Page 87 of The Devil You Know
Somehow I say the right magic spell and the image from the computer suddenly appears on the overhead screen. I’m so relieved, I nearly cry.
“That’s fine,” Alyssa says to me, because saying “thank you” would be far too challenging for her.
The last thing I want to do right now is listen to Alyssa lecture for an hour, but I grab a bagel from the back of the auditorium and sit down in the last row. I don’t have any patients scheduled for this morning and I’m already here. Might as well listen to Alyssa’s talk.
“Hello, everyone,” Alyssa says. “Today I’ll be speaking to you about Overcoming the Risk of Suicide in the Hospice Population.”
Well, this is sure to be depressing.
“It may seem counter-intuitive to treat suicidal behavior in a patient who is already terminal,” Alyssa begins. “But part of the goal of good hospice and palliative care is to make those final days more comfortable for your patient. You might wonder why patients who are going to die soon anyway would try to kill themselves, but you’ll soon see that there are a plethora of reasons why a hospice patient might become suicidal.”
For example, if Dr. Alyssa Morgan became their hospice physician.
“For example,” Alyssa says. “They may worry about becoming a burden on their family and friends. Or they may see their strength and abilities deteriorating.”
Somehow, something that Alyssa is saying tugs at the back of my head. The bagel I managed to take one bite of churns in my belly.
“Let’s start with some statistics,” says Alyssa. “Suicide is the tenth leading cause of death in this country. By age, there is a bimodal distribution, with a peak over age seventy-five, but the largest peak in the forties. Women are more likely to attempt suicide, but males are far more likely to be successful.”
A man in his forties who is deteriorating.
“The most common means of committing suicide is by firearms,” she says. “Of course, pills are most commonly used in attempts, but firearms are the most successful by far.”
A man in his forties who is deteriorating and owns a gun.
“So let’s talk about risk factors,” Alyssa continues as she flips to the next slide. “The emotions that contribute to suicidal behavior arehopelessnessandhelplessness. The patient feels hopeless because he’s in a situation, such as terminal illness, where there is quite literally no hope. And he feels helpless because there’s nothing he can do about this situation. Suicide gives the patient what theyfeel is an escape from a hopeless situation. And it gives them control in a situation in which they feel helpless.”
Control. What every surgeon is obsessed with.
“It’s a common myth that most people commit suicide without warning,” she says. “Most people who are suicidal communicate many warning signs to the people around them, even if these signs aren’t always picked up. They may even communicate having a plan…”
I’ve got a gun locked away in my desk drawer at home.
“Although after they make the decision,” she continues, “interestingly, their mood can lighten because they feel that they are finally escaping from their problems.”
I close my eyes and remember the way Ryan smiled and winked at me when he had just been stripped of his surgical privileges.
Oh my God.
I sit up straight in my seat, knocking over the cup of coffee that I took but haven’t been drinking. A few people turn to stare at me, but I don’t care. Something has just occurred to me. Something horrible. Something I probably should have realized last week, but I ignored all the warning signs.
Ryan is going to try to kill himself.
And I’m the only person who knows it.
Chapter 34
Everyone is shooting me dirty looks as I slip out of the auditorium. Partially because I end up leaving behind a huge puddle of coffee under my seat. But what am I supposed to do? Crouch down in the middle of the lecture hall, wiping up coffee with the little tiny napkins provided with the food? It would take like a thousand of those napkins to clean up all that coffee.
I’ve got to see Ryan now. I’ve got to convince him not to do what I know he’s thinking about doing. Before it’s too late.
I race over to the elevators, and just my luck, the doors open and there’s George. I hesitate, knowing that I don’t have the stamina to make it up all those stairs.
“What floor?” he asks me.
“Ten,” I say. “And… it’s kind of… an emergency.”
Our eyes meet for a split second, and George nods. Someone else starts to board the elevator, but George holds out his arm to block them. “Sorry,” he tells thefrustrated would-be passenger. “We’ve got an emergency and we’re going straight to the tenth floor.”
