“Ms. Taylor*?”

“Yes, it’s me. I’m so deeply sorry to you and the team. You all helped me so much when I was here. But I started drinking a day after I left and blacked out.”

Two weeks ago, Ms. Taylor was found by her sister lying unconscious on the bathroom floor after a week-long alcohol binge. Next to her was a suicide note.

“My depression is robbing me of my freedom. I love my children James and Madison with all of my heart. I no longer want to be a burden to them. I no longer want to be a burden to Mom and Dad, to Jenny my sister and my best friend. The physical, emotional and spiritual pain I feel every day is not how I am supposed to live. I will be in a better place now. Please know I did everything I could, but I can no longer continue on. I no longer want to be a burden to any of you, my family!”

Brought immediately by ambulance to the ER, Ms. Taylor revealed that she has been in and out of depression for years and has been extensively searching online for suicide methods.

“I drank the rest of the alcohol in my liquor cabinet. I wanted to sleep and never wake up again.”

After I contacted Ms. Taylor’s parents, they came within the hour and broke down into tears when they saw her.

In the waning hours of daylight, the ER was getting increasingly busy and crowded. I asked Ms. Taylor and her family if I could escort them to a private room and they said yes.

Ms. Taylor’s depression started after her first pregnancy and worsened as her marriage fell apart.

“I didn’t work and stayed at home to take care of my kids. My husband was a construction worker and would often go home, drink until he became angry and would beat me until he was satisfied. I never reported him because without him my kids would not survive. I told no one what was happening out of fear he would go after whoever I told because he is a monster.”

“My parents suspected that something was going on. And on that rare day my husband stayed late at work, I packed up the car and took my kids to my parents’ house and told them everything. We eventually divorced. But whenever I think of him, the memories come back in waves. And I feel like I’m underwater. I would even have night terrors.”

“Have you seen him in the years since?” I said.

“Not for years. By that time my kids were practically grown-ups and out of the house. So it was just me in my apartment. Last summer, a friend was hosting a Fourth of July party, and everyone was there. I saw him there. He looked at me with the same eyes as when he would grab me by the throat and slam me against the wall.”

Silence permeated the room.

Ms. Taylor’s mom was holding her hand, and her dad laid his forehead in his palm, looking down at the table’s surface. Jenny walked out of the room.

“Thank you for sharing your story Ms. Taylor and to your family for being here. I know how hard this must be for you and we will do everything we can. I will talk with my attending and come see you tomorrow morning in the inpatient unit.”

“That sounds good to me, thank you.”

The next day, I spoke with Ms. Taylor’s night nurse to see how things were going.

“She struggled with sleep last night, maybe two hours at most. Says she still feels low energy, concentration difficulties and feeling hopeless. Was restarted on duloxetine and will continue to monitor for signs of alcohol withdrawal.”

After the debrief, I saw Ms. Taylor in the commons area. She was sitting in a chair, looking at the row of birds perched outside the window.

“Hi, Ms. Taylor, how are you doing this morning?”

“Slowly better, it’s nice to see sunshine again.”

“Would you like to talk some more in the team room?”

“Sounds good.”

As medical students, we speak with patients in the team room where the attending and residents listen in. It’s a back and forth conversation where we as a team gauge how patients are doing, their mental status and seeing what is needed for a safe and effective discharge when the time is appropriate.

“Welcome to the team room, Ms. Taylor. This is Dr. Sanders the attending, and Drs. Smith and Evans the residents.”

“Nice to meet you all.”

“Ms. Taylor was telling me earlier that she is feeling better this morning. Can you say what do you feel better about?”

“I am feeling more optimistic. My children visited me early this morning. I know I have a support network and people that love me. I just need to work on myself more.”

“It’s important to have that network and to reach out when you feel things are becoming out of reach. Do you see a psychiatrist for your depression?”

“I do actually. He knows I’m here. I’ve tried a variety of medications, and none of them have worked for me. I had horrible diarrhea with one, and thoughts of suicide because of another. I think Wellbutrin? I don’t remember, none of the SSRIs have worked either.”

“There is a therapy called ECT that may help you. We’ll put in the consult for the ECT physician to see you today.”

“Thank you. By the way, I don’t have thoughts of hurting myself anymore. It is against my beliefs. I drank so much the other night in hopes I didn’t wake up.”

“That is great to hear Ms. Taylor. I think I speak on behalf of everyone on the team that we are very happy you are feeling better. If you feel that you are having any new symptoms from the medication, please let us know. We’ll also come by to see you periodically. What is your goal for the day?”

“To do whatever it takes to conquer this depression now and forever.”

* All names and events have been altered to protect confidentiality.

Ton La, Jr. is a medical student and student editor, The New Physician.

Image credit: Shutterstock.com