Depression. Despair. Suicide.

I originally wrote this post about suicide two years ago after several incidents of “jumpers” from a nearby parking garage occurred within a short time frame, and I couldn’t get past the sadness and horror as I walked past it everyday. It touched me deeply, and I didn’t even know them… but I knew of them, and seemed connected to them in some way. Each time it happened, it seemed like a dark secret no one would talk about. There was minimal information in the newspaper, and I had so many unanswered questions. There is a stigma that comes with mental illness that many do not feel comfortable talking about. So we don’t.

Now, I’m going to open up and get very honest and personal. My cousin committed suicide when I was young… it was something that wasn’t talked about in my family, and I am still not certain of the specifics and I wish I knew more. A dear friend’s son committed suicide last year… it has been absolutely devastating for her, her family, and Alex’s friends (my daughter was one of his friends). They will always mourn his loss… he was gifted, and kind, and successful, yet he couldn’t ask for help to get out of the darkness.

Something happened recently that shook me to my core; my daughter attempted suicide. She became so overwhelmed with her work in the news industry, with this relentless cycle of negativity and civil injustice, that she quite literally “broke”. Her compassionate heart could not continue to write (and re-write, and re-re-write) about the horrific acts of violence and sadness in the world…. that, and the tragic loss of life with the global pandemic, and the isolation of being in quarantine, was too much for her to bear, and she lost something that keeps most of us moving forward… hope. My own beautiful daughter became so depressed that she didn’t want to live another day. That shocking realization is something that I was not prepared for… not my sassy, funny, bright, strong, successful daughter…. that can’t be… under my own eyes, in my own house. How did I miss this? I felt like I had failed her. In hindsight I did see some subtle changes, but she was good at pretending she was ok… she stopped working-out with her virtual trainer because it was so hot outside. She stayed in her pajamas all day because didn’t everyone who worked from home do that? She wasn’t sleeping because she was working so hard writing for the news show that she produced. And me…. I am a Nurse, so I went to work like I always did, even under the stress of Covid… I came home late, sore, and tired… and I missed it. But thank God, I was able to stop her in time… and I got her help. Yes, we have guardian angels among us.

We have all felt sad, disappointed, and alone at one time or another in our lives. Those of us who have struggled with depression, or other high risk factors such as loss, low self-esteem, rejection, or stress, have experienced varying degrees of darkness and despair; it’s not a fun place to be, and not everyone makes it out alive. Some have been in such a low place that they feel their only solution to overcome this immense pain and suffering is through one final extreme act of choosing death over an unbearable life. We all have our own inner demons that come out when we are at our most vulnerable.

Depression is an illness that often can be mistakenly viewed as a sign of weakness, or an inability to cope with everyday life. This is just not true. The American Psychiatric Association (2018) defines depression as a medical illness that affects how one feels, thinks, and acts; it can lead to thoughts of suicide if left untreated with the right mix of therapy and medication.

Suicide has been described as death from despair. According to the Center for Disease Control (2018), suicide rates in the U.S. have increased 25% in the past two decades and are increasing among adults aged 45-64. Among those aged 15-34, suicide is the second-leading cause of death. These are scary statistics…especially when they hit so close to home. Those of us in healthcare have seen the outcomes of an attempted suicide. My first experience as a young PICU nurse caring for a teenage girl who attempted suicide by hanging was extremely difficult; there was no happy ending or miraculous recovery for this young, troubled girl. This story was tragic, and yet it happens everyday. She had gone through a bad break-up with her boyfriend, and the pain and rejection led her to self-mutilation, which didn’t dull the pain deep inside of her, so she hung herself. Her sister found her, and called 911. She was brought back to a life of vegetation. She wore a haunted look of pure rage, which seemed to be her only facial expression when “awake”. She had just enough brain activity to continue medical interventions. I still think about her from time-to-time and I wonder if she ever found the peace that she was looking for so long ago. I truly hope so.

What can we do to prevent our loved ones from choosing this ultimate act of despair? First, we need to be able to recognize the signs and symptoms of depression and not be afraid to ask if they need help or want to talk….or even if they have ever thought about hurting/killing themselves. We need to support better medical coverage for mental health and pre-existing conditions; we need to prevent those who have mental health conditions from being able to legally purchase a firearm; and last, and most important, we need to support them and not judge them. “There but for the grace of God, go I”. Timing is everything, and if the pain and despair are recognized early enough, perhaps a life can be saved.

Linkin Park wrote a beautiful song about suicide called One More Light (2017). The irony that one of the writers, Chester Bennington, committed suicide a year later, speaks to his state of mind and intimate understanding of the effects of suicide for the ones who are left behind to try to heal from this great loss.

Video:

One More Light (lyrics)

Should’ve stayed, were there signs, I ignored?

Can I help you, not to hurt, anymore?

We saw brilliance, when the world, was asleep

There are things that we can have, but can’t keep

If they say

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

The reminders pull the floor from your feet

In the kitchen, one more chair than you need oh

And you’re angry, and you should be, it’s not fair

Just ’cause you can’t see it, doesn’t mean it, isn’t there

If they say

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

Well I do

Linkin Park (2017)

Songwriters: Brad Delson / Chester Charles Bennington / Dave Farrell / Francis White / Joseph Hahn / Mike Shinoda / Robert G. Bourdon

One More Light lyrics © Universal Music Publishing Group

If you, or someone that you know, are having thoughts of suicide, please seek professional help; call a friend or family member, or call the

Suicide Hotline: 1-800-273-8255

References:

American Psychiatric Association. (2018). What is depression? Retrieved from https://psychiatry.org/depression

CDC. (2018). Suicide rates rise sharply across the US, new report shows. Retrieved from https://washingtonpost.com

Linkin Park. (2017). One more light. Retrieved from https://youtu.be/Tm8LGxTLtQk

Nursing…for better, or worse

Working in the pediatric intensive care unit (PICU) and the pediatric hematology-oncology unit, I have grown very close to many of my patients and their families. When kids are sick, they can be in the hospital for extended periods. It is inevitable. The timing of illness is never “perfect”. So, in a way, we become one another’s extended family, and we find opportunities to celebrate and plan special parties for “our” kids; we throw birthday parties, play Santa on Christmas, dress up in costumes for Halloween, and we even have an annual prom, where many of our patients dress up in fancy gowns and suits, and dance the night away (like a “normal” kid).

We celebrate the happy events when we can, because the sad ones are all too common. Loss is hard. Some of us are able to put up a protective shield so we don’t “get too close”; we try to protect our hearts from the pain of bearing witness to life and death on a continuous basis. But there are always those patients who break through that shield and you find yourself attached, whether you like it or not. This has happened to me many times. My first experience with losing a patient was when I was a young PICU nurse; I cared for a 10 year old little girl who had Fanconi’s Anemia. She was not an easy patient to care for, and she hated taking her medications. She basically gave me a hard time for every thing that needed to be done (to/for) her… bath, dressing changes, oral care, vital signs, etc. We worked through our challenges, and we compromised when able; yes, even at 10, she was quite the negotiator. After she passed, I went to “sit shiva” with her parents; it was the first time I had ever experienced a Jewish “wake”. I remember her father greeting me saying “finally, I have someone to drink with me”. I wasn’t sure whether to take that as a compliment or not, but dutifully accepted the large glass of vodka, straight up, no ice that he shoved into my hand. I would have preferred ice, and maybe a splash of cranberry or orange juice, but he never asked, and I didn’t have the heart to object or refuse. He seemed so proud and happy that their daugther’s “favorite” nurse came to sit shiva with the family; we quietly spoke about her, and our time together. Her parents looked lost and broken, and I remember feeling so guilty. I felt like we failed her, and her family. There were a lot of mixed feelings that were hard to work through for a young nurse. The vodka helped a bit with that…from what I recall.

After awhile, we try not to attend the shivas, wakes, or funerals of our patients; it can be heartbreaking and can sometimes be a slippery slope with crossing professional lines. But self-preservation aside, I have never had an experience where a patient’s family did not wholeheartedly welcome their child’s nurses at his/her funeral. It shows that we care, that their child made an impact on us; they were special.

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My father passed away last Saturday. While I knew that his time on earth with us was coming to an end soon, it still seemed sudden to me. The days leading up to his passing have been the worst days of my life. I can’t get his pleading voice, “Debbie, please help me” and “let me go” out of my head. No matter how much pain medication I gave him, he woke up soon after in even more agony.  By Friday, he was getting Morphine and Ativan on an hourly (sometimes half-hourly) cycle, and it still barely kept him comfortable. I tried so hard to save him from the only thing he feared in the end…a painful death. Finally, on Saturday morning, we seemed to reach that peaceful period when he no longer needed medication. We had a brief moment alone when I was making sure that he was comfortable, and put some Chapstick on his lips… he opened his eyes and looked at me and I said “I love you Dad”, and he said what he always said to me, “I love you more”. Those were his last spoken words and I will forever cling to them. Soon after, his breathing was slowing down, and he was fading away from us. I could almost see it happening. He passed away peacefully. It was a relief that he was out of pain, but the most heartbroken that I have ever been at the same exact time.

My father’s hospice nurse, Patty came to his wake. When I saw her, I immediately understood what it meant to see your loved ones’ nurse paying their “respect” to the family. Patty said she really liked my Dad; he was a good patient, with a great sense of humor. He bravely accepted his prognosis, and made peace with it. My father made her laugh. She would care for him, and talk him through what medication he needed to take, and when, and he would say “whatever you say kid, you’re in charge”. She would gently correct him and say, “no, you’re in charge”. She gave him back what he lost, which was control. He was unable to walk, or do many of the things that we all take for granted, but he could still make decisions about his care, and how he wanted to pass. Patty made sure that his wishes were honored, and for that, I will always be grateful.

Rest in peace Dad. I love you more.

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The Gift of a Dog’s Love

Anyone who loves dogs as much as I do knows that they have a special gift of “knowing”. They instinctively pick up on how people are feeling; they know joy and sadness, and everything in between. Without saying a word, they have the uncanny ability to be able to just sit beside us in silence and solidarity as we navigate through difficult times; their presence is comforting, and it reassures us that we are not alone. We can say anything to them and they will never fault us for our honesty and moments of weakness; they do not judge, only love without condition. I can’t imagine my life without a dog by my side. Every single failure and heartbreak that I have had, I’ve gotten through it with a loyal best friend to give me strength and purpose.

dog therapy

A dog has a gift of sensing when someone is ill, and even near death. There is scientific evidence that therapy dogs provide both mental and physical benefits to those that are in hospice care; their presence has a calming effect. The soft texture of their fur can provide warmth and comfort to those who are in pain and feeling anxious.

My father loves having our family dogs visit; they are a welcome distraction to our new reality. Watching our golden retriever, Riley, play with a squeaky toy, or gently drop a tennis ball into his lap, brings a smile to his face that is usually grimaced in pain. His moans become chuckles as he throws the ball to watch Riley run after it with pure focus and intensity; sometimes bringing it back for more, sometimes just chewing it for awhile to revel in victory.

Riley

The love of a dog is the gift that keeps on giving.

Nursing at end-of-life

Nurses are both blessed and cursed with witnessing life, death, and everything in between in our professional roles. We see pain and tragedy all too often… sometimes every day if you work in a busy Emergency Department or Intensive Care Unit. It can be very difficult to experience the feeling of helplessness when caring for a patient who is not going to “make it”. Our goal is to save lives. “Not today”, we tell ourselves as our patient crashes; we call for help and start resuscitation…sometimes it works, and sometimes it doesn’t. Highly skilled and experienced nurses are able to adapt to the stress of life-saving emergencies, but it is still a very difficult process; we focus on tasks and try not to think about the patient being so young. We try to block out the cries and looks of fear from family members as they pray for their loved one to survive. We get through them because we must; we have other patients who need us, and this is what we signed up for when we chose our profession… or it chose us.

We take the laughs when we can because humor really does help us get through those horrible shifts. We create “inside” jokes with our friends and colleagues to stay sane. I believe this is why nurses develop such strong bonds; we understand each other.

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And then there comes a time in every nurse’s life when we are faced with the challenges of caring for a loved one as they near the end of their life. I am here now. Both of my parents have cancer; my mother has malignant pleural mesothelioma, and my father has stage IV bladder-lung-bone cancer. Fortunately, my mother has outlived her predicted life-expectancy of less than a year by an additional year, and has responded to chemotherapy, Alimta. My father, on the other hand, has not responded to chemo (IV or instillation directly into the bladder), cyber knife, radiation, or immunotherapy. We have had those difficult conversations with the oncologist, who is as kind and compassionate, as he is honest. As a family we have practiced patient-centered care by placing his preferences and needs at the center of his treatment plan; he is now in hospice and we are focusing on comfort and quality of life. To say that I am deeply grateful to their expertise and care is an understatement; they are truly amazing.  They manage pain with all the available tools in their “comfort care” toolbox; what they don’t have, they get. Quickly.

Talking openly about funeral arrangements, and what to expect as death becomes imminent, can be impossible to imagine when you are face-to-face with your dying parent. I suddenly forget that I am a nurse, and am back to being a daughter that can’t form a sentence without crying. You are torn between wanting (much) more time, and wanting the pain to end for your loved one. I am much better at holding things in and not saying what needs to be said, which has led to a mountain of regret in my lifetime… but that’s another post, for another time. Trying to manage my feelings and emotions about being a nurse, and caring for my father, who is nearing the end of his life, is what inspired me to start this blog. I hope that it can help me to find the words that I need to say in the end.

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