Suicide… It’s Not About Dying !

Tonight we learned  that Robin Williams is dead, and the consistent information is that he took his own life.  Social media being what it is, there are many comments.  Most are of shock and acknowledging the incredible talent and genius of a brilliant actor and comedian; another  who is gone too soon.  There are some  comments that are just rude and clueless.  But there are also those who just don’t understand how someone could get to the point of feeling that it was just time to give up on life, that it was too painful.  That there is no hope in sight, and that the people closest to him/her would be better if he/she was just gone… Thank God most people don’t understand what it’s like to be so far down in a pit of ‘no hope’ that suicide makes sense.

Suicide isn’t as much about dying as it is about wanting the pain to stop.  The cause of the pain isn’t really that important, though addiction is often a component.  Alcohol, drugs, eating disorders, gambling, etc. are ALL ways to numb some sort of emotional pain.  I worked as an RN in drug/alcohol rehab and adolescent psych for years, and nobody ever listed death as the main reason they considered suicide.   I had a good friend (also a co-worker) who was so solid in his sobriety and recovery  when I knew him.  He became a well-known therapist in the city where we worked.  Recently, I found out that he killed himself a few years back , while  I  was searching for him online, hoping to reconnect.  He had great local resources about where to get help (including where he could get away from town for treatment).  He knew the warnings… and yet, he relapsed into drugs, and overdosed in an amount that was said to be inconsistent with an accident.   I was able to find a close friend of his who could help me fill in the blanks, enough to know that something happened to take him into that dark hole of depression and relapse. Those are never good together.

With Robin Williams, he had resources and had recently gone back to treatment for a ‘tune up’ of sorts, knowing that he was feeling a need to protect his sobriety, not that he’d relapsed  (common knowledge).  He was getting help.  None of us know what his pain was from.  We look at the professional aspect of the man and can’t make sense of what could have been so bad in his life that he decided to give up.  But even if we knew the ‘reasons’, for most, the decision to end one’s own life will never make sense.

In 1982, I was battling an eating disorder, and got to the point of feeling very overwhelmed and unable to see that things were going to get better.  I don’t remember wanting to die.  I overdosed and was in a coma for 3 days.   I was lucky to have survived, and was able to get past those feelings of just wanting to go to sleep so I didn’t hurt (in my situation, nutritional ‘rehab’ was a huge part of clearing up my thinking).  I remember taking the sleeping pills, but don’t remember ‘death’ being my goal.  I don’t remember taking the 50 antidepressants.  I don’t remember the ambulance trip, or anything else until  I woke up in ICU three days later.  At other times, always when dealing with eating disorders, I would find myself in a mindset that didn’t see an end to the overwhelming hopelessness I felt.  I would feel myself on the edge, and yet I didn’t ever want to die.  I just didn’t want to feel so much pain.  It’s an incredibly dark place to be… and there’s a feeling of loneliness that has no words to adequately describe it.  Even with people in my life, they didn’t understand what was going on in my head, and the surrounding circumstances made things more isolating.

For those that don’t understand, please be thankful that you have no frame of reference for that kind of despair.  Please look around and see if there is someone who might need a quick phone call or note to say that they matter, and to just check in to see if they’re OK.  If someone you know has changed and either seems really down, OR suddenly ‘up’ after a period of severe depression, see if they’re really OK.  When someone makes the decision to give up, sometimes they are so relieved at making the decision, that their mood improves.  That type of ‘improved’ mood (sudden) is an alarming sign.  Gradual improvement is more likely due to good treatment ( medication for the biochemical issues, and/or psychotherapy to resolve emotional pain).  Don’t be afraid to ask direct questions.   When someone approaches from concern, it’s unlikely that it will make a situation worse.

Clinical depression isn’t sadness.  It’s not about ‘reactive’ grief that many people will feel during their life when they lose a friend or family member to death, or the loss of a job, pet, or if someone moves away who had been a part of daily life.  Clinical depression is often a biochemical disruption to normal thinking and feelings.  Hopelessness and helplessness become so pervasive that the ‘normal’ way of seeing solutions to problems just doesn’t work.  While suicide is a permanent solution to temporary despair, it doesn’t feel that way to someone who finds it  worth considering.  It doesn’t feel temporary.  It’s kind of like being too far underwater after falling off of a boat, and wondering if getting to the surface is ever going to happen… like there’s no air left in life, and no ability to feel that the surface could be reached with just a couple of kicks to reach the air that restores hope. Even if getting back on the boat is a ways off, at least there would be air.  It’s like treading water UNDER water, and never getting closer to the surface.  It’s hard to withstand that type of hopelessness and helplessness for a long time, and each person has their own threshold for how long they can hold on.

People can’t snap out of it.  They can’t just go pop in a funny movie and everything is OK.  It’s a disease, that needs treatment, and  support of friends and family that understand that the person is doing the best that they can.  And when the ones who are depressed are finding themselves going further from their normal way of looking at life, they need someone who can help them hang on…

But sometimes, it just isn’t enough.   And those left to make sense of the loss  will never have a good reason to satisfy the ‘why’ questions that inevitably come up.  It definitely isn’t fair to those left behind.  And while it’s something they have to live with for the rest of their lives, it really wasn’t about them.  Sometimes, there is nothing that will redirect a tragedy.  But nothing can take away the good memories the person leaves behind… always remember the good.

Working Drug and Alcohol Rehab…Voluntarily !

I worked at a great drug and alcohol rehab facility for about 2 1/2 years (minus a few months when I was sent for eating disorder treatment).   When I tell people I worked with drunks and junkies, I get a look that hollers ‘Ew’.  But it was great!  We had people from all over the country and several other countries come there for treatment. One arrived by limo after landing in a private plane, most came through a nearby large airport on commercial flights, and one person arrived on a bike with a backpack and everything they owned.  Addiction doesn’t discriminate.  Doctors, lawyers, nurses, construction workers, homeless, wealthy… didn’t matter. They all needed help. Many were really nice people and quite enjoyable to get to know, even during a really hard time in their lives.

People who end up addicted to drugs and/or alcohol are just folks.  I’d be really surprised if there are any people out there who don’t have someone in their family who is addicted to something, or know of someone by name who has addiction issues (my family has had its share).  Nobody decides to become an alcoholic or addict.  It’s not a lifelong goal they set out to achieve when they’re kids.  It’s a disease.  That doesn’t excuse them from their behavior- but it does give a reason. And the addict/alcoholic is still responsible for their actions, and consequences of what they do when loaded.  They’re also responsible for the decision to get help.

To the average person, the amounts of substances that were ingested by our patients sound unbelievable.  I admitted many people who took 70-80 Vicodin a day, or drank 36 beers in 24 hours, a quart of vodka in a day.  Their admitting blood alcohols (breath tests and blood samples) were often .300 and higher, and they were talking fairly well.  I remember one youngish patient who blew a .500+, and while not doing well, had stable enough vital signs to not ship him/her to the medical hospital; he/she was that used to being bombed at that level.   (I can’t give anything away that is identifiable about a specific patient).

The doses of stuff we gave these folks (depending on what they were primarily detoxing off of) were generous.  We didn’t want them to suffer any more than they already did. If they were willing to come for help, we wanted to help them.  Many people say let them suffer.  What that does is send them back to the bottle or pills (or needle) because the symptoms of detox are just too much.  It keeps them sicker longer. The most cruel detox I ever saw (repeatedly) was from methadone.  The medication meant to get someone off of heroin is worse for detoxing than heroin, which is bad enough.  I remember one patient who spent three weeks in active detox; the acute phase of heroin detox is a few days.  There’s no comparison.  They’re all miserable, but looking at all of them  from the outside, methadone is the worst, hands down.  I’ve been given methadone for chronic pain, and it scares me to death.  I never take it two days in a row, and generally only once every few months.  I wait until I know that I can’t get by with something less potent.

Many addicts started out with pain medications for legitimate physical pain.  But addicts generally have a different reaction to drugs.  Most non-addict people get sleepy from opiates (narcotics) and alcohol; addicts and alcoholics often report feeling energized.  So, they use them for non-pain related reasons.  There’s the problem. Pain medications aren’t ‘bad’…it’s when they are misused that they are an issue. People taking legitimate prescriptions by the label instructions aren’t likely to get addicted (less than %6).   There may be some tolerance that builds requiring increased doses to be prescribed, but that’s not addiction.  Addiction happens when someone is using something for a reason other than its intended use, has negative consequences for using that substance, not stopping when they have negative consequences, denial, and the inability to stop on their own.  There’s also the psychological need for the substance to help deal with emotional pain.   It’s not ‘just’ someone who wants pain relief for physical disorders.  I have never met an addict that didn’t have emotional pain that was deeply rooted, and they didn’t have any other coping skills with which to handle them.

I am often looked at with skepticism when I report pain (I haven’t had a pain-free day in about 17 years).  SO I stopped, except when I see the board certified pain management doctor I  see – who doesn’t prescribe over the phone, never changes doses without an exam and face-to-face discussion, and who has the right to obtain random drug tests or no longer see me, should I refuse (which I wouldn’t do).  I like it that way. In the days of some people misusing narcotics, it leaves those with legitimate pain diagnoses hurting, which is to make the %94 who won’t become addicted suffering unnecessarily because of the %6 who misuse the prescriptions, and seek illegal or bogus ways to get the drugs.  But that’s a whole ‘nother blog. 🙂

Sometimes things went badly either during detox, or during their last hurrah on the way to the facility. I sent a couple of patients by ambulance before they even started their admission paperwork because they couldn’t stay awake enough to get basic information and give ‘informed consent’.   One person showed up dead on a different shift.  Glad I missed that.   Another patient  forgot to let us know that sleep apnea was one of their diagnoses.  That person woke up to paramedics grinding their knuckles into their breastbone.  I’d tried waking that person up in various ‘deep’ ways, and got nothing.  That person refused to go to the ER.   If  they were awake enough to complain, I felt better.   Another patient ended up septic from IV drug use infecting the lining of his/her heart. The night nurse (a temporary weekend nurse; the regular guy was good) didn’t know that a decrease in fever to a sub-normal level, after having a significant fever, was a BAD sign and said that the body was decompensating into septic shock, which is lethal if not treated.  I couldn’t get out of report fast enough to go see that patient, who was seriously ill. The local hospital really disliked the detox patients (I worked there, also; it wasn’t a bad place by any means, but detox wasn’t their thing, like septic patients weren’t going to get the proper treatment at a detox center), but they got that patient  for a couple of weeks.  More IV antibiotics were required after he/she returned to complete treatment with us.  Another blew the blood vessels in their esophagus, hemorrhaging blood all over the place; he/she survived and it scared him/her into taking things more seriously.

The facility I worked at had a good rate of recovery, but many addicts/alcoholics from any treatment center go through relapses. Sometimes they make it back to rehab, and sometimes they die in their disease.  That’s sad.  I got the call one weekend from one of the guys who arranges admissions to go get the medical record for a young person who had been in the facility before and was coming back, only didn’t figure that one last fling in the hotel before readmission would be fatal.   The admissions guy needed the kid’s (20’s) parents’ phone number so he could notify them.  That was really sad.  We got news about the deaths of other former patients as well.

I had a neighbor  (no confidentiality issues) who could have benefitted from alcohol rehab.  He lived directly next door to me; our front doors faced each other in the apartment complex.  He was stupid drunk at least 4-5 times a week.  I saw some lady walking him home one afternoon; he’d wet his pants. Another night, the police were at his front door.  Through the peek hole, I could see he was naked as a jaybird, just standing there talking to the officers until one of them suggested he go get some clothes.  It didn’t occur to my neighbor that standing in  his open front door, naked, was inappropriate.  I got tired of talking to him when he was drunk.  He always had the same conversation over and over again.  He asked me one night when he wasn’t drunk if I was mad at him.  I told him no.  But when he was drunk, I wasn’t really talking to him- I was talking to the booze, and if that’s what I wanted to do, I could go to the convenience store on the corner, and chat with the Bud Light in the cooler.  That stopped him cold, but it did nothing for his drinking.  I moved away, and have no idea what happened to him.  I left him a ‘Big Book’ from Alcoholics Anonymous and the phone number for the local chapter in his door when I left  before dawn, that morning I moved.

Addictions nursing is actually really rewarding.  All specialties of nursing have sad aspects, but watching someone get their life back in order and work through the pain that go them to the point they reached in their addictions was pretty cool.  They’d come in broken and deeply hurting, and leave with hope and a support system of any alcoholic or addict that they encountered in the 12-step meetings they had been attending. The actual steps they were working on were giving them a second chance at life, and even the early changes were amazing, and an honor to watch.