It was 3:00 p.m. on a Friday afternoon. As I was pulling into my parking spot, the car radio reported heavy delays on a major highway; a man was threatening to jump off an overpass. My heart began to pound. That overpass was right outside my home. After quickly walking through the building, I saw a shirtless man leaning on the outside of the curved fence overlooking the median of the highway. While I was climbing up the highway slope in my heels, a thought entered my mind: “What am I doing?”
A police officer approached me at the intersection. I nervously stated, “I was wondering if I could help.” I hesitated to add the next part: “I’m a psychiatry resident.” He asked me to wait there in case I was needed.
The sight was heartbreaking and frightening. Men from construction sites gathered around the side of the highway. Crowds assembled on balconies and rooftops. Traffic on the highway crawled as cars slowed down to voyeuristically observe the scene.
As I stood waiting, I thought, “What if I make the situation worse?” I worried that the man was up there because of trouble with a woman or his psychiatrist. What if my presence pushed him over the edge?
“I wanna die!” was all I heard from the barefoot man. The officers did not have much information. A member of the Houston rescue team said that this man was a patient who had just left a nearby psychiatric facility. I felt I was in over my head. I considered calling Dr. Gabbard, my mentor, for advice.
Some of my thoughts were so unacceptable to me that I did not admit them for several days. For a brief moment, I was actually annoyed by this man. If he was suicidal, would he be at one of the busiest intersections in Houston during rush hour? But that skeptical feeling was a countertransference I was trained to recognize. I ignored it with all of my strength and reminded myself of his mortality.
As I inched closer, I noticed the man was weeping. The conversation between the officer on the fence and the patient suddenly seemed disconcerting. The officer was saying, “Come on, man. You don’t wanna die. Keep it real.”
It occurred to me that I did know what to say and how to talk to him. I asked the officer if I could speak with the man. He gladly resigned his post. I scaled the overpass fence, mounting myself on the crossbeams with my heels, my hands grasped tightly to the tall wire fence. I looked up and said, “Hi. I’m here to help you. You’re crying. What is it that you’re crying about?”
“I know things can get tough. What’s making you want to die?”
He cried a little harder. The construction workers on the side of the highway yelled, “Jump!” as people driving by after their release from long traffic jams yelled, “Asshole!” The man held a cigarette to his mouth with his left hand, stretching out his right hand, middle finger raised to the world. He suddenly flicked his cigarette away, put both hands forward, and reached for the lamppost on the edge of the overpass. I gasped as he leaned forward, away from the overpass and toward the road below. I pressed my face against the fence near his head: “I’m still here. Help me understand.”
He remained silent. I was worried that I may be the deciding factor in his decision. I didn’t want to push. He curled into a fetal position at the base of the lamppost. I lay on the street, seeding my hair with pebbles, so I could hear him.
I coaxed some more. He suddenly yelled, “I just wanna die!” and placed both of his feet on one side of the lamppost, arms forward in a jumping position. Panic overcame me. The 12 policemen below mechanically put gloves on and positioned themselves where they expected him to land. I looked down and convinced myself the jump was survivable. At least that was my wish.
I thought about all the responsibility I was assuming. Sure, I spent 20 hours per week in the emergency center of a large city hospital dealing with suicidality. But despite my extensive training, I had never been taught how to handle a man on the verge of jumping off a highway overpass.
My fears were selfishly translated into how this would reflect on my skills as a psychiatrist. I thought to myself, “I don’t have a permanent license to practice medicine yet. What if I lose it before I even earn it?” Did the so-called Good Samaritan law really exist?
I found myself embarrassed that I was thinking about self-interest when a man’s life was at stake. I wanted to tie a rope around his limbs to prevent him from jumping. I felt responsible for his life, and I was getting desperate.
I did the only thing I could do. I kept talking to him: “It’s a big place out there. I know it’s hard sometimes.” And with insurmountable passion, I added, “But there’s always a better way.”
The man stood up and grabbed the pole again, pushing himself back up onto the fence. He looked determined: a decision had been made. He was coming down. He wasn’t going to jump. He slowly descended onto the overpass and walked briskly away.
The large rescue team quickly surrounded the man and escorted him back to his inpatient unit. I wanted to bring him to the emergency room with my fellow residents so I could make sure he was safe. But that decision, unfortunately, was not up to me.
The frustrating end to this harrowing tale was that I could not find out what happened to the man. He was not taken to a teaching hospital in my residency program. We did not even know his last name. I can only hope that somehow I made a difference.
From the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Address correspondence and reprint requests to Dr. Gary, the Menninger Clinic, 2801 Gessner Dr., Houston, TX 77280; firstname.lastname@example.org (e-mail). The author reports no competing interests. The author thanks Glen O. Gabbard, M.D., for his help in writing this essay and her fellow psychiatry residents at Baylor College of Medicine for their support.