My patient returned a folded paper to me. This was a safety plan, a contingency to help when thoughts of self-harm appeared. One month ago, this individual thought about ending her life, and even had plans how to make that happen. That first visit made my own blood pressure rise. On top of severe depression, she suffered from anxiety, insomnia, and some other symptoms which concerned me for manic tendencies, the type of things I would prefer to refer to someone more specialized, but I doubted this patient was willing to go to the one hospital in the capital city with a psychiatrist and an inpatient mental health ward. Our city doesn’t have many resources to support emergency mental health situations, so we creatively brainstormed how she could stay safe until the next visit. A month ago, I prescribed an easy-to-get medication which could help with sleep, and gave the patient my personal number, a boundary I don’t often cross, but felt appropriate in case of emergencies. That evening, I sent off an SOS email to my best buddy from medical school, a psychiatrist who knows me and my context and helps me with the tough stuff.
The following day, I spent the morning sifting through local resources, referral options, guidelines for diagnosing bipolar disorder, and checking with area pharmacies to inventory every available medication and balance side effects. My friend stayed up until 3 am California time, not resting until sure that we had a good plan moving forward. I connected with the patient via email to offer encouragement, and learned she was already improving her sleep and exercise, and had stopped drinking alcohol. A follow-up visit two weeks ago showed the patient much better even on the simple medication, and we agreed to be cautiously optimistic. Today, at our third visit one month in, she returns the action plan to me, indicating that it probably won’t be needed in the future. This individual is using healthy reframing to turn destructive thoughts into productive thought, and investing deeply in positive relationships. “At one point I felt so trapped, [I had] no hope” the patient confides as we finish our visit, “I don’t feel trapped anymore.”
I’ve walked alongside many patients during dark times, and I know that rapid recoveries are so rare that I openly celebrate them as the miracles they are. Today, my in-office spiritual support is a prayer of thanksgiving, giving God glory for the healing. My patient believes these prayers are part of what brought healing. Even amidst struggles to reconcile a strict Muslim upbringing with current lifestyle and values, this individual sees value in prayer and meditation. I hope that I can continue to walk beside her and witness the processes of discovering purpose and joy.
My patient and I agree to remain cautiously optimistic, because nobody can predict how long healthy times will last or when darkness will return. My next patient reminds me of this. Last night I received an email from him asking “Why don’t I feel better? When will I ever feel like the sadness is gone?” And today, indicators show his mood is as low as the day we met two months ago. I don’t have specific answers, but since this patient is a Christian, I cite examples from heroes of faith, reminding of countless men and women who went through much darkness themselves before returning to a taste of God’s glory. Ninety minutes later, it seems there is at least a way forward. Our prayer is for fast, miraculous healing and patience to stay strong until then.
It is a blessing for me to help provide care to people in some of their darkest hours. Sometimes, it stretches me professionally, and I need all the support available. Other times, the very same day that I encourage a patient saying that they can’t control life’s outcomes, I feel personally drained and discouraged not only because I can’t control the healing process in others, but I can’t even control my feelings of depletion at the end of a long day. I praise God that I am in a place with deep resiliency, where I can serve others well because I am renewed in my own heart, body, and soul. But I continue to pray for wisdom so I can be faithful with the opportunities that come across my path and into my office.