Situation: Her name was Barbara and this was the third time she was admitted for suicide attempts. At that time on our Behavioral Medicine Unit, the severely depressed patient would stay for an average of 14 days per admission. This was the first time Barbara had come to our hospital.
Usually these patients need some sort of anti-depressant medication to chemically 'lift' their moods. After Barbara was able to rest and take medication for several days, the 'talk' therapy began. Between the psychiatrists, the nurses, and the various groups, patients would have therapy at least four times every day. In addition, they privately filled out the "Beck Inventory for Depression," a short questionnaire about how their moods were, their feelings, and their symptoms, such as loss of appetite.
As her assigned nurse, I read her history in her chart before I even met her. Barbara was 50-ish, from a small farming community in the other end of Kentucky, and had major depression on and off for more than twenty years. For several days she sadly talked about her life, her marriage, her problems that led her to try to end her life. She had married at age 18. Her husband was an extremely successful farmer. He virtually ignored her, coming home to sleep, have breakfast and read the newspaper. Barbara spoke very quietly, "In the mornings, he won't talk to me. I fix him breakfast and he reads the newspaper and never says a word. Then he goes off in his truck with his hired hand all day."
Barbara continued, "We don't have any money problems. I can pretty much buy what I want. Sometimes I see him in town with the hired hand in the truck, talking and laughing. That really hurts." She was still very sad, very much in pain. Then I asked her, "What do you think your OPTIONS are at this time? Something has to change. You can't keep doing this. The next time you might not make it."
Barbara sat up and appeared more energetic. "You know, I never thought there was anything I could do. He just would stare at me, never talk, then leave." She thought for several minutes. Then she offered, "I suppose I could get a divorce. But I really don't want to. If he only would pay me a little bit of attention. But what could I do to get his attention?" There were more minutes of silence.
We psychiatric nurses are taught that we can never solve a patient's problems, that the choices have to be his or hers. We don't offer advice. Barbara was now mad. She said, "I know what will get his attention. Several years ago, he cheated big on his taxes. I believe he'd like to listen to me very much. Then we can go from there."
Lessons learned: No matter what the horrible situation is in own lives, there are ALWAYS OPTIONS! If we feel we're backed into a corner with no way out, we need to talk to someone - fast! It would be far better to never let our lives deteriorate to the point where we're desperate.
Outcome: The next day Barbara's husband came to visit. They sat opposite each other in the patient dining room. Barbara sat straight up, had amazing resolve, and looked him straight in the eyes. He looked scared. I never heard what was said. Barbara went home the next day. I can't help feel that she never again felt severely depressed.
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