The end is not for me, but for one of my patients. A homeless alcoholic, “Jason” came to see me in intermittent bursts. I could tell when he was on a bender because I wouldn’t see him for a few months, and then I would see him once a week for a few weeks in a row. He’d come back to the clinic ready to enter detox, pledging to take care of his health, take his meds, give up drinking. He’d do well for a little while, but eventually he would slide back into the streets and start using his SSDI for alcohol instead of medication. Despite his drinking and his anger management problems (which could usually be defused by a few jokes and a smile), I liked him. Over the past 6 months, I saw Jason going downhill. A few times he asked to be sent to detox, only to be turned away for lack of beds. He started talking about wanting to kill himself, and he started making suicidal and self-harming gestures. He was seen at the ER on multiple occasions, drunk and cutting himself. Each time, he was evaluated by the local crisis team and deemed safe to release once he sobered up. Once he was evaluated by the crisis team in the morning, cleared for release and seen by me in the clinic 4 hours later, threatening to kill himself. We talked him into going back to the ER to try again for a psych bed. He did go back to the hospital…only to have the crisis team refuse to evaluate him because he “has already been evaluated today.” It was really disheartening to watch, because I knew that he wasn’t a guy who was just looking for attention. He was a guy who was really, seriously depressed and had no resources or support. And our sad little city didn’t have enough resources to help him, either.
Today I got a call from the medical examiner. Jason was found dead a few days ago. It looks like a suicide. I’m not surprised. I am sad, to know that this was the culmination of months of struggling, asking for help and being turned away. This wasn’t a guy who was pretending to be happy until the day he killed himself. This was a guy who was asking–sometimes begging–for help. We just didn’t have the resources to save him.