Ms. McDonald* was admitted to my team after a suicide attempt.  She had taken several handfuls of her medication- and she was on a lot due to severe depression- all mixed together, and all at once in an attempt to end it all.  It didn’t work and, like many patients who attempt suicide in this way, she had to stay with us on the internal medicine service while we monitored the rhythm of her heart until the risk of medication toxicity was over.

The first day I met her she was too sedated to say much.  The second day her affect was flat and she had hardly anything to say to me.  The third day I was busy and I selfishly expected another quick encounter. I bent down so I was at eye level with her.  The only chair in the room was occupied by a hospital companion who sat in the room at all times for the patient’s safety. With my back to the companion I softly asked Ms. McDonald how she was feeling.  I expected monosyllables again. This third day, though, she needed to talk.  Her tears and her words came pouring out at the same time, torrents of pent-up feelings and unfortunate situations. I just listened. The rhythm of her words was fast, jumbled and choppy like river rapids. But like flotsam caught on top of the current one theme was clear above the debris. She was certain that her mental illness had tainted the one pure, good accomplishment in her life: motherhood. I’m so sorry, I murmured, I am so sorry that this is happening to you.

The words stopped as suddenly as they had started and for a moment we both respected the silence broken only by her deep shaking sobs.

Then I, ever the internist, said, “Ms. McDonald, I need to listen to your heart.” I paused for a beat, considering my own words. I put my hand on her shoulder and listened until her respirations changed from great gasps to measured breaths under the weight of my stethoscope.

*All identifying details have been changed to protect the patient’s identity