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Suicide. The word itself is frightening and shocking and leaves so much pain in its wake. How tragic to reach the point where life is so insufferable that one simply doesn’t want to exist anymore.

Bob, who was 34 years old, married, and with two children, arrived at the psychiatric hospital and said he lost his will to live. He had put together a plan to hang himself. However, he first shared this plan with his wife. She then did not let him out of sight until he was delivered to the emergency room.

Bob showed a nice improvement in the hospital, seemingly. But there were concerning signs. Whenever I would ask him about his will to live, his eye contact would shift and be avoided. For Bob, there was also a family history of suicide. Studies have shown that there may well be a genetic predisposition, that among those who think suicide, some people are more likely to carry it out than others.

So I met with Bob together with his wife multiple times. We talked about life, his future, their future, their kids. I started him on antidepressant medication.

Bob would smile, but to me his smile was forced and filled with agony. When he finally denied feeling suicidal, the insurance company said they would no longer pay for his hospitalization. Next, the hospital administrators insisted that I discharge him right away, that his stay was now costing the hospital money.

I didn’t care what the insurance company or the administrators said. There was no way I was going to discharge him despite all his proclamations that he felt fine.

And so, after another week, which included daily meetings with his wife which went well, after more time on the antidepressant medication, after Bob was able to talk about his dreams for the future and his love for his family, and with a seemingly real smile on his face and more spontaneity, I discharged Bob from the hospital. The plan was for him to follow up with myself at my office the next week.

Humans are complex. We have so many things rattling deep inside us. Too often we hide our real emotions not only from others, but from ourselves.

Four days after Bob was discharged from the hospital, while his wife came to the hospital to pick up some belongings that had accidentally been left behind, Bob hanged himself at home.

Why?? I will never know for sure. There was no note, no last words. In retrospect, I believe that both before and during his hospitalization Bob had quietly, secretly, firmly made up his mind that he would take his life. He was at peace with it and that’s why, outwardly, he appeared to look better. But who knows??

From a professional point of view, I searched and searched for why, how, and what. What did I miss? What could I, should I, have done differently? These questions haunted me.

From a spiritual perspective, the sages say that suicide is never an option. That our body and soul are gifts from G-d and therefore it is not our choice to take our life. I actually shared these spiritual thoughts with Bob, but it seems they did not truly resonate with him.

As I grieved for Bob, I realized my failings, that somehow I had not communicated well enough.

But also there’s only so much one can do.

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