After observing an electroconvulsive therapy (ECT or "electroshock") session in the morning, I followed a third-year medical student and an attending psychiatrist to the bed of an unusual patient. The man was a prisoner serving three consecutive life sentences at San Quentin -- he was also a compulsive swallower who ingested razor blades, metal wires, and sharp objects.
Today, he was in the hospital for swallowing a box cutter blade, but the surgeons were having a hard time preparing for the operation because they had already operated on the prisoner seven previous times for similar reasons. Psychiatry is more difficult than I imagined, because it is hard to discern with certainty what makes one person mentally troubled and another person functionally normal after speaking to him for an hour. At one point during the psychiatrist's interview, the patient-prisoner remarked:
"I'm livin' to die and dyin' to live."
For a man who swallowed a large blade currently sitting in his stomach and who is waiting for a surgery that will save his life...the comment was strikingly paradoxical and fitting. Maybe he was suicidal and depressed, but he was also hopeful and unwilling to die.
He was living to die, like so many other incarcerated prisoners.
But he was also dying to live, like so many other human beings.