The Mamas and the Papas think we can’t trust Mondays. I'm not sure what's so shady about them but they definitely have an air of superiority.... as if they have the monopoly on dread. There is something I can trust about them though. I know they'll be swamped. There is always a Monday morning line-up of patients outside the clinic, anxiously awaiting 8:00 am. We can almost hear the customers chanting “open, open, open” like the old Mervyn’s commercial. After spending the weekend coughing or vomiting or hurting, they can hardly wait for the doors to open, heralding hopes of a quick fix or a definitive diagnosis.
This busy Monday morning was no exception. Except that my first patient wasn’t there for illness. Belinda was there to go over lab results from our initial visit. They were mostly normal, which [usually] lends itself to a cut-and-dried appointment, something my next three sick visits, already waiting, would be thankful for.
“Your Vitamin D level is low….” I said, “so I would like you to……”
I stopped mid-sentence and took a good long look at the hollow, deadpan eyes staring back at me. The person I was talking to was not the same person I met two weeks ago. Something was off. Really off.
“Is everything ok?” I asked, sincerely and softly, abandoning the topic of Vitamin D, which suddenly seemed banal.
“Today is the one year anniversary of my son’s death….he needs me to be with him.”
“What do you mean?” I implored, aware of the instant chill down my spine.
“I mean that I don’t want to be here any more…I can’t do it anymore….I want to be with my son.”
“What about your other children and husband, who live with you? Do you want to be with them?"
“They will be just fine without me….” she said flatly.
As we talked, I learned she had been stockpiling sleeping pills, which she was planning to swallow after going home and cleaning her house. “I want it to be spotless when I go.” She reached for her purse and pulled out a tattered wallet-sized picture of her angel son along with a two-page goodbye letter to her family. She assured me of being at peace with taking her life. "God knows my pain. He will forgive me."
I told her she needed to go to the hospital and get some help. She obstinately refused. “I am NOT going. I hate hospitals. I hate psychiatrists. I do not need help. Please, don’t make me go.”
“We have a counselor here today," I volunteered. “Would you at least be willing to talk to him for a little while?”
Thankfully, she agreed, which allowed me an excuse to leave the exam room. I immediately summoned Rafael, a LCSW, who luckily didn’t have a patient in his office. He introduced himself to Belinda and settled in for a crucial conversation. Meanwhile, I called 911, knowing confidently this was what I had to do. And yet, a little part of me felt a sting of angst, knowing I had just betrayed her confidence, and she would forever swear my name.
I was sad and hopeful for her, and now very behind. Monday, Monday.
Later in the day, Rafael stopped by my office.
He explained that Belinda was very upset when the police officer walked into the room. She just kept saying ‘I trusted Dr. Fisher…how could she do this to me?!’
“But you know what?” Rafael continued. “You really did something good today….I am convinced she was serious and ready to kill herself. In fact, I think she had already taken some pills….she was starting to slur her speech and couldn’t tell me the day or date.”
Six weeks later, I was surprised to see Belinda back in my exam room. The empty gray haze in her affect was gone. She smiled. She twinkled. And she said this:
“I want to thank you…. I got some medicine and am seeing a therapist. I am doing so much better. I can't thank you enough from the bottom of my heart. I was so mad at you at first, but I’m so glad you sent me to the hospital. I know that you really care about me.”
What if I had not asked her if everything was ok that gloomy Monday?
If you don’t ask, patients won’t tell.