I was starting one of my usual working days, seeing patients as a family physician.
I got a call from the sheriff’s office early in the morning. I was interrupted from seeing a physical to come out and talk to a deputy on the phone. He was at the scene of a suicide in the northern part of our county. We discussed the case. It was an elderly man who had shot himself in his yard. He had left a note. His wife had found him, shot in the neck and head with a shotgun. The deputy described the scene and the circumstances to me. The man was suffering from some condition with chronic pain. He had seen his physician in Spokane the day before. He had been denied his usual pain medication for reasons that were unclear. This was quite upsetting to the man, according to his wife, and he returned home despondent. The next morning, he shot himself after leaving the note. His death was pretty clearly a suicide and the sheriff’s deputies felt comfortable handling the investigation. They didn’t think I needed to come to the scene, and I was thankful.
I spent the rest of the day being a family physician. Later that afternoon, in a clinic we have in a smaller, rural town, I visited with a young high school student. He described vague abdominal complaints to me. While I was talking with him it seemed like there may be more to the story.
I found him likable, but he had deficits. He was on a regular seizure medication for epilepsy and his features were a bit dysmorphic. That means, “funny looking”.
I asked him if his parents were with him, and he allowed me to invite his mother into the room. A prolonged discussion ensued.
He was not doing well in school.
He had medical problems, but they were stable.
I could see how he might be labeled by his fellow students as not bright. He spoke slowly; his speech was sometimes slurred. However, in my discussions with him he seemed to have insight and be cheerful.
But he was not doing well in school.
His mother said he didn’t study or apply himself. When I asked the student what he would change about school if he could he said, “I wish they’d ask me to do more things.”
“What do you mean by that, more schoolwork, or more activities with your fellow students?” I asked.
“Both,” he said. “They think I’m dumb but I’m not.”
I looked at his mother. She looked at her son. She asked, “What do you do when they ask you to do more?”
“I don’t do it,” he said looking at the floor. I could see this conversation had been done before.
“What does he like to do?” I asked the mother.
She paused for a moment and the two discussed this. It sounded like he likes to play computer games, listen to music, and play sports. He really does not like to read or do schoolwork.
The mother has tried to encourage responsible behavior by getting him a job mowing lawns. But she described continually nagging him to get this done. He doesn’t do it on his own. The two talked with each other in a warm and open fashion, but it was obvious there had been some conflict, maybe even a lot of conflicts.
I asked the mother if she had tried withdrawing privileges. She said she had tried but it never really worked. I asked her how hard she had tried. She seemed puzzled. “Have you taken all the things that he likes to do away from him?”
“Well, I’ve tried, but that doesn’t really work,” she replied.
“How long did you do it for?”
“Oh, a day or two, and it works a little bit, but then he slips back into not doing his homework.”
I looked at the mother, and then I looked at the boy. “What we are talking about here is learning discipline. Do you know what discipline is?”
I looked at the young man. “Discipline isn’t spanking or punishment. It’s what we all need to learn to be happy in this life. It’s the duty we feel and the obligation we fulfill to do the tasks we need to do, when they should be done.”
I turned to the mom. “You’re going to have to do it for longer. He’s going to have to understand that you mean it.” As I looked at the boy, he looked at me and actually grinned. I smiled too. It seemed like he knew this was coming, and he was somewhat relieved by this discussion.
I outlined the plan to both of them. Everything except the bed, his clothes and a lamp were to be taken out of his room. No extra activities until his grades were at a certain level (C’s-B’s, whatever was an agreed, realistic goal). As he achieved these marks the privileges are reinstated. I warned this usually takes a couple weeks. It will not be without conflict or anger. The two seemed quite comfortable and warm with each other, even loving.
I wasn’t sure if the mother had the fortitude to pursue this. I had never met this family before. This is what I call, as a physician, shooting from the hip. You try to get a sense of the family and advise as appropriate.
I had a good sense about the meeting. Maybe even a little elation, like I might have actually helped somebody in the allotted fifteen-minute time slot. But then, who really knows. They go home and I see the next patient.
Later that night I got another call from sheriff’s dispatch. Another suicide. It seems they come in bunches. This one was in the eastern part of our county; out past that rural clinic I had been in this afternoon. A 16-year-old boy had shot himself.
Usually, I ask the dispatcher the name, so if I know the person I’m not surprised at the scene. A little preparation helps the mind be clear for observation. I forgot to ask this time. Then, as I was driving through the night to the small town, a worry came over me. A deep sense of dread weighed down that this might be the kid I saw today. I wondered if I had misread the family and things had gone very wrong.
I drove through the small town where the clinic was. The old brick high school on the hill looked down on me darkly. I didn’t get lost this time on the rural county roads and I approached the location where the dispatch had told me the suicide had occurred. The deputies’ cars were parked off the rural lane and their lights were circling red and blue in the dark. I approached Brandon, the deputy in charge of the scene and asked him first thing, “Do you have the name of this kid?”
He scowled and admitted he didn’t. He’d forgotten. He got on the radio to call dispatch to get the name.
As we waited for the reply he launched in: “Let me tell you the story, Doc,” he said.
Then he turned and started to lead me back into the brush with his flashlight to look at the body. He’s walking ahead with his flashlight, talking, leading. I follow. “It sounds like the parents weren’t happy with this kid’s school performance. It sounds like they came down on him pretty hard tonight, and he got pretty upset. They were giving him grief, I guess around dinner, about schoolwork, and saying he couldn’t see his girlfriend anymore. He grabbed a gun and ran out of the house.”
I step over branches and brush, following downhill, listening.
“The way the parents talked he was a hot head and had stormed off like this before, so they didn’t run after him. When he didn’t come back for half an hour his little brother went looking for him. He found him out here in the brush. There’s a note by him, and there’s a gun. He’s just back here in the brush down off the bank.”
By now, I’m reeling. I’m following a bobbing flashlight into the black and enclosing brush. As we step over twigs, and they snap and crunch I tell the deputy he has to stop. I can’t look at this kid until I know his name. I bend over and put my hands on my knees to steady myself. I say out loud, to the ground and the dark warm air, “If this is the kid I saw this afternoon this family will never forgive me.” And I wonder if I could either.
There are no blood or guts nor dismemberment, no bloated body to see on this dark brushy hillside, but it’s the closest I’d ever come to throwing up or passing out on a coroner call.
This one might not be all right.
I have come to find that most deaths are forgiven. Homicide, suicide, accident. In some way the sense of it fills in and I can come to peace.
The families do or they don’t, and it wears them down, but peace and forgiveness heal. Maybe not this one for me.
It’s taking forever for dispatch to come up with the name. I stand up and wait for the name over the radio. Brandon is walking on in the dark, leading the way, unaware of my hesitation. He’s talking away into the radio.
I steady myself and follow.
Down the bank I can see the flashlight beam on the shoes. I’m dizzy and cannot brace myself, but I can see the shoes.
They are not the shoes I looked at on the kid in the office today.
The name that finally comes through the radio is not the name I heard today.
It’s not the same kid. So, my guilt is assuaged. And I can now recover the distance. The faint I feel fades.
I climb down the bank to look at the face. It is misshapen now with the top of the skull gone and the bones of the face left with little to hold them up.
The buzzing in my head recedes. I can look at the suicide note to his girlfriend and find myself smirking at the misspellings. Distance lets you smirk.
But it’s still a dead kid. Another dead kid.
I look up at the deputy. I can’t see his face since he holds the flashlight. “Kinda makes you not want to lay down the law on your kids, huh?” I say.
“You got that right Doc. I was riding my daughter about her homework tonight before I came on shift. And soon as I heard this one, I called her on the cell and said, ‘You know honey, it’s OK how you’re doing in school’.”
I thought about the kid this afternoon and his mom.
Was this the horror she thought she was avoiding? Or did she know she could not forgive herself if this happened.
We cannot prevent the tantrum.
A gun makes a tantrum fatal. And our sense of self can be so confused that we feel responsible for the cause or the cure.
And then there’s the gun.
Cause of death: Rifle shot to the head.
Manner of death: Suicide