Tuesday, August 12, 2014

Suicide Is Painless, It Brings On Many Changes, And I can take or leave it if I please.

If you are in crisis, call 1-800-273-TALK (8255) 
National Suicide Prevention Lifeline

(CNN) -- Robin Williams -- who first made America laugh and eventually touched "every element of the human spirit" in a remarkable range of performances -- died at his Northern California home Monday. 
Williams apparently took his own life, law enforcement officials said. He was 63."He has been battling severe depression of late," his media representative Mara Buxbaum told CNN. "This is a tragic and sudden loss. The family respectfully asks for their privacy as they grieve during this very difficult time." 
Coroner investigators suspect "the death to be a suicide due to asphyxia," according to a statement from the Marin County, California, Sheriff's Office. (Source: CNN)

I chose the picture of Robin Williams from his role as "Patch Adams" because this tragedy not only is a wake up call for everyone but especially for physicians. Much of this blog so far has been about "Patient Dignity," part of the problem is "doctor burnout" (which can lead to physician suicide). Part of the solution for is freeing physicians from external forces and letting them heal.

Here is the plot summary of the 1998 film, "Patch Adams," starring Robin Williams:
This may be an old comedy, but its relevance is timeless. The message this film sends across is that love, laughter and affection can go a long distance in healing a person more than the usual doses of medicine. Well, there is a great difference between ‘cure’ and ‘healing’. A physical disease may be cured by the medicines prescribed by the physician. However, there is no guarantee that the person is healed. Healing has to do with the whole person and not just his or her physical ailment. Even a person with multiple physical ailments can be a completely healed person when he/she is completely free from within. (Source: Reading Films)
Ironically, the film deals with physicians, the humanity of the patient, paternalism, and suicide.

Hunter "Patch" Adams (Robin Williams) commits himself into a mental institution. Once there, he finds that using humor to help his fellow inmates gives him a purpose in life. Because of this he wants to become a medical doctor and two years later enrolls at the Medical College of Virginia (now known as VCU School of Medicine) as the oldest first year student. He questions the school's soulless approach to medical care and clashes with the school's Dean Walcott (Bob Gunton), who believes that doctors must treat patients as patients and not bond with them as people.  (Source: Wikipedia)

The Real Patch Adams: Art imitates life...

Adams had a difficult childhood. His father, an officer in the United States Army, had fought in Korea, and died while stationed in Germany when Adams was a teenager.[1] After his father's death, Adams returned to the United States with his mother and brother. Adams has stated that, upon his return, he encountered institutional injustice which made him a target for bullies at school. As a result, Adams was unhappy and became actively suicidal. After being hospitalized three times in one year for wanting to end his life, he decided "you don't kill yourself, stupid; you make revolution. (Source: Wikipedia)

Suicide Is Painless

Through early morning fog I see
Visions of the things to be
The pains that are withheld for me
I realize and I can see...
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
I try to find a way to make
All our little joys relate
Without that ever-present hate
But now I know that it's too late, and...
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
The game of life is hard to play
I'm gonna lose it anyway
The losing card I'll someday lay
So this is all I have to say.
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
The only way to win is cheat
And lay it down before I'm beat
And to another give my seat
For that's the only painless feat.
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
The sword of time will pierce our skins
It doesn't hurt when it begins
But as it works its way on in
The pain grows stronger...watch it grin, but...
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
A brave man once requested me
To answer questions that are key
Is it to be or not to be
And I replied 'oh why ask me?'
That suicide is painless
It brings on many changes
And I can take or leave it if I please.
'Cause suicide is painless
It brings on many changes
And I can take or leave it if I please.
...and you can do the same thing if you please.

This is the lyrics to the theme song to the 1970 movie MASH. An instrumental version was used for the TV series (1972-1983). The lyrics were removed from the TV series because the issue of suicide was very controversial, especially since it aired during prime time. 

You can hear the song and see the "funeral" scene here:

The music for the "M*A*S*H" theme song was written by Johnny Mandel. The lyrics were written by Mike Altman, the 14-year-old son of the film's director, Robert Altman. It was originally penned for a scene in the movie, where a faux funeral was staged in hopes of talking a suicidal character out of his plans. Two of the men at the unit sang "Suicide Is Painless." An instrumental version of the song was subsequently used as the theme for the TV series. (Source: Yahoo TV)

Some people may say that this scene and song is inappropriate but it it is NOT.  The most important line of the song is: "And I can take or leave it if I please."This says that you DO NOT have to do it. There is hope.

A Physician Advocating for Physicians

Pamela Wible M.D., is a physician who suffered burnout. She found a way out. As a result, the care that she offers her patients is exactly what I advocate for. You can see her web site/blog here: She has a video on YouTube titled: "How to get naked with your doctor" (see below).

One of the most repeated comments about this video is "I would get naked for her." That is because of the trust that she instills. It is because she treats her patients as human beings and NOT like living cadavers on an assembly line. I wish that she was on the East Coast because I would try to deal with my medical phobia by seeing her.

A Cry for Help

Suicide attempts are said to be a cry for help. Robin Williams suffered addiction and depression. These go hand-in-hand. Many times addiction is the result of trying to self-treat depression. Depression can also be the result of the hopelessness of enslavement to addiction.

Note: This is my opinion, not medical advice (take it for what it's worth):

I feel that thoughts of suicide are normal. Especially for people like physicians. They play countless simulations of "what if" scenarios in their head. That is how you solve problems. It is not surprising that suicide might be an option. This is actually healthy when you realize that suicide is a bad option, when you realize all the people you hurt with this choice.

Thoughts of suicide become unhealthy when they become reoccurring, persistent, or seem like a rational option. Just like "First, do no harm," remember all the people who will be hurt, feel guilt (for not being there for you), all the people you could have helped but won't (because you are not there, and so on...

Some people have argued with me on "thoughts being normal," but consider "do not resuscitate advanced directives" or cancer patients refusing chemotherapy. It is about "quality of life." There are certain circumstances where the choice of death is acceptable (even to providers). It is NOT acceptable when the body is healthy.

I deal with really bad industrial accidents. I have to interview survivors and make sure that they are referred to counseling if needed. Many are reluctant to "relive" the events, some suffer PTSD. I tell them two things: First, this was a horrible tragedy that you went through, but you are going to wake up tomorrow. They will get through whatever, it may hurt, but life goes on.

Second; acknowledge the pain, deal with the pain, get help, but don't dwell upon that. If their mind is on that, then they may get hurt at work or hurt someone else. The point is, it may hurt, but you will get through it. Getting help makes it easier. The worst thing is NOT to ask for help if you need it. 

Why Do I care?

First it is the right thing to do. I would feel awful if i could have helped someone and did not. Just as bad, if I caused someone mental distress and did not consider the possible consequences.  Our actions have consequences. As I said before, I am NOT against physicians.

 For I was hungry and you gave me food, I was thirsty and you gave me drink, a stranger and you welcomed me, naked and you clothed me, ill and you cared for me, in prison and you visited me.' Then the righteous will answer him and say, 'Lord, when did we see you hungry and feed you, or thirsty and give you drink? When did we see you a stranger and welcome you, or naked and clothe you? When did we see you ill or in prison, and visit you?' i And the king will say to them in reply, 'Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.' Then he will say to those on his left, 'Depart from me, you accursed, into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me no food, I was thirsty and you gave me no drink, a stranger and you gave me no welcome, naked and you gave me no clothing, ill and in prison, and you did not care for me.' Then they will answer and say, 'Lord, when did we see you hungry or thirsty or a stranger or naked or ill or in prison, and not minister to your needs?' He will answer them, 'Amen, I say to you, what you did not do for one of these least ones, you did not do for me.' Matthew 25:35-45

I preach that providers do not realize the trauma that their actions cause patients. How could I not believe that what I say here, despite being the truth, could not harm someone? Imagine a physician (or other provider) realizing after reading my blog and (possibly) becoming a patient themselves, what I say is true and that for years the experiences that some of their patients may have had with them was the equivalent to being RAPED?

Take someone already depressed and show them that they "are a serial rapist." (I know this is an extreme view, but this is how many patients actually feel.) Still, we blame the system.

If you think you MIGHT need help, talk to someone: a friend, a priest, a family member... there are more people that love you and care for you than you realize. Don't say that you have no one that cares about you. If you think that, I am about to prove you wrong...

...talk to me because I care about you. 

The best choice is:

If you are in crisis, call 1-800-273-TALK (8255) 
National Suicide Prevention Lifeline


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