The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.
Pain, both physical and emotional, were overwhelming the patient. A victim of a nasty trauma, the patient had injuries to both the cervical and lumbar vertebrae, not to mention the spine. The patient's injuries inflicted pain when the sun rose, and pain when the sun set. Pain was never absent. I could tell this interview needed to be directed towards a darker area, despite the fact that I was on my surgery rotation and as one attending told me, "I'm not a *%)$*#( psychiatrist. Focus on the wound."
But being an older student, I'm more concerned with learning how to be a good doc, not on getting a good grade. Sadly, there exists a massive chasm between being a good student and a good doc. They are not necessarily one and the same. So I gently asked the patient about suicide. Without any surprise, the patient confirmed what I already knew. Loss of physical vitality, loss of livelihood, loss of sleep, loss of hope coupled with ever present pain is enough to drive the most resilient of person to consider the notion of "opting out". For all the talk and hype surrounding murders in this country of late, suicide destroys far more lives than homicide (twice as many, in fact). I have no idea if the patient solicited the help to which they were referred. I have no idea if their pain was ever brought under control enough to enjoy life again. It's on one of the reasons I want to go into Family Medicine. I want to know the whole patient's story, not just one specific problem.