Last night I took care of a man who was on suicide watch. This crops up occasionally, usually when someone has taken an overdose or has some other acute medical issue going on that prevents them from being directly admitted to psych. Instead they come to the ICU, where we can monitor them closely until they are stable enough to go to the psych ward or be discharged. I had the luxury of plenty of notice that this patient was on his way (something that has been in short supply lately), so I was able to set up the room to my liking, restock supplies, even read through the patient's chart for the back story I knew I wouldn't get in report. I brought my coffee into my room, despite the fact that this is forbidden, and tried to drink as much as I could before my patient arrived. I had grabbed a mug from the break room that said "HO HO HO!" in clusters all around, and as I sipped and perused the chart I looked around and thought of the scene that this must set. Working leisurely, with an out of season and forcefully cheery mug in hand, thinking detachedly about the man on his way to me who appeared from his chart to be severely depressed and unable to cope.
When my patient finally arrived, at his side was his wife who had obviously been crying. I suppose this shouldn't have been surprising, but the truth is that most of the time patients on suicide watch have families that have long gone home by the time they reach me, tired of yet another emotional crisis from their loved one; that is, if they have any family at all. So the crying wife got to me. I got my patient hooked up, assessed, and settled. He seemed plainly depressed to me, slow in his movements and though process, with a flat affect. No tears from him. When I was done the wife came back in and they talked in low voices, with lots of sniffling. I sat outside, "HO HO HO!" in hand, and tried to chart, but mostly I was thinking about how just another day at work for me was another worst day ever for my patient and his wife. What would I do if it was my husband lying in that bed, trying to explain to me why he had decided to empty the rest of his painkillers into his belly, then changed his mind and decided to, of all things, take the bus to the hospital? What if it was me sitting there sniffling, trying to understand this awful situation while a stranger sat just outside, drinking coffee out of a Christmas mug?
