Tales from the New Asylum: Yesterday


As I came closer, I could see Mr P more clearly. He was in his own world, wearing a Walkman with earphones on. I puzzled for a brief moment over this-was this to shut out attempts to talk him down? I could also see more clearly the rivulets of blood dripping from the incisions on his wrists to the concrete ground below.

[Editor's Note: Click here for the recorded version of this blog.]

He was five floors up, grasping the outside railing of a medium-security prison dormitory balcony. His grip and feet on the outside railing-the only things keeping him from plummeting five stories to the concrete courtyard below. However, the immediate problem was that his grip was slipping. This was due to two main factors-his copious blood loss making him weak and dizzy, and the blood trickling down from his wrists onto his palms making his grip less secure. The result was a slippery, bloody surface between his hands and the smooth, hard steel railing that was keeping him alive.

Mr P had chosen this day, this time, for a most serious reckoning. As he clung to the outside of the top-story railing, correctional staff began to gather around the scene. I first saw it from the roof of another unit I was working in after I got the breaking news from a nurse. My first viewing was a curious thing. Time moved so slowly. I was unsure of what I was seeing. When it became clear to me, I left my rooftop spot and raced over to the scene which was approximately 75 yards away, but through a number of stairways, sally ports, and security gates. Fortunately, correctional staff knew me well and gave me speedy access.

As I came closer, I could see Mr P more clearly. He was in his own world, wearing a Walkman with earphones on. I puzzled for a brief moment over this-was this to shut out attempts to talk him down? I could also see more clearly the rivulets of blood dripping from the incisions on his wrists to the concrete ground below. By now, special emergency response teams had arrived and were carrying out their duties as best they knew how. My guess was that this was not likely a scenario they had covered in training. In a well intended, but pitiable gesture, officers had thrown down some inmate bedding mats on the hard concrete ground-mats that inmates routinely complained were too thin and uncomfortable, as they were a generous two inches thick.

I bolted in my dissociated state, as if through molasses, to the courtyard that led up to the stairwell and top floor where Mr P was dangling. He appeared to be looking down and thinking very hard. Every so often, he would let one foot dangle in mid-air, as though he were working himself up to doing the same with the other foot. I could barely make out an expression on his face-it was tense, yet oblivious to all the commotion around him.

I could tell-he was deliberating. A private, life-or-death debate was unfolding moment by moment in his mind.

As director of psychiatry, I knew him only peripherally-a name on a case load of a therapist colleague. As correctional staff scurried around behind and around me, I felt total impotence sink in. It hit me that I might only be able to bare witness to the end of Mr P's life . My throat tightened. My face and chest felt like they were on fire. I hated that idea and these feelings, and tried to suppress them.

My gaze was fixed on Mr P and the fifth-floor balcony around him. Everything else in my world ceased to exist. I saw a correctional officer (or CO-it's an insult to call them guards) trying to interact with Mr P. The CO was at a safe distance, maybe 10 or so feet away. I watch the CO lower himself to one knee and continue to try to engage Mr P. Immediately, I thought: Thank God-this man knows what he's doing. He was using nonverbal body language like a professional-just as we had learned in crisis negotiation training. This CO had the presence of mind to remember it and use it on the spot. He had placed himself in a lower, nonthreatening position with regards to Mr P. No doubt he was using sincere, open communication to listen to Mr P and keep him engaged. But I was still guessing all this as I couldn't see their mouths. A lieutenant offered me a pair of his binoculars, but I still couldn't make out what was being said.

Just then, a trusted friend and colleague tapped me on the shoulder. It was Dr F, the chief psychologist of the prison, who also happened to be Mr P's therapist. Dr F had worked in the prison system for a very long time. Yet somehow, he had managed to maintain a genuine caring and desire to do psychotherapy with the patients under his care. Every time we talked, he had to tell me the same story of how he "never expected" to be working in prison as a career-he just found himself staying there, year after year.

We had a rapid, highly concentrated communication that took mere seconds to minutes-the type of conversation that only good colleagues can have in a major emergency. Dr F wanted my approval to ascend the five flights of stairs to help the lone CO coax Mr P off the railing and back to safety. By this point, I had already received reports from the Lieutenant that Mr P has been telling the CO not to come any closer in a desperate, yet hostile tone.

I've always been a firm believer that in the midst of a serious, acute emergency, one must make a quick, albeit well-reasoned decision. Then, one must live with the consequences. Mental paralysis was anathema to me, particularly as the COs had already done everything they could and were expecting some type of assistance from mental health. I knew Dr F well. I knew his skills, what he was capable of and how he operated. I gave him the nod. As I watched him walk towards the stairs all by himself, I was suddenly overwhelmed by respect for him.

Dr F was a seasoned correctional mental health veteran. Otherwise, I never would have considered this option. He ascended the stairs quickly, and then, as he reached the top, his pace became much slower. He seemed to float slowly towards Mr P-very slowly-and stopped approximately 10 feet out. His body language suggested: "May I have your permission to approach you?" Mr P immediately recognized Dr F, and appeared suddenly invested. However, Dr F still did not move-he stood still, hands folded in front of his waist, shoulders ever so slightly slumped forward. Mr P and Dr F proceeded to have a conversation to which I was not privy. Only once did Mr P look down again and appear to be considering letting go. . . . (Dr F. would later tell me he had more than a few moments of serious doubt about his efforts).

Their conversation seemed to last several hours, but my watch told me it lasts about 15 minutes. Verbal exchanges back and forth-devoid of content for me, but intensely observed. During this time, an ambulance and EMT team pulled up around the side of the building-ready to deal with the aftermath of full-body trauma after a five-story fall. I would later learn, from forensic pathology research, that five floors is approximately the threshold where there is a fifty-fifty chance of the victim living after a fall, but most certainly with massive internal trauma. However, this depends on many variables such as the landing surface below and the height of each floor. In this case the courtyard was hard and unforgiving, and the dormitory floors were slightly higher than the standard floor described in the literature.

So Dr F had taken a big risk. He put aside his fear to help a murderer. To save a man that society had cast away. Mr P had murdered a woman he loved. The details of his crime are irrelevant now, but I am quite aware that to most in society, Mr P's suicide would not likely mean very much. He had no children, and what was left of his family had abandoned him long ago. Meaning-a theme that is a ubiquitous and relentless undercurrent in prison. Mr P's search for meaning had reached an impasse. If we weren't physicians who swore an oath, if we were in a nonhelping profession, it is possible we would count ourselves among the ranks of those for whom what happened next held no meaning. Or perhaps we would care, but only because we would want to know what happened next . . .

We'd wanna know if he jumped. If he fell.If his body plunged to the concrete while everyone watched.

Well he didn't. The CO and the psychologist saved him. They got minimal credit. A brief "congrats" here or there at most. Dr F came to the CO's aid and expertly negotiated with Mr P's survival instinct to temporarily allay his death instinct. Continuing to impress me, the COs did not "pounce" on Mr P. Rather, they extended a hand, and walked side by side with him down the stairs. They gave him his dignity.

At this point, perhaps there are some skeptics thinking: He probably never intended to kill himself in the first place-it was a highly dramatic behavior designed to get attention. I don't judge anyone thinking this. All I can tell you is that you had to be there. You had to see the look on Mr P's face as he yelled at the COs to back away. As he stared downward toward death. Dangling his foot. Working up his nerve. Fighting a battle between life and oblivion. And had he lost that battle, I would have a very different memory in my head.

The nurses knew immediately that I would want to treat him as an inpatient. They didn't even ask me, we knew each other so well. Mr P had come so close. I had to listen to him, work with him so I could understand. It turned out that he was a pretty tough, macho guy-frankly admitted that he didn't want to hang around on the planet any longer. Wanted to leave, but decided (with help) at the last minute to stay. The date he had chosen turned out to be significant-the 2-year anniversary of his crime. He turned out to be a likable guy, and not hard to treat at all. As an inpatient, he got better relatively quickly, about two months or less, and was discharged. I put him on the best anti-depressant regimen (with augmentation) I could devise at the time, and Dr F went above and beyond by meeting with him periodically as an inpatient.

Mr P is still alive as far as I know. He just needed some solace and sanctuary around the anniversary date. He got it and it seemed to help. He would continue to get it every time the fateful anniversary came around. After I got to know him a bit, I had to ask-were the headphones to keep out other's pleas, or was he listening to something? He was listening to something: "Yesterday" by the Beatles. Some found this melodramatic and even histrionic. Somewhat understandable from their perspective. Again, I don't judge as I realized they had no way of knowing the inside story-from Mr P's perspective. The gist was that he had been deep in his own private hell, where he was unable to fend off tormenting memories of yesterday.

Yesterday came suddenly. . . . Now I need a place to hideaway.
Oh, I believe in yesterday.

-Paul McCartney and John Lennon, "Yesterday"


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