It's Too Late for Sheila

I met Sheila, a twenty-six-year old, on the Psychiatric ward. I was a greener-than-the-Grinch third-year medical student completing my three-month psychiatry rotation, and Sheila was on suicide watch after a half-baked suicide attempt (she overdosed on Tylenol but then immediately called 911.) Thanks to Weight Watchers, Sheila had lost fifty pounds the previous year, but had recently regained thirty of them back because of her binge eating disorder. When we rounded on her each morning, Sheila parroted the same words: "I hate myself for gaining that weight back. I could kill myself. I'm such a loser." Sheila's entire self-worth was wrapped up in one thing---a number on the scale. Since this was 1984, before the release of Prozac and other effective medications for eating disorders and severe depression, the only drugs available had nasty side effects, including weight gain. Sheila refused to take them, and Cognitive Behavioral Therapy had yet to be discovered.

The head of the Psychiatry Department was an atheist and wouldn't even allow Bibles on the psych ward. He attempted to treat Sheila with what he called "extinguish" therapy. This meant that anytime Sheila mentioned her weight, self-hatred, or a desire to kill herself, we were supposed to ignore it and immediately change the subject. If she talked about anything positive, we were supposed to reward her by staying engaged, telling her how much we enjoyed her company, and giving her attention. He claimed this would use positive reinforcement to encourage her not to dwell on her weight. I was unconvinced. I felt she was just being taught to not talk about her feelings and to hide her self-hatred from us.

Since I have always struggled with weight myself, I understood Sheila's disgust at gaining back weight she had worked so hard to lose. Though I've never been suicidal or prone to severe depression, I hoped by spending more time with her, I could somehow help her. I got permission to go for a one-hour walk with her each day. I pointed out to her the best thing she could do is not focus on the past, which she couldn't undo, but to start working on the future and to slowly lose those thirty pounds. Focus on what you can change, I insisted. A daily one-hour walk is a great place to start, right?

While we walked each day, Sheila seemed obsessed with self-flagellation; all my encouraging words were ignored. As far as she was concerned, she was a completely worthless person because she was thirty pounds overweight. Every time she said the words, "I hate myself for gaining back that weight; I could just shoot myself," a chill ran down my spine. "Don't do that, Sheila! People love you and would be devastated if you killed yourself."

"Nobody loves me," she sputtered. "Who'd love a 'Goodyear blimp'?"

After two weeks of walking every day with Sheila, she began to open up a bit more about her dysfunctional childhood and her step-father, who'd made snide, cruel remarks about her weight on a daily basis throughout her childhood. I now understood why she overemphasized weight as a barometer for her self-worth. She shared her goals of one day becoming a librarian because she loved to read. I brought in several of my favorite novels and told her we'd talk about them once she finished reading them. I hoped reading would get her mind off her weight and would give us something to talk about besides her self-loathing. On several occasions, I threw out the comment that God loved her unconditionally, no matter what she weighed. He had a plan for her life, I insisted. Since the head of the Psychiatry Department had already given me an ultimatum for sharing scriptures with another suicidal Christian patient, I had to be careful how much I shared, or I would be thrown out of my psych rotation. (His exact words!)

After three weeks in the Psychiatry ward, the head of the department said he was going to dismiss Sheila from the hospital. He claimed she was no longer ruminating and was much better. It was audacious of me, but I told him I disagreed. From my daily walks with Sheila, I felt she was still suicidal and was not safe to go home. I informed him on my last walk with her, she'd told me, "I could shoot myself for gaining all that weight back." The psychiatrist peered over the top of his reading glasses, clearly nettled that I'd dared to challenge his judgment. In a condescending voice he inquired, "And you completed your Psychiatry residency and passed your Psychiatry Medical Boards, when?"

Titters erupted from the other medical students. Completely humiliated, I said no more. Thus, Sheila was discharged, against my better judgment. But I still worried about her. A lot.

I called her and walked with her as much as my schedule allowed. I even invited her to attend church with me that next Sunday. She said "maybe." I mentioned the Bible verse that said while man looks at the outward appearance, God looks at the heart.  I told her God loved her unconditionally. I tried to share verses of hope, without turning her off completely with obnoxious preaching and Bible-thumping. Since she'd grown up in a non-religious home, I'd hoped to develop a relationship where she totally trusted me before sharing the full gospel message. Sheila needed a friend and didn't need to feel like she was some "evangelism project."

One day, a week after she was discharged from the Psychiatric ward, I called to check on her because she'd seemed especially depressed on our walk the night before. Imagine my horror when her roommate informed me that Sheila had purchased a gun and shot herself in the head. Sheila was dead. My heart lurched and I could barely breathe. She really did it? I flopped into a chair too shocked to utter a word. Twelve hours earlier, we'd walked on the shore of Lake Champlain. Now she was dead.

Guilt overwhelmed me. I should have stood up to the the head of the Psychiatry department and told him even though I was just a lowly medical student, Sheila was NOT safe to leave the hospital. I should have called her more often. I should have shared the full gospel message sooner. What did I have to lose? Would it have made any difference? Probably not, but here's the rub---I'll never know because now it was too late.  It was too late for Sheila.

Around this time, a Christian group named Petra recorded a song that ministered to me and encouraged me to be bold in sharing about God's love. Quit tip-toeing around in fear. If someone is not interested, she can tell me and I'll shut up. Plus, body language lets me know if a patient is not interested---I'm not autistic. But Sheila died without ever knowing the full message of God's love, forgiveness, salvation, and purpose for her life. I learned my lesson---at Sheila's expense. Read the lyrics to the Petra song below; it fully encapsulates what I learned---the hard way.

FOR ANNIE  by Bob Hartman of the contemporary Christian group, Petra.

No one ever noticed Annie weeping People all around, but she was all alone Mama's got her meetings, Daddy's got his job And no one's got the time so Annie's on her own
No one ever knew her desperation People couldn't hear her cry out silently Locked inside the bathroom she grabs a jar of pills The medicine that cures becomes the poison that kills.
And it's too late for Annie, she's gone away for good There's so much we could tell her and now we wish we could But it's too late, it's too late for Annie.
Sadness fills the hearts of Annie's family Daddy tries to comfort Mama uselessly They hoped she knew they loved her, but they really didn't know They just want to know why did their baby go?
(2nd Chorus) And it's too late for Annie, she's gone away for good There's so much we could tell her and now we wish we could We would tell her Jesus loves her, tell her Jesus cares Tell her He can free her and her burdens bear But it's too late, it's too late for Annie.
If only we had known her situation, We'd have tried to stop this senseless tragedy Annie's lost forever, never to be found But there are lots of others like her all around.
(3rd Chorus) And it's not too late for Annie, she could be next to you Don't miss the chance to tell her before her life is through We gotta tell her Jesus loves her, tell her Jesus cares Tell her He can free her and her burdens bear Tell her Jesus loves her, tell her Jesus cares Tell her He can free her and her burdens bear You've got to tell her Jesus loves her, tell her Jesus cares Tell her He can free her and her burdens bear It's not too late

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