Nurse tells her experience – Suicide

Guest Post

by, Leslie Oneil, RN

Nurse extraordinaire!  Person to know.  More.

Nurse extraordinaire! Person to know. More.

In The Ring

I sat at a table in a large meeting room watching Dr. as she stood in front of the room. She stood in front of us with poise…armored with stories, analogies, statistics, and invisible red boxing gloves to match her red dress. She was ready to defend mental illness, and fight for its proper place in medicine and in the spot light where it belongs…right next to the heavy hitters: cancer, heart disease, diabetes.

Dr. delivered the statistics….”1 in 5 people suffer from depression.” She counts the room, “1, 2, 3, 4, depressed. 1, 2, 3, 4, depression.” She continued, “Put all of the depressed people in a room, and look around. 1 in 15 of those suffering from depression will go on to commit suicide.” It’s dramatic. The room was silent. It usually is. I am not comfortable with the topic anymore than I was the first time, but I am getting used to hearing the same phrases, the same statistics, and responding to the same questions from the audience. I am now familiar with the language of mental illness.

Last Friday, as I stood in the middle of the PACU, our eyes met. It felt intense. it was an emergency, and an emergency in behavioral health means…

Then I heard Michael Buffer, the master of ceremonies, in my head. He introduced the statistic to the ring. Dramatic music played, and before I had the chance to raise my gloves, the statistic nailed me…First with a left hook, then went below the belt. I was knocked out. Speechless with my face in my hands. Gloves were off.

 

Your patient committed suicide.

 

No amount of training prepares you. No power point presentation. No book. No doctor.

TKO.

I never even imagined how I would handle the news. I was weak in the knees and shook.

The patient was starting electroconvulsive therapy in 3 days. The patient had just called me. The patient denied any suicidal thoughts. The patient…….It doesn’t stop.

The gravity of what I do hit me. It hit me hard.

As I drove home I thought, “Have I entered a losing battle? I’ve wanted to be a nurse to comfort people, advocate for them, care for them, and try to help improve their quality of life if possible.” If possible are the key words.

Am I okay with, “We did everything we could. Stop. Time of death….”

 

My question to you: “Do you find gratification with the result or with the process?”

You think you know the answer…until you’re in the ring.

 

Leslie Oneil, RN, is a ECT specialist nurse.  She writes at a blog worth following, A Very LOshow.

 

Answering Jim, professionally and personally – ECT

A few days ago, Jim, from blog, “I Don’t Want To Talk About It,” asked in his comment to my blog post,

What is your educated opinion about this?  A friend of mine is seriously considering this.

Jim was asking regarding ECT – electroconvulsive therapy.

021 Side Effect

021 Side Effect (Photo credit: Jester Jay Music)

Responding to a question that asks me to answer both personally and professionally is a little uncomfortable but this is my best effort.

…Alright, Provocateur Jim, I have been chewing my cheek on this, wanting to say something profound, considered “educated,” 🙂 yet not to turn anyone off with an up-tilted schnoz.

I do love ECT as a treatment option.

ECT is not for everyone of course, as nothing is, but consider it if you are looking for a treatment to work quickly and effectively .

Quickly is important.

  1. Can be life-saving, (“Timing is everything,” they say)
  2. Brain health short and long-term
  • less dementia,
  • less onset of other brain illnesses that come when one brain illness is not fully treated,
  • easier to respond to any future necessary treatments when we get more rapid and full treatment response to current illness episode,
  • ECT (as with medication therapy) that is done earlier in illness episode has a more robust response,
  • relapses are less severe, and we do not drop as rapidly when treatment is obtained more quickly for current illness episode

3. Quality of life,
4. Halt the damage to interpersonal relationships,
5. Diminish financial demise secondary to disability of brain illness,
6. Minimize side-effects,
7. Minimize medications.

Efficacy… do we really need to even say that the goal is to use a treatment that works?  ECT works more often and more thoroughly than any other treatment options.

Furthermore, we suffer less illness relapse when ECT is continued in maintenance.

Treatment response is much more robust when ECT is combined with medication.

Side Effects:

The side effects can only be measured on an individual basis, as qualified by the person going through them.

First off, there is no brain damage done by ECT, as seen in medical studies. This is a common fear.

Neither does ECT go through the body systems, it is not metabolized, and does not touch our body organs.  Yay, right!?  Medication side effects are a huge pill-dotted elephant in the room.  ECT does not touch the body (i.e. It is not a substance ingested or entered materially into the body,) all related potential side effects never happen.

The number one reason for relapse in brain illness is medication noncompliance.   This is due to many reasons, such as intolerable side-effects and the cascade of subsequent related issues.  Even dry mouth can lead to root canals.  We do not think of osteoporosis from serotonin agents.  Not taking our medication daily can be for more obvious reasons, like not climaxing during orgasm.

Zoloft Side effects in women

Zoloft Side effects in women (Photo credit: Life Mental Health)

Plus, it is just hard to remember.  Even the most consistent of us generally miss one to two days of medication a week or a month.  It is tough to be consistent.
ECT is less difficult to remember and maintenance ECT is much less frequent than taking pills every day.  Even when the ECT is combined with medication, if a day or two is missed, at least the ECT will be consistent as it has the support of the community of ECT staff and the transportation person to and from the surgery center.

In these regards, ECT has fewer barriers to treatment compliance that the majority of us suffer with medication therapies.  That is a big deal.

The side-effects of ECT are generally headache and temporary memory loss.

During index treatment, (about the first 3-4 weeks,) it is common to experience difficulty imprinting/recording memories. This typically takes about five weeks after the index treatment to return toward baseline. 80 years of data do not demonstrate that there is other memory loss but there are individual complaints of that.

Headaches are common for the the first couple treatments until the anesthesia becomes customized to the individuals experience. Generally after the first few treatments, the personalized anesthesia medications are able to resolve these from causing too much suffering. Not universally of course, but generally. Then once the maintenance treatments get going, memory loss and headaches are not common complaints.

…Big breath…

Did I do it?  Any questions about this diatribe?  🙂  Thank you for your patience.  I am trying…  Please let me know.  Keep on.

Past week, latest on ECT on the web

  1. Shock therapy used to treat depression video from wzzm13.com community
  2. Wrong Planet Autism Forum Index -> Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions
  3. Why are we still using electroconvulsive therapy?
  4. By Jim ReedBBC Newsnight
  5. PLOS ONE  :  Electroconvulsive Therapy Induces Neurogenesis
Cured by Electroshock Therapy,  Wall Street Journal

Use something other than your condition to mark your value

typical American family, September 1940

typical American family, September 1940 (Photo credit: austinevan)

I do not really want to examine my faith.  It is just a paper flower.  Where my faith comes from, now that excites, like a outlet into energy.

Watching, The Grapes of Wrath 1940 drama film directed by John Ford, tonight with my family, we all knew that we were frail, one or two missteps from disaster.  One of us asked,

“Why wasn’t it a big deal when someone died?”

Oh, but it was.  The people were breaking, could barely dig a grave for their family member, and that may have come across to a youngin’ as if they did not care.  When we are breaking, we look at life differently.  It is a big deal.

Casy says it at Grandpa’s burial, “All that lives is holy.” Chapter 13, pg. 184

I see this in patients sometimes.  People who are done with the bull.  People who know that whatever it is they thought was so great about themselves is just rubbish.  People who know they are more than the sack of skin that holds their fire.  These people are looking for where their life comes from, for a moment of realness to fuel on.  And these people taking medications, getting electroconvulsive therapy, dialectical behavioral therapy, scraping at life to survive, these people are.

However, we do not really want to examine our hard work, though it is so close to what makes life great.  Our courage and grit rises up like a green mountain.  Where our grit, hard work and courage comes from, that is Holy.

There is strength and Holiness there, no matter about our condition.

Question:  What is special about humanity?

Self-Care tip:  Use something other than your condition to mark your value.

A Note of Thanks For Collaborating

typewriter 1

June 30, 2013

You
Friend to Yourself
Colleagues
Practitioners
Referral Sources

Hello,

I just wanted to send a note of “Thanks!!!!”
Thank you so much for including us in the care of your patients.  I hope we continue in your and their trust.

Practicing variety psychiatry brings me toward my quality of life experience and I am grateful.  I am not alone in this but blessed to be included in a fantastic team and community of treatment providers.

We believe passionately that our own quality of practice experience is the first step to engaging in a patient-doctor relationship.  Connection brings change and so our patients become a changing force in our lives with their courage.

Our patients work through multiple modalities, pressing toward healing and presence with electroconvulsive therapy, treatment-options awareness groups, medications, psychotherapy, and homeopathic remedies.  If there is more we might benefit from in practice, please let us know.  This is a life-journey we are honored to share.

Keep on.

Dr. Q

951-677-2333 ECT Centers, Medical Director
PrimeTelepsych.com Personal cell available, Concierge Telepsychiatry
951-677-2333 Treatment-Options Awareness Community Groups
800-670-4960 Pharmaceutical Research, such as, for those who cannot afford care otherwise – Principle Investigator
PatientFusion.com or (951) 514-1234 Outpatient Psychiatry Clinic
FriendtoYourself.com Us, you and I, Writing and Public Speaking

another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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