This is a true story. The reality is it could be your story or that of someone you know. It probably already is, whether you know it or not. It’s a story everyone needs to hear.
It’s the story of how last Friday changed my life and that of a dear friend. A story quite literally about life and death. A story that could save the life of someone you know, work with, or love.
It's a suicide story.
And you need to know what to do if someone you know tells you they want to kill themselves, or have a plan to commit suicide, or have actually tried to end their own life. This is a great resource if you ever need it: https://afsp.org/
Last Friday was like any other day, until I met up with a friend in the evening. She struggles with depression, but is on medication and sees a therapist regularly. Over the past several months, she has shared with me things about her life and her struggles that she had never told anyone else, other than her therapist. It was clear from her behavior, it was a bad day for her. I could tell she was “off”. She appeared on the verge of tears and more sad than I’d seen her in a long time.
I asked her what was going on. At first, she dismissed it. “I’m just having a bad day.” But I pushed her on it. “Sweetie, I can tell you are having a hard time today, what’s going on?”
She fought back tears. We hugged. Finally, she said, “I was at your house today.”
Me: “Oh, really? Why?”
Her: “I brought you a box… for safe keeping.”
Me: “Where did you put it? I didn’t see a box.”
Her: “I came back to get it.”
Me: “Why?”
Her: “I didn’t want to scare you.”
Me: (alarms going off in my head) “What was in the box?”
Her: “Letters… dreams.”
Me: (Thinking holy crap, this is way worse than I thought. Putting my arms around her and hugging her as she started to cry) “Tell me what happened”
Her: With tremendous pain, fear, and profound sadness in her eyes and her voice, “I… (she told me the story of her suicide attempt that afternoon)” The details of the day omitted to protect her identity, but she tried deliberately to take her own life through carbon monoxide poisoning. She didn’t want to live with the emotional pain any more. She did not see any other way out. She didn’t want to be a burden to anyone. She was “done”. And she was absolutely 100% convinced it was her only option.
Me: (doula mode) “Oh, sweetie. I’m so sorry you are hurting so much. I’m so glad you didn’t go through with it. Why did you stop? What made you change your mind?”
Her: “I didn’t want to hurt anyone”
Holy freaking crap. She almost died today. By her own volition. And I’m the only one who knows.
What does one do at this point? When a friend isn’t just depressed, doesn’t “just” express suicidal ideation (“I wish it would just end” or “When I’m gone, this won’t be a problem anymore”), but actually has a plan to end their life, or worse, in this case, has actually made an attempt, it’s a mental health crisis. You MUST take it seriously. It is truly a life or death emergency.
It’s a very delicate dance. One between getting them to the help they need and driving them further into their depression and a future attempt, one that very well could be successful.
I knew she was in a mental health crisis. Obviously. While she stopped her attempt that day, she was in no way out of the woods. She was still in crisis. She needed intervention and help. Yet at that very moment, only me and her therapist knew about her “baggage” and I was the only one who knew she had attempted suicide that day.
She needed to go to the ER. She needed crisis intervention. Her life was literally in the balance. She wouldn’t go. We talked for over an hour. Her therapist was out of the country on vacation. It was Friday night. Of course. Late. Her doctor was not the one on call, and even so, they would have told her to go to the ER.
I tried to get her to come home with me for the night. She refused. I tried to get her to let me go home with her for the night. She refused. Adamantly. She was going home to her husband, who was sleeping and had no idea how depressed and suicidal she was.
I told her I loved her, that we’d get through this together, and that she needed professional help. I made her promise that she would not make another attempt that night, and if she wanted to, she was to call me ASAP. No matter what time it was, and I’d talk to her, come to her, do whatever she needed to get through those feelings. Or she could call the suicide prevention hotline or 911. She agreed. I knew it could be an empty promise, and she’d never call 911, but I also felt I had to walk a very fine line between trust and intervention at this point. We made a plan to get together the next morning and she agreed.
Mistakes…
In retrospect, I should not have left her alone that night. Neither of us slept very well. I should have insisted on staying with her. The anxiety I had all night was nothing compared to what she was experiencing. By the grace of God, she kept her promise to me.
The next day, which I later learned, was actually national suicide prevention awareness day, we spent almost the entire day together. It was eye-opening. We talked. A lot. She shared openly and honestly about how she was feeling, some of the things in past and her current life that were contributing to her emotional pain. Some of which I had not heard before. She shared about the history of her depression, what her thought process was on Friday, the planning, the letter writing, how she went about her day, the attempt, what stopped her, and that she regretted turning off the engine. (more alarms in my head). The only thing keeping her from going through with it then or again, was that she didn’t want to hurt the people she loved.
We talked about how maybe her meds needed adjusting. It can happen that over time, they become less effective. Suicidal ideation can be an ironic side effect of antidepressants.
We talked about others I knew who had struggled with the same situation. Depression, suicide attempts, intensive hospitalization and therapy, and where they are today in terms of coping, thriving, and how they are feeling emotionally. How important support and understanding is for family and friends, but that they need to know to be able to support and help you.
We talked about how she needed more intense therapy than once a week or every two weeks to get through this rough patch. Maybe even an inpatient program for a few days to help her through this until her therapist was back. Or a daily outpatient program. I was trying to plant seeds gently, that she really needed more support and professional help, what the options were, and gently nudge her toward it.
Her therapist had NO Idea she was suicidal. No one did, except me and now my husband, also a friend of hers, who she shared with as well. She hadn’t told anyone else. My friend still did not understand why all of sudden, she was so overwhelmed on Friday that she tried to end her life. She admitted to thinking about suicide before, but this time she had a plan, took the time to write goodbye letters, bring them to me, and then follow through with an attempt. This was a big, scary change for her, and for me.
I have had basic suicide prevention training in the past and my doula training and grief support work and experience all came in handy in this situation. I had done some research for her that morning (she is not technologically savvy and in her current state of mind, would not have thought of or had the energy or motivation to seek help or information on her own) and printed some articles specifically directed to those considering suicide. They were excellent articles. She looked at one and said, “Yes! That’s it. That’s how I feel!” They were written by people who had attempted and recovered. Others were written by professionals, but specifically to the suicidal person. I also lent her some books I thought would be helpful for her. I gave her the suicide prevention hotline numbers and resources. All in a purple folder, which she drew a heart on.
I reminded her she was not alone. She wasn’t alone in feeling this way. She wasn’t alone in needing help to get through it. And that she could and would get through it. Suicide is a long term solution to a short term problem. The problem is our brains, when we’re depressed, because of the chemical imbalances in there, can’t see that it’s a short term problem, and suicide becomes the only apparent way out. But it’s not!
One of the articles included a safety plan or contract. I guided her through it, helping her to make her safety contract with me. I reminded her I loved her. I was there for her 24/7, and she was absolutely to call me if she felt overwhelmed, wanted to talk, couldn’t sleep, or felt like she wanted to attempt again. She still was not willing to share her pain and feelings with anyone else. She still felt like she was a burden to everyone, especially me. But she also didn’t want to disappoint me.
She was still not willing to go to the emergency room. She would still not stay with me or allow me to stay with her. Her husband was home though and they had plans together for the evening that she didn’t want to change. She wouldn’t be alone, even if he had no idea what was going on. She said she felt much better if she was not alone or busy. She was adamant, ADAMANT that he not know.
She did not understand how dire a crisis she was in. The depression was too profound and overwhelming. She did agree to contract for safety with me. We did it together. It concerned me that the part of the contract that said “these are the things I have to live for” was the hardest box for her to fill out.
Yet, something in her eyes, her voice, told me she was in a slightly better place than she was 24 hours earlier, but still at huge risk. It was probably the fear of breaking a promise to me that kept her alive that day. Again, I should not have left her alone, but I was still walking that tightrope of trust vs. forced intervention. I wanted her to get to the point of being willing to get the intervention.
We kept in close contact via text and phone that evening through the next day. She went to church and spent the day with her husband and working, she said being busy was good and helpful. She felt a little better. But woke at night scared and panicked not knowing why. She struggled when she was alone. She was not going to be alone at all that day or night. This was a good thing.
I called a friend who is a physician to talk about the situation in confidence and protecting her identity. She was very helpful. She, too, said close observation was really important until we could get her to the doctor or ER.
I realized my goal, what I’d been doing all weekend, was that I was trying to keep my friend alive until Monday morning, when her doctor would likely be the one to convince her she needed the hospital.
Monday was an incredibly stressful day. My friend went to church in the morning, then was going to work. I texted with her from the time I got up at 6, all morning, until she heard back from her doctor. In the meantime, I was managing a rather emotional crisis at work, as well.
Then I got the text, “My doctor can’t see me today. She told me to go to the ER. I can’t go. I have to go to work!” I excused myself from an important meeting I was in and called her. We talked. She was in a panic about work. I gently said, “if the doctor thinks you should go sweetie, you should go. We’re all worried about you. At the hospital, you can see a doctor and a therapist. They’ll help you figure out what you need next. I’ll come get you. I’ll go with you. I’ll stay with you. I won’t leave you alone. We’ll do it together.”
We talked for a while. Finally, we reached a compromise. She agreed to go after work. She agreed to let me meet her at her work so I could go with her. When I got there, she said the doctor’s office had called a few hours ago to ask if she had gone yet. I said that’s because they care and are worried about you, too. We sat in my car and talked for about 45 minutes. We talked about how she was feeling, what might happen in the ER, and why I really, really, felt this was important and necessary, even though I wished it were easier and didn’t involve an emergency room. While we were sitting there, her actual doctor called to see if she had gone yet and to try to compel her to go if she had not yet.
The ER system for depression and suicidal ideation is horribly broken
What happens next is a horror story of sorts. Our emergency mental health system is fucked the hell up. I’ve been in emergency rooms before, and this particular hospital's ER is one that personally, I’d avoid like the plague, but it was not my choice.
And truth be told, from people I’ve talked to, this is the way mental health emergencies are handled in most ER’s. It’s a freaking nightmare, especially for people like my friend, who are *just* depressed and suicidal, not suffering from drug addiction (and combative, restrained, and psychotic), schizophrenia, violent, or otherwise socially disruptive. Unfortunately, nearly everyone else in the ER that night was like that.
We arrived about 6:15 pm. She was triaged, and that was the only point at which we were separated. It was about 15 or 20 minutes. Then I was allowed to join her in the ER bay. Unfortunately, we were brought to the psych ER. Which was packed.
Because it was a psych ER, and they had no idea how much of a danger to herself she was, they took everything away from her. This is protocol. She had nothing but her clothes, which they also eventually took in exchange for the sexy hospital johnnie and pants and socks. You couldn’t have curtains pulled unless the doctor was with you, so we were forced to witness the craziness that was happening around us. It was downright scary for her. I’d seen much of it before in my 25 years in health care, but I was horrified that this was the system. It was painfully eye-opening.
Who the hell ever thought it was a good idea to bring someone who wants to end their life into an ER for “help”, where they sit for 8+ hours, alone, frightened, held against their will even if they wanted to leave (she was section 12’d, which is a precaution for anyone who is suicidal, which means with a doctor’s order they can be held against their will for 72 hours), and have to witness things that you normally would only see in scary movies? How is that helpful? How does that make them want to see that there is something to live for? How does that convince them an inpatient stay on a mental health unit (which they assume is just like this) is a good thing or something they would want to do?! Seriously? How can anyone think this is a good or helpful thing? Why can’t it change?
We saw a woman kicking, screaming, swearing, being held down by 3 people, 4 point restrained and then actually break leather restraints. She was then handcuffed to the stretcher. We saw a man come in with a huge backpack, and then the police officer confiscate 3 knives from him. He later escaped the ER. There was yelling, screaming, swearing, chaos, gawking and commenting by the other patients, and it was in overflow. It was noisy. It was loud. The energy was negative and chaotic. There was no way anyone could rest who was not flat out unconscious. It was horrible. It was exhausting to witness, let alone be in crisis yourself and having to process and cope with all that.
Neither she, nor I, are likely to ever go to an ER for a mental health crisis again. Certainly not that one. And that’s really sad.
It was close to 2 hours before she saw a doctor, who was not at all compassionate, and came in to say “It’s my job to medically clear you” put a stethoscope on her chest for 10 seconds and said, “You are medically clear, but you have to be seen by our crisis team. They’re busy, it could be a while. I’ve signed a section 12, so you’re not leaving. Then we’ll try to find you a bed here, but it’s really busy.” And she walked away. WTF?
My friend looked at me, eyes wide and full of fear, “I don’t belong here” She was right. She belonged where she could get immediate mental health support, yet unfortunately, in a mental health crisis, the ER is the gateway to *real* help. There are no direct admits to inpatient mental health programs. There are no direct admits to intensive outpatient programs. Or if they are, they are for those with established histories, not for people like my friend.
And it was the only place for her to go to get TO the help she needed. Every other person in a position to help (therapist, MD) told her she had to go to the ER.
She allowed me to call another friend (the doctor friend) to join us. We distracted her from the chaos around us, we talked, we hugged her when she cried, we watched DWTS (a nice distraction), we praised her for doing this incredibly difficult step to helping herself to get better, we asked for water for her (they never once offered), we fed her a snack when she was hungry, because she never had dinner and barely ate lunch.
We kept asking the staff when the crisis team would come. They kept saying they’d call and then we heard nothing. “Might be 2 or 3 am…” Seriously? When she’s friggin exhausted and scared and has been here for over 8 hours? How is this helping her? No wonder the other guy escaped.
The other friend left around 11. I stayed with her. I was the only visitor still in the psych ER. At one point, a nurse or sitter came by and rudely said, “You’re going to have to leave, no visitors” But she never came back. I think someone saw that my friend was not like the others, and really, she wasn’t. They saw how scared she was, how “simply” depressed she was, and how much having me there was helping her to cope. I was quiet and so, I stayed. I’d have put up quite a fuss if they tried to kick me out. Maybe they knew that too?
Finally at about 12:45 am, after asking AGAIN, when the crisis team was coming for her, the social worker came. They went off to a private room to talk for about an hour. I did some work.
They returned about 45 minutes later. The social worker asked to meet with me. We went off to the private room together and talked for about 15 minutes. She was very kind. She asked me about what had happened to make me bring her here, thanked me for being a good friend and for quite possibly, saving her life. She expressed her concern for her, mostly for the level of planning that went into it and the fact that she had actually attempted suicide. She recommended an inpatient program. Said there were no beds at that hospital, so she’d be in the ER for a while, and then either go upstairs or somewhere else for inpatient.
We went back to my friend. The social worker told her she was going to have to stay. She cried. But by then, she realized she needed the help and had given in. She really didn’t fully understand she couldn’t have left if she wanted to. She just wanted the hell out of that ER. IF she needed to stay inpatient, they let’s get this show on the road.
We hugged. She asked if she could have her phone to get a few phone numbers. The social worker got her phone, allowed her to write down the numbers and then took the phone away. She could use the house phone on the wall. The social worker said I could stay as long as my friend wanted me to, they would not make me leave. They would call her husband for her.
We talked for a bit more. She was tired. I encouraged her to try to get some sleep. She told me to go home. I offered to stay, reminding her I’m a doula, I’m used to and good at this all nighter in a hospital thing. Besides, I was now overtired and wide awake. It was 2 am. She said she really wanted me to get some sleep and she was going to try to do the same. I asked for another pillow and blanket for her, turned out the light in her bay, tucked her in with a kiss, told her I loved her and I’d be in touch. I got home about 2:30 am, but couldn’t really sleep.
The next morning she called from the wall phone to update me. She called again that afternoon to tell me they were transferring her to another hospital’s adult mental health unit. From what I’d heard about it, it was a good place for her. I thought it would be better than the unit at the hospital where she was.
We’ve kept in touch via text messages. She gets to use her phone a half hour in the am and pm, and can use the house phone other times to call. I finally got to visit her yesterday.
She’s in a better place emotionally. She has a new med and it seems to be helping. The education and support on an inpatient unit is proving to be insightful and helpful for her. Her husband and family and some friends now know at least some of the story. They are visiting her as well. Her support network has gone from two people to double digits. There is relief in that for her. She doesn’t have to carry it herself. She doesn’t have to hide her feelings. And of course, everyone is supporting her, not saying she’s a burden or a “horrible” person like she feared they would. She is grateful. Even though the work is hard and the process is long.
Yesterday, she said it was the first day she woke up and thought that she actually wasn’t ready to go home. She realizes now, with the distance, clearer head, and perspective of seeing what other people with mental illness struggle with, and the benefit of the group work and hearing other people’s stories, what a bad place she was in and that she didn’t see it at the time. She doesn’t want to feel that way again. She wants to live. She wants to get better. She believes she can now. She knows she needs more coping strategies, med management, and talk therapy. She knows she still needs a safety plan when she gets home. She is glad she is where she is, as hard as it is. She thanked me over and over. I told her the best gift she can give me is to get herself well so we can go out and celebrate the amazing person she is and her life, together.
Hopefully, she’ll be home by the end of next week. She’s already getting support systems in place with the help of the staff there. They asked her if she wanted me to be a part of her discharge planning family meeting, because I was the one who saw the need to get her to this level of help and she apparently told them how much she valued my support. She doesn’t want to bother me or make me miss work. I told her if she wanted me to be there, I would be. Not a problem. And even if I wasn’t there, I am still a part of her team as long as she wants me to be. That contract doesn’t expire. Ever.
Caring for the Caregiver
Now that it’s been a week, and I’ve had the chance to talk with her for the first time since that nightmare in the ER, I realize how incredibly stressful it’s been for me. When you are in crisis management mode, you are in that mode. The emotional impact of that often hits you later.
I barely ate or slept all week. Work has been insanely stressful as well, which of course, did not help.
I realize now, I spent 3 full days last weekend, desperately trying to keep her alive and get her to the help she needed. I did so without the full support of my husband, who disagreed with me on how at risk she was and taking her to the ER (despite the fact every therapist and doctor on the planet would likely say the same thing). And that was hard. I knew I was doing the right thing by trying to get her to the ER, but still, I felt very alone.
I realize now, I took a tremendous chance by not insisting I stay with her or taking her to the ER the day she told me, or the next day, or the day after that. And I feel guilty about that. She was incredibly unstable and that contract could have easily gone out the window in a heartbeat. It could so easily have ended differently… and this story could easily have had a much more tragic ending. Easily. And that scares the bejesus out of me. I’d never forgive myself if that had been the outcome.
And so I share this story, because it’s not just mine, or my friend’s.
It’s the story of far too many people every day. Statistically, 117 people commit suicide every single day. Over 42,000 people a year in the U.S! It’s the 10th leading cause of death in the United States. For every person who succeeds, 25 attempt suicide, like my friend did. While men are at higher risk, women are certainly not immune.
How a safety plan can help and the suicide prevention lifeline
Please, if anyone shows signs that they may be at risk for or ever confides in you that they are considering suicide, don’t dismiss it. Don’t think you alone can help them. Know the warning signs. Help them to get the help they need. Don’t tell them not to feel the way they do, they can’t help it. Get them help. Immediately. It could literally save their life.
September is suicide awareness month. I hope in sharing my story and that of my dear friend, your awareness of suicide signs and prevention is greater than it was. Reach out to someone who is struggling. No one needs to go through it alone.
