The Patient

CW: Suicide and abuse

The ambulance arrived promptly at the hospital, and the crew hurried to unload the stretcher. They carefully transferred the semi-conscious patient to the emergency department, where two nurses sprang into action. Siobhan, the experienced ER nurse, approached with a calm yet attentive demeanor and asked, “What do we have, John?”

John, the senior ambulance officer, reported, “Laila Akbari, a 28-year-old woman, attempted suicide by ingesting three packs of Paracetamol about two hours ago.”

Upon hearing John’s report, Tina, the other nurse, shouted, “Code Blue,” signaling a life-threatening adult medical emergency.

They transported the patient to a designated bay in the emergency room, where a team of nurses, with military precision, swiftly connected her to electronic monitors to continuously track her vital signs, including heart rate, blood pressure, oxygen saturation, and respiratory rate. Dr. Scott, a young yet highly experienced ER doctor, rapidly assessed her symptoms to determine the severity of her condition. Concurrently, the nurses inserted an IV line to deliver fluids to stabilize her blood pressure and hydration levels and administered oral activated charcoal to absorb any remaining toxins in her gastrointestinal tract. To prevent liver damage from a potential paracetamol overdose, Dr. Scott promptly administered N-acetylcysteine (NAC) via the IV line.

In a few hours, Laila’s condition showed signs of improvement as her symptoms of paracetamol poisoning gradually decreased. The administered sedative not only helped her relax but also enabled her to fall asleep peacefully, which was crucial for her recovery.

The next afternoon, after Laila had woken up and felt better, Dr. Alex Turner, the hospital’s psychiatrist, walked to her room. He carried a clipboard with the patient’s detailed medical report. He gently knocked on the door before stepping inside and, with a calm, reassuring smile, greeted her warmly, saying, “Hello, may I come in?”

Upon hearing a man’s voice, Laila instinctively pulled her headscarf down over her forehead, adjusting it to cover most of her hair. She glanced toward the door to see who had entered, though still weak, her eyes cautious and alert. After briefly assessing the person’s presence, she responded politely, “Hello.”

“I’m Dr. Alex Turner, the hospital’s psychiatrist.”

“Hello, Doctor.”

“How are you, Laila?”

“Fine, Doctor.”

“Please call me Alex.”

Laila nodded but said nothing.

“I am here to check on you and see how you’re feeling.”

“I am well, thanks.”

“If you are feeling well and are willing, I was wondering if we could have a chat.”

Laila nodded again, and after a short pause, she said, “Okay.”

“Good to hear. Are you comfortable?”

“Fine,” she replied shyly.

“Last night, you were transported by ambulance to this hospital after ingesting many paracetamol tablets. Is that accurate?”

She nodded shyly, avoiding eye contact as her cheeks flushed with embarrassment.

“I’m sure you had your reasons for what you did,” Dr. Turner said, watching her reactions.

Laila stayed silent and avoided eye contact with the doctor for a while. Then she said, “Allah forgive me, I committed a mortal sin.”

“I am not here to judge you, Laila,” Dr. Turner said, watching her reaction closely.

She smiled faintly.

“If you’re feeling up to it, I would like to talk with you about yourself, your family, and the reasons for ingesting the tablets yesterday,” Dr. Turner said in a gentle tone.

“Sure,” she murmured shyly, as if embarrassed by what she had done.

Dr. Turner gestured toward the lone armchair in the room and asked, “May I bring the chair closer so I can sit for a proper chat?”

“Sure, Doctor.”

He pulled the chair closer to Laila’s bed so he could sit comfortably and face her. “Is it okay if I sit here?” he asked, mindful of their cultural differences.

“Yes.”

“Good,” he said with a nod. After a brief silence while he scanned the patient’s report, he looked up and asked, “Is your name Laila Akbari?”

“Yes,” she muttered, readjusting her headscarf.

“If you don’t mind sharing, how old are you, Laila?”

“28 years old.”

“You are the same age as my older daughter,” he said with a warm smile.

Laila smiled back faintly.

“Jennifer, my daughter, is a wedding photographer and currently lives in Sydney.”

“A photographer! Not a doctor?”

“Yes, she is a professional photographer. Jennifer has enjoyed photography since she was a teenager and didn’t want to become a doctor. In fact, she is afraid of blood.”

Laila nodded thoughtfully, considering the differences between Australian and Afghan cultures. In her birth country, girls were expected to follow their fathers’ decisions without the right to object or voice their opinions. They were even deprived of education. She wished she had never been born there.

“Are you married?”

“Yes.”

“Do you have any children?”

“I’ve four children.”

“Can you tell me about them?”

“I’ve two girls and two boys.”

“What are their names?”

“Mohammad, Zainab, Ziba, and Hussain.”

“I presume Mohammad is the oldest and Hussain the youngest?”

“Yes.”

Dr. Turner nodded thoughtfully. After a pause filled with reflection, he finally looked up and inquired, “May I ask why you take those tablets?”

Laila avoided eye contact and said in a shy voice, “I wanted to end my life.”

“Why did you want to end your life?”

“I don’t know.”

Dr. Turner noticed her hesitation to discuss her feelings openly, so he didn’t press the question and adjusted his approach to make her more comfortable. “Do you feel sad?”

“Yes, Doctor.”

“When did you begin feeling sad?”

“About a year after getting married.”

“When was that?”

“About twelve years ago.”

“Can you tell me more about it?”

“I don’t know how to start.”

“Laila, my role isn’t to judge but to help you with any challenges you’re facing. Talk about whatever you’d like.”

Laila nodded thoughtfully but remained quiet.

“If you are not ready to talk about yourself, I can come back later today or tomorrow morning.”

“No, I want to talk about my life, but I don’t know where to start.”

“You mentioned that your sadness began about a year after your marriage. If you wish, you can begin your story from that point. Alternatively, you can start from the time of your marriage.”

“Okay,” Laila said, pausing briefly to gather her thoughts. She took a deep breath and said, “I was fifteen years old when my paternal uncle and his wife came to our house. They came to ask my father for my hand in marriage for their youngest son, Mahmood.”

“Mahmood, your cousin?”

“Yes.”

“I see. You said you were fifteen years old. How old was Mahmood?”

“Twenty-two.”

“I see. You were telling?”

“Within a few months, we got married, and shortly thereafter I moved into my husband’s house. At first, everything went well, and we happily settled into our new life together. However, about a year after our wedding, we faced a serious challenge,” she said, then paused.

As her silence dragged on, Dr. Turner asked, “What challenge did you face?”

“Despite our hopes and efforts, I still hadn’t become pregnant,” Laila said, then fell silent, staring at the wall in front of her bed.

“I suppose that, within your cultural norms, you were expected to bring a child into the family soon after marriage,” Dr. Turner asked.

“Yes, that’s correct. I didn’t become pregnant for a few years, and during that time, I faced significant criticism from my in-laws, especially my mother-in-law. She blamed me and called me barren. She suggested that Mahmood take a second wife or divorce me to marry a fertile woman. Their attitude and behavior made my life miserable. My parents also began asking me personal questions about my sex life and why I hadn’t been able to conceive.”

“I can’t even imagine the tremendous stress you must have been under. Did you seek help?”

“Help?”

“I mean, did you see a doctor to find out why you could not get pregnant?”

“Yes, we did. I saw both doctors and traditional healers, but to no avail. In Afghanistan, we don’t have many good doctors.”

“I see.”

“As we grew tired of being the main topic of conversation and criticism among family and friends, my husband and I felt it was time to make a change. So we moved to Iran to start a new life away from everyone.”

“Moving to another country has its own challenges,” Dr. Turner said.

“Yes, it did.”

“I guess that with the help of doctors in Iran, you finally became pregnant. Am I right?”

“Yes, doctors in Iran found the problem was with my husband’s sperm quality.”

“I see.”

“However, Mahmood was unwilling to accept responsibility for the problem on his end. From that point on, he changed his attitude and began treating me differently.”

“How did he change?”

“He began treating me coldly, frequently calling me hurtful names and sometimes even raising his hand in anger.”

“I am sorry to hear that. A typical traditional man.”

Laila nodded in response and added, “Eventually, Mahmood’s treatment worked, and I became pregnant.”

“Did his treatment change after you brought him a child?”

“Initially, his treatment improved, but everything changed when I became pregnant again in less than a year. During that time, we also discovered that our first child, Mohammad, had autism and developmental issues.”

“What were Mohammad’s issues?”

“At a year old, he didn’t say a single word, didn’t crawl, and didn’t even cry much. Aside from a few words, he still doesn’t speak,” Laila said. Sadness was clear in her eyes.

“Did your husband blame you for your child’s issue?”

“Yes, he did,” she said, then fell silent.

“How did you come to Australia?” Dr. Turner asked.

“My second child was a baby when we received a humanitarian visa for Australia, so we moved here.”

“Were your two younger children born in Australia?”

“Yes, they did, but all my children are autistic and have significant developmental issues.”

“How does your husband react to your children’s problems?”

“According to my husband, all their problems are my fault.”

“It’s not fair.”

“Yes, it’s not fair.”

“Does your husband help you with the children and their needs?”

“No, he doesn’t,” Laila said softly, her eyes filling with tears. “He works hard and bears all the expenses, but he is usually not at home. I feel he doesn’t like or is ashamed to see his children with disabilities. Most nights, he stays at his friend’s house. When he is home, he often verbally criticizes me for giving birth to children with disabilities,” Laila said, then fell silent.

“So, you became exhausted by the ongoing burden of caring for your children and the constant criticism from your husband, which ultimately led you to take the tablets.”

“Yes,” Laila said, her voice trembling with sadness.

“I’m so sorry to hear that.”

“Thank you, Doctor.”

He nodded thoughtfully. He then said, “I will ask the nurse to give you a strong sleeping pill to help you get a good night’s sleep. I will see you tomorrow, and we can continue our conversation then.”

Laila nodded sadly and asked, “What should I do with my children? It feels beyond my ability to help them. I’ve constantly looked after them, taken them to medical appointments and rehabilitation sessions, cleaned up their mess, fed them, put them to bed, and tried to keep them quiet. Our neighbors have brought the police on us a few times.”

Dr. Turner knew the extent of her physical exhaustion but could do little. To reassure her, he said, “Don’t worry. Worrying doesn’t solve anything. I will consult with my team and the hospital social worker to explore the best ways to support you and your children.”

“Thank you, Doctor.”

“Talk to you tomorrow, Laila.”

Laila nodded thoughtfully, unsure whether the doctor and the hospital could do much to help her. Despite her doubts, the conversation with the doctor briefly lifted her mood, offering a moment of relief amid her worries.

Dr. Turner left Laila’s room with a heavy heart. He had tried to offer her hope, hoping she might find some comfort despite her difficult situation. He knew, however, that his efforts were limited. The hospital couldn’t provide a long-term solution for her or her children. Laila was trapped in a never-ending cycle, constantly caring for her disabled children with no relief or support, and it was wearing her down. As a mother, she wouldn’t harm them, but the pain she carried was so intense that she might consider harming herself again. This reality caused Turner great sadness and frustration because he genuinely wanted to help her, yet he felt powerless to do so.