Tuesday, February 02, 2010

Heaven Can Wait, Redux

I forgot to mention that my latest column is up at Hope and Healing. This piece was mined from my fuller and longer blog post on the same subject, which some of you will already have read.

Happy reading!


  1. That's really good. I have a feeling that most people in that situation in the ER don't get to have someone as kind and understanding as you are.

  2. As a veteran of a couple of units of CPE, I really appreciated your article on suicide. The hardest visits I had always involved suicidal patients. One man told me that the only thing that kept him from following through with his suicidal impulses was the belief he'd go to hell if he committed suicide. Thanks for presenting a helpful way to be with such a person.

  3. You're welcome. Oddly enough, they're usually my favorite visits, even when they're hard -- maybe because they give me the chance to be with suicidal people the way I wish I'd been able to be with friends I've actually lost to suicide.

  4. It seems like you must encounter people who aren't satisfied with that, who have in fact "thought of that before" (permanent solution to a temporary problem, biochemical problem, &c.) and been unimpressed. How do you deal with them? How do you deal with people who don't believe in an afterlife and aren't concerned with heaven and hell but only believe in, and actively seek, oblivion? I don't mean to be accusatory but am really curious--I'm fascinated by your posts about being a chaplain but as I'm not a believer myself the theological aspects just seem irrelevant, and you must deal with patients who are similar?

  5. Thanks, Inky -- somehow your comment got lost, and I just found it!

    And Katie, thanks for your excellent, and tough, question. People who are determined to kill themselves will find a way, which is why survivors should never blame themselves (although they always do). Most of the patients I see have gotten to the ER because they called someone, which means by definition that something in them wants to live. That's why "how did you get here?" is always my first question.

    People who didn't get to the ER under their own power, who were discovered after an attempt or had the authorities called on them before an attempt, are more difficult to reach. And people suffering from some of the conditions most resistant to effective meds -- bipolar and schizophrenia can both be notoriously difficult to treat -- are indeed skeptical of the biochemical argument. If you've been on a dozen med combinations, none of which have worked, well, of course you're exhausted. I've read that bipolar increases the risk of suicide by 35 percent.

    Luckily, I play only a very small role in the treatment process. The patients I see in the ER will go on to at least three days of hospitalizaton, followed -- with luck -- by outpatient treatment. They'll all encounter folks far more knowledgable than I am. And, as a chaplaincy truism puts it, we all need to remember that God was in the room before we entered, and God will be in the room after we leave. As someone who came to belief in my late thirties, I believe that's true even of people who don't believe. In retrospect, God was present for me long before I believed in Her. YMMV!

    Nevada has one of the highest suicide rates in the country. This isn't, as many people believe, because of gambling: most of our suicides occur in rural communities with even more dismal mental-health resources than the rest of the state, where guns and alcohol (and toxic individualism) are as prevalent as intervention services are rare. So generally, I never get to see the people who are truly determined to die. Someone else finds their bodies.

    That's why I rejoice when any suicidal patient makes it to the ER.

    Thanks again for your question, and please excuse the long answer!

  6. No need to apologize for the long answer--I appreciate it, as I'm just really interested in all of this, and can't help but be most interested in the things that must be the hardest to address. I worked for a very short time in EMS and I had a very hard time with people who were suicidal--like, what in God's name do you say to someone in a situation that if you were in it you'd probably kill yourself too?

    I think I saw enough in my short time in EMS to see that there really is a difference between people who make serious suicide attempts and people who make Cries For Help(tm), and that the latter are much easier to cope with. And while the former are probably much more likely to succeed in their attempts, they survive often enough that someone's got to know how to talk to them, and what do you say to someone who's been through all of it (hotline slogans, psychotherapy, eighteen different med combinations, &c.) with no success? Someone who's thought about what wonderful things they might accomplish, what sort of god might really care about them, how many people care about them, how distorted their perspective is, and understood all of it and still wants to die?

    This is probably a rhetorical question, really. I just think it's interesting, in a distressing sort of way. Oh and I love your blog :) I think I find your chaplain work so fascinating because it seems to me like it must be so incredibly hard.

  7. Katie:

    Sometimes all you can say is, "I hope you get through this. I want you to live. I believe that other people want you to live." Sometimes all you can do is hope (or pray, in my case) for people to find reasons to keep going. And yeah, I've had patients who've made me think, "If I were in your place, I'd want to kill myself, too." Definitely not easy.

    Thanks for the kind words about the blog! Actually, 97% of the time, I don't find chaplaincy work hard at all. I find it fascinating and rewarding. Even in the hard times, I'm glad I can be there for patients and families, can maybe make a micromillimeter of a difference (and we never know that at the time, can never see the results of our actions).

    For me, the hard part is when I feel I haven't responded in the most helpful way, which is when I start beating myself up and doing that "every other chaplain is better than I am" thing. But most of the time, I at least know what I should have done, which is a start, and I'm getting better about letting go of my misery over mistakes. It helps that the staff chaplains and nurses -- and sometimes even the doctors -- where I volunteer are so affirming and glad that I'm there. (Some of them, anyway. Others clearly consider me a clueless bleeding heart liberal, but I avoid those folks! ;-)) We're not supposed to be doing this for the "attagirls," but all of us need one occasionally to keep going.


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