Tag: suicide ideation

Review: Risk Management with Suicidal Patients

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Review: Risk Management with Suicidal Patients

I found this book very easy to read in laymen terms. It was a short book but held important information for clinicians to protect themselves from liability and malpractice should a client/patient die by suicide.

The authors stressed that this was more an outpatient issue than an inpatient issue, least that is my interpretation. This holds true in the day an age where inpatient psych admission are short and not very helpful. In fact, there has been more suicides post discharge or during an admission than there has been outpatient deaths. I would quote where I got this but unfortunately, I don’t have it handy. It has been my nemesis to remember information but not the source.

The information about inpatient suicide care is a little outdated for the current time period even though the book was written in 1996. The important points are to have a standard of care that protects the client/patient from him/herself as well as the clinician taking care of the said client. The general rule is to seek supervision where appropriate or consultation with other clinicians that have more experience in the field of suicide and not to have more than at least 2 at high risk clients.

Suicide research and treatment has come a long way since 1996. More safety protocols have been created as well as safety planning that promote a life worth living. I highly recommend this book to any clinician in the field of mental health and dealing with the suicidal patient, even though there has been some things that need to be updated.

Bongar, B., Berman, A. L., Maris, R. W., Silverman, M. M., Harris, E. A., & Packman, W. L. (Eds.). (1996). Risk Management with Suicidal Patients. New York, New York: Guilford Press.

Hosp vs no Hosp

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Hosp vs no Hosp

I have been thinking about this for the past hour, talking it over with the voices. They are loud tonight. I haven’t taken my night meds yet. But I am thinking this, what if I go in the hospital and they smack the “complicated grief” bullshit on me because my father died two weeks ago? I have been struggling with the hospital for more than a month now as the depression was and has been steadily getting worse. I only avoided getting in the hospital a week before my father died because I didn’t want him to die while I was inpatient.

My depression started the last week in January and then got complicated when my father had to go for radiation treatment, then two weeks later was in the hospital because of chest pain. That started his decline. We spent most of March in the hospital with him for pleural effusions, lung collapses, and ascites build up. In April, his ammonia levels were up, causing confusion and more lethargy. His appetite then became non existent and we were told he had a few weeks to a few months to live. Turned out he had just a few weeks. We put him in the nursing home on April 8th and he was gone by April 25th. Not even twenty days later.

In the middle of March, I got started on an antidepressant. Thoughts of wanting to kill myself were rampant. I should have been in the hospital but I became my father’s health care proxy during one of his admissions in March. I couldn’t go in because if they needed my signature while he was confused or needed treatment he couldn’t consent for, I had to be there. It was a delicate situation.

I think starting on antidepressant therapy helped me cope. I still wasn’t eating as I have lost a considerable amount of weight during this time. My last physical in August, I was 218. I am now 203/205. I am struggling to keep this weight because I don’t want to balloon up again. I still don’t have a full appetite like I used to have. Food doesn’t interest me much. I lost a lot of interest in things I used to enjoy. I should be watching the Sox game right now but I am blogging because I really don’t care about the game anymore. It’s lost its appeal with me, and that is not because of the team and all the drama it has this year. I have also lost interest in coffee. I don’t drink it every day like I used to. I can’t remember the last time I made it at home. I don’t go to Starbucks as often as I used to either. I just lost the taste for their coffee, which I used to love. I go there out of habit now but only if I have an appointment in Boston. Otherwise, I just stay at home.

I don’t know if I need to be in the hospital. Sure I am at risk of suicide, that is a given. But will I be helped while being in, is the question. I don’t know if it will annoy me or help me. I don’t know what hospital I will go to. If it isn’t the hospital I was in before, I will hate being somewhere else. The past three years I have been going to this unit when I need to be inpatient. It will be difficult being somewhere else that I haven’t been to before. And I don’t want to be in the ER all day and night waiting for a bed, though I will if that means going to the hospital of my choice. Last admission, I made it to the hospital and was admitted through their admission office rather than through the ER. I just cut the middle man out.

I just really don’t want to be admitted and then have the admission focused on my grief for a father I really didn’t care for or love whole heartedly. He wasn’t a dad by any means. He wasn’t loving towards us, though he probably would have said so. The only time I seen him show affection was when he won at the track and wanted to share his prize winnings. I could go on about the cruelty of the man but I won’t. That will be another blog. I will be damned if some social worker or attending psychiatrist pegs me as a complicated grief stage when it’s only been two weeks and I have been depressed since around the 19th of January. I only remember that date because I know that is when my feelings changed and my appetite became less. The physical symptoms of depression reared it’s ugly head and I was in pain. I was walking in mud. My thoughts were slow and painful. It took me hours to write a 300 word blog. All the while, I would have urges to take a bottle of pills. It didn’t matter which one I took. I just knew to not reach for my pain medication because I was not going to die of liver failure due to acetaminophen. That bottle was not to be touched. All the others were up for grabs. I had a choice or I could take all of them. Mix and match. I didn’t care as long as I didn’t see tomorrow. My hanging myself went out the window because I don’t have a beam. And partly because I don’t like things around my neck except for a tie.

My father died before I could have killed myself. I find this ironic. I know that between my therapist and my psychiatrist, both will make it so I get in the hospital. The only question is what kind of care I will have there. I know I will have a mountain of meds to sort through and I hope they don’t deny me my pain meds. I will not be happy about that one bit. I guess that it’s the care that keeps me from going in the hospital as well as the list of medication that I take. I take around 12 pills every night. I know if I go to the hospital of my choosing, it will be more like 20 pills because they will break up one of my medication. Instead of taking 1 pill, I will be taking 4. I go through this every admission. They don’t have the formulary in the hospital so they make do with another formulary, which means more pills. Guess I will find out tomorrow if I will go in or not. I am scared though. Giving up my rights and my cell phone is hard, even if it is for a little while.

After the Party

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

After the Party

I left the party soon after the cake was served. I had two slices and a lot of pizza. My sister had made this flatbread type pizza with I think pita bread and it was so damn good. I couldn’t stop myself from eating it. I overate and my stomach is killing me. My ankle was bothering me and I couldn’t stand being near my aunts and uncles so I left. I went to my room and watched a few episodes of Friends.

After the shows, I started feeling palpitations. Now I feel psychache and I want to die. I just don’t want to live anymore and am contemplating drinking gin. I just took my night time dose of pain meds. Alcohol would not be a great idea. I just want to feel numb. Drinking will do that. I have thought of going in the hospital. But I know my family needs me and it’s killing me. The next few days are going to be tough. I just don’t know if I can be there mentally. I am already stressed to the max.

My biggest fear about my father being home is that if he ends up being in pain, we can’t alleviate it because he can no longer swallow. His mouth is just too dry from the dehydration. He can barely spit his phlegm out. Then I worry about falls, either with my father or my sister transferring him. We don’t have a wheelchair so I don’t see how we are going to get him to the bathroom should he need to go. I know he isn’t eating or drinking and his kidneys are shot but he still needs to poop. And wheelchairs are expensive. My sister thinks that we can just get an ambulance to transport him home. I don’t think she realizes that is not how ambulances work and even if we did, we would have to pay for it and it could be at least $1000 or more. I just have a bad feeling about this and unfortunately, there are no other alternatives. We can’t afford to keep him in the nursing home.

I just don’t know what we are going to do. We know he doesn’t have that much longer but we can’t make it go any faster. I just feel awful. I am tired and I need to sleep but my worries are keeping me up. I never showered. I might do that tomorrow. I hope I sleep through the night. Last night I went to bed early and woke up around 0200. It just stinks having broken sleep on top of being depressed and grief stricken.

I am tired of fighting my suicidality. I want to give into it so badly. I want to get a life insurance policy so my family doesn’t have to worry about my funeral expenses. But suicide is usually excluded from policies or you might have to wait until the policy matures or something. I am actually kicking myself for living through my birthday because then I wouldn’t have to worry about my father dying and shit. I would be fucking dead. I’m going to drink and take some Ativan after I take my night meds. Fuck it, I don’t care anymore.

Can’t sleep for a lot of reasons

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Can’t sleep for a lot of reasons

I am so tired that I can’t sleep. I have a million things on my mind. It didn’t help that my brother in law pissed me off with his ignorance in medical matters. The idiot thought my father is in acute liver failure. I had to correct him several times. Then he thought that the medication my father has been taking for years has contributed to the kidney failure. He just doesn’t get it. And it’s so painful because he thinks he is right and the world is wrong.

I also have been fighting my suicidal urges for most of the evening. I took 2 mg of Ativan to calm myself down as I am just a wreck. The news of my father being in KIDNEY failure is not sitting well with me. I know that it is going to be down hill after this. He is just going to get worse. I keep praying he goes in his sleep one of these days.

I also took 900 mg of Neurontin because I can’t stand the burning in my ankle/foot anymore. It’s been helping increase my appetite the last few days. I am hoping I can have my favorite breakfast sandwich tomorrow and finish it without a problem.

I see my psychiatrist tomorrow. I am nervous about seeing her. I told her today that I think my father is going to die within a week’s time and that hospice has been called. I also told her that I have to put off going in the hospital because my father is closer to dying. I can’t wait for this to be over with. It’s been really tough. My youngest sister is in denial about him dying. She said it “doesn’t make sense”. I don’t know what to say to make it make sense for her. She thinks that my father will bounce back and have the energy he once had. Denial is a powerful thing.

I hate being in pain but especially nerve pain because Neurontin is the only thing that helps with it but it takes hours for it to work. That’s why I took the Ativan to help me sleep. I really felt like taking the rest of the bottle but I didn’t. My psych would have really put me in the hospital if I did, regardless of the situation with my father. I can’t risk being sectioned involuntarily.

I wish I could just lay down and fall asleep. I am going to try in a little bit. Today has been such a hard day and I didn’t need the tangle with my brother in law to get me more upset. I just hope that I don’t wake up at 0400 like I have the past few mornings. That has really disrupted my sleep, not to say I have been sleeping right but it just makes it worse.

I have been slowly gaining interest back with the Sox. They are doing horrible tonight. They have had a few chances to score and blew it. Right now they are scoreless in extra innings, least they were when I last checked.