Jack

 

I guess it’s uncommon for a GP to be asked by a patient to kill them.  But it happens. 

 

What made it more unusual was that the request was conveyed by my patient’s mother, calmly sitting beside him in my consulting room.

 

I’d known Jack for several years, just seeing him for everyday ailments and immunisations.  Now 19, his mental health had never seemed to be an issue, with most of my focus being on minor musculoskeletal problems and the occasional respiratory infection.

 

Yet, here he was, his eyes pleading with me as his mother handed over the slip of paper on which his request was written: “Please kill me”.

 

I sat back in my chair and returned Jack’s gaze.  Did I mention he had cerebral palsy with spastic quadriplegia and no verbal speech?  No, that never seemed very important before.  He was just Jack.

 

Or he had been.  The young man looking back at me now seemed a different person.  His eyes were deeply sunken yet glittering bright, and I became aware of an unusual smell.  It was as if his emotions were seeping through his pores in a cortisol stench of despair.  I could feel my own mood being dragged down by the weight of his affect.

 

Through his communication device, Jack told me of the thoughts that were crowding his head and the unseen people who were trying to harm him.  His mother sat like a statue, hearing the flat, robotic voice recite these horrors as his eyes darted over the keyboard. She offered to leave, but Jack insisted she stay.  As he put it, “You’re still stuck with cleaning up my shit at 19, Mum.  I’m not ashamed of you hearing this.”

 

Jack told me that suicide was the only way he could see out of his pain.  This was a complete change from the Jack I thought I knew well and I figured he had an acute psychotic depression.  I reached for the phone and dialled the Crisis Assessment Team.

 

“Hello, I’ve got a 19 year old man sitting here who wants me to end his life.  He’s previously well but now acutely suicidal.  Can you come?”

 

“Of course!” was the response from the CAT intake officer.  “That’s definitely an emergency.  We’ll come straight away.  What other details can you give me?”

 

“Well, did I mention that he has cerebral palsy with spastic quadriplegia and no verbal speech?  He communicates via a…”

 

I was interrupted. 

 

“Hang on.  Cerebral palsy?  Does he have any voluntary muscle control?”

 

“Well, no, “ I replied.  “He’s got spastic quadriplegia with flexion contractures.  He’s dependent for all care.”

 

“Oh, OK,” came the response.  “So he can’t actually harm himself…  Let’s see, there’s a shortish waitlist for the outpatient clinic in six weeks.  We can send him an appointment”.

 

It took most of the rest of the afternoon and into the evening to work my way up the chain of command to the state’s Chief Psychiatrist,  who listened unctuously but made no promises.  Still, I was rather glad to be woken at 3 a.m. that night by a vindictively timed phone call.

 

“Dr Trumble?  CAT intake here.  We’ve just noticed that the road your patient lives on is one of our service boundaries.  Which side of the road is his house?  He might be another health service’s responsibility.”

 

This was back in the days before Google Maps, of course.  “Let me think,” I said, swinging my legs out of bed and feeling for my slippers.  “He lives on whichever side of the street is yours.  See you there.”

 

 

Professor Stephen Trumble

Head, Department of Medical Education

Melbourne Medical School

The University of Melbourne