incompleters

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there is an ER physician in the great pacific northwest i am in no hurry to meet. from his blog, he seems a decent enough guy. his political heart, for one, is in the right place. and he writes nicely. i have a soft spot for bloggers who write nicely. it gets me every time.

but i read a post he wrote a few weeks ago and it made me terribly sad and disturbed. according to this man, i am an incompleter. incompleters are people who commit suicidal gestures without really meaning to die. this is a difficult post for me to write, because such things should not need to be explained. the ER physician who wrote the post about incompleters (actually, the post is about completers, while incompleters function as a negative, puny contrast) has no sympathy whatsoever for imcompleters. this is how he describes us:

These patients are often a huge pain in the ass. They are usually intoxicated, often combative and agitated, may require extensive workups to ensure that no actual life threats exist, and wind up spending hours and hours in the ER, weeping and wailing, puking charcoal all over and annoying staff with their dramatic and manipulative behavior. Occasionally a non-serious gesture winds up being more dangerous than the patient intended. (”You mean tylenol is dangerous?”) Many a time an irritated nurse has approached me and grimly suggested that we publish an educational flier titled “Suicide: getting it right the first time.”

If this makes it sound like we don’t take suicide attempts awfully seriously, then you’re right. Mostly it’s due to the preponderance of minor suicidal gestures over real attempts. Don’t think we’re not professional about it — we know how to rule out the serious threats and make sure that a safe disposition is accomplished. But we are not overly impressed with the low-level stuff we usually see.

i know that when i end up in the ER after having overdosed or cut my wrists i am a huge pain in the ass. this has been made as clear to me as the light of day on a bright coastal morning. i was told in no uncertain terms that i had to be quiet because there were very sick people in other beds. i know i am not welcome and i know i get no sympathy. on a miraculous occasion i have found a nurse who was sweetness personified. when, clumsily (people who are intoxicated tend to be clumsy), i upset my bedpan, i was so grateful for her kindness that i cleaned it up myself, stealthily, without bothering anybody. when she realized what i had done she gave me a great big smile and said, “honey, this is what i’m here for.” i thought, when i get out of here i’ll send her flowers. but i never did. i’m sure she went home with a light and full heart, though.

i have always drunk my charcoal without making a fuss, even though charcoal is nasty. when i had my stomach pumped i took that, too, without complaint. but there are two occasions i remember vividly in which, alas, i did weep and wail. you see, i was absolutely desperate. maybe the ER physician who wrote that post doesn’t fully realize that both completers and incompleters come from a place of terrible pain. yet, his sympathy goes only to the completers:

When a would-be completer comes into the ER, it changes the whole tone of the evening. A pall settles over the department; the place is unusually quiet and staff uncommonly grave. This guy really meant it. It’s a weird feeling.

Like the guy I saw the other day. A classic completer: middle-aged male, rather heavy drinker, recently lost his job and losing his marriage. His wife came home to find him in the garage with the engine running, unconscious, with an empty vodka bottle and pill bottles in his lap. Only she came home earlier than he expected.

…

This was an uncommon case with a reasonably happy result; many serious-but-unsuccessful suicide attempts wind up causing devastating consequences, especially when the method is violent: handgun, hanging, and certain poisonings can cause permanent brain damage, spinal cord injuries, or other organ failures. It’s all very sad. I probably feel more empathy for these folks and their families than I do for almost any other patient. How terrible must their perceived suffering have been to drive them to actually pull that trigger?

I am glad we don’t see them too often, because it’s a hard thing to stare in the face:
This guy really meant it.

i am not sure why terrible suffering should be the prerogative of the completer. i can well imagine a case in which two people with an equal amount of devastating pain might choose to do a “complete” suicide attempt or simply, as this man calls it, a “gesture.”

what is it that keeps us, the incompleters, from calling it a day? maybe that there are others, too many others, too many loved others, whose life would be all but over if we were completers instead of incompleters. maybe that we see, in some bleeding corner of our bleeding hearts, a glimmer of hope, something resembling a future. maybe that there’s enough in life to keep us going — jobs to go to, children to raise, old parents to take care of.

the subtext of the ER doctor’s post is that the incompleters are the women and the completers are the men. handgun, hanging: we don’t do that. we down a bottles of pills or hack in the inside of our wrists. we weep and wail. sometimes we puke charcoal.

but the pain, mr. ER doctor, is real, and terrible, and devastating.

perhaps people have it all backwards. instead of celebrating our will to live, our determination to stick around in spite of the horrendous pain that compels us to attack and mangle our bodies, they scorn us as silly, pusillanimous, manipulative incompleters (if i never again see the word “manipulative” referring to a woman it will still be too fucking late). the completers, may god bless each and every one of them and grant them a peaceful and joyful afterlife, stare life in the face and decide they are done with it, sorry guys, it’s too much. it is a step i can barely fathom. but the incompleters, the incompleters go through the humiliation of the ER and the psych unit, sweep up the dirt and the pieces, put themselves together, and resume the awful job of living. if i hadn’t done it, i couldn’t fathom the courage of such a choice either.

(if you want to give a piece of your mind to the ER doc, do so at his site. i will delete abusive comments left here)

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Filed under pain, suicide, the healthcare establishment, the pain of others

Tags: ER physicians, suicidality