Monday, September 10, 2012

September 10 - Suicide Prevention Day

A bit of a gloomy post today...

It's been brought to my attention that September 10th is Suicide Prevention day. It doesn't feel great to have a lot to say about this but I do.

I remember the first one I lost to suicide. Then I remember the second, the third, and possible fourth. And then I think of myself.

When the first beautiful soul left this world, I was devastated. I resolved to make the loss of her life count – I wanted so badly to continue living for her. It didn't last.

The second entered and left my world in a very short time but had a great impact. A brutal end to an amazing life. Through the loss of her life, I was brought to know one of my closest friends. That makes my life richer but doesn't make the loss of her's okay.

The third had helped me through the grief I went through with the second – slipped away during her sleep; who's intent was never discovered. Had she wanted to numb the pain that was particularly intense that day and just “sleep it off”? Or had she really just wanted it to stop completely? We'll never know.

By the third suicide, I had become jaded. I'm alarmed to say that I had accepted that this would be the end for about 20% of my friends who struggled with eating disorders and possibly for me (this is not a supported stat about suicide, just something I came up with in my mind to "prepare" for the losses I might endure).

Yeah, me too. I had a history of adolescent suicide attempts that were scary at times, but never like what I experienced when I really reached the deepest state of hopelessness as an adult. As a teen, I was asking for help without words, I knew it and I got help. I was also very impulsive but when I reached one Spring, where taking my life was actually the only solution I could see, it was completely different and I wasn't acting completely on impulse.

People seem to wonder why they didn't see it coming when they lose people to suicide. I asked myself the same thing about my friends. What had I missed? From my perspective, I see my own attempt as having had a very drawn out prelude which had actually been identified the year prior. For some it may be impulsive, a reaction to something. I can only explain my side of my story because I lived to talk about it...

I didn't see my ED as a form of suicide until 2010. Prior to that, I understood it as expression of all the things I couldn't say as well as an identity. When I gave up on any hope of recovery and was finally told by the provincial ED program that I was “chronic” and going to have to learn to manage my life with an ED, I translated chronic to terminal. I researched how long it would take me to die from starvation and acted according to my research. I didn't tell anyone this but I was approached at one point during a rapid decline, by someone who asked me if I saw that I was actively committing suicide in front of everyone. Of course I knew, but hearing it made me realize how unfair that was. Therefore, there had to be a different plan. No one needed to watch me die, it was bad enough that someone was going to have to find me one day.

At that time, I knew I had to leave where I was living – with my sister – and find my own place if this was the route I had chosen. However, I was scared. I knew I didn't want to die but I had accepted that that was what was going to be the result for me.

This is not okay and I know I'm not alone in this acceptance. There is a quote from Dr. Gabor Mate's Realm of Hungry Ghosts (though not Mate's words): Where there is life, the possibility for renewal exists.

I didn't understand that.

The descent into complete darkness took over a year. It explains why my weight loss slowed considerably and I allowed it too – I had resolved that it was just a long, slow, walk towards death and decided that if I could be a learning tool while I lost my battle, I had to allow that to happen. There was no rush to achieve a "goal weight" because I knew I would get there eventually or at least die trying.

Death from an eating disorder is not easy when you are allowing people to intervene (allowing...I have to use that term loosely because there were usually two options: cooperate and be admitted voluntarily and maintain some privileges while in hospital or be certified – I usually chose the elective route). Eventually, it was one frustrated comment that sent me over the edge and brought me to the attempt to hasten the end but it wasn't just that one comment alone, it was over a year's worth of thoughts, plans, and hopeless resolve. Had I been successful, there shouldn't have been any “What went wrong?” but inevitably, there would have been – that's just how it is for people left behind.

People often wonder what someone plummeting from a bridge or building thinks, if they could, would they turn around? Perhaps those are questions that the impulsively suicidal person asks. For me, I had planned and calculated what would be most effective. I guarded my loaded “shot gun” for about 2 years. When the day came, I researched some more and somehow, but the grace of something, I miscalculated somewhere and was just a few hundred mEq from “success”. Once I realized this, I understood I had two options with three potential outcomes: go to hospital and be saved again; or wait and see what happened which would have likely been a) the desired dead outcome or b) a PVS. The PVS (permanent vegetative state) scared me enough to go to hospital. Why? Because I knew that if I was in a PVS, I would be fed and therefore become a fat person without a voice or mind. In that respect, my eating disorder may have saved me!

Because I tend to go about things a little differently, I knew that the treatment for my particular situation may not be common knowledge in our ER. I believed my GP knew the treatment but I had chosen this day because he was out of town for the weekend (the planning was excessive as you can see, I didn't want him to be the one to pronounce and on the flip side, he knew me so well, he may have intervened on a gut feeling) – and so, I researched some more in case I needed to help guide any staff.

This was my most humiliating presentation to emergency and I will come back to touch on this reality in a little while.

I told them what I had taken and waited...then I laid out what I understood to be the next step.

Google proved to be very helpful at this point. :)

People speak of having their stomach's pumped, I've never had a tube down my throat for that but I suppose we effectively pumped my stomach with the first 5L of PEG lyte that I was instructed to drink quickly. I knew this was the first step but I didn't know that it was going to act as a powerful emetic. So, with 2 large bore IVs started - one in each arm - nurses popping in from time to time as I projectile vomited into a metal bowl telling me things were “going well”, I sat, otherwise alone, on the stretcher with the curtains open a crack so the nurses and doctors could see me.

Then they approached me with The Tube. I thought it was just a normal NG feeding tube and I wondered why they were so keen to feed me when my ED was not the primary complaint this time. In my delirious state (as I had also sedated myself significantly more than usual because I had been prepared to sleep through my anticipated cardiac event) I certified that they were not intending to feed me – they were not. No, this happened to be a naso-jejeunal tube that needed to be inserted to effectively “irrigate” my gut.

At this time they prepared me for transfer to ICU and I was encouraged to call my parents as no one knew I had come to emergency:

Hi, Dad. I have overdosed on *******. I have been treated in ER and they are moving me to ICU. I don't need you to but they say you can come if you or mom would like to. I'm going to be fine.”

End call. They came.

I was told I wouldn't get much sleep that night, was connected to monitors and IVs and another pole that hung the litres and litres of PEG that would clean out my gut. For this, there was no simple activated charcoal drink...

With my parents by my side, white knuckled as they watched what had to happen, I moved from the bed to the commode all night with any dignity I had left completely lost because as time progressed I regularly did not make the transfer.

More blood work...more telemetry print outs...more calls made...bags of different solutions hung.

Then came the D50 (IV dextrose solution) and insulin. I had anticipated this intervention also but again, ED had a little spaz – didn't they know how many calories were in one gram of dextrose and just how many they were pushing into me compounding it with insulin so that I would absorb every last bit of it?! Why were they trying to make me “fat”?

Three times we had the same interaction until I was stable enough. With the ever-patient ICU nurses explaining the necessity of this treatment, I would uncross my arms and sob as they did what they needed to save my life. It worked and eventually I was sent up to medicine.

That's it. I survived. Of course the story continues for a few weeks longer spent being followed by a guard or on complete bedrest with a 1:1 nurse. I remember that was the first time anyone had come into my room with two injectable sedatives and said, “I have your *** and ***. Do you want it in your arm or in your butt?” I also remember how I cried for days wondering how I could even screw up suicide – my plan had seemed fool proof. Eventually I got it together enough, endured refeeding again in addition to coping with having survived and figured out the right words to say to go home.

Returning to the embarrassment I felt when I chose to go to ER. It is important to understand that presenting to ER at anytime required humility on my end and it happened frequently, perhaps approximately every 2 weeks with various situations. However, when I knew I had to present as an active, obvious suicide attempt, the shame I felt was almost unbearable and nearly kept me from going in. In my subjective world, everyone was judging me and I felt that a suicide attempt – and asking for treatment of it - was the ultimate display of weakness.

I also knew that some people would see it as a “cry for attention” or at best a “cry for help” and it was neither of those. I had all the help and attention someone in my situation could have possibly been given. I wanted to be dead. I wanted the pain to stop. I wanted people to be free of the burden that was me.

The way I saw it was that the pain that people might naturally experience following my death may have been more intense for a while but much shorter lived than having to exist with me in my deteriorating physical and mental state for what could have been years. I wanted to die for me, yes, and I believed I was "weak" enough to succumb to suicide but on the flip side, the part of me that didn't want to die, justified that end by viewing it was a favour to others.

This thought was thoroughly disproved when I “came too” emotionally, after a few days recovering from my “failure”, and I looked at those around me: the pain and desperation that racked my parents' faces the few times they visited me in hospital before I was shipped out and over the next weeks as I recovered physically; the deteriorating physical appearance of my family as they walked through these weeks with me likely sleeping little and crying a lot; the disappointment in my doctor's eyes when he walked into my room after his weekend away and saw my state (disappointment may be the wrong word, perhaps a bit of exacerbation but always coupled with compassion); the nervous chatter of friends who came and went graciously during visiting hours to distract me; and more. No one blamed me or seemed to judge me but I saw the impact of my survival and had a sense of what the impact of a successful suicide would have been like – just a tiny idea.

It wouldn't have been better for anyone.

I had classic signs in the beginning and remember journaling about them without recognizing them. I gave away very special belongings with thoughtful intention to close friends, and family, and other things to strangers. I also made an effort to have fun and photo-document good times with friends so that the last pictures of/with me would be of happier times and things that people could look back on with smiles and fond memories rather than photos of a very sickly looking me. I don't know that had I seen these behaviours in someone else that presented the way I did (as positive as possible in my interactions; verbally very hopeful; etc.) that I would have seen them as warning signs or as improvement for that person. I did my best to hide the mental and emotional decline and I think I did a fairly good job as when the actual attempt happened, people did seem alarmed.

I know from an adolescent perspective what it is like to feel impulsively suicidal and act on it and am thankful for what I survived then. As an adult, I had the one obvious attempt to take my own life. I also struggled for over a year with significant self harm during which I severed veins and watched myself bleed until I was too weak and dizzy to stand. In that regard, I am very thankful to have not hit arteries and to have had the inner strength to, again, go to emergency or call a nurse when I needed medical attention.

Knowing my own story, I wonder how many people lose their lives to apparent suicide when it's really some other form of self-sabotage gone wrong. I wonder who felt too much shame to go to ER, especially in a smaller town where everyone knows who you are. I wonder what angels out there spent years plotting their own demise. I didn't have a letter written to anyone or any obvious signs of imminent suicide after a while. Some people have times and dates which may or may not be recorded. If someone had read my journals prior to my attempt, they would have likely intervened earlier. Does that make it okay to read the private writings of someone you are scared for? I'm not sure. Should one choose to go that route, I can say I would have hated you and would have been high risk for a longer time after an inevitable psychiatric admission as I was resolved, determined even, to end my life. Are you ready to take that on? To be the receiver of vicious words, to possibly lose your relationship with that person for sometime. Can you help find the support they need to get them through and past the acute time of suicidal ideation? I would hope so. It can be completely exhausting to deal with someone who's at the end of their rope but it can be overcome and quickly for some when they are brought to understand that not only does their life have value but that they have the support to make it through and beyond.

Be aware also, that to have a certification lifted in hospital, one needs only to convince a practitioner or two that they are sane again and capable of safely continuing on in their environment – simply lip service in a compliant patient. I convinced enough people that I was okay prior to really feeling safe with myself and was allowed to leave the hospital. Thankfully, always, I have/had the family and care providers I did to really monitor me closely.

Brushing off an attempt as a cry for help is minimizing the experience for someone like me. I didn't want help, I realized I had messed it up and needed to pick up those pieces before I moved onto something more effective. I didn't want/need attention, I had enough of that that I hated already.

Please, don't ever take it lightly. These are human lives at risk and they can be helped.

By a bit of luck, a lot of inner strength, and amazing support, I survived and can talk about what it was like for me. Can it prevent one person from losing their life? Who knows?

It was during this time that my family got in touch with the program that eventually proved to work for me. I laughed off the idea of going to Europe for treatment - as if I was worth that much effort! But the evidence of people's belief in me to really get well began to sink in over the next few weeks. My parents wanted this for me, they knew I needed a lot more help than I was getting and they knew I was desperate. Thankfully, they saw past the darkness that had taken over to the little glimmer of light and hope that every, absolutely every, living, breathing human being has. I was brought to the program and people that could effectively channel that light and hope, guard it, and help it grow.

It took a team of countless people, each with vital roles and the team had to include me.

I reached the brink, put one foot over the edge, and was brought back. I look back with absolute relief. I know now that death would not have been better for me, or for anyone, and I am ever in debt to the universe for my survival. I'm so grateful that I pulled through all that I did and that I have been given a chance to really live my life. At the time, I was sick physically, I was a handful in all ways to put it lightly and I think it is safe to say that everyone was exhausted. So, at the time, one can see the appeal of releasing everyone – myself included – from what we were dealing with.

I don't think suicide is ever simple. For me it built for a long time, for others I'm sure it was completely different.

If you see the signs, reach out to the person, or to others if you are the one entertaining the thoughts. Above everything, that person needs to know their incredible value as a member of the human collective; that mistakes happen and lessons can be learned and moved on from and contribute positively for years following; that to feel and be weak and overwhelmed at times is simply human; that feelings including loneliness, heartache, guilt, sadness, anger, and all other unpleasant emotions pass and in themselves, are never fatal; that no one is so flawed that they don't deserve a place on this earth; that pain can be worked through and overcome.

Beyond identifying the people at risk, seek out the help needed for that individual. It exists and it might not be readily available. Know the people in your life.  Listen to your intuition, if what you read in a text or hear from a professional doesn't sound like it would fit, keep searching. Above everything, keep that person safe until you have found the people or place that can bring them back.

I believe that there is very little that cannot be overcome together.

If you are scared for your own life because of the thoughts and impulses you have, please find someone to be with and talk to and do not be disheartened if/when you are brushed off. You need and deserve help and it is out there...keep looking – often it is closer than you think. Don't forget that professional helpers are not the only people who can walk next to you through your painful journey. It can be shared with any safe person.

Life lost to suicide is unacceptable in my opinion. It can be selfish, in some instances, but that is not always the case.

Finally, to the rest that have already been left “behind” by loved ones who ultimately lost their battle against their mind, there is healing. The footprint those people left never goes away. For me, I had to stop analyzing what happened and just let it be, feel the horrible feelings and keep moving forward. So, keep walking, keep living – because you can.

1 comment:

  1. You are a very good writer Julia and even though the subject matter is a difficult one, you make it an "easy" read. I have contemplated suicide for years (25, maybe 30) when I have been in the abyss of depression (in fact that is how I know I am getting "bad" is by the start-up of ideation) so I know that side of it but have never made a truly conscious plan, or an attempt.

    I find my thoughts turning cynically these days especially where I live as the "attempts" are seen so often. They come in, we patch them up as best we can and send them back into the same environment that fashioned the desperation, and become frustrated when the events repeat.

    I do not pretend to know the answers but I do realize that I can empathize with the struggle even if I force a necessary remove for my own sanity. Keep up the good fight and realize as you have that there is something out there for all of us to hang on to even when things seem particularly tumultous.