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I hadn't remembered the last time I was so flushed with anticipation. An almost irresistible desire to please spread like bolts of electricity down my fingertips into my very gait. Four weeks into my psych rotation, I realised something had changed within me. I'd heard and seen enough of the vagaries of the human mind and soul to be hooked on other peoples' stories, patients' stories. There was no going back. Somehow the hour-long armchair MSEs of patients at their lowest darkest points, coupled with the uncompromisingly encouraging teachings of one particular consultant, had incited a revelation and conviction that mental health was more than just medications. It was about saving people. Or so I thought.
The mental health unit was a pleasant one. Flowers overflowing from jars and thank-you cards strung up like a giant smile at every corner were enough to make you think everyone was friends here. We'd been given leave to roam the unit for patients to take histories from, as good medical students do. I had witnessed how many of the therapies and treatments enlisted by the doctors from their clinical arsenal had helped improve the day-to-day functioning of several patients in the grips of depression and anxiety. One such day, I noticed Nerine's name being written on the nurse's whiteboard in red ink beside her room number. A new patient. She had been admitted under Dr M, the aforementioned kindly consultant.
I decided to visit Nerine to make out her story. She and I had met the day before, very briefly, during the consultant ward round when she was introduced as a patient undergoing neurostimulation for treatment-resistant depression. My usual habit of knocking timidly at the door was met by a pause, then a barely-audible 'yes'. As I entered the room and asked if I might invade her space, I was greeted by a woman in her mid 50s-60s, hunched over in a chair with her back towards the light. Before long, we started talking.
I began with the standard questions like any other situation. The stuff they teach you in medical school, as they say. Her answers were terse, and almost brutal in their delivery. She had left home at an early age and worked in various places, determined to cut ties with a family that was already broken. Her sadness had always been there, and every so often would seep into the cracks of her mind like the oil of some heavy machinery, Work as a bookkeeper sustained her for a while, until it didn't. She valued productivity and liked cold hard evidence, but after a while she became stagnant with misery.
I listened as she talked, the pain etched across her face. It was hard to see where things went wrong, but I realised she was alone in the truest sense of the word. She had no friends, no family, and nothing that brought her joy in retrospect. I was no stranger to depression, but with Nerine it was different. With her, there was an overwhelming sense of defeat and an unerring disregard for her own life. Any attempts to end things were listed off ruefully, like anniversaries that occurred every few years. Drugs had failed her, as had people. She had given up, this final round of treatment was merely a formality.
Over the next few days I visited her and got a sense of where she was at. She was proud that she had come this far, but prouder still that no one could help her. Once again neurostimulation hadn't worked and there was nothing to show from it. I was surprised at the way she so defensively rebuffed any attempts at consolation; any well-meaning conjectures that things would get better. I realised in the isolation of her illness, she was used to pushing away the tides which might bring her to shore.
The last time I saw her before she was discharged, I remember Nerine sitting against the bright blue sky of the window behind her. I was reminded of sunflowers, of how they turned their faces toward the light when they wished to grow further. I asked her what was next and she didn't know. There was a lack of finality in her answer, but mostly a lack of hope.
At the unit meeting, the doctors discussed Nerine's case. I asked them how they dealt with a loss like that. A loss of a patient's confidence in the system, such that their individual autonomy ruled against any further beneficence on the part of the treating team. A loss of a patient's life at some indefinite point in time, which might only be described as self-inflicted. There wasn't a right answer.
One of the doctors turned to me and I knew in his eyes he understood. Nerine's uncertainty would weigh on us both; but I realised neither one of us could be the decider of her fate. The resolution of living was not something we could enforce, like a pill or a shackle to the Earth. The beauty of life was that it was often a choice; and that we, as doctors, were not the ultimate saviours.
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(Names have been changed to protect the privacy of individuals).
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