some days earlier and it had taken this amount of time for the news to filter through to me. I was the last but one clinician to see her alive, and I had made the decision at that time not to admit her to hospital.

As I recoiled from the shock of hearing this news, my mind frantically leafed through the faces of patients I had assessed after their suicide attempts. I paused on one face warily, and as she came into focus I pushed her away again.

This lass had troubled me at the time. We were the same age and her loneliness had touched me, as did the dreary, bonescraping nature of her loss of self. As I made my notes during the assessment, she said that she was not suicidal at that time, the overdose having quelled her feelings for a while. I was heartened by aspects of her behaviour that made this admission not unlike many of the others that had taken place throughout her life.

Strange, then, that I should also have harboured a sense of doubt about her future. I discharged her and made follow-up plans for her, and was glad that she had animals she loved to look after and nurture at home. But she killed herself.

I knew her for two hours. I asked her for details of her life that she was used to parading before people like me. Yet although I had known her for only two hours, when she died I felt a stab of grief, the shock of losing someone who means something to you.

As a practitioner I have witnessed many deaths. I worked in Accident and Emergency and have tried to resuscitate many people. Sometimes they lived; more often they died. I have failed to resuscitate children. I have nursed people through the end stages of their lives, whether with all the bells and whistles of emergency medicine or within the tranquillity of a palliative care setting. I have been to patients’ funerals. I have received letters from families thanking me for my care of their loved ones, and I have got wildly drunk with colleagues to drown our sorrows.

I have felt really moved by all these people. I remember them and their families fondly. It was a privilege to help them navigate a last illness or tragic news. There are so many of them to remember. But this was the first time that it was only me making the decision not to intervene.

My colleagues were amazing. One of the consultants gave me the support and advice that only a more weathered practitioner can provide. We talked about the tragic stories we are exposed to as clinicians time after time; that each person is unique and worthy, and that we cannot change the world as we would like to.

He said that it was quite natural to become unhelpfully overcautious in the future, or at least during the period while I was feeling winded. He told me anecdotes about others, and that helped because then I felt I had been initiated and was part of a quiet team of people who bore their wounds with the dignity of old warhorses. I was not alone – unlike my patient.

For a while the world seemed divided between people who had been through the same experience as me and those who had not. The former treated me gently, with few words required. I encountered one of the latter in the panelled halls of a hallowed medical institution over a glass of red wine, where he repeated the myth that those who talk about suicide rarely do it. I felt so angry with him. What did he know? I wanted to tell him he was wrong, wrong, wrong; to channel all of my own rage into wiping the sanctimonious wryness from his face. I withheld.

The truth is that one day I will be in the caring role for a colleague who faces the same mixture of fear and grief that I am experiencing now. It could be the man I met over red wine.

The truth also is that it is in the gentleness with which we treat each other as colleagues that we pay our respects and mourn the men and women who have died in our care. This is the tenderness that was missing from their lives at the end and the embrace that they should have received.

I wonder if there was anything I could have done to change her mind? I doubt it. I was not important or powerful enough an influence in her life. It seems she has been in mine, though, and I will never forget her. It will have to be enough that we left each other on good terms that day.