Casting: Patient A, Doctor B, Doctor C, Nurse D, Patient's husband
[Scene 1: Nurse Station at a general ward of internal medicine with Doctor B, Doctor C and Nurse.]
Nurse: Hi, Doctors, Ms. A doesn't seem to sleep well after she was told about her medical condition the day before yesterday. I gave her some sleeping pills, but every time I make rounds I can hear that she is awake in the night. Besides that, she seems to have a poor appetite.
Doctor B: Is that so? I just told her that she had only a stomach ulcer, which would be cured by the endoscopy. It should be OK, shouldn't it?
Doctor C: But I heard that the other patients in A's room worried about how she had changed. They saw her apologizing to her family pitifully. She used to be a cheerful person before.
Nurse: Even though there was no problem when the otolaryngologist examined her, she keeps calling us and complains about her headache and dizziness.
[Scene 2: in A's room. When Doctors and a nurse entered, Ms. A was having conversation with her husband.]
Dr. C: Ms. A, how are you today?
A: Doctor, recently, I really don't know . . .
Nurse: Ms. A, recently, you've been telling us about your headache and dizziness, haven't you?
A: Yes, I do have strong headaches, I feel dizzy and I can't sleep well . . .
Dr. B: Ms. A, there wasn't anything wrong with you when we examined you. You have nothing to worry about.
Dr. C: I see that you have headaches. What kind of pain is it?
A: I feel very dizzy and have throbbing headaches; I can't sleep and eat at all.
Dr. C: Oh, really? I'm sorry to hear that.
Nurse: If you have any other worries, please tell us.
A: I . . . well . . . er . . . here, I can't say . . .
Dr. C: Well, as I'm your doctor in charge, would you please tell me? I would certainly keep it a secret.
A: Thank you, well, later could I confide only to you?
Dr. B: (In a loud voice, angrily) Wait a minute, please. The most important thing for us is to think what is best for you. Let us all consider your treatment and find the best solution.
A's husband: Doctor, my wife has always been cheerful but over the last three days she keeps apologizing, “I'm sorry it's because I didn't go for a check-up for a long time . . . It's all my own fault that I became ill.”
A: I'm the one to blame. I've caused so much trouble to my family . . . I'm sorry . . .
Dr. B: Ms. A, you are very lucky to have such a nice and caring family, they came all the way to see you. You should face your illness bravely also for the sake of your family.
A: It's very hard for my family . . . the treatment costs a lot . . . someone like me isn't worth such treatment and money . . . especially as I'm not able to work anymore . . .
Dr. B: (interrupting A) So, you're worried about money, aren't you? I can understand that. All the patients are like that. But you don't need to worry because you have your nice family. It's not a big problem at all.
Dr. C: (Soothingly) Ms. A, you feel that you're causing trouble to your family, don't you? That must be hard, I suppose.
A's husband: I've been telling her that there's no need to worry about money, but she doesn't seem to understand in the slightest. I tried to get her to go for a walk to change her mood, however she keeps refusing.
Dr. B: Ms. A, your family cares about you in this way, so you should do your best to get better, shouldn't you?
A: I'm sorry . . . that's why I'm worthless . . .
Dr. C: Ms. A, it seems to me you may be thinking that it's not worth living, is that right?
A: Just like that . . . well . . . I've been a burden to my family . . .
Dr. C: Have you ever thought about disappearing or dying?
A: . . . (nodding without uttering anything) . . .
Dr. B: What a terrible thing to say!! Our hospital is supposed to do all we can to help all our patients.
Nurse: (reproving Dr. B) Doctor!
Dr. B: (embarrassed) So, do you want us to send you to the psychiatric ward?
A: . . . (lapsed into silence) . . .
Dr. C: Ms. A, have you ever had any concrete idea or plan of suicide?
A: Sometimes I think, ‘If I jumped out of this window, I would be free from all this pain.’ Yesterday, I thought, ‘I could hang myself if I put a rope on that rail.’ . . . But I realize I shouldn't be thinking like that . . .
Dr. C: That is painful, isn't it? You must feel really distressed to be thinking about dying.
Dr. C: Ms. A, thank you for telling us.
A: Doctors, Nurse, don't tell anyone about this, please. If people knew that I am having such dreadful thoughts . . .
Dr. C: (Slowly with emphasis) Ms. A, listen carefully, please. You are feeling really depressed right now. This feeling is, however, completely different from what your natural condition is, isn't it?
Dr. C: You are experiencing depression now. It is a medical symptom and because of it, I think, you are feeling sad, blame yourself and feel like dying.
Dr. C: I think there's such possibility. There are now many remedies for depression. You can get much better than how you feel now. In this hospital we also have specialists who treat the mind, they are doctors specialized in psychiatry and psychosomatic medicine.
A: (with surprise) Psychiatry and psychosomatic medicine?
Dr. C: Yes, that's right. We want you to get well again. I can introduce you to a kind psychiatrist, so won't you come to see him with your family tomorrow?
Dr. B: Well, but this is not something that we can do at our Department.
Dr. C: First of all, today I'll give you medicine so that you can sleep well. Don't worry too much, please, and have a good rest today. Should you have any anxiety, you can call our staff. And please promise me that you won't definitely do anything rash.