Friday, July 14, 2017

In The Land of White Bandages

These are a series of vignettes I've written over the last several months. 

Our country's most successfully decorated Olympian: 
Michael Phelps 

Did you know Michael reached a point of severe depression, in which he seriously contemplated and planned his suicide? He had been smoking a lot of marijuana, was consuming alcohol excessively, and then proceeded to get arrested for driving while intoxicated. These events all played out in the public eye. In his own words: 
In the immediate aftermath of that DWI arrest, I cut myself off from family and other loved ones and “thought the world would just be better off without me ... I figured that was the best thing to do — just end my life."

At the age of 30, before her worldwide fame and renown, J.K. Rowling, author of the beloved Harry Potter series, had survived an abusive marriage, was divorced, diagnosed with severe clinical depression, and also reached a point of seriously contemplating suicide.

I can't remember when I started sharing these stories in my groups-but I've watched the shame abate from the eyes of many (teenagers especially) as they recognize fame and achievement don't serve as effective remedies or masks against depression and distress. As they imagine a reality in which Harry Potter might never have been penned, there is a little spark that does not go unnoticed as they begin to recognize their own lives have many chapters ahead to unfold.


       At the first hospital, I watch the patrol car pull up outside. One of my former coworkers comes through the sally port door with his partner, escorting my patient. He gives me a professional nod and the slightest trace of a smile. We are too focused on the situation at hand, to be distracted with small talk or catching up right now.  "10-15, attempted 11-28 in traffic, 38 history" the officer says to me quickly, quietly, and solemnly in policese. I nod sadly and step out of the enclosure to consult with one of the other clinicians, and to grab the breathalyzer. When I reenter the sally port, our PNA is preparing to wand the patient and lead them through the metal detector. I begin my introduction and spiel: "If we take these handcuffs off, I need to know you aren't going to try to hurt yourself, or hurt any of us...will you agree to that?" 

After the police officers exit, all of my senses are honed and heightened as I watch for any signs of danger. The team is aware of where we are each standing, our proximity to the patient, and our hand positions. The initial clinical assessment is brief and needs to be very accurate. My team needs to be kept safe, the patient needs to be kept safe, and my clinical judgment needs to be thorough and sound before I give the okay for us to proceed into the hospital. Adrenaline rushes through me as I gauge for lucidity/psychosis/mania/acute drug withdrawal...any sign that violence could be imminent.  Imposter syndrome makes a momentary entrance into my psyche and shivers its way down my spine, and as I mentally chastise myself for the defeatist thought, it passes as quickly as it came. "St. Michael, the Archangel..." My silent prayer is always the same as the door closes behind us, and we all walk down the hallway toward the evaluation clinic.  


       At the second hospital, the following day, it is a sunny dawn as I pull into the parking lot. Par for the course, I've already spilled a little coffee on myself (truly, a daily occurrence). A momentary rush of love warms me as I walk past the Jesus statue, with his arms outstretched like a welcoming orchestra conductor. "You and me, Lord...give me your strength for the day, and guide my words and actions."
It's a little sacrilegious, I know, but sometimes I imagine the statue is animated, giving me a little wink and thumbs up (like the buddy Christ from Dogma) complete with a "you got it, babe!" 

I make my way through the doors, as various doctors, nurses, technicians, and other hospital personnel rush past me through the hospital corridors. As I walk by some of the bleary eyed night shift staff, I am tempted to give them a high five as we pass one another. They hand us the metaphorical race batons with a "tag, you're it, go," as we prepare to sprint our leg of patient care. My hand moves up to my forehead to make the sign of the cross as I rush past the chapel. An unknown coworker smiles and beckons to me from the elevator she is holding.

My spirit is very tired today. Of my own doing. I haven't taken a day off in a long time between the two hospitals, and the much needed ├╝ber introvert alone time to recharge has been fleeting. There is a secret spot on my floor, to be alone for a few minutes nestled amongst some plants. I begin to pray for the patients I am about to work with that day. My thoughts drift to some former and current coworkers from several agencies who are participating in a suicide awareness event tomorrow. 

As my eyes close, a rolodex of names flips through my mind...all
the patients and clients I have worked with over the years who have completed suicide. The many souls I have privately mourned in my HIPAA shrine of solitude...tears and prayer as I've read about their deaths through the years...or watched their faces staring back at me from local television newscasts, or heard a coworker whisper to me at shift change, "so and so was found dead last night." Internally, I scream. Internally, I weep. Internally, I feel defeated and curse the darkness. Externally, I convey barely perceptible emotion, a deep sigh and slow metered head shake left to right. The conversations often feel like a hellish version of Groundhog Day. "What?" I exclaim to the nurse.  "So-and-So was just here a month ago, and was doing so well!"  "Yep," "I know," the nurse responds with heavy familiar resignation and her own obligatory head shake. Duty affords us only that brief exchange and acknowledgement, as we each have pressing patient duties to attend to.  I stuff the news down somewhere in my compartmentalized mental landscape, to deal with later.

There was a facebook post on a friend's wall called 'describe your job in a sentence.' What popped to my mind was "cheerleader against death, in the land of white bandages."  I didn't post that on the social media thread. It's morbid. It's gallows humor...a way to joke and make light, a strong mental defense, so as not to drown in the sorrow of so many peoples pain. 

It hurts, Anastasia. Everything hurts. Tears stream down so very many faces. My eyes have grown accustomed to the sea of bandages; to the carved up arms and legs, to the ligature marks around necks, to the seizures from the toxicity of overdoses, to injuries I never fathomed before being here. When they tell me everything hurts, they are never referencing just their physical injuries. 

Life is hurting. Living is hurting. Everything seems like too much, and they are so weary and bone tired of fighting to live one more day of painful misery. Sometimes, they vent and dump their rage and sorrow that they were unsuccessful in their suicide attempts. Furious to have woken up on the other side of an overdose, a crash, a hanging, slit wrists. Often embarrassed, they feel deep shame at what their families and friends will think of them, and what they have tried to do to themselves.

The next few weeks will involve helping each of them to come up with plans to support their recovery, to attempt to inspire them to hold on one more minute, hour, day, through the depths of the gripping convince them there are reasons to have hope for the future. Our teams work diligently to provide the best care we can. We strive to be effective healers, empathetic listeners and encouragers, and try to provide connection as they grope their way out of the blinding depression/anxiety/mania/etc... 


       Sometimes, I feel like a sommelier of suicidality. This type of therapy for major depression with suicidal ideation...that type of therapy for borderline personality disorder with suicidal ideation, this intervention for mania or psychosis with suicidal intent.  It's really tough work...individualized trial and error to help someone find the right breakthrough and will to keep holding on.  

When I was much younger, people would often praise me ("I don't know how you can do that job, I could never do something like that!") for work that involved exposure to a lot of horror/suffering and things not spoken about in polite society. Their words once spurned me on to work harder...mentally arming myself with a badge of determination-tough, hardcore, able to withstand whatever was thrown at me, bring it on! It fed my pride quite terribly. But, I was naive, and ignorant then, and blithely unaware of the cumulative effects of vicarious trauma that would level me several years later.  

Now I am much older, painfully wiser, and incredibly realistic. I am in a profession that breaks my heart all the time, in a vocation that once in awhile leaves me crying alone in a utility closet after I've simply heard and sat with too much pain. But I wouldn't change my life in the trenches, nor the ability of keeping my heart soft, open, and malleable. I never want to be able to look into a pair of broken eyes, and listen to a shaky voice telling me about what it was like to be trafficked, while possessing the capacity to return that gaze with a blank stare, and a deadened internal response of numbness. The day that ever happens, is the day I need to walk away from this work.  
Time has taught me not to bottle the pain of what I hear for more than a day, and it has also stripped away any vestige of belief that I am super human in what I can handle. Sometimes, I simply need to cry, pray, listen to music, go for a drive, and then I am fine. I've learned to cling tightly to all the simple joys my life affords me, and diligently and unapologetically practice self care.   


       One of my dearest and best friends is perhaps the most naturally empathetic man I've ever known. He might argue that being true, but it doesn't change the fact that he is. I lovingly call him 'a real life Gilbert Blythe' (If you've seen Anne of Green Gables, you'll be able to imagine the level of kindness and goodwill he possesses toward others). After grueling work weeks, I will habitually begin a lunch excursion with him by exclaiming in exasperated frustration, "I'm done! To heck with this! I'm going to go work at Nordstrom!" He will usually smile at me with an amused and knowing expression and join me in a sigh. He gets it--- as his vocational demands, and the suffering he has to sit with are equally grueling. 

Once, when I was ticked off that God kept putting so many people in my path when I was feeling like an empty cistern, my friend said very matter of factly, "Anastasia. There is no vacation from vocation." 

It is a sentence I repeat to myself often when things really sting or my heart is particularly black and blue. The phrase reminds me that this isn't my work at is God's. I may be one of the associates in the vineyard, but I am neither the vigneron, nor the vine. 


       Awhile ago, a woman I had worked with since her early childhood, (through various agencies) completed suicide after taking another's life. Thinking about this woman through the years has bothered me for the entirety of my adult life. When I met her as a child, and after spending time with her, she went quickly into the category of "child I had no idea what to do with, or how to help." I was once in a situation with her when she was a teenager, in which she got a hold of a weapon, and had an opportunity to take my life, had she been so inclined.  Because I was a constant figure in her life (one of the few), she chose not to harm me. But I will always remember watching her eyes make the determination as to whether or not she would follow through. She chose to hurt someone else later in the day.  

I believe we are made in the image and likeness of God, and that we are each inherently good. Yet, there have been a handful of children I have worked with over the last twenty years that seem to contradict that truth in every manner possible. It's not merely a matter of traumatic experiences and attachment issues shaping their reactions, nor merely a lack of empathy in their character; not even demonic possession...rather, it is an absolute and sheer delight in harming others, seeking violence at every turn, with no traceable or discernible qualities of what it means to be human. To cope with exposure to this thing the mind cannot process, I used to semi-joke, "well, Ted Bundy didn't wake up an adult. He was a child, and those lacks would have shown up for him in childhood as well."

Once, a coworker strongly upbraided me for saying that I believed this little girl was going to grow up to become a monster. What an absolutely heartless thing for any decent person to say about a child...especially after multiple paragraphs of me waxing poetic about empathy and hope. But I have worked with thousands of traumatized children with emotional disturbance, and there remained a handful, the one percent extreme that I could never internally reconcile or ever be at peace about. 

She did, in fact, leave a tornado in her wake, and sowed seeds of destruction and violence everywhere she went. She committed horrible and heinous crimes, society loathed her, everyone who worked with her eventually gave up on her, and some even wished her ill. I spent years praying for her, knowing with certainty that she would die by her own hand, or someone elses very early in her young adult life. I remain haunted that some of us could see her trajectory from the time she was a small child, and could do nothing to stop it-or stop her. I am haunted by the theological confusion she caused for me for so many years. I am haunted that we were right about her early death, and I am haunted imagining what her last moments on Earth were like. Haunted, until one day, finally choosing in my utter powerlessness, to turn her over completely to God's mercy and providence. 

Age and wisdom bring freedom from the bullshit they teach you in school, "you must never take your work home, because if you're thinking about a case on your off/personal time, it means your boundaries aren't strong or solid enough."  Granted, cases shouldn't be invading one's thoughts frequently or daily on off time, but if one's profession is to be steeped in tremendous suffering, if it is to really connect with other humans in their pain to steer them through darkness, if it means hitting your knees every day pleading with God to do something to help them, for their anguish, the chance of it always being nicely contained and wrapped into a small eight hour bubble is very slim. Especially, when you see and work with the same patients/clients throughout their lifetimes.


       There have been and continue to be many beautiful moments encapsulated in my heart and in this work. I pause in the grocery store as a former adolescent patient bounds toward me with her friend. "OMG, that's totally my therapist! She's so rad."  I can feel myself grinning uncontrollably from ear to ear at the compliment I overhear...what higher praise from a young one? She excuses herself from her friend and before I know it, she throws her arms around me in an excited hug. She whispers to me, "I'm doing really good. Really. I mean it. A lot better! SO much better than before." She smiles at me warmly, waves, and skips off with her friend in a fit of teenage giggles. 

And I keep smiling to myself the rest of the way home.