A blue-tinged pale face with telling red marks encircling the neck.    I had nothing to do with this patient who I saw during my emergency medicine rotation in med school.  No one in the hospital had much to do with him, actually, as he arrived dead.  DOA.  The young man had hung himself, and the emergency room was a waste of time.  He was long gone.

But almost two decades later, he is not long gone from my mind. ¬†Every time a patient reports suicidal ideation, I see his face. ¬† And, my pulse quickens. ¬†I am haunted. ¬†Surrounded by endless tragedies, I don’t think those of us in medicine can escape such hauntings. ¬†Certainly not me. ¬†Most of the time, though, I think I’m glad.

As the haunting keeps me alert — reminding me that suicide is real and to never underestimate a patient’s illness. ¬†I know I can not help everyone who walks through the door, much as I long too. ¬† The mental illnesses are too deadly.

However, as I listen to any patient’s suicidal ideas, I remember that face and my vigilance increases. ¬† I check. ¬†And check again. ¬†And adjust medicines. ¬†And adjust plans. ¬† And encourage every treatment that ¬†may possibly help. ¬†And encourage it again. ¬†And try. ¬†And try more.

And so,¬†I do hope that hauntings continue to inform my work. ¬† Even here. ¬† As I feel compelled to warn: ¬†If anyone out there is worried about themselves or a patient or anyone else who is having suicidal thoughts, please don’t wait. ¬† Don’t worry alone. ¬†Call the psychiatrist. ¬†Or, ¬†911. ¬†Or, the suicide hotline 1-800-273-8255. ¬†I’m thinking that maybe that haunting can reach out once more. ¬†This time online. ¬†And help one more.