One Monday morning there was a queue at the counter. I approached a young man in the line and asked, ‘Can I help you?’ His eyes started to well up so I suggested he meet me in the consultation room.
When we met in the consultation room, he had regained some composure. He handed me a bag of medication. He said he had to give me back the medication. I looked into the bag and the first thing I saw, was a six week course of steroids. I asked him why he was prescribed the medication. He told me he had Crohn’s disease and that the medication was to be taken in preparation for surgery.
I told him that he couldn’t bring them back, that he needed to take them. He then started crying and went to get up to leave the consultation room. I protested to him to stop, sit down and tell me what is going on.
He then calmly and candidly told me that, he had spent the entire weekend staring at the bag, resisting the urge not to take all the tablets.
I told him, he was depressed and he needed to go to see his GP. He needed to tell his GP, that he was depressed and had suicidal thoughts. I got the number for the Samaritans local branch and told him, he was not leaving until he spoke to them. I told him I would hang on to the tablets but he would call in every day and take the tablets he needed to take for that day until he had surgery. It also meant I could talk to him every day and gauge his mood.
He really believed he was not depressed. He began to tell me how he had been a complete idiot. He and his girlfriend had left their home country hoping to make a better life for themselves somewhere else. He said things started okay, they both got jobs. Then they had an unplanned pregnancy. From what he said, I believe his girlfriend may have had post-natal depression after the birth because he kept saying she doesn’t care about the baby. Then on top of that, he got Crohn’s disease and could not work.
I asked him a few basic questions about his lifestyle. He wasn’t sleeping, he wasn’t eating properly or doing any exercise. I told him that I could never understand his situation as I have never been in a situation as difficult as his. However, I told him that he needed to get on top of his health. I told him he needed to (as well as connecting in with the Samaritans) start eating properly, sleeping, exercising and he needed to somehow learn to relax. Every day after that when he came in for his daily tablets, I wanted a report of how he was tackling those four things. He went to the doctor and got on antidepressants, he started going for long walks every day, he started eating properly and sleeping better. The process of change was very slow to begin.
A couple of months after the surgery he called into see me with his Mother. He told me that the surgery went well, he was back to work, his Mother was over helping with the baby. He said his relationship had improved slightly but still was not very good.
Do I think my pharmacy degree prepared me adequately for dealing with this patient?
To be honest, no. Now I can’t speak for every school of pharmacy and I can’t speak for my own, with complete certainty because I did miss some lectures but I don’t ever remember suicide being spoken about at university.
However, I did feel comfortable and competent dealing with this situation. A few years prior by pure accident I had read a great book on suicide called, ‘Night Falls Fast: Understanding Suicide’ by Kay Redfield Jamison.
The book is an absolute masterpiece and essential reading for anyone in health or anyone affected personally or through a family member or friend by depression.
The facts and figures are astonishing as they always are with suicide. Every 17 minutes someone in the United States takes their own life. In 1995 more young people died (again these figures are for the US) of suicide than of AIDS, cancer, stroke, pneumonia, influenza, birth defects and heart disease combined. When you read that last line, it seems incredible that I can’t remember studying suicide at university as I can clearly remember, studying all those other conditions.
The unacceptably high levels of suicide in our societies will remain until we take mental health as serious if not more serious than physical health. Mental health services are notoriously underfunded. Mental health affects everyone. Your mental health is in constant flux the same way your physical health is. While most people will avoid severe, debilitating mental health illness in their life, everyone will have times in their life when their mental health is at a low ebb. I believe we need to be more honest about that and we need to invest much more resources in mental health services and research.