Clouds and Depression

“He blew his mind out in a car
He didn’t notice that the light had changed.”
-Lennon and McCartney

He was a tall man; a large man.  He could do anything with his hands. Built his own house; had a successful career in manual labor; raised three children who were devoted to him. A gentle giant.  He was shy and self-effacing. Except when his family was in need, or distress. Then you could see a look of determination in his face. No rational person would get in his way at those times.

He retired. He had saved enough, and he had so many loyal customers that he could pick and choose if he wanted to do an odd job. He planned to spend more time at home. There were infant grandchildren that soon would need toys and swing sets built for them. His wife, his rock, and his main reason for living, would finally get to travel and enjoy herself.

I met her first. She had some minor joint issues which promptly resolved. She kept coming to see me for colds, and routine checks. I kept telling her that this was not my forte. She ignored my pleas and soon had him coming to see me for the same routine maintenance. This was her way. She did whatever had to be done to provide what she felt was the best for her family.

After a few years, it became clear to me that she was the one who ran the show. Both at home and in his business. She was brilliant and creative. She saw trends before they were in common use. She invested money well. She knew how to pick good workers and straighten out those who were lazy or discourteous. Nothing ever happened in that house, or that place of work, that she did not have a hand on. As kind and as nice as he was, he was not creative or forward-thinking. He followed her lead in everything. He never regretted that choice.

She was in her early sixties when she had a seizure at home. The brain MR showed a large tumor, which was later on found to be malignant. The prognosis was dismal. I explained to her that there were radiation treatments available. There were also experimental medicines being tried. She studied my information and made a quick decision. She would have radiation to shrink the tumor. She made it clear that she was only doing this so that she could have some extra time to make sure that everything was left in order for him.  

“I know that I will die. I don’t want to string things out; it will be too much of a burden for him and my kids. Just give me a few more months.”

She got her wish. She spent the time she had left literally writing a book on what had to be done to allow him to exist without her. To the faintest detail. She gave me a copy. At her last visit to my office she asked me to promise that I would follow up on him. That I would call him every week to see how he was doing. That I would talk to the children frequently, in order to get follow-ups that they were doing their share. That, if I retired, I would make sure that he had a doctor just like me. Where she wanted him to go if he ever needed a nursing home. Everything.

She left my office and arranged for hospice care for herself. She died soon afterwards.

I complied with what she asked of me. I made appointments to see him at frequent intervals, even though there were no symptoms. I spent most of our visit time making sure that he was busy and that he had something to look forward to; every day; every month. I called his children, I am sure excessively, to see if they were having him over for dinner often enough. All the bullet points were checked. 

He was doing well. He laughed. He enjoyed the grandchildren. He was not overspending. He had a couple of projects going.

On Christmas Eve, one of his children prepared to host the annual dinner that mom had catered for many years. When they went to his house to pick him up they found him in his basement; dead amid a pool of blood; brain tissue on the wall; a gun lying by his side. There was no note. Maybe there was no need for one.

I was distraught. I had failed. I did not see this coming. I had done everything that I could; above and beyond. And I failed.  

Now think about how his children felt. Spending Christmas cleaning up your dad’s remains off the walls.  All of mom’s plans; the book we had jokingly referred to as our holy book suddenly completely irrelevant. What did we do wrong?

To this day I still think about him at every Christmas. In my mind I go over all of the preparations that we made. To this day I cannot see how we could have done more.

I’m not a psychiatrist, so please don’t quote me as an authority. It seems to me that a huge percentage of the people that I have taken care of who tried to harm themselves were angry. Life presented them with very strong evidence to show that they had no control of what had happened to them. Or what would happen in the future. They were unable to handle this truth.

I have seen it so many times… It is as if some evil power drapes a black blanket over a vulnerable individual’s eyes. All of a sudden, this person is unable to see any color but black. His or her vision of their universe; their reality, is severely impaired.  

One of my med school professors, a world-famous specialist on depression, went to great lengths to plan his own suicide. A thousand miles from home. Why would he want to put his survivors through the horribly complicated process of carrying a body through state lines? He knew everything that there was to know about his condition. He knew that treatment was available. And yet…

“A poor fellow went to hang himself. Finding by chance a hidden pot containing money, he flung away the rope and went merrily home. He that had hidden the money, when he found out that it had been removed, hanged himself with the rope the other man had left behind.” 

Ausonius, a Latin poet

It makes no sense. Because we are people; because we are not wired to be predictable; because we love, and we sing, and we laugh. None of which are rational behaviors.

I can only close with one plea. When you see clouds crowding your existence, force yourself to wait until tomorrow. Think of how your presence is inextricably tied to so many people that interact with you from near and afar. 

If we think of life as treasure; as gold; we have to force ourselves to understand that this pot of money does not belong to us. Everything that we have is on loan. When under severe duress, we must take a deep breath. We need to wait. We cannot, ever, be the one that failed to notice that the light has changed.