family

Confidentiality versus Life

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Three years back I joined a club no one wants to be a member of. I became a parent who lost their beautiful child to suicide. He was 20. I didn’t think it was possible. I trusted his doctors to take good care of him. I trusted they would tell me if there was a real risk of him dying, given I am his mother and was his prime carer. I thought they had the expertise to identify and address ‘crisis’ when they saw it. Suicide was not in the script. It was not supposed to happen. I turn the fact of his sudden traumatic death over and over in my head and it makes no sense.

There are hundreds of distraught and bewildered members of this club. Common themes emerge from their stories. The commonest one is:

“They knew our child wanted to end his/her life but they didn’t tell us anything about it.”

Who are they?
Decision makers – Medics. Universities.

Why?
Because he/she is over 18, hence, technically an adult.
Their ‘confidentiality’ is paramount.

Is it?
Is it more important than helping them stay alive?

The Hippocratic oath states:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

According to experts[1], these are the essential components of an effective suicide prevention safety plan:

  1. Discussing the reasons for living
  2. Safe environment
  3. Identify distress triggers
  4. Removing ways to harm yourself
  5. Activities to calm/lift mood or distract
  6. Contacts for general support
  7. Specific suicide prevention support
  8. Professional support
  9. Emergency contact details
  10. Personal commitment to follow safety plan

Most of the above cannot be implemented without the help of carers and families if the person in question is seriously unwell. This has been recognised by the Department of Health, Royal Colleges of Psychiatrists, GPs and Nursing along with The British Association of Social Workers and The British Psychological Society. Together they published a consensus statement entitled[2] “Information Sharing and Suicide Prevention” in 2014, the same year that my son, Saagar Naresh[3] passed away. It clearly states that practitioners should disclose information to an appropriate person or authority if this is necessary to protect a child or young person from risk of death or serious harm.

“If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is considered to be in the person’s best interest to do so.”

This is still not being practised. The world of medicine is a conservative and defensive one. Until the regulatory bodies, NHS Trusts and the Government come forward to reassure practitioners that their decision to share information appropriately will be supported by them, nothing will change.

While the world carries on, innocent youngsters die from lack of support and understanding from the very people who are best placed to help them. PAPYRUS, a UK charity dedicated to prevention of young suicides[4] demands that information be appropriately shared with carers and families by all who take care of vulnerable young people at risk of suicide.

Confidentiality versus Life. It’s a no-brainer.

References:

[1] https://www.healthcareconferencesuk.co.uk/news/newsfiles/alys-cole-king_1219.pdf

[2] https://www.bl.uk/britishlibrary/~/media/bl/global/social-welfare/pdfs/non-secure/i/n/f/information-sharing-and-suicide-prevention-consensus-statement.pdf

[3] www.kidsaregifts.org

[4] PAPYRUS (https://www.papyrus-uk.org/)

Yes. It’s different.

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A few days before the wedding Si asked me how I felt about getting married. Smiling, I said “Well, it’s a good way to finally get to know you.” When two people get married after an 8 years long relationship, they hope like hell things stay the same. Do I feel any different after the wedding?

Yes.
It’s like becoming an important part of something much bigger than me. I feel entrusted with a higher level of responsibility and I feel confident that I can live up to it as I feel deeply connected and resourceful. I feel closer to Si than before if that’s possible. I feel stronger and well supported by many. It feels a million times healthier than being the ‘lone wolf’ I have been for a long time.

Our loose 10 day itinerary explores the godly province of Himachal Pradesh in North India. Today we are at ‘The Mirage’ in a tiny village, Andretta.

Andretta is a traditional hub for painters, actors, potters, ceramic and other artists. Norah Richards, an Irish play-write established this focal point in 1924 through her passion for local art and culture.

The artistic heritage of Andretta is evident from the presence of a fascinating pottery museum and a quaint art gallery within half a kilometre, on the village “High Dirt-track”. Being here is tranquil and uplifting. People here are warm, kind and eclectic. They smile generously and look content. Their simplicity is exquisite. Si and I dream of spending more of our time around here.

khalilgibran1

Silk resembles love.

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Rose petals

Couple of years before he died, Saagar thought I needed to see a therapist. He didn’t explain why. At the time I couldn’t figure out what he meant. I guess he could see that I did not know how to access the sweetness of life. I allowed preoccupations of work and practicalities of life to fill my time, leaving little room for love.

Painfully delicate and surprisingly strong, silk resembles love. The silkworms destroy the silk they produce as they emerge from their cocoons. That is why farmers have to make a choice between silk and silkworms. Often they kill the silkworm while it is inside the cocoon so as to pull the silk out intact. It takes the lives of hundreds of silkworms to make as scarf. But for the silk to survive, the silkworm has to die.*

At a small and sweet ceremony, in the middle of nowhere, in the presence of twenty people, holding the holy fire as witness, Si and I tied the knot yesterday. It was a joyous day, a celebration of love.

On the previous night the moon was full. Saagar was with us.

“Sorrow prepares you for joy. It violently sweeps everything out of your house, so that new joy can find space to enter. It shakes the yellow leaves from the bough of your heart, so that fresh, green leaves can grow in their place. It pulls up the rotten roots, so that new roots hidden beneath have room to grow. Whatever sorrow shakes from your heart, far better things will take their place.” – Rumi

*Ref: ‘Forty rules of love’ by Elif Shafak.

 

Time is like flowing water.

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If you like someone and they like you back, it’s pretty awesome. If over time they come to love you dearly and enjoy spending time with you, it’s a miracle. After a few years if the love grows and they want to spend the rest of their lives with you, it’s quite marvellous, especially if you feel the same way.

3 years ago, we were planning a funeral. This year we are planning a wedding.

Time flows in its water-like way. Asking why it flows the way it does gets us nowhere. It flows in line with its own path, following its own laws. That’s all. It’s a constant effort  breaking away from the time gone by and being fully present to right now – consciously,  with awareness. With gratitude for what was and what is. With gratitude for love.

Lifting a big rock feels heavy. If I put it down it’s not heavy anymore. As soon as I lift it up again, it’s heavy again. Where does the heaviness come from? It comes from lifting this thing. So, I put it down. That’s all I need to do. Just put it down. And stay still. That’s all.

Si and I get married in 2 weeks. 🙂

A life sentence.

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The best part of being human is to be able to feel stuff. All kinds of stuff. The world seems to be forever in pursuit of happiness in more money, more holidays, more clothes, more children and so on. The elusive ‘happiness’ is put on hold until the ‘more’ arrives, soon to be followed by more ‘more’.

In a week, it will be 3 years since Saagar died. For days I have been feeling this day approaching like a huge oil tanker which is going to squash my dinky little boat. This inauspicious day should be removed from all calendars everywhere for all the years ahead. It should be obliterated, erased, deleted and destroyed.

I think back on this time three years ago, trying to understand how Saagar must have felt. I try to find words for the thoughts and feeling that he could not verbalise. I lament the fact that no one could read his body language. I admire him for coping with his state of mind with patience and dignity. I look at his face-book post from this night. It was a full moon. He said ‘big ass moooooon innit”. I marvel at his ability to appreciate beauty. I remember how funny he was. I get a smile on my face. I promise myself never to take one moment of those 20 years for granted. Each of them was a blessing. Yes. It’s true that this feels like a life-sentence sometimes. Yet, I know I am blessed.

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“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
― David Foster Wallace