On Suicide

I am very sad about the death of opera singer Jerry Hadley, who shot himself with an air rifle at his home in Clinton Corners, NY on July 10 and suffered severe brain damage. He was on life support at St. Francis Hospital in Poughkeepsie until July 16 and died yesterday.

I remember being a young girl watching a concert on TV with my mom, and after hearing him sing - he was then "new" to the scene, as I recall - she and I looked at each other and exclaimed, "WOW, who is THAT?! He's amazing!"

He was only 55 when he died. I cannot imagine how anguished his loved ones must be.

I have scanned through many posts and web articles about suicide. So many of my search "hits" opened their discussions with reasons people try to kill themselves - despair, lost love, money problems, low self-worth, and any number of contributory factors. But these are not the ultimate reason people commit suicide. I was relieved when at last I found a site that states the truth from a medical standpoint: "Simply put, people commit suicide because they are ill."

This is not an insult, any more than saying people with diabetes have an illness, or people with cancer. In fact, depression, be it major depression or manic depression, is considered by many psychiatrists and psychologists to be not just an illness but a potentially life-threatening illness.

No, you can't tell someone to just snap out of it and pull themselves up by the bootstraps, unless you also think you can make someone's islet cells secrete more insulin somehow, without medical intervention.

Neurotransmitter deficiency can be just as lethal as insulin deficiency. We are, to a degree many people don't want to acknowledge, at the mercy of these chemical messengers, for cognition, perception, and emotional well-being.


The problem with accepting mental illness as a physiologic reality lies, I believe, in the nature of thought. Thought is a very real presence for most people, yet it cannot be seen or physically grasped. It seems otherworldly, mysterious; we don't know what it's made of, but we know it's there. In part it's made of cells and electric charges and neurotransmitters, but these are so physical, and thoughts are so...ethereal. Surely despairing thoughts can be healed with something other than medicines for a physical process such as the biochemical pathways between serotonin and its receptors? Surely thought is not so bodily?



Well, it IS, like it or not. Mind is body. We would like it to be more, but the evidence we have so far is it's all right there, in the workings of the physical brain. Take the case of Phineas Gage: all it took was an iron rod through his frontal lobe to change his character completely - all those elements we think are part of some more metaphysical realm, like virtue, and personality, all of that, very physically inhabits the frontal lobe. Frontal lobe syndrome has been observed with traumatic brain injury, strokes, tumors. People all of a sudden are no longer who they once were. So who are we, really? Personality, taste, character - these all depend on the little molecules bouncing around inside our frontal lobes. Beyond those - who am I?

Through medicine I have had to confront suicide up close. The trauma ICU was a charnel house for terrible stories. Even now I don't breathe comfortably any time a guy in my family goes up a ladder, and I can't even begin to count the patients who lost the use of their limbs because of motorcycle accidents. But the patients who had attempted suicide made me especially sad and feel particularly helpless. I had to take care of a young woman who had jumped off a building and whose mother kept hoping for signs that she was "still in there somewhere." On my last ICU call I also had to admit a man who tried to electrocute himself on the high voltage line of the subway system but managed only to burn half his face off. It was awful.

I cannot help being offended by Sean Kingston for trivializing suicide in his current hit song (on a completely borrowed base line) "Beautiful Girls (Suicidal)." Suicide is tragic and terrible, not something to toss around in a pop song about getting rejected by people you're regarding merely as objects anyway.

If you know people who might be depressed, please don't blow them off for being "down" or treat them with exasperation or contempt.

If you think you might want to end your life, PLEASE don't, please get help.

Where does It come from?

I marvel at a gift my daughter has and that I, alas, do not: composing. She took up piano a little over a year ago. I heard her playing something so evocative after only two lessons that I poked my head out of the kitchen, where I was doing something completely ordinary like chopping vegetables, and asked her, "What's that you're playing?" The music reminded me a little bit of a procession for kings in a fairy tale or a bible story. Like something out of Menotti's Amahl and the Night Visitors, which we had recently seen and try to see every Christmas season.

"Oh, I'm just composing."

Composing! Wow, she was making that music up? How do people do that? Where does that music come from?

"It's wonderful, sweetie. Reminds me of Amahl."

"Yeah, actually, I'm calling it A Royal Appearance." That was her first composition. She was 8.

More recently she has composed a piece called At the Arcade, which sounds just like someone playing pinball or video games, and another called (at my suggestion), Stirring the Brew, a playfully spooky piece that sounds just like, guess what, someone stirring brew in a cauldron. She's also working on a musical, and the parts she has sung for me so far have blown me away.

Where does creativity come from?

One could spin an endless web of theories. In ancient Greece there were the nine Muses. Today the fashion is to attribute most things that involve human cognition to the function of little molecular messengers, the neurontransmitters. Some might add genes, spirit guides, environmental factors, God, faith, early childhood education, exposure to music, good nutrition, or any number of influences to explain people's gifts, and logically a combination of any of these factors might certainly contribute to human creativity. But it's like trying to explain how it is we hear certain combinations of sounds and call them "music," or why certain strains of music elicit tears or fears or longings. Ask my daughter where her music comes from, and she'll say, "It's been with me for months," or "I hear it in my head."

"Intuition" is similar. The day before my oral boards, at my husband's suggestion, I booked myself a massage. What better way to de-stress, right? There's a funny story about the whole spa experience that day that would take a whole other post to relate, but for purposes of what I'm thinking about right now, let me skip to the part where the massage therapist, seemingly out of nowhere, placed a hand right in the middle of a muscle in my lower back that couldn't have been more in need of a little un-kinking. I was shocked at the sure-fire accuracy of the maneuver and asked, "Wow, how did you know that?"

The laconic, Italian-accented reply: "Experience."

And I've said the same thing. At one of the hospitals my anesthesia group serves, we teach EMTs and paramedic students about intubation. When they really can't see the vocal cords or can't place the breathing tube in the trachea, I quickly step in and complete the procedure, and often I'm asked, "How did you know how to adjust that so you could get it in?" The answer truly is experience. I always tell the paramedic students it took me HUNDREDS of airways (as in, intubating 3-4 times a day for 2-3 months) to feel really comfortable with the "straightforward" ones, and hundreds more to feel I had the ability to tackle a challenging one.

Once in the ICU during my residency the surgeon in charge watched me do one of those God-help-me intubations, and while I was doing it he asked, "Can you see anything?" The answer was no, but I asked him to hand me the tube anyway. It went in. "Lucky," he said. Maybe, but the more I learn and the more experience I have, the luckier I seem to be. Yet never "lucky" to feel smug about intubating people. If I've learned anything in my line of work, it's respect for the airway!

Just last week at one of the other hospitals we serve, the E.R. doc had a really tough time with the airway, had tried for a while to secure it, but then sent someone to the O.R. to ask me to come and take a look (another long story that would take a separate post to relate). I looked. It was tough. Darn tough. I could easily have missed. But something told me to bend the tube a certain way, and wiggle the laryngoscope just so, and thankfully the tube went in. But no amount of success, at least for me, will make these "scary" airways less caution-worthy. Difficult airways just can't be taken lightly, ever. My heart still quickens a little every time, and I still say a split-second mental prayer over them to help focus my efforts.

But this is all stuff that involves training, learned skills, and practice. Granted, creative acts take work and practice too, but with those, there's that inexplicable element, the mysterious "place" that works of art (and life) come from. How did Ralph Vaughan Williams come up with his Concerto for Oboe and Strings? How did Harper Lee's vision of Calpurnia or Jem come to life so vividly on the page?

Sure, neurotransmitters are important. I've seen and heard of enough anecdotes about people "losing" their creativity when they take certain neurotransmitter-altering drugs. One writer I read recently also describes the opposite - a medication that seemed to give her hypergraphia, a need to write often and copiously (and no, despite what the entries in this blog might suggest, I am not taking the aforementioned medication, unless it's at all similar to any compounds found in chocolate!). So yes, the brain matters. (And just as an aside, I think people should be less critical of the use of some of the medications I've alluded to here. You wouldn't tell diabetics to just "get over" their pancreas problem if they need medication. If people with neurotransmitter issues need medication as well, and have the guidance of experts to help select those medications, they should take the meds they need, and/or practice yoga to boost their levels of GABA, etc.) Clearly, neurotransmitters are powerful agents for human ability, behavior, emotion, health. etc. But are they the whole story?

When I think of my children's faces, my daughter's pieces, places I love, stories I want to write, I have a hard time imagining how those thoughts could simply be stored and recalled, repeatedly, by neurons and their neurotransmitters. I think there's more to thought than we think.

***

Had my 5th oboe lesson today. Lots of fun. We laughed over how "I hate half holes!" Went over C, F, & G major scales as planned, and a couple of others, E flat and A major. I have my work cut out for me but I'm excited to get into some "real" music-work. Started to work on dynamics too for the first time - and again, that feeling of "where did that come from" arose when I hit a note more piano by accident after trying several times.

Kyoko asked, "What did you do just then?"

"I don't know, I don't know! What did I do? I have no idea why that worked!"

But just like intubation, playing repeatedly gives you an idea, maybe one that you can't verbalize readily, but it's certainly there. A "gut feeling" about how to move your muscles to produce an effect. I hope as I practice and play more, I'll have more of that inexplicable "instinct" about what adjustments to make. Dance was like this too. After a while, with lots of training, lots of practice, lots of work, I needed less thought to do what I wanted to do. Less thought, more...what? Very mysterious, all this brain / spirit / creativity stuff.