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    Passive Suicide

    Hi all. I am an OT who works with those with SCI, ALS, MS both inpatient and outpatient. My philosophy varies dependeing upon the patient and their support- but I certainly work to maximize a person's safety and independence with their ADLs, and functional mobility. I feel like I am empathetic - I mostly utilize humor and laughter to get through some tough and frustrating times.
    I am in contact with probably 75% of my former patients via email- just to chat, some to ask questions about problems, looking for resources etc. I have gotten the note or too saying " you were so damn positive it made me sick. But I am so glad now, because you were right- life does go on- not the same, but life does go on."
    This brings me to my point. I had a patient with C6 quadriplegia who came to me from another rehab facility that after 4 months, left him dependent with transfers, had not even trialed learning to feed himself etc.. We had a lot of work in outpatient therapies. He was generally unnaccepting of his condition, but he worked very hard at therapy. He was very self-depracating and humorous. He really needed additional interventions to improve his success such as botox, tendon lengthening, baclofen pump etc. Unfortunately he was being seen by a physiatrist at another facility who did not respond to our requests (PT or OT). We did succeed in getting him to transfer, feeding himself, pushing the button for the elevator, drive his wheelchair without a midline drive. But we were quite stuck- more accurately he was quite stuck.
    He was paying for everything out of pocket- including remodeling his condo, his monthly rent for an AFH etc. He had the kindest friend who helped with everything. Then came December 27th- he attempted suicide, but was found before he had succeeded. The form of suicide caused a cascade of medical problems, which hospitalized him for months. Once he got healthy enough to go to a SNF (the AFH wouldn't take him back for fear of a repeat), his MDs educated him on the POLST form. His eyes lit up, and he signed for comfort care only even though he had nothing that was within hospice type problems. He did have a UTI, and because of his requests he was not treated.......... he sadly passed away two weekends ago.
    As a therapist I have had probably 100+ patients pass away from a variety of reasons including suicide. This just hit me particularly hard.
    I guess I just wanted to share this not to give anyone ideas, but to help me process, and to help me to better understand the ramifications of the POLST form. I personally believe that people do have a right to death with dignity. I believe my friend did so, but I am sad because I saw his life as moving forward, given some help from the medical community. I also thought of him as someone with so much to give to others.
    May he rest in peace and bring as much laughter wherever he is as he did with me during our therapy sessions. May he have a free body to rollerskate and dance as he used to.
    Thankfully he was able to do a couple of the most important things to him prior to his death and that was 1- vote, and 2- witness an African American become president. Two very important things to him.
    I will miss him greatly- and to those of you who have had therapy, please know how much you affect us, and motivate us, and give us the courage.
    My humblest appreciation for what my patients teach me,
    Pam OTR/L

    #2
    Pam, I'm deeply sorry to hear of this loss. I'm glad he had a positive influence like you in his life. My greatest sympathies to you.
    Courage, it would seem, is nothing less than the power to overcome danger, misfortune, fear, injustice, while continuing to affirm inwardly that life with all its sorrows is good; that everything is meaningful even if in a sense beyond our understanding; and that there is always tomorrow.
    -Dorothy Thompson

    Comment


      #3
      I'm sorry Pam. It has to be hard to go through deaths like this.
      I'm sure you helped him alot. You sound so caring and understanding.
      God Bless you.
      sigpic

      Comment


        #4
        Such a sad story. I have seen people with SCI die from different reasons and I always feel sad because they have always died too young.

        I am sorry, Pam
        TH 12, 43 years post

        Comment


          #5
          Pam, I am so very sorry. You sound like an incredible therapist and human being, which is why, of course, this is hitting you so hard. I would have similar feelings because it all seems so unecessary. Passive suicide is something I can agree with for someone with a terminal illness, but certainly not in this case. Despite all your work it sounds as though he just wasn't going to make it, either out of depression or simply being overwhelmed. I so often think that suicides of all types need intense psychological counselling, and only then could one make an "informed consent." Anything else is too much like trying to fight your way out of a paper bag, with the confusion, the fear, the sadness of finding your life forever changed. Most adapt, fortunately, and I am sure your gentle humor and ribbing helped them to do so. The fact that you keep in contact with so many of your patients says a lot about your caring level, and I, for one, would have been thrilled to have you as my OT. I guess what I am trying to say, without sounding cavalier, is that maybe you just can't win them all, despite your best efforts. I had a good friend commit suicide a couple of years ago. She was not the least bit disabled, and had no major problems (health or finances) that were obvious, and yet she did this anyway. I am sorry, and I hope you can take comfort in the 100's of people you have helped, who have gone on to lead lives of much greater quality than if they had never had a committed OT to guide them.

          Comment


            #6
            Pam,
            I am sorry about his death and its impact on you. I suspect you are a good therapist by the way you write about the experience.
            jon

            Comment


              #7
              Hi Pam,

              You're a very special and caring person. Thanks for helping people out.

              Personally I think anyone who has a UTI should be treated for it. In this day and age of antibiotics, their use for simple acne duly noted, the range of basic life sustaining treatments should be extended to include them. To knowingly allow a simple UTI to progress into sepsis is practically murder. And on the economic side of the argument, a very expensive way to medically treat a patient. Death by sepsis is anything but a dignified way of checking out.

              BTW, what was the method of suicide? I don't think you'll be encouraging its use. From my gleaning, it doesn't seem very appealing.

              Your acronyms killed me! The 3 that stumped me were:

              SNF = Skilled Nursing Facility

              AFH = Adult Family Home

              POLST = Physician Orders for Life Sustaining Treatment

              Acronym Finder

              Sorry that your work brings such sadness and confusion into your life. What you do does matter and you're making valuable and positive contributions to other people's lives- so keep up the good fight.

              Bob.
              "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

              Comment


                #8
                Pam, so sorry to hear about this man, and how it affected you. This sci crap is so devastating to so many people and families. You therapists have a job that can have such emotional highs and lows, along with all the gas accidents we sci's have.
                Every time I tried to tell Whitney and Marie how much they did for me they po-po it, but you guys really are the first line of positive for us.I did however get some good hugs from Wh. a couple of times when recalling times I fell outof w/c and had to climb back in. She couldn't get me to get outof my chair during rehab.
                Thanks for posting about the living will so people realize how it affects treating the little things like a uti, that one needn't die from. It also gives all of us a view into the lives of our therapists, not just "our " life experience with you.
                I really mean it when I say you ladies there at the UW have made me the w/c man I am today, I was so fortunate to have had the group I did up there, thanks to all the great tips and exercises I am able to get up. I walked into my inlaws house, upstairs for the first time in 19 months, was rewarded with hugs around. I am fearless when it comes to trying new objectives in the chair or out. Your smiles are so much like coming home to a family when I come there, I love you all. God bless you ladies and keep up the good work.
                Last edited by fishin'guy; 10 Apr 2009, 6:15 PM.

                Comment


                  #9
                  Originally posted by bob clark View Post
                  Hi Pam,

                  You're a very special and caring person. Thanks for helping people out.

                  Personally I think anyone who has a UTI should be treated for it. In this day and age of antibiotics, their use for simple acne duly noted, the range of basic life sustaining treatments should be extended to include them. To knowingly allow a simple UTI to progress into sepsis is practically murder. And on the economic side of the argument, a very expensive way to medically treat a patient. Death by sepsis is anything but a dignified way of checking out.

                  BTW, what was the method of suicide? I don't think you'll be encouraging its use. From my gleaning, it doesn't seem very appealing.

                  Your acronyms killed me! The 3 that stumped me wer

                  SNF = Skilled Nursing Facility

                  AFH = Adult Family Home

                  POLST = Physician Orders for Life Sustaining Treatment

                  Acronym Finder

                  Sorry that your work brings such sadness and confusion into your life. What you do does matter and you're making valuable and positive contributions to other people's lives- so keep up the good fight.

                  Bob.
                  When the bug do not respond to antibiotics ....Sepsis ...and bye bye .
                  Is called resistant bug.

                  Comment


                    #10
                    Originally posted by maximus1 View Post
                    When the bug do not respond to antibiotics ....Sepsis ...and bye bye .
                    Is called resistant bug.
                    Hi Adi... err... I mean Maximus,

                    That's true. But in this case, due to the patient's POLST, antibiotics of any type, effective or not, weren't even tried.

                    Bob.
                    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

                    Comment


                      #11
                      Hi Bob,

                      If I read it correctly the patient opted out of treatment and just wanted to be kept comfortable while nature took it's course.

                      A sad, sad story.

                      Comment


                        #12
                        Originally posted by bob clark View Post
                        Hi Adi... err... I mean Maximus,

                        That's true. But in this case, due to the patient's POLST, antibiotics of any type, effective or not, weren't even tried.

                        Bob.
                        If the antibiotics worked to kill the bug .....Shame on people who could save a life.

                        Comment


                          #13
                          Originally posted by maximus1 View Post
                          If the antibiotics worked to kill the bug .....Shame on people who could save a life.
                          Shame on the system for not getting him proper treatment to begin with.

                          I'm sorry for your loss SCIOT.
                          If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


                          Sometimes it is easier to widen doors than it is to open minds.

                          Comment


                            #14
                            God bless you and all of your ilk. You all saved my life and those of so many friends, and so many friends I've yet to meet...maybe you didn't drag me from the fountain, or scrape my friends from the pavement, or pull the bullets from their necks. But OT/PT gave every one of us our lives. For those like me, with impaired finger function, OT is most critical. OT was what convinced me I could live, showed me some light at the end of an unbelievably dark tunnel, told me that my 3 biggest losses, the ones I feared most, weren't silly because they were important to ME. I needed to learn to pee and to poop and to roll over and sit up and yes, there is sex, and my diaphragm is partially paralyzed and my body's thermostat is now that of an iguana, and I couldn't do my money earning job and my ability to do my other jobs-mom, wife-were in serious jeopardy. But my biggest fears were 1. Not being able to turn the pages of a book and 2. Not being able to tweeze my eyebrows or highlight my hair and 3. Never traveling again without an entourage I could never afford.

                            My OT, Rafferty Laredo of TIRR, asked me straight up, which losses were scaring me most. He listened, then he brainstormed. Raff never lied to me and he never let me down. I needed help with an aspect of cathing, he created a solution using plastic salad tongs (LOL, don't laugh, it worked!) When I told him to patent it IMMEDIATELY, he said he'd rather present it for free at some OT convention, where he was to speak on the topic of "Thinking Outside of the Box".

                            Within 8 weeks, he gave me the skills to survive. Every time I meet someone that got no rehab, or had really crappy rehab, or weren't in a condition to take it all in, I wonder how they're alive today. I'm not sure I'd have made it.

                            For every one you lose, you must save dozens, even hundreds. I'm glad you're not jaded, but sorry you're hurting. People fail to see how often SCI is a terminal illness. We live close to the edge in these chairs.

                            I hope he's at peace now, and that you rest well tonight. Our people need you.


                            My heart bleeds from stories like this. I can only imagine how it hurts you.
                            Blog:
                            Does This Wheelchair Make My Ass Look Fat?

                            Comment


                              #15
                              People fail to see how often SCI is a terminal illness. We live close to the edge in these chairs.


                              Very well said betheny.
                              My respect.

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