Originally published in The Ottawa Citizen October 9, 2001

There are times when one encounters a patient who leaves a haunting permanent impression in your mind. The situations that lead to such heart-wrenching memories can make it difficult to remain objective.

Melinda was 13 years old. Her guidance counselor advised her to see me at our school clinic. There were concerns that she was severely depressed and needed help. Earlier in the week, she had consumed about 30 Tylenol tablets. Her parents, aware of her actions, did nothing. According to the guidance counselor, their assumption was that Melinda was acting-out for attention. Suicide is the number one cause of death in teens.

She was an unassuming polite girl but looked sad. She seemed adrift. Her school performance was good. She had friends and participated in school activities. I could not shake my impression of her that she was resigned to some predetermined fate.

Both her parents worked long hours. She had an eight year old brother. After school their nanny cared for them until her parents returned home. She said her parents had little time to spend with them. She missed this time and was concerned about how this affected her little brother. She did not want him to suffer the same “rejection” she felt from her parents. This was her reason for the Tylenol overdose. She said that if she killed herself her parents would spend more time with her brother. By removing herself from the family there would be only one child to focus upon. Perhaps then they would make time for him.

She did not want to tell her parents her reasons for taking pills. She did not want them to feel guilty. She loved them and felt they were working hard to help the family.

It was imperative that she let her parents know how she felt. I suggested she write a letter to them if she was uncomfortable talking about it. The guidance counselor and I both offered our support to help her communicate with her parents. She wished to do neither. I only saw her only the one time. She did not return to follow up.

Her guidance counselor was able to follow up with her. She stated that Melinda did not resolve the issue that led to her overdose. She continued to consider herself an obstacle to her brother’s happiness. There were no further suicide attempts that school year. This occurred 3 years ago. She was lost to follow-up thereafter.

Everyday we face problems that can seem unsolvable. I am struck by the degree of pain and suffering endured by some children. Melinda was willing to sacrifice herself in order to better the life of her brother. It is a sacrifice that she should never even have had the opportunity to consider.

An interesting dichotomy exists particularly at this age. Entering early adolescence, Melinda was beginning to mature and consider the problem from a different perspective. Yet her thinking demonstrated a childlike simplicity. She saw the problem as one requiring an immediate solution although it existed for some time. Little consideration was given to the consequences of her actions. Her behaviour was based in the present. Future considerations or longer term solutions were not acceptable because they were incongruous with her world view. She loved her family yet did not consider the effect her suicide would have upon them. She did not feel valued ergo her death would be of little consequence. In her pursuit to make her brother happy, her death would result in the opposite.

I wish she had come back. You want to reach out and protect them from their altruistic yet misguided solutions to their problems. The parent in me wanted to make her happy. She needed someone to help her develop a sense of self-worth and perspective; a time consuming process she rejected.

Professional demands insidiously consume our time. The time we spend with our family can be compromised. For those of us with children, we all try to be there for our kids. They are remarkably resilient and recover from the occasional disappointment. But I now have this image in my head of a child so utterly abandoned that I will never allow my sons to experience such despair. Work be damned.