Yeah...I've only been in residency for three months...

The other night I was doing my usual short call, and I got a phone call from the primary service regarding a patient with (what else) suicidal ideation...but there's a twist. This individual also happens to be a doctor. Oh goody. And wait!! she's also a borderline, a group of patients I find particularly challenging. None of this makes makes me feel good. Long story short, the patient denied any active suicidal ideation, what was said was "who wouldn't have thoughts of killing themselves if they had pain like this." So, a gray area. But there was a past suicide attempt. I wanted this patient in the hospital, because there was a pattern that looked like it was about to be repeated, but the patient did not meet requirements for committment. And then the patient eloped prior to discharge...security was called and

Here's where things hit the fan like a steamy cowpie in June, the patient goes home, sends an email to her outpatient psychiatrist saying that I was right, that I should've kept her. Doctor calls the police. Patient leaves her house, and shows up on the floor after I've signed out to the night resident. Then the patient codes. What has the patient done...taken over 100 pills of oxycodone, percocet, and valium...

I cannot even begin to put into words what I felt in that moment. Anger, at myself and my inexperience, frustration with the patient, anger at the patient. It completely ruined my day. I kept asking myself over and over again what I could've done. What trick of the trade did I not know regarding how to commit her....because doesn't every psych resident deal with a borderline who's also a physician who knows exactly what to say and has been planning a suicide attempt for two weeks....
One of my attendings stated that "it's ok to feel that way. First year residents are constantly afraid that they'll be exposed as a sham and not knowing anything. But it's ok, because first years really don't." While that didn't exactly make me feel great, it is an accurate representation of how I feel at the moment. I've been told by several people in the crew that I did everything I could, and that I did everything right...but at this point I don't know how much of that is avoiding a problem with me going off the deep end, or if I really did do everything I could do.

People in my program have been very nice about it, stating that more or less "it happens, and sometimes there's nothing you can do." Pardon me if that's comforting, yet not.