A difficult subject

Stroke and suicide a personal note

As you approach this blog I want to assure you, the reader, that I am in a good place despite what I am writing about. But I want to be honest and true to myself, as Duncan keeps reminding me.

What a tricky subject!  Suicide is often unspoken about and difficult. We don’t like it.  It is an unutterable consideration. People who have had a stroke often feel, depending on the severity, that their quality of life is so compromised that what is the point of continuing to live. There is perhaps a feeling you are too much of a burden and in the way.  Pompili et al state that “stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; However, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases the risk of suicide” (Pompili, et al 2014). 

I have become very distressed on occasions. The thought of being seriously disabled, is completely overwhelming, wondering if I will be like this for the rest of my life. As I write I am listening to Songs of Praise and a couple of hymns and worship songs are featured, those I used to play on the piano. I start to cry, feeling immensely sad as I will probably not be able to play again. I wonder, again should I sell my piano?

When I was in hospital I remember a woman talking in a support group, she announced that her favourite pastime was driving her car and if she could not do this again she would end her life and said she was very serious about this. I just hope this was followed up by the psychologist. I also wonder what impact this might have had on other members of the group. This encounter still plays on my mind.

I have, at times, when I am distressed, feel overwhelmed and how life would be unbearable in the future. I struggle with not knowing how to escape and deal with the loss I experience. I wonder sometimes if I would be better off dead. On one occasion, Duncan was at the bottom of the garden and I was trying to contain my distress, I was sitting by the back door and I knew there were plenty of paracetamols in the kitchen. I had a choice, turn left, walk into the kitchen and swallow a handful of them or turn right and join Duncan in the garden. Clearly, I turned right and I am able to write this now. I honestly now feel I would not really want to take this selfish course of action. Those with their clinical/therapeutic hats on – there is no need to start the risk assessment!

Research has shown that stroke patients are up to twice as likely to commit suicide as people in the general population, and the risk of attempted suicide was highest in the first two years after a stroke. Among stroke patients younger than 55, the risk of suicide was five times higher than in the general population.

When I worked in the NHS I started working towards an MPhil (I ended up completing an MBA – don’t ask!!). As part of my study I interviewed the consultant oncology staff I worked with, about their attitude towards death.  I found interesting results. A lot of the clinicians held various views on life and death and this influenced their approach to treatment offered to patients, some would go to the last possible course of treatment in an attempt to rescue the patient but one in particular stood out for me, he stated that he would only go for one round, possibly 2 but after that finish treatment as he believed we “come from dust and will return to dust” but the question remains is the attitude towards rescuing patients. Is offering treatment an attempt to preserve life at all costs worthwhile, if the quality of life remaining is poor?  A lot of clinicians felt they had failed if the patient died, despite all treatment offered. 

I was admitted via A&E when I first had my stroke. I was kept on an acute admissions ward for observation, with a view to a further transfer to a rehabilitation unit.  However, I deteriorated and was transferred to Addenbrokes Hospital for neurosurgery to open my skull and drain the bleed. It is now a thought of mine that I was subject to life saving procedures but sometimes wonder if it would have been better if they let me go.   

There is a piece circulating, via Facebook, describing a new indicator for stroke recognition emphasising the need for urgency to get the patient to hospital to make every opportunity for survival and a good recovery.   The article then makes the point that those who might survive, when perhaps intervention has been too late, might be severely disabled and become “hopeless and helpless”.  This might be true but reading this, as a so called “stroke Survivor” (I don’t like being labelled in this way!), does not really inspire or motivate me now that I have survived. This articles comment makes me feel especially angry as I, for one, intend to have hope and do as much as possible towards my recovery. 

I hope I have been honest in this blog and even more so, I hope it opens up a dialogue about this very difficult subject. It has resonance for me.  I hope you feel able to comment on this subject and open up a discussion in the comment section below. I look forward to that.

8 thoughts on “A difficult subject

  1. A well written piece Peter. I don’t have any personal or professional input as far as the subject of suicide is concerned but commend you for opening up this sensitive topic.

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  2. Well said Peter life can be very difficult at times but everyday is a blessing ,Duncan’s Uncle Cliff has Dementia and it is a hard road to travel but we are blessed,may. Your days be filled with love and laughter.lots of love and many blessings to you and Duncan

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  3. Thank you for your courageous words and bringing the subject of suicide to the forefront.
    I have also had several very low points in my life and suicidal thoughts were strong. It was because I had lost hope. Good to hear you are holding on to hope. Hope is so important to keep us going.

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  4. Thanks Peter for your honesty. It is so often said that men are more reticent to talk about some of these difficult personal issues – but it is so important. Interestingly your blog stands alongside two other things this week from men who have spoken about their own personal struggles. First there was Freddie Flintoff on his fight with Bulimia (BBC1) and then the two brothers speaking about their struggles with testicular cancer and infertility (BBC3). These three examples of male openness and vulnerability are so important and so often bring their own degree of relief and healing both for those who hear and those who share. I send my ongoing thoughts and prayers to both you and Duncan.

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    • Thank you David. This week is mental health awareness week I believe. I have not been engaged with mental health matters on a professional basis but now I am experiencing it for myself it is very challenging to say the least. The number of kind comments I have received is so touching and supportive and that makes such a difference as I tackle this. Many of us may not understand the impact of any mental health problems, and feel we should just get over it or “get a grip”. You can even try this approach yourself however we do know that if we try and bottle it up or push it down as I have tried to do it will “pop” out in different ways, whether irritation or anger or becoming low/depressed. So we cannot ignore it but need to deal with it in other ways.

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  5. Dear Peter

    I find this a very powerful blog and agree with Liz and Kim that you are courageous to raise the
    topic of suicide/hopelessness, and own that you have had thoughts and feelings about this from time to time. I well remember some of those discussions with oncologists and medical professionals and was also struck by the imperative most clinicians embrace to preserve life at all costs, with little, if any, regard for the person inside the body being treated. It’s not so much that physical therapy is not the right course of action, but it needs to be seen in a more holistic way, that the person temporarily inhabiting that that body needs to be addressed and engaged with, and his/her/your psychic, mental and spiritual needs also need to be an integral part of the recovery process (and, indeed, ongoing life living through recovery and beyond. I think I’ve just fallen into the trap of focusing on the physical there myself!). There is something very important in here which also emphasises the fact of being the patient, the one being done to, having to acquiesce to the administering of treatment regimes without question or consultation, and perhaps one of the motivators in considering suicide is about actually being able to do something, to make a choice and take independent action? Anyway, I digress …

    So much of the care and treatment of stroke (and many conditions – interestingly perhaps with the exception of cancer, where there is more awareness of emotional wellbeing) seems to be focused almost entirely on the physical. It is about getting the body going again at all costs. Of course it is absolutely fundamental that physical therapies continue (so, keep that gym going! No excuses!), but I wonder about the impact of emphasising the body and what happens to the overlooked psyche/soul. Does the very fact that so much is focused on the body mean that the deeper parts of the self are not attended to in the same way, and does that then skew the individual’s perception of him/herself as (just) a body rather than a full spiritual being? In other words, have you become so identified with your body because the physical has dominated so much over the last two years, that the rest of you is neglected? And when the body has distressing limitations it just exacerbates the tendency to hopelessness. Most (young) people live without awareness of their bodies at all, a comfortable inattention to them. For you, I guess you can hardly ever forget your body because you are so painfully aware all the time of tingling sensations, pain, frailty, limitation, etc. The physical again dominates.

    I love the picture you have put up of the geranium and wonder the significance of this for you? What is it that helps you to hold on to meaning in life much of the time? How do you understand that drive in you that made you turn into the garden rather than to seek out the paracetamol? That, surely is the question (which actually could literally be “to be or not to be?”!!!). What is it within your/the human spirit that chooses life and what gives that life meaning? For me, this is the big question, and I wonder if it is about meaningful contact (with the self, the world, the other, God … though not necessarily in that order!) and I think nature plays a big part in that and feeds/nurtures the soul in a way that is so important and needs not to be neglected as part of a therapeutic programme (maybe this is unconsciously what you were thinking when you chose that picture?)

    I have been watching the sad case studies of elderly folk in care homes being “shielded” from Covid 19, which involves being isolated from their loved ones. Again, the emphasis is on the body, keeping the body going, making sure people do not die, but at what emotional cost? What gives their lives meaning is human contact and interaction, and for those who have been able to speak out, they are saying that they would prefer to have that quality of life even if it means they might be physically in jeopardy and quantity might be limited. I’m not advocating throwing caution to the wind and ignoring physical risk, as there are complex ethical issues that involve so many people, but what hit me in listening to them is that this same message was clearly coming through, that for them life is more than just keeping the body going. I think, reading between the lines, that this is what you are saying (or at least a debate that you are opening up), and that, perhaps, it would be good to recognise this and that recovery is so much more than just getting the body going, it’s about the whole person.

    What I am picking up from your blog is a longing to have this recognised, to be able to talk about how things do feel hopeless sometimes, and yet the hope and fighting spirit is there and most of the time it wins out. Let’s keep talking about it!
    Much love
    Val

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  6. Hi Peter, it’s Roger and Jan here – your old college chums for those interested.
    We lived and breathed life together for a wonderful, full and active 3 years in Sheffield. We knew you well and recall what you displayed to all those around you – laughter, joy, humility, selflessness, wisdom, generosity, optimism etc etc. Having lost touch with you through the many subsequent years, we wondered who we would encounter when we were blessed and privileged to meet up with you and Duncan a few years back in London. No need to worry at all. The same man with the same qualities and characteristics was there, right in front of our eyes. The meeting was seamless and full of amazing memories. Meeting Duncan was the absolute icing on the cake! Then, sometime afterwards we were treated further to the warmth of your combined hospitality in your beautiful home. We rejoiced in listening to your hopes, plans and dreams for the future. So……………..
    We have absolute empathy for and acceptance of your deep and sincere thoughts expressed above. To be stripped of so many of those treasured, post retirement ambitions would test the resilience and positivity of the finest man or woman. We have always subscribed to the view that we never bury emotions dead, but always alive. And if we don’t learn to release them, they will surely well up in the depths of our being and explode at some stage. So, you do right to share the good, the bad and the ugly of your life in the real and raw.
    My sister Isabel has had to endure and manage almost 40 years of the most unspeakable robbery of vibrant living through ME. To make matters worse, many medical “experts” dismissed her condition for years or, at the very least, categorised it as more of a mental condition. My anger on her behalf has been off the charts at times. I know my sister and she has gone to unbelievable lengths to defeat the condition. Sadly her physical life is now restricted largely to a few rooms in her small house. Do I think on occasions she has wondered about the point and validity of her existence – 100%!
    What we read in your blog Peter are the words of a transparent and honest person who has no need to camouflage his emotions and battles from those more blessed in body. If it helps you in any way, please continue. We are sure it will resonate with other sufferers and throw a literary arm around their shoulders.
    Our remaining hope is that you refuse to yield to the awful robbery of this condition and stay strong, inspirational and always looking to your Heavenly Father.
    Our love always Roger and Jan xx
    PS Thank you, thank you, thank you Duncan for being such a diamond to Peter and a shining example to everyone privileged to meet you.

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