suicide | Elbrecht's Corpuscle

Where the Heart is

Posted on May 5, 2014 by Elbrecht

Kristi called out to me in a soft whimper, “Ean?”

I responded by peering up the stairway to the third floor, whereupon I could see her right hand grasping her left wrist. Blood was visibly seeping out between her fingers.

It was Martin Luther King Jr Day. The year was 2007. And at that point, I had been living in a group home for 2 and a half years.

I had arrived home a few moments earlier, ascended the stairs to the second floor, and set my bag down outside of the small staff office. It would remain there until I returned home from the Emergency Department by myself several hours later.

Kristi heard the front door close all the way from the third floor. Perhaps her senses were exponentially heightened due to the shock of seeing blood spray from her wrist as it was sliced by a razor. Her next instinct had been to leap from her bed and into the hallway. She could only see my shoes from her vantage point to the second floor, but even such a minute bit of information gave me away.

Kristi’s decision to end her life had coincided perfectly with my return home from a peaceful day off.

I quickly scampered up the stairs as Kristi stood outside her bedroom. I unlocked the door to my own bedroom, which was located caddy-corner to hers and grabbed a towel. Kristi was half-sobbing, half-whimpering as I pressed the dark blue hand towel on top of her right hand. Standing outside her room, I could tell that she had been seated on her bed when the razor punctured her radial artery; a fine spray of red blood was juxtaposed against the yellow wall.

She pulled her right hand from below the towel so I could apply even more direct pressure. After a moment, she made a fist and flexed at the wrist as I took a quick peek at the damage. The pressure kept more blood from squirting out, but I could tell we needed to head to the nearby Emergency Department immediately. Kristi resisted my initial suggestion to go to the hospital, but after a moment of thought, she could see the concern in my face, as well as the blood on her right hand and now the towel and agreed to go.

I knocked on one of the other staff’s bedroom door, located directly across the hall from Kristi’s, hoping she was home. Thankfully, she was. I gave her a quick synopsis of what happened and asked her to clean the wall with some bleach before Kristi’s roommate returned.

The Cambridge City Hospital was only one street over from our home, a social project developed by Harvard psychology graduate students over forty years earlier. Our close proximity meant we were in the ED only five minutes after Kristi retrieved a razor blade. Once there, Kristi was apologizing profusely every few seconds for ruining my towel; its dark blue color disguised the carnage beneath.

The ED was not particularly busy, especially for a holiday, but I didn’t like the idea of sitting in the waiting room any longer than necessary. Though the bleeding had almost completely subsided, my rudimentary medical knowledge in those days told me this was due mostly to the flexion of her wrist and the pressure it was causing.

However, I could not help but visualize Kristi extending her wrist and spraying blood on the backs of the family sitting in front of us. So I went up to the triage nurse and politely explained that my friend’s injury was self-inflicted and would she please move us to the front of the line so she could be evaluated.

Through the glass partition, the nurse looked out into the waiting room and saw Kristi sitting there, holding the towel against her flexed wrist and nodded at me. I called to Kristi and she stood up, took a few steps towards the door separating the waiting room from the triage bay, and grimaced.

Only fifteen minutes earlier, as I had been walking home from the YMCA in Central Square, Kristi had been on the phone talking to her older brother, who happened to be a physician. Despite his training as a psychiatrist, he had not sugar-coated his concerns about her mental health when he informed her that he didn’t feel safe leaving her alone with his young son during an up-coming visit. She began crying and hung up the phone.

Despite Kristi’s battle with depression in her early twenties, she had graduated from law school and begun a successful professional career. But as it does with so many individuals, depression seeped back into her life and had become all-encompassing. A suicide attempt led to a hospitalization for several weeks at one of the world renowned psychiatric hospitals in Boston.

Upon her discharge in the fall of 2006, she joined our group home after a week-long communal interview process that was required for all residents and staff. The first few months had been difficult for Kristi, due to her inability to find a steady job in the legal field again. When a reliable temp position opened up a few weeks earlier, she began to thrive.

But that call, and the message therein, drew out her self-hatred and the fury of “helplessness and hopelessness” which characterizes depression. Unbeknownst to myself and the other staff, who lived in the home with the residents, Kristi had been prepared for this desperate last act. When she returned from the Emergency Department several hours after I had departed, she asked me to remove the box of razor blades hidden in one of her drawers.

Over the course of three years, I lived in two group homes belonging to the same organization in Cambridge, MA; first as a counselor, then as the director of the home where I lived with Kristi. Focused on helping high-functioning individuals transition from in-patient hospitalization (for mental health issues) back to independent living, the opportunity to be a part of this unique program had brought me to Cambridge from Ohio in my pursuit of becoming a clinical psychologist.

But in the fall of 2004, after only a few short months of living in one of the homes and participating in the project as a counselor for its residents, my purpose in life was irrevocably transformed. I had come to get hands-on experience by living within the mental health population, learning how to best serve their health needs, but I was shocked to see how pathetic the basic medical care is within this portion of our community; a chance encounter with another young professional who was going back to school to become a physician set my wheels in motion.

The three years I spent living with over 60 incredible people, those who were trying to conquer their illness and others like myself who wanted to help, transformed my life and gave me the strength and perspective to survive my own trials and tribulations.

My experience as a medical student, my failures and successes therein, the friends I made, the colleagues I cherished, the patients I cared about and for… all of them were a direct result of my life in a group home.

Home. Truly, where the heart is.

Trauma E

Posted on January 6, 2014 by Elbrecht

Trauma-Team-4

—–

My final clerkship of medical school was a Trauma Surgery rotation in Columbus, OH. As a “Level 1” Trauma Center, I was certain to see all sorts of medical traumas. From horrific car accidents, penetrating stab wounds and life-ending gun shots, to suicide attempts, both successful and unsuccessful, sporting injuries, and the aftermath of violent beatings.

Rather than leaving Columbus and heading to Worcester, MA for a radiology clerkship where I could stay with some of my dearest friends and put in 4 hour days, I decided to stick around Columbus, have a 4:30A wake-up call, 9P bed-time, and expose myself to an aspect of medicine that I was unlikely to encounter in my future practice as a Family Medicine physician.

—–

And that is exactly what happened, as the four weeks I was on the Trauma Service was the busiest month in the history of the hospital.

Anyone who knows me well, or has spoken to me about my experiences in medical school, knows that I typically don’t care for the attitudes of surgeons. While it is a profession that requires its practitioners to be exquisitely skilled, the god-like aura that typifies a surgeon, especially towards students, is enraging. (And completely unnecessary.)

—–

But despite this behavior, I wanted to be a part of the care of patients who present to the hospital after a traumatic accident… Or as I was resoundingly corrected by one of the trauma surgeons when speaking of a motor vehicle accident (MVA), “it was a motor vehicle collision, as we don’t really know if it was an accident.” Thanks a**hole.

On the student’s first day of any clerkship, the other students, residents, and physicians will ask about the new student’s future career aspirations. This is done to determine the level of shit the student should be given over the course of the next four weeks.

If the student is interested in becoming a member of that medical profession, they will be held to a higher standard, given more grunt work, asked to work longer hours, and expected to know a ton more than someone who’s professional aspirations are 180 degrees different.

—–

Thus I found myself having the following exchange with the Chief Resident two minutes into the rotation: “So what year are you?”

Me: “I’m a fourth year. And this is my last rotation of medical school.”

CR: “Are you going into Surgery?”

Me: “No. Family Medicine.”

CR: “What the hell are you doing here?”

Despite this inauspicious beginning to our medical relationship, the Chief Resident ended up being a terrific teacher, physician, and all-around good guy.

His “Surgeon’s Aura” was usually absent. In regards to surgeons, this guy was the proverbial medical zebra that you are taught to stop looking for… But in his defense, it’s simply not common place to see a 4th year medical student sign up for a grueling clerkship as their last hurrah of medical school. Typically, it’s something like… Radiology.

—–

Several of the Family Medicine residents with whom I worked previously had suggested the clerkship, so I went into it with a positive attitude. I figured, if anything, that I could bring some humanity into the trauma bay… as by-in-large, the trauma bay is one of the least “human” experiences in medicine.

Upon a patient’s arrival, multiple people are poking, prodding, screaming, shouting, slicing, sticking, cutting, and tearing… at the life and limb of this latest entrant to the trauma bay.

—–

Depending on their level of consciousness, the patient may or may not be screaming and shouting. If they are unconscious, the distractions are seemingly less, but the situation is quite significantly more dire. I preferred the screaming and shouting patients because it meant they were more likely to survive.

But the surgeons, they prefer the deafening silence of the patient because the stakes are raised, the opportunity to transport them to the surgical theater more likely, and their god-like skills are soon to be exercised.

—–

Over the course of four weeks, I cut off my fair share of pants and underwear, placed innumerable Foley catheters [a tube into the urethra of both men and women], and stuck a gloved and lubed finger into the rectum of more people than I care to admit… but that was all done so that I could say to the patient, “We are going to take care of you”… and to mean it.

In a nutshell, that is the humanity that is absent from the trauma bay. It is a rarity for someone to ask for a patient’s name; no one states a desire to care for you; no one even thinks of doing either of those until the patient is either on the way to the CT scanner, surgical theater, or morgue.

—–

But one of the clinical psychologists I encountered during a previous rotation had mentioned a quick anecdote that stuck with me. His father had recently been in an accident and while laying on his back, with numerous people he didn’t know poking and prodding him, he had some of the terrifying fear, anxiety, and uncertainty removed by someone who immediately stated upon his arrival in the trauma bay, “We are going to take care of you.”

—–

I carried that anecdote with me each time another Trauma was called over the hospital’s intercom system.

I think this kind of humanity becomes absent as a defense mechanism from the care-providers.

Because when someone is wheeled into the trauma bay, their next destination may be the CT scanner to determine the extent of their injury.

Or the surgical theater as a last-ditch effort to save their nearly life-less body.

Perhaps the morgue, because the extent of their injury was too great for even a god to cure.

—–

And when the outcome could be either of the last two, I would imagine it becomes difficult to not simply view each new patient as a body on whom your craft can be practiced… until your craft has provided a life-sustaining result.

Then, after all is said and done, and the patient is alert and speaking to you, their worst day behind them, only then can you entertain the idea of knowing their name; Or offering to care about/for them. Until then, they are simply Trauma [A, B, C, D, etc].

—–

But what if that next day never comes.

And in their final moments no one is calling their name.

No one is telling them that they care about them.

Then what?

—–