Day 138

‘Situational awareness’ (SA) is one of the major tenets of safety in high-risk situations such as aviation, policing and medicine. As the name suggests, it means having an accurate understanding of our surroundings or situation – where we are, what happened, what is happening, what is changing and what could happen. Good SA requires:

  1. Gathering relevant information
  2. Making sense of the collected data
  3. Thinking ahead about possible outcomes

Let’s look at the areas where SA could have been better in my son’s care.

Gathering information:

  1. He was under the care of his GP who saw him 2 days before Day 0. Neither did he talk to him about suicidal thoughts, nor did he get him to fill out a PHQ-9 that would tell him about his overall mental state.
  2. I told the GP that he was really depressed and I would like him to be referred to Psychiatry services but he decided to increase the dose of his antidepressants instead. We know that antidepressants may worsen depression and cause suicidal ideology.
  3. Nobody suggested that he maintain a ‘Mood Chart’ so that the trends in his mental state could be known better.
  4. The patient is a young male with recently diagnosed Bipolar illness who is not on Lithium which is the drug of choice and has proven anti-suicidal effects in such patients.

Ref: http://www.bmj.com/content/346/bmj.f3646

 Making sense of collected data

  1. Given that not much data was collected and my assessment of the situation was not given much attention, there was nothing much to work on.
  2. NICE guidelines suggest that if a patient is depressed for 6-8 weeks, they should be referred to specialist services and he fell in that category but this action was not taken despite being suggested.
  3. It was not picked up that this patient needed specialist care for various reasons that were known : young male patient with recently diagnosed Bipolar illness, severely depressed for 6 weeks, prematurely discharged by Psychiatric services due to extraneous factors without any expert follow-up or monitoring in place.
  4. He was on medications that might increase his risk of suicide.

Thinking ahead about possible outcomes

  1. Young males are at the highest risk of suicide. So, that was a very real possible outcome that was not anticipated.
  2. His illness had been diagnosed only 10 weeks prior so it was very early in its course and hence unstable.
  3. The depression had been preceded by a manic phase and that puts him in a high-risk bracket.
  4. He had shown some signs of improvement over the previous weekend that also put him at higher risk.
  5. No discussion took place with me as his sole carer about his care at home, signs of crisis and when I should think of taking him to Emergency services.

So, our Situational Awareness was poor. Not surprisingly, so was the outcome.

Day 137

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‘This leaf, so complete in itself,
Is only part of the tree.
And this tree, so complete in itself,
Is only part of the forest.
And the forest runs down from the hill to the sea,
And the sea, so complete in itself,
Rests like a raindrop
In the hand of God.’
-Ruskin Bond

Even now as I wake up in the morning, my first thought is of him but the degree of sadness associated with it is a bit less. A few days back I decided to consciously associate his thoughts with gratitude. Despite the grief, I feel so fortunate to be chosen to be his Mum. He brought so much joy to this world.

So every time I think of him I say a big thank you! He really was a ‘master in disguise’ for me, teaching me not just about impermanence but many other lessons; living life to the fullest with great enthusiasm, to dearly cherish friends and family and make time for them, to excel in everything I do, to be kind and sensitive and to spread smiles and laughter.

Now it is for me to not only learn those lessons but to live them.

Day 136

It is ironic that some comedians should commit suicide. There must be a dark side to being sunny and funny. We have a recent example in Robin Williams who made the whole world laugh for many years and then succumbed to his demons.

Here is the proposed theory on how it starts. Say there is a kid who feels a bit different for whatever reason (wearing glasses, being overweight, foreign or just plain different) over which he has no control. At some point he makes a joke or has a fall or some such thing that gets a laugh from the room. A positive reaction that he can control, a buffer that keeps anyone from getting too close, a barrier that helps him keep the part of himself that he does not ‘like’ hidden away or use his insecurities and fears as fuel for his jokes.

Soon he could get so good at comedy that a false persona is created which represents him and people can never get past it to see the ‘real’ him. The jokes keep the crowds happy and everyone at a safe distance.

Have you ever had that funny friend, the class-clown type, who one day just stopped being funny around you? Did it make you think they were depressed? It’s quite possible that for the first time they were comfortable enough around you to drop the act, in which case, the ones who kill themselves are funny right up to the end.

What about the ones who stop being funny because they are actually depressed? How do we tell the difference? They stop being funny and we hardly have time to understand them before they are gone.

http://www.cracked.com/quick-fixes/robin-williams-why-funny-people-kill-themselves

Day 135

He was a straight ‘A’s student right from the start of his schooling till his second year at University which was his last year of formal education before his illness was discovered. While he was at school, the Parent-Teacher Meetings (held in the same hall where his Memorial service was held in November last year) were a great source of joy. His teachers were more than happy with him. He asked intelligent questions. He contributed well to school activities in and outside the class and they enjoyed teaching him. They had no concerns whatsoever.

Intellectual ability delays the diagnosis of mental illness as the patients are smart enough to handle it and hide it for a long time. They can find out everything about their illness and know the implications. They feel the sense of loosing themselves very acutely and it pains them deeply. They worry about what they might loose next. They are very concerned about how they might be perceived as they are used to being very good at whatever they do. There is too much uncertainty and too much at stake. I know these things to be true for my son.

Today I watched the film ‘Still Alice’. The protagonist has early Alzheimer’s, a mental illness with behavioral implications. She reminded me of him and gave me a deeper insight into his world. Great film and a well deserved Oscar for Julianne Moore. In one scene she says that she would much rather have been diagnosed with cancer. I understand what she means.

I hope mainstream media puts more attention on increasing the awareness of mental illnesses. It’s good some celebrities are. Here is a TV interview by Stephen Fry that is as always, honest, compassionate and informative:

Day 134

“I was the wind last night –
I vaulted the mountains and crossed seven rivers.
And turned aside the tall trees guarding the valley.
I caught glimpses of you through the window
As I wandered around the little stone house.
They would not let me in; too cold a wind!
I hung around listlessly, afraid to call too loud.
Then like a weary man limped homewards over the sleeping mountains.
When will I learn the secret of stillness?”

– by Ruskin Bond

And now, I think I have learnt something of the value of stillness.
In it I find relief from thoughts, events and happenings.
In it I find everything that I look for outside, within myself.
In it I find myself. I find some light. And lightness.
I find forgiveness.
I find glimpses of divinity.
Possibilities and hope.
Most of all I find love for myself.
And the ability to give myself a hug for everything I have been through.

Unless I feel love for me, I cannot feel the love that is around me.
Thank you Stillness. 🙂