The Time I Almost Set Myself on Fire
A doctor's mind attempts to figure out a vexing biological puzzle.
This article is about a misunderstanding. It’s a misunderstanding about my own health, in which what I thought was a psychiatric and even suicidal crisis turned out to be nothing more than the wrong dosing in a medication taper for an unrelated sleep condition called restless leg syndrome.
I hadn’t slept well. It had been a couple weeks of not sleeping well. On top of a few years of not sleeping well. This is the kind of not sleeping well that people describe as “not sleeping well” in order to not have to say “I literally didn’t sleep at all, and that’s definitely pathological, so I’m not gonna say that part.” My situation, at least the prior night, which was debatably still going on at 5 AM, involved the “not sleeping at all” variety of the problem.
It was 5:15 AM. There wasn’t a ferry coming to the dock in front of me until 6:25 AM. It’s probably worth noting that this was the dead of early spring. It’s like the dead of winter, in that it’s just as cold, but it’s early March instead of February, so you can’t really say “the dead of winter” and have it be accurate. But it’s still below freezing. I was wearing a coat that wasn’t appropriate. This is also defined according to the situation: no coat is appropriate when you’re just sitting there for long periods of time and not moving if it’s a coat that would be appropriate for moving around. I was wearing the kind of coat that was designed to take into account body heat having been generated over some period of time thanks to robust strolling. I was not strolling. At best, I was robustly sitting. Which was not the intent of the coat designers.
I live next to the East River. Manhattan is flanked by one river on the west side, the Hudson, and one river on the east. That river, the East River, separates Brooklyn and Manhattan. On the Brooklyn side, you can live right on the water, as it were. I do. And I did. And there’s a ferry that comes to a dock. It’s a good boat. It’s a reliable boat. It’s not a far walk from my house. And so I was waiting for that boat to come get me. The other side of that boat ride was a grand total of 15 minutes away. NYU Langone Medical Center has an emergency room with an entrance at 33rd St., and First Avenue, which is one block from the ferry. Instead of taking some more sensible form of transport, something like a cab, that would’ve taken me right there, or a subway, which would’ve moved me on my way, and probably gotten me there at the same time, I decided to allow my ambivalence about the whole situation to dictate my mode of travel, and I selected the mode of travel that wouldn’t come for another hour. In my mind, I had no choice but to wait. My mind, as we will see, was acting quite unreliably at that time. I had headphones on. They were playing music that was dark. There was ice on the ground, and I was wearing converse, which are not appropriate shoes in these conditions. It was quiet and the early morning pre-dawn light was flickering in the presumably halogen bulbs of the street lights positioned on the boardwalk. Frankly, I wasn’t in a rush. Because I knew where I was going. And I thought I knew why I was going. In fact, I couldn’t stop thinking about why I was going. Something was wrong.
The image of pouring gasoline over oneself and lighting a match is not a pleasant one. It’s not pleasant even when you’re thinking about someone else doing it, who is invariably a monk. Monks are in virtually all of the pictures that exist of this activity, because the most viewed image of this is on Rage of The Machine’s breakthrough album. Monks are different from regular people. Monks are not you or me on average. You don’t go to work wearing a monk outfits unless you’re a monk. Monks are conceptually far enough from early-40s, tubby, balding, white physicians as to allow for a sort of emotional and cognitive distance. This distance is what allows people, including myself prior to this moment, to look at these pictures of monks burning themselves alive and not immediately have the uncomfortable imagined experience of it being themselves. It makes these pictures bearable.
Have you ever burned your hand? I have. You probably have too. You might have done it by touching a hot plate, or taking something out of the oven, or something like that. If you’re really unlucky, you had a bad run-in with a firework. But because of these minor burns, you’re aware of how bad an idea burning yourself alive is. Almost everyone is. Don’t touch the hot thing. Don’t leave the stove on. Did you turn off the oven? There are entire psychiatric disorders based on the fear of not turning off the oven and having to check.
But pouring gasoline on one’s self, and then lighting a match–that’s something most of us don’t do. Even the most suicidal of individuals usually thinks about things that will get the job done quickly and painlessly. There’s a lot of fantasizing about getting hit by buses that happens among the chronically suicidal. Stepping in front of subway cars is something that goes through one’s head over and over again for many many people. Overdoses of pills seem like they’ll be nice for some folks. Large amounts of sleeping pills are frequently recommended by brains obsessing about annihilation. People will buy this or that to die quickly. Guns will end the “being alive” situation quickly. There’s so many ways to imagine dying that are presumably pain-free. I promise you that in reality, they’re not. As someone who’s done a lot of consultation in ICUS with people who made suicide attempts that did not lead to death, I can verify that it’s a terrible idea to do any of these things.
The experience of burning alive seems like it would be so horrific that even those who crave death avoid thinking about it. And yet here I was, sitting in the very, very cold morning, and thinking, over and over again, without having much say in the matter, of having my body be engulfed in unbelievably painful flames for as long as it would take to go into cardiac arrest.
I’ve worked in burn-trauma ICUs. I have seen the many months of painful recovery, IV pain control, sedation, skin grafting, and the rest. It is a miserable-fuck thing, even if it happened on accident. It’s a miserabler-fuck thing if you did it on purpose. It’s an unimaginable thing for anybody but a monk. And apparently, me.
Here I was, sitting in the 20° early spring cum late winter weather, freezing my ass off, listening to Danny Carey drum away on the most recent Tool album, with images I did not find pleasant running through my mind. In fact, they seemed really wrong. This is the kind of thing that just didn’t make a lot of sense to be thinking. I was frustrated about stuff in life, but not really even depressed. Annoyed, at best. Stymied? But the internal world I was living in was not one that inspires the kind of despair that would normally be aligned with fantasizing about ending one’s life. If I had just wanted to endlessly experience pain and suffering, I could have just submitted more prior authorizations to United Healthcare for perfectly reasonable treatments, and have them denied. Then I could have easily simulated the experience of mortifying pain without all the hustle bustle of having tortured myself like I was a protest against the Vietnam war. God, it’s cold out. I moved my toes. First up, then down. Then up, up and down. Then up and down. And I pressed them down really hard inside my converse. During all this ice and fire, the right Converse sneaker was having a serious failing as well: the bottom was detaching. These were not structurally robust sneakers at that point in time. But they’re all I had. I took out my phone. Five minutes had passed. Sigh. That’s not enough minutes. It was also more minutes than I would have liked.
I have bipolar disorder. I have been depressed and suicidal before. This mental state was not a completely novel experience for me. But it was strange, even compared to prior psychiatric episodes in my life. I was aware that this was different. I was also aware of what was waiting for me on the other side of the East River in the emergency room of NYU Langone Medical Center. I knew that I was gonna walk in. I was going to shuffle a little bit, because my feet would be as cold as they were then. I was going to have to go to the registration desk. I was going to hand them my insurance card. They would ask me why I was there. I would tell them, “I am thinking about killing myself.” They would ask me to take a seat. There would be a period of waiting. And then some more waiting. Eventually someone would come and take my blood pressure.
Fast forward. Let’s assume that’s happening right now at this point in the story.
I sat down in the chair, slipped my arm out of the insufficient winter jacket, and pulled back my sleeve, as they wrapped the blood pressure cuff around my arm. “Hmmm hmmm. Hmmm. Hmmm hmmm hmmm, hmmm, hmmm, hmmm, hmmm, hmmm, mama.” was the sound of the blood pressure cuff inflating as the air compressor does it’s level best to figure the fuck out what’s happening with my blood pressure. They stuck a lame plastic condom-esque thingamabob around the thermometer, that they placed, with a lack of gingerness, under my tongue. For whatever reason, this was the point in time when they decided to ask me, again, why I was there.
“Bad blood by blah blah blah blah blah to draw myself that that that shoulay about that.”
“I’m sorry, I didn’t hear that come out. What brought you in today?”
I take the thermometer out of my mouth
“I was having suicidal thoughts, but you asked me when I had a thermometer in my mouth. It’s really hard to both have it not fall out and say those things. That’s why you can’t understand me. I’m sorry. I’ll put the thermometer back in now.”
I placed the thermometer back in my mouth.
“Shhhhhhhbhbhbbbbbbhhhhhhhh. Beep!” exclaimed the blood-pressure-cuff-thermometer-combo-unit.
The nurse leaned in, knowingly. Her eyes did a quick survey of the screen, which was not pointing towards me.
“What is it” I asked.
“It’s a little high. 135/90.”
“Yeah. I don’t think I took my blood pressure medicine last night.”
I take medicine for my blood pressure. Actually, it’s medicine that I originally started taking for the condition that I have. It’s psychiatrically impactful but cardiogenic in nature: benign supraventricular tachycardia. What this means is that my heart randomly beats too fast. Like, way too fast, like, way more than panic fast. I have a rogue area of my left atrium that generates extra beats that are faster than the sinoatrial node. The sinoatrial node is supposed to be doing the work of creating my heart’s electrical rhythm, but I’ve got an alt node–a literal different drummer–that my heart beats to.
Twenty minutes later, a nurse, who I recognized from five years ago when I used to work in this very emergency room, was walking me back to the psychiatric area of this general medical emergency room. The psychiatric area has two rooms. One of the rooms I was last present in when my patient, Margaret, spent her last night alive in this room.
I went through the seemingly locked door of the psychiatric mini area. I had to give them all of my things. Giving up all of your things, which includes all your clothing, is an unbelievably annoying but time-tested routine in psychiatric evaluation settings. As if there’s something magical about wearing a hospital gown that doesn’t allow you to do anything dangerous. As if that magical power that the ER has to keep you safe is in having you wear something deeply embarrassing and denying access to any of your stuff.
To be continued…