Carolyn Snow knew exactly how she was going to die.
And she said she told Waterford Hospital staff just that before she was discharged April 21 and sent home after a failed attempt at overdosing on an over-the-counter medication she found in her cupboard.
So the 28-year-old St. John’s woman went on with another overdose plan. But before she did, Snow drafted a letter to Eastern Health. By the time someone read it, she expected to be gone.
“And that was it. Nothing I could do? Nothing I could say, no one I could speak to, to try not to kill myself? I still sincerely wanted to commit suicide,” Snow wrote of that visit to the Waterford.
“Is this the way psychiatrists practise medicine these days? By discharging people who have just overdosed and are still suicidal?”
According to Snow, who has a stack of discharge slips reflecting a thick medical file, the message she eventually got from Eastern Health in a phone call was that her complaint was “passed on to the appropriate people.”
Snow said that on April 22 she carried out her intentions for a second overdose, but the side-effects were so hellish that she called an ambulance, was admitted to the Health Sciences Centre and was finally transferred to the Waterford Hospital’s short stay unit.
Since then, a change in medication has put her in a more stable situation and Snow decided to speak to The Telegram about her concerns.
“I have never written a letter. I would have been too scared of the repercussions and people finding out,” she said during an interview in her kitchen.
“At this point I have lived with it for so many years, that this is my life, sadly. … To deny it is to deny a part of myself. Even though mental illness isn’t me, it can sure feel like it sometimes.”
Had she not been admitted to the Health Sciences Centre on April 22, she has no doubt there would have been another try.
“If they sent me out again — no pills, quick, simple, sweet, the third time,” said Snow, who did not want to specify the medications she took or her plan because she does not want to give others ideas.
“Something has got to change, that’s all I know. … I can only assume they thought I was crying wolf or whatever. They can’t assume that about someone. It could get (the patient) killed.
“I was suicidal. I had a plan and I was intent on doing it.”
Snow, who has multiple diagnoses, believes one diagnosis — borderline personality disorder — colours the way her case was handled by the psychiatrist on call at the Waterford, suggesting it’s presumed she is making “gestures of suicide” and that she will not be taken seriously because of her history of unsuccessful attempts.
She said she was transferred April 21 to the Waterford from emergency at the Health Sciences Centre with the expectation she would see the general physician on call. Instead, she saw a resident working with the psychiatrist and was discharged. When Snow requested a second opinion, she was refused, she says.
“I told the resident, flat-out, that if I was discharged from the hospital I was going to overdose again, and I clearly indicated that there was a formulated plan,” Snow said in her letter to Eastern Health.
“I was flabbergasted, enraged and deeply saddened.
“My psychiatric hospitalization record is very long, yes, but so is my list of diagnoses. I cannot help what I suffer from; if I could choose, I would certainly never have chosen this. But until the day comes when accessible, thorough treatment is available to all mental illness sufferers who need it, I can only use the resources I have. Which is, currently, one outpatient psychiatrist who also serves as my therapist, and one mental hospital.”
As a teenager, Snow said, she would cut herself. But when she was 19, birth control medication to treat a hormone disorder seemed to trigger major depression. In her second year of university, she dropped her music major. Then began her experiences with the hospital system.
“I was asked, ‘When was the last time you felt happy?’” she recalled. “I remember sitting back, thinking, I don’t remember. … Maybe in Grade 6 or 7?”
Since then, there have been too many hospital visits to count and numerous admissions on the short stay unit, she said.
Snow still can’t handle a part-time university course load, but the worst so far hit this spring while she was being weaned off Seroquel, which caused her to binge eat, and eased onto a replacement. Snow tried to ease off some of the medication herself.
She’d heard other patients’ stories and said she had been sent home before from the Waterford on other occasions with suicidal feelings.
But this spring she’d been getting more and more depressed as the weeks went on.
“I got lower and lower and lower,” she said. “I just remember it coming down to I had absolutely no hope at all.”
A couple of days after going off the Seroquel, she became utterly suicidal, she said.
“I felt this was what I deserve. And I deserve to die and that was it,” she recalled.
“That day and the one following were the worst two days in my entire life, and I have had some very hellish days because of all this mental illness.”
Hours after taking the over-the-counter medication, Snow said, she realized it wasn’t going to kill her and the side-effects prompted her to seek medical attention so she could then find another way.
By midnight, she was home writing the letter to Eastern Health, and then downed other pills.
But instead of a peaceful ending, she began having hallucinations and delusions, paced the room in a frenzy while her heart raced, and wrote inspirational suicide notes, which she said she later deleted from her phone.
“(My mind) would go in the most horrible places. It always ended with something really terrible, bad. I can’t give specifics because I don’t remember,” she said.
Her legs buckled a couple of times, but she couldn’t sit still.
“At some point I decided this is a completely awful way to die,” Snow said.
Already rail thin, she was shocked at her hollow appearance and seemingly green skin tone in the mirror. By then she hadn’t slept for two or three days. The mental torture was too much.
“At the end, I concluded I have to die, but it can’t be like this,” she said of her decision to call the ambulance.
After a couple days of medical treatment, her psychiatrist at the Health Sciences recommended admission to the Waterford short stay unit.
Snow said she shouldn’t simply be labelled by textbook diagnoses.
“I think the real point, when somebody comes and is really suicidal like that, what is the justification for turning them away?” Snow said of her April 21 visit.
“I definitely feel people are dying from lack of help, absolutely. How can they not? I almost did.”
Eastern Health cannot discuss specific cases.
However, a spokeswoman said in general, people who go to the psychiatric assessment unit (PAU) at the Waterford are seen in order of urgency based on a triage process. All patients are assessed by a team of nursing staff and physicians, which may include family practitioners, psychiatry residents and/or psychiatrists.
The decision to either discharge or admit a patient is made by the assessment team. If it has been determined that a patient does not require admission and if they already have support services set up in the community, they are encouraged to follow up with their care provider. Other services may also be suggested.
If a patient requires admission, they may be admitted to a unit at the Health Sciences Centre or the Waterford Hospital.
Eastern Health was unable to confirm whether or not it had received a specific complaint, due to privacy rules, but said the usual process includes a concern being forwarded to the particular program for investigation and the outcome would be either communicated to the patient by program officials or by a client relations officer.
Eastern Health operates a free, provincial 24-hour confidential Mental Health Crisis Line (1-888-737-4668) staffed with professionals trained to help deal with crisis and suicidal thoughts.
There is also a Mobile Crisis Response Team that is able to respond to those in crisis in their home, or a designated meeting area in St. John’s and area. This service is available from Wednesday to Saturday, 4 p.m. to midnight.