Act of Self-Harm Vs. Suicide Attempt

 

"To: [Psychiatrist], MD
From: [Jae Jagger]
Received: 3/21/2022 6:15 PM PDT

Hello Dr. [B.], On April 1st, I plan to overdose on Gabapentin (I have 120 pills of 600mg). Soon after ingesting the pills, I will walk into Stanford ED and receive help. I do believe I have no other options. [Jae]"

 

Today, in front of a group of Stanford resident doctors, I was asked what my thoughts were surrounding this note just before I sent it off. What was I thinking? 

 

First of all, I believe this would have been an act of self-harm, not an suicide attempt for two reasons. One, gabapentin is safe even in very high doses (according to the expert Sean Mackey). It only gives you bad diarrhea, and then you're fine.  Two, I was walking into the ER immediately afterwards.

 

 Obviously, if I really wanted to die, I'd do several things differently. One, take the super-size bottle of Tylenol in my drawer, add alcohol (definitely would go with the classic favorite Grey Goose and orange juice), and bam! Dead in several hours! It would be an excruciating several hours where you would doubt the will to die and the will to live, but you would get the job done. You could even throw yourself a little party, when drunk, everything is better. If you read Manic, you notice the author likes to mix in Tequila with her attempts.

No, I chose a safe medication and was planning on seeking help. It is true that 120 is a lot of pills, and 600mg is a high amount, and yes, during my googling, I did find one woman who died from gabapentin overdosing. It's possible. I was obviously risking my life.

Also, I was telling my psychiatrist my scheme days before I was planning on doing it. I told my psychotherapist about the note during our next session, and she prompted me to call my psychiatrist. During my therapy session, while my therapist, my mother, and I are discussing all of this, I brought up the really obvious question, why hasn't my psychiatrist called me? He returned my note with a shorter note. He wrote:

"To: [Jae Jagger]
From: [Psychiatrist], MD
Received: 3/22/2022 11:00 PM PDT

This sounds like a different plan than you've typically had in the past. Could you explain to me what you think this about?"

 

(Originally, during the previous Stanford G2P stay late February/early March of this year, I deflected many questions about my suicide plan, and back then, I had the ingenious idea to swallow one of my mother's fentanyl patches [with what? I never figured that out]. They can't save you from that. A few minutes and you're dead. I do have Narcan in my bedroom, but I probably wouldn't even stay conscious long enough to use that unless it was in the very same room.)

 

I was really trying to make a point to my Stanford outpatient psychiatrist, who blatantly told me that there was no medication that would help me (you're a fucking psychiatrist whose job is to dispense pills, so prescribe pills!), that yes, I was crazy enough to hurt myself, take those tablets--whether it be Tylenol, Norco's, Gabapentin--and that yes, I needed real help. Someone help me. If no one would have stopped me, I would have went through with my plan. There is another layer, and I spoke about this during my interview in front of the resident doctors this afternoon--I am in so much pain from hearing the awful voices (frequently off and on all day) and the depression that I have to act this way, risk my life, because I don't want to live like this. It's either I receive treatment, get better, or I pass away.

 

I was willing to accept if the doctor wanted to go up on the clozapine prescription, and wait and see for a couple of weeks if there were changes. Or admit me to the hospital again. 

Even being back in the hospital again, Dr. [Psychiatrist] has not suggested a medication change. Per our last conversation, he told me that "there's lots of things to try." When are we going to try them?

Thoughts on Being a Nurse [Updated]

Over the past few months, I've been playing around with the idea of going to nurse school after learning that I'm only two classes away from qualifying for the RN program at my local community college (I have anatomy and physiology left to take, and I've already taken those classes in other forms--Anatomy and Physiology of Farm Animals and Human Biology). At my community college, the RN program is a lottery system since about 250 applicants try for 45 slots. Some people wait years. I didn't see the point, and I brought up the idea to my mother (after some preliminary research) that I could just attend Fresno State. I could live in Hanford, Ca with my grandmother (father's side). My dog would be welcome there, and my horse would just live a few miles away. My mother was firmly against the idea--both me living in Hanford and driving to Fresno and me going to school in Fresno. She cited the dangerous nature of the roads during the winter, the deathly fog that occurs in the morning and only fades into the afternoon. 

The Stanford inpatient psychiatric team, however, was happy to learn that I was thinking about my future, because both it was important for anyone, and because it meant I wasn't always thinking about hanging myself or jumping off the building, etc. They wanted me to find meaningful work, no matter what that was.

During the family meeting, with Mom on the speaker phone and the rest of us in the small conference room, the attending psychiatrist brought up the idea to my mother. "We're excited that [Jae] is thinking about these things, and what she's going to do with her life, and what next steps she's going to take..." He offered. He talked specifically about Fresno State.

"I'm encouraged that [Jae] is wanting to go back to school full time, but I'm against Fresno State.." Mother had her reasons. She even stated that Fresno was a "demilitarized zone." The team asked her questions about her opinion, and she mostly commented that Fresno was just a bad area. Someone from the group, I don't remember who, asked her how long ago was her last trip to Fresno. "About twenty years ago," she commented.

Faces around the round gave that nod, and looked to me sympathetically.

Over the weekend, I did research and realized that Fresno State's BSN program is impacted, and there's a good chance that I will not be accepted. The average accepting GPA is a 3.75. I don't remember my current GPA (at one point it was a 3.9, but I've endured some hits since then), but it's probably a little bit less than that. I figured I'd break the news to my mother, thinking she would be happy or relieved.

Her response was, via TXT message, "Are you positive that is your chosen profession? How are you going to keep your dog and horse living in Fresno?"

I explained to her what I previously wrote in the beginning of this essay. "She's an emotional support animal, she can stay with me in my residence. They can't discriminate.." This is true. I asked my mother, "Do you have better ideas??"

"No I just don't understand..." She writes, "Trade school for vet tech is an option...have you looked at any trade schools? for any occupation?"

I was beyond hurt. I was heartbroken. I didn't want to be any nurse. I wanted to be an PMHNP, with the autonomy similar of a doctor, but you spend time with patients similar to a nurse. And other educational options are available, including research. There was more than one way to skin a cat I was finding out. But my mom didn't aspire with me for these big goals. And swimming in those big, deep dark holes, I wondered if mom thought, was I just not intellectually capable of handling university work. And again, did I believe I was acceptable of the rigors of university work.

What kind of person did my mother think I was? Dull? Stagnant? What kind of work would I ever achieve? My attending psychiatrist told me that I would just have to defy her expectations. Do it while she looked on in bewilderment. Maybe so. But what do I believe? I have to internalize the positive messages, and turn away from the negative ones. Ignore James when he calls me a "stupid bitch" a million times a day, which he does. I don't get called a brilliant bitch. To be fair, you don't need to be brilliant to be a nurse practitioner, but sometimes in struggles, I wish I heard more compliments from the people around me, i.e. my mother. I'll admit to that, as ashamed as I am to do so.

Doctor's Consult, All the Things Left Unsaid

Yesterday morning, the psychiatrist greeted me normally as if nothing had happened between us the day before. Or maybe I just remembered our previous session incorrectly.

I was anxious all day about it, the prospect of being alone with him. What would I say? I would have to explain my behavior.

Finally, around four o' clock, he flagged me down in the hallway, and we met privately in the conference room.

"What happened yesterday?" He remarked casually with little affect. "Why did you leave?" It was as though this was a simple business matter to get out of the way.

"I didn't want you to see me cry."

"Why were you crying?"

"I just had hoped...we...would have had..."I balked. "More progress during this admission before the discharge date...I know we talked about Friday or Monday..."

"Well, that's where we left it yesterday, but it doesn't have to be a hard fast rule...we can think on it, and see how things go. Maybe decide more early next week?" He looks at me with compassion. He had obviously thought about this, and figured out this was what I wanted--more time in the hospital.

"I know that [the psychologist] wanted to work with me on Friday, and I didn't want to miss that if at all possible."

"Yeah, yeah, definitely."

(Morpheus) Part 2

"What did you want to happen? Have him show up on your doorstep with a cup of coffee and a marriage proposal?"

--James

Doctor's Consult, I Didn't Want to Cry

"You're all I have," I say, pleading, opening up my hands to him. "[Regular Stanford psychiatrist] has run out of ideas and was going to refer me to the Depression Clinic." 

He sat across from me, unmoved. Or if he was moved, he was smart enough to bury his emotions under years of practice and discipline. He could not survive being pulled into every patient's whirlwind of problems and troubles. He had to stand back and watch the misery continue unabated, if that's what happens when the pills failed.

And sometimes the system breaked us. We humans who were too frail of mind and emotion. We get caught up and damaged. Who is accountable for us? Who will say, yes I will take care of you until you are well and good. Who?

Doctor's Consult, I Wanted to Cry [Updated]

"Why are you leaving?" He says in a tone I've never heard before as my back is turned.

I face him as I'm at the door. I place my hand on my chest. "I'm sorry, but need my space." I walk out. ''I'll talk to you tomorrow. I'll talk to you tomorow," I promise like I would a young child.