Quoted: Suicidal medical student friend

[Doodledog]

A member of the SDN community writes:

I'm writing here because I'm really at a loss as to where to turn.

Lately my girlfriend (who's in med school with me at a 'top 10' institution has been getting more and more verbally abusive. For a while it was limited to insults and yelling.
Last Sunday, after I stood up to her, she threatened to kill herself. I took her seriously, backed off and tried to talk her down. The next day I found out she'd taken a handful of Vicodin I'd had lying around from an old surgery.

Today she went off the handle again and just told me she took the rest after storming out the door. I went to check the bottle and thank God most were still there, but I really don't know what to do. If I go to the police or the administration I'm worried it'll have huge repercussions for her academically and professionally. I don't think she's actually trying to kill herself, but I have to take every threat and action seriously. I have to do something but I don't know what. Help!

Response: Do the right thing and notify the medical school administration immediately.

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[Apollyon]

Seriously? You have Vicodin "lying around"? First thing is flush it right down the toilet. That you still had it, after she took several, is perplexing.

 

[Smurfette]

Your gf needs professional help. Do not let things escalate further. Threatening suicide in response to any type of argument or stressor is abnormal and highly concerning behavior. Next time, she could overdose (even unintentionally) or hop in a car and kill someone/herself while driving under the influence.

And get rid of any meds in the house that she could try to use.

 

[shopsteward]

Your first responsibility is to yourself. Firstly, that means being responsible about what medications you have in your home: they must be properly obtained, properly stored and properly disposed of when you no longer need them. That holds true for the rest of your life: are you going to still have medicines "lying around" if you have children or teenagers in your home?

Secondly, it means recognising that some-one who is verbally abusive to you, and who is trying emotional blackmail on you, is someone who doesn't respect you and doesn't qualify as a "friend" of any kind. You shouldn't be spending any more time with them than an absolute minimum. That should hold true for the rest of your life too: don't put up with having abusive people in your private life. (Also, there is nothing wrong with doing a quick self-audit now and then to make sure you are not the abusive person.)

My view would be that if this woman is in medical school, she is a responsible, intelligent adult who should be able to cope with the usual support we all need and get from friends and family. From what you say, she has gone past any reasonable amount of help you can give her, and your presence in her life may in fact be making things worse for her. Is there confidential counselling or medical help she can access through the school that you can suggest to her? If so, remember that you can make the suggestion to her, but it is not necessarily your responsibility to make sure she follows through.

On the question of informing your med school administration, it appears that the two threats she made and drugs she took did not result in any apparent harm or need for medical treatment? If so, I would be wary of informing authorities about it: if she denies your story you are in a difficult position where you have said something damaging about a fellow student which you can't substantiate, and have also admitted to having drugs "lying around". If you think this woman is a danger to patients or other people, you might need to report her anyway: it could be worth checking what your school/hospital rules and professional obligations say on the point.

If your school offers welfare services or counselling, you could also try that for yourself: they may have good advice on what you can do, and help you to sort out your own situation.

 

[Goro]

If this were one of your patients, what would you do? Worry about the person's job, as opposed to their life? Your girlfriend's behavior is automatic justifiction for getting her hospitalized. NOW!

And toss that Vicodin.

A member of the SDN community writes:

I'm writing here because I'm really at a loss as to where to turn.

Lately my girlfriend (who's in med school with me at a 'top 10' institution has been getting more and more verbally abusive. For a while it was limited to insults and yelling.
Last Sunday, after I stood up to her, she threatened to kill herself. I took her seriously, backed off and tried to talk her down. The next day I found out she'd taken a handful of Vicodin I'd had lying around from an old surgery.

Today she went off the handle again and just told me she took the rest after storming out the door. I went to check the bottle and thank God most were still there, but I really don't know what to do. If I go to the police or the administration I'm worried it'll have huge repercussions for her academically and professionally. I don't think she's actually trying to kill herself, but I have to take every threat and action seriously. I have to do something but I don't know what. Help!

Response: Do the right thing and notify the medical school administration immediately.

 

[nitemagi]

If this were one of your patients, what would you do? Worry about the person's job, as opposed to their life? Your girlfriend's behavior is automatic justifiction for getting her hospitalized. NOW!

And toss that Vicodin.

Whoa. There's a lot here. And I'd say there isn't a "right way" to manage this, because every path may have serious consequences.

I disagree that this is automatic justification for hospitalization. Not that she might not benefit from it, but it's hardly a slam dunk since this was somewhat of a retaliatory/manipulative statement. Sad, but it happens quite a lot. She might be kept briefly for observation but she's probably high enough functioning she wouldn't be kept long anywhere.

And it is a real concern that she could do something (deliberately or accidentally) to herself to retaliate if you did break up with her. That's a real concern. I would probably have a sitdown with some of her closest friends (or family) and softly bring up some of the issues. Make sure she'll have some kind of support system should you break up with her.

I would also consider having a confidential discussion with a mentor at your medical school, talking about a friend but not naming names. You might even seek out a faculty psychiatrist at your school to talk to about this. Recognize that disclosure of suicidality may trump any confidentiality and obligate a clinician to get others involved. That's a risk, but it might be necessary nonetheless. You shouldn't be carrying this on your own as a medical student. You have many professionals available, and someone should be helping you directly.

Absolutely get rid of anything easily available for her to use.

Finally, I would consider setting some form of an ultimatum that she gets into treatment with someone. Either she does that, or you have to break up (or consequence of your choice). I'd be mindful of the threats of suicide. It can go either way. Once someone realizes that playing that card works, they'll be sure to play it again. And they may escalate if it doesn't immediately work. So there's a lot of risks. Talk to someone. Soon.