* * *
—
ONE WAY TO get at someone’s intent at the moment of death is the psychological autopsy—where you trace back in time to get a sense of what was going through someone’s mind and whether they wanted to die. At Ian Rockett’s suggestion I called up Los Angeles forensic psychologist Michael Peck, who compares his psychological autopsies to background checks: “You interview people who knew the deceased. You find out what their life was like, what their last two weeks were like, who they talked to, what they did, what they didn’t do. And you examine the details of the death method.”33 Some methods of death make it easier to suss out intent than others: a gun to the head is obvious; a gun to the chest is a little more complicated—could have been a cleaning accident. An overdose can be even tougher to suss out, depending what the person took and how much of it and whether this was something they had been prescribed for a legitimate purpose. If a person swims too far out and drowns, determining intent could rest on their swimming abilities, their mood or emotions leading up to death. Peck classifies some things as “sub-intentional suicides”—a single-person car crash, for example. “Even hanging deaths have been equivocal,” he says. It could have been autoerotic asphyxiation gone awry. “The main way to get the intent is to interview the survivors of the deceased. It could be schoolteachers, it could be family members, it could be workplace friends. And try to get a picture of the last week or two, what was going on with them.”
Even an unclear picture, a lack of contact with other people in the days or weeks before death, can itself be telling. “Most people tend to be surprised by the suicide. But as they’re talking to someone like myself about it later on, it turns out they had more information than they knew they had. They saw things but never put it together.” I’ve heard these kinds of rear-view mirror insights from the loved ones of a suicide victim and they are heartbreaking.
Peck tells me he gets a fair bit of pushback from people, especially those closest to the deceased, who often refuse to believe their loved one ended their own life. And there’s more pushback if the person’s young. “They usually say, ‘Oh no, it couldn’t be suicide. It’s impossible.’…Our job would not be to convince them. Our job would be to give them information.”
Sometimes there are psychiatric diagnoses in a person’s past. But he won’t fill in the blanks if there aren’t—he doesn’t try to diagnose the person postmortem. But he’s unwound enough suicides after the fact to get a good sense of the most common precursors: social withdrawal and increased substance consumption—usually alcohol.
Michael Peck harks back to the halcyon days, decades ago, when there was the will to put time and money into proper psychological autopsies by trained professionals. Since then, he’s seen policymakers’ interest in suicide and such labour-intensive postmortem investigations come and go like loud music and big hair. “It costs money. So there has to be somebody willing to pay for it.”
In the meantime there’s the pressing question: What do you do while the suicidal person is still alive?
10
Getting in Trouble
It took almost four years before I got myself in trouble again. Spring of 2015. I was twenty-eight.
This is how it begins: Can’t wake up. Can’t get out of bed. Can’t escape my personal infinite void. Can’t shake off the oppressive weight that beggars verbalizing. I spend most of the day (Thursday) in a semiconscious haze and by the time I get vertical I am convinced: I have to die. I can’t countenance the prospect of more days like this, lost to uselessness and sweaty bedsheets.
There were window cleaners on my side of the building that day, and their presence added abstractly to my shame at the unmade bed, the papers scattered everywhere, the dishes lurking in the sink: I never draw my blinds, figuring I’m too high up in a neighbourhood with too few tall buildings to bother. But now I did, and eavesdropped on the faceless male voices whose language (Portuguese?) I didn’t understand on the other side of my window. After they moved on to the floor above mine the twisting rope securing their scaffold remained, grey snaked with threads of pink and yellow tautly bifurcating the skyline. And I was propelled, by imperative, to action.
I cleaned the apartment, took out the trash, recycling, compost. Paid outstanding bills. Cancelled via email a Friday morning doctor’s appointment and plans to watch a documentary with a friend that evening. Then I swallowed all the Parnate, my antidepressant, that I could handle.
Hundreds of those lovely circular scarlet pills tipped into my palms and tossed to the back of my throat. I’d just refilled my prescription and had at least six weeks on hand—about 4.2 grams of active ingredient. My gag reflex rebelled before I’d emptied the last pill bottle but I took enough—at least 3 grams—to comprise what should have been a lethal dose. Or so the papers I’d found online suggested. By this point I was being prescribed such a high dose, I’d developed a freakish tolerance for the drug.
For a minute or two I felt great. Surprisingly great. Like all conventional antidepressants, Parnate doesn’t have an immediate effect and isn’t supposed to. But I’d taken a monster amount and got a momentary high out of it. That didn’t last long. I felt very awful very quickly. Dizzy and nauseous and trembly, unable to focus on any of the fiction I’d assembled by my bed to kill time. I breathed through my nose and swallowed repeatedly to keep sloshing stomach contents from rising to greet my upper esophagus. I tried to focus my unravelling attention on the window-cleaners’ rope outside my window; on the labels on the world map on the opposite wall.
It was the questions that did it. The dumbest questions popped into my flailing mind—about labour rights and protections for people working on high-rise scaffolding; the places I’d never visited; the narrative arc of the book I’d just started (Dust, by Yvonne Adhiambo Owuor. A great read, if tough to follow while drug-addled). These were questions I wanted to be alive to ask. It’s a curious revelation—like getting a second wind when you’re about to collapse, combined with the sense of almost locking yourself out of the house. I wasn’t happy. I wasn’t hopeful. But I wanted to know things I didn’t yet know.
I rocketed to the bathroom, watery Parnate filling the toilet with vivid fuchsia. I had the sudden urge to take a photo, willed myself to grab my camera on the other side of the apartment. But I wasn’t moving. It didn’t feel like I was having trouble moving. I just wasn’t moving. Noticed from a distance that, as I washed my hands and face and tried to brush my teeth, I couldn’t stop shaking. I’d grown used to antidepressants giving me microtremors. But these were not micro. I gripped or leaned against the white buzzing counter, unworried and unthinking.
Time passed faster than it should have. I retrieved my phone and watched the minutes tick by and battery drop one percentage point at a time. Exchanged texts with the friend I was supposed to meet, who’d kept my ticket, who urged me to cab it to the movie theatre. I registered detachedly how slow I was to dredge up words, how uncoordinated my fingers. I switched to a more predictive text input method on my phone only to find myself transfixed for ten, fifteen, twenty minutes at a time by the options it suggested. What did I want to say? The conversation did not go far. I wrote “sorry” a lot. By now it was late. Or dark, anyway. I knew I should email my psychiatrist, whose appointment I’d cancelled, but couldn’t unlock my laptop. Had my password changed? Had I forgotten it? Even then, it did not occur to me that I was just messily mashing the keyboard, fingers like hot dogs.
I was intermittently awake for much of the night. I couldn’t figure out why the city lights outside had all turned deep red, then green hours later. My eyes ached. There was still a delirium-inducing amount of neurotransmitter bouncing around synaptic clefts in every part of my body, from brain to gastrointestinal tract.
The next fourteen hours are fuzzy. When I wasn’t asleep I sleepwalked or went dazed through drunken motions. I only registered efforts to reach me enough to avoid them. During a moment of semi-consciousness I tried to respond to a text fr
om my sister, who’d asked me to check out an apartment for her that weekend. Typed garbled nonsense. Much later I was shocked to find photos with that day’s timestamp on my camera’s memory card, which means at some point I must have gotten up to shoot the view from my bedroom window.
That evening: more knocking, which I ignored. But then I heard keys rattling in the door as it swung open.
I remember the desperate dismay I felt as I leapt out of bed, half-dressed, and registered the pair of paramedics and the superintendent who’d let them in. I tried to piece together who had sent them. I willed my facial muscles and vocal chords to form words that would somehow compel them to go away and leave me alone. But I couldn’t.
There’s a disorienting panic at the sudden inability to communicate, like stepping forward and finding only air where ground should be. Whatever I did or didn’t say was enough to convince them I should be hospitalized. I can’t remember what I grabbed as they ushered me out the door but I remember going to grab a book when they stopped me.
“You won’t need a book.”
Lie. Boldfaced lie. But I was in no position to argue and lacked the motor skills to smuggle out reading material.
I couldn’t tell you how I teleported to the ambulance—I mean, I assume I stood in the elevator, walked across the lobby and out the door, but I may as well have choppered out of there for all I know.
And then there I was. Back in the psych emerg at St. Joe’s—fluorescent beige assaulting my eyes, plasticky chairs stiff and sticky against my limbs, cloaked again in mortification, my poor cousin summoned by family bat signal to my side. Humiliating memories of being instructed to pee in a cup but being too drugged up to do so or to communicate my inability to do so; of getting my period in the crisis ward (do not, ever, get your period in the crisis ward) and forgetting the word for “tampon.” Then, several erased hours later, the sinking déjà vu of awaking in an ICU bed, be-gowned and strapped to IVs. My family flown in, again, freaked and teary but stoic and so goddamn loving I could not deal.
Failed suicides are not fun for emergency health workers, but I was an especially weird case. I remember having to get my blood work done a second time because apparently my circulatory, respiratory, nervous systems were functioning better than they should have been for someone with that much tranylcypromine inside her. At some point a physician returned with a scan of my brain (don’t ask me when in the previous fourteen hours that happened; I’ve no clue) asking if I’d had a stroke. It took a bit of back and forth for them to confirm that this scar tissue was, indeed, a relic of my first suicide attempt, my pal antifreeze.
The choking guilt of causing pain to those you love, of betraying the trust of health practitioners who let you remain an outpatient and fill a month-long prescription, is only compounded by repetition. Shuffling from the intensive care unit to the short-stay psych ward is worse the second time around. You know what you’re facing and you know you should know better. I was greeted by rueful nurses who remembered me from forty-four months earlier; I pretended I wasn’t such a space cadet as not to remember them.
No matter how nice you are and no matter whom you sweet-talk, if you’ve just tried to kill yourself you’re certifiable.
You’d think I’d be used to this but to have my craziness once again negate my freedom of movement was tough to bear. In no small part because the rules had changed thanks to an uptick in elopees and a couple of high-profile, outcry-provoking suicides in the region by inpatients who’d supposedly been under intensive psychiatric observation. I couldn’t wear grown-up-person clothes. I couldn’t leave the small windowless ward, not even with a chaperone. Again, I understand the public health concerns at the prospect of people like me doing rash things while in care. But even inmates in solitary confinement are entitled to an hour of fresh air a day. (They rarely get it in any meaningful way, and that’s unconscionable. But still.)
I somehow prevailed on the empathic staff psychiatrist on duty that weekend to allow me off the Form, to stay as a voluntary inpatient in the short-term psych ward. I cannot adequately express the degree to which this simple act ameliorated my life in the immediate term.
Back to the psych ward. You know the drill. Sleeplessness that defied the earplugs and meditation apps the nurses gave me. Three tasteless mushy meals a day that I pushed around my tray while engaging in reluctant fragmented conversation with my fellow inmates.
I was more honest with my kind health practitioner interrogators this time around: I knew myself better and wasn’t as desperate to prove my sanity. My expectations were low—I knew better than to expect any quick fixes—and I genuinely tried to engage in whatever treatment was put before me. I also got to know these nurses and social workers better. Talked with them about their lives, their hobbies, their teens’ growing pains, adopted children, mixed-race families, workplace politics. Most had been propelled into the field by personal confrontations with mental illness, but their career choice still astonishes me. I implored trainee residents rotating through my ward to stick with this specialization. That weird plea from an oversolicitous mental patient could well have had the opposite effect.
My psych ward cohabitants were much more diverse this time around. A young Black woman who donned her hijab as soon as she graduated from hospital gown to real clothes—imagine being told you’re too crazy for your articles of faith—asked which way was east so she could pray. It took a nurse and me a minute or two to figure it out; this would have been easier if we’d had windows in the ward, dammit. I was no longer the youngest one there. A lanky, sallow young man who worked airport security had checked himself in when his death obsession overpowered him. He was terrified he’d be fired for taking too many sick days. Another man, in his mid-twenties, had been arrested at the train tracks where he was prowling and preparing to throw himself in front of a locomotive. He was charged with trespassing (criminalizing suicidality seems like a great idea, right?) and had to call his parole officer from the patient landline on the counter. He read thick books on computer programming in between bouts of electroconvulsive therapy. They’d wheel him in afterward in a wheelchair and he’d be sleepy, slow, forgetful for a day or two. I don’t know if the treatments did their job. I don’t know what happened to the trespassing charge. I felt I’d aged much more than the three-and-a-half years since my last inpatient stint. I felt decades older than the young girls in their early twenties brought sobbing into the ward by grimly desperate families, girls who snapped at the nurses and sequestered themselves in the dim behind bedside curtains. I was suddenly the most experienced person in the ward, the one who knew the rules for different forms, knew how often the psychiatrist would come and how much face time you could expect to get.
And my family was there. Again. I marinated in useless post-facto guilt. They brought me snacks and news from the outside world—there had been a major boxing match that week; apparently the domestic abuser won. We cackled too loudly, joked inappropriately, read aloud from newspapers and made each other guess which headlines were real and which we’d invented. Another lovely thing about not being formally committed (thanks to that kindly psychiatrist) was not needing them to chaperone me everywhere. I could leave the hospital for brief stints and meet them for dinner or whatever like a normal human being. I was irrationally worried that someone from work would see me and call me out for not really being sick. But it felt so great to locomote independently.
Let the record show I was a model patient. I changed my sheets daily from the linen stacked on shelves by the washroom. I made small talk and acted like a person who enjoys other people. I tried to explain ward protocol to the uninitiated. I loaned books destined never to be returned. I could have signed myself out but stayed for as long as the staff psychiatrist recommended, even when it meant sticking around an extra weekend so I could get a more complete assessment the following Monday. Before taking off I even did a weird mock assessment with a bunch of friendly, wide-eyed doctors in training, during which I told t
he truth to the best of my ability despite feeling I was either too crazy or not crazy enough to be a representative sample. I’ve no idea if I helped or hindered their training but I got a coffee shop gift card out of it, so I win.
* * *
—
TAKING DRUGS SUCKS but my god, withdrawing from them is worse.
My psychiatrist decided my Parnate overdose indicated it was time to wean me off Parnate. So he prescribed an antipsychotic olanzapine bridge during the weeks-long washout period before moving me to a new drug (you’ve gotta wait for the old one to clear out); and that wasn’t enough to keep me from being an emotional train wreck after leaving hospital. And, as tends to be the case in downward spirals, my cognition was crap. It didn’t even occur to me to attribute this total garbage feeling to antidepressant withdrawal until someone else pointed it out. I was on vacation spending a few days at my friend Omar’s place in Portland, Oregon, so irrationally despondent that I convinced myself I needed to leave so as not to inflict my despair on him. He stopped me, and on an aimless impromptu sightseeing drive that would include visiting a Vietnam War memorial asked me what was up.
“I don’t know.”
“Are you still seeing your doctor guy?”
“Yeah….”
“Have you switched up your meds at all?”
“Yeah, I’m off the stuff I was on before but I have this weird in-between period before I can start new stuff, because serotonin—”
“Okay yeah, I think we’ve figured out the problem here.”
“…”
So that was a fun time. I had a similar experience while chasing Hurricane (later downgraded to tropical depression) Florence in North Carolina for Reuters in 2018. When my editors asked me to extend my stay I of course acquiesced, even though it meant I would run out of meds—I’d brought just enough to get me through the week as planned. I tried getting my doctor to call a North Carolina pharmacy, I walked into an urgent care clinic, I got my sister to try to mail meds but still ended up sitting shaking in the Raleigh airport, three days into going unwillingly cold turkey. Thankfully getting back on the meds swiftly recalibrated my neurochemical equilibrium. But fuck.
Hello I Want to Die Please Fix Me Page 9