The Valedictorian of Being Dead

by Heather B. Armstrong

  “I’m so good,” I said, “that I’m seeing someone here in Utah and he doesn’t make me want to be dead.”

  “Are you kidding me?” she asked. She’d endured hours of my online dating stories and tried to help me work through why I was attracting that kind of frustration into my life.

  “Yeah, it’s nothing too serious. He’s a musician, sort of, and by day and sometimes through the night he works on film sets. We’ve seen each other a few times.”

  “What do you like about him?”

  “Well, he has a job! My God, my bar is so low. We share a common Mormon and Southern heritage, which is always nice to have. He’s a little wacky, and it’s kind of cute. But this thing happened after my last treatment.”

  “What do you mean?”

  “Well . . . my parents took my kids to dinner for the second night in a row so that I could get some work done. He texted me and asked if he could stop by and say hello. Since the kids were gone I told him to come over and, I don’t remember why, but I had run downstairs to get something from my room when he started to play some chords on the piano. You can’t escape the piano in that house. And I was about to walk back upstairs when he began playing the first few lines of a song by the Cure. And I froze. I totally froze. I couldn’t believe it, I was in total shock. Because that song—it’s called ‘Trust’—is a song I used to play on repeat in high school when David Smith broke my heart. David Smith, oh my God. In eleventh grade David compared me to Dominique in The Fountainhead so I read it and fell in love with him. This is so embarassing.”

  Mel started to laugh a little.

  “I know I am a totally dramatic hag, but hear me out.”

  “I’m sorry: Go on.”

  “Sure, I was a moody teen and just had my heart shattered into a million pieces, but you and I both know that I was so depressed in high school. I just didn’t know it was depression.”

  “You’ve been depressed since your childhood,” she confirmed, almost as if to remind me.

  “Right. So, this song—I played it on repeat for months and months. I’d lie on the floor in my bedroom in total darkness and just cry. This song was the soundtrack to my depression.”

  “Did he know this? The guy you’re seeing?”

  “NO! That’s just it. Of all the songs in the world to pluck out on a piano, of all days? That day? I haven’t heard that song in at least a decade, if not longer. He was playing the soundtrack of my depression on the last day of a treatment that had healed the worst episode of depression in my life.”

  “That’s pretty wild,” she agreed.

  “I’m not gonna get all woo-wooey about this, but shit is happening, Mel.”

  “Go on.”

  “I’m going to Paris.”

  She shook her head in confusion.

  “I remember sitting on my porch after that fifth treatment when I texted Dr. Mickey to thank him. And I was suddenly overcome with the thought that more people need to know about this. This whole thing could save so many lives.”

  She nodded and was waiting for me to elaborate.

  “And I know that you and I and my mom, we were all afraid that Jon would find out about this—about how bad my depression was—but this is too important. I want to write a book about it.”

  “Okay, first, this is what you were meant to do. That you have arrived at this conclusion on your own is huge. Two, who cares if Jon finds out? We do not care anymore.”

  “I did arrive at this conclusion on my own, yes. But one afternoon my mother could tell that I was waffling about quitting the nonprofit—Oh! by the way, I quit the nonprofit. I was going to wait to get a pep talk from you, but I died ten times instead. I am so happy to be alive that I quit my job! And I’m not experiencing any second thoughts. I asked myself, What would my therapist tell me to do? And I did that.”

  “HEATHER!” she shrieked.

  “I know! But wait! We were waiting to leave for my seventh treatment and my mother could sense my hesitation. I mean, money is a trigger for me. I had to decide if that steady paycheck was worth the ongoing panic attacks, and as I was talking through that with her, she looked me squarely in the eyes and said, ‘Look at me. Your calling is not with those cows.’ And I started laughing because she sounded like she was really angry at cows. But then I realized she was on the verge of tears. She was, like, ‘Your calling is with your sister whose children suffer from something she cannot possibly understand, and you are giving her a peek into their worlds. Your calling is with her children who now have a mom who has a reference point, who has words she can put to what they are feeling.’ ”

  “So, you’re going to Paris to write, aren’t you?”

  “Yeah. I am. The girls will spend half of their summer in New York with Jon, so why not take some time for myself and write?”

  “Heather, this is the best idea you’ve ever had. Other than agreeing to that treatment, of course. Bravo. Standing ovation.”

  “Thank you. It was an easy decision to make. Things are just easier. I don’t know how to explain it.”

  “You’re more relaxed, that’s why. And the change in your face is so dramatic that it says to me that shit is happening because you are putting out a completely different energy.”

  “That’s just it! I am! I mean, I was on the phone with AT&T, telling the customer service representative where I was going. She was making friendly small talk and asked if I was going with anyone. And when I told her that, no, I was going to Paris to be alone and write, she asked me what I was going there to write about. And I was, like, oh no. Womp-womp. Here’s where things are going to get awkward. So I told her, ‘It’s a book about depression.’ And, Mel, I mean . . . she perked right up and asked me about my own depression before launching into a forty-five-minute description of the months she spent battling suicidal ideation, how her daddy stepped up and saved her from it. And by the end of the phone call we were both crying. Because my stepdad did the same thing for me. An AT&T representative, for God’s sake.”

  “That’s what a dad is supposed to do,” she reminded me.

  “Yes. I know that now. There’s so much I know now. These people keep coming out of the woodwork, people I do not know, to talk to me about how depression has affected their lives. Over and over again I keep finding myself in these conversations. Just . . . from out of nowhere. And not a single one of them has batted an eyelash when I tell them what I just went through.”

  “How could they? Look at you. I’ve never seen you so inside of your body before. So alive. You have color in your face. And your eyes, Heather: when you walked in, your eyes told me that you’d robbed a candy store and were not worried one bit that you’d be caught.”

  I laughed under my breath and sat there taking all of this in.

  “You have to promise me a couple of things,” she said, and I could tell she was serious. “This book . . . no one knows how afraid you were about losing your kids, do they?”

  I shook my head.

  “You’re going to write about that in this book. Single parents need to hear that coming from you. Single parents who don’t even suffer from depression fear this all too often. I talk to them every day of the week. Your calling is with them, too. Don’t forget that.”

  “Okay,” I agreed, and nodded.

  “And your father—”

  “Oh God, wait—”

  “Hear me out. You and your mom and your sister and your brother all tiptoe around him like he’s some sort of land mine just waiting for you to step right on top of it. You know I think you should jump on it like a trampoline, but he’s the father out there you’re trying to reach. How many other fathers out there refuse to accept the supposed shortcomings of their children? Not that depression is a shortcoming—”

  “I know what you’re saying.”

  “Those children out there need to hear it from you, too. You are living their experience. You’ve lived it your entire life.”

  I nodded. And then I began silently sobbing for a
ll the children out there whose parents don’t believe them. We so desperately do not want to feel alone.

  We don’t want to feel this way.

  We would do anything not to feel this way. The lengths we will go to so that we no longer feel this way. I sat there crying for those of us who believe the only way out is through death, wishing we all had someone like my mother who chooses to listen and believe. I cried harder for those of us who don’t, who do not ever make it up and out of the hole. I cried for those of us stuck in the loop of the lie, that the world would be so much better off without us.

  Please believe us.

  Help us find our way up and out and back to the truth that you would not be better off without us.

  EPILOGUE

  AS OF AUGUST 2018, I haven’t experienced any sort of relapse or bout of depression in eighteen months. I haven’t had a single thought resembling, “It would be nice to be dead right now.” In fact, I still feel like I’ve been given a second chance at life. I’m still hopeful. I’m energetic, and dare I say this out loud? I’m happy.

  Recently, I interviewed Dr. Mickey in his office a few blocks away from the ECT clinic at the University of Utah. This was the first time I had seen him since I ended treatment. The fact that my bout of suicidal depression had lasted eighteen months—and that eighteen months later I was able to sit across from Dr. Mickey feeling whole and good and happy—will not ever be lost on me.

  His blond hair still looked boyish, and when he spoke I remembered how gentle he had always been during our conversations. I was asking him to explain some of the more technical aspects of the treatment.

  “Can you tell me more about ‘the abyss,’ what exactly that means you’re doing to someone’s brain?”

  “The BIS, yes,” he answered.

  “No, I mean, ‘the abyss,’ ” I clarified. “My mother took a picture of the lines on the monitor during one of my treatments to show me the line indicating my brain activity. And when it was near zero you called it ‘the abyss.’ ”

  “Well, the monitor itself is called a BIS. B-I-S. It stands for bispectral index,” he clarified. “It’s an EEG-type of machine that gives feedback to an anesthesiologist. We used that machine to target the propofol treatments, since we were using a level that is far deeper than what anyone would receive for any kind of surgical procedure.”

  He continued to explain the state of burst suppression that he and the anesthesiologist tried to achieve with each treatment. I’m relieved that I recorded our conversation, because all I could concentrate on was the thought that my mother had misheard him while I was under anesthesia during my first treatment. She thought he had pointed to the line on that monitor lingering at the very bottom and called it “the abyss.” That term made so much sense that I never questioned it. In fact, “the abyss” became so emblematic of the journey that I took with my mother through ten treatments that I had it engraved on a gold bracelet that I gave her on Mother’s Day.

  When I left Dr. Mickey’s office, I immediately texted her: “You’re going to want to sit down for this.”

  I also found out that morning that Dr. Mickey and his team had completed the first round of the propofol study. It included ten patients, all of whom received ten treatments over the course of three weeks. Of those ten—the only ten people in the history of humanity to receive propofol in this way—he said that six experienced a positive response. That included me, the third patient. Of those six, five continued to experience positive effects after three months. I don’t know how those other five people continue to feel, but eighteen months after completing this experimental study I still feel exactly as I did when I looked at that questionnaire after the fifth treatment. Had I really wanted to be dead?

  When I asked Dr. Mickey how he felt about the results of the study he said he was encouraged. “As a scientist you have to be very self-critical, that’s part of your job,” he said. “You have to be very circumspect about other possible explanations for what we saw. The results were pretty impressive, though, when you’ve treated a lot of people with treatment-resistant depression. These are the kinds of results that we see with ECT. We see a high response rate, usually very quickly.”

  Those other explanations, he told me, included things like the natural history of the disease—many depressive episodes will end on their own because they are situational. There’s also the placebo effect to consider, as well as all the attention a patient is suddenly receiving from medical staff and family members. There’s even the fasting aspect to preparing for the treatment itself. He said, “When you get these treatments you have to fast three time a week. Fasting three times a week for three weeks, does that have antidepressant effects? We don’t think so. We think that’s unlikely, but we don’t really know.”

  I’m not fasting three times a week anymore. I’m no longer spending that much time with my mother and stepfather, and I still have a list of All the Things Needing to Get Done that doesn’t ever get done. I know that my depressive episode wasn’t going to end on its own, and I’m confident that without this treatment I would still want to remain forever in the abyss. My life is as chaotic and unmanageable as it has ever been, and I am handling it.

  Dr. Bushnell now requires that I see him every three months for a checkup, and at this checkup he writes the refills for all my prescriptions. I take six different medications to manage my depression, including the original cocktail that treated my insomnia. I took all six during the treatment. Dr. Bushnell changed a couple of the antidepressants I was on because certain medications can lose their effect due to hormonal changes, physiological changes, age, and a myriad other reasons. When it was over he emphasized the importance of staying on my medication to help prevent any deterioration in my mental health. I don’t have any problems following this order. Although that may sound like a lot of medication to take every day, I feel happy now—I’d gladly take double that amount, if necessary.

  I have in the last eighteen months been invited to run several long-distance races for various worthwhile causes, and every time I have experienced no hesitation when declining the offer. Part of the ongoing “medication” for my mental health has been identifying triggers for my anxiety. I either avoid these triggers altogether or I develop habits to handle them. I have developed better ways of thinking about life. The treatment got my brain back to a place where I could start making these cognitive changes. This includes asking for help, all the time. I have no doubt that one major contributing factor to my happiness is the teenager I hired to help Marlo practice piano.

  I used to think I was good at choosing my battles. What that depressive episode taught me was that I was terrible at it. In order to manage my anxiety, I have to let so much go. This isn’t easy for a valedictorian. I have to practice letting go every single day, and it’s hard. But I do it—for myself, and the people I love, and on behalf of everyone who is fighting for their lives.

  AFTERWORD

  Brian J. Mickey, MD, PhD

  YOU’VE BEEN STRUCK BY a debilitating brain illness. A cardinal symptom of this particular disease is the inescapable urge to kill yourself, fueled by a loss of hope. Even in the face of these symptoms, you have somehow managed to diligently attempt multiple treatments that were recommended by your doctors, to no avail. You, along with tens of millions of other individuals around the world, have treatment-resistant depression.

  One of my roles as a psychiatrist who specializes in this illness is to provide hope. And there is indeed reason for hope. We have in our toolkit more evidence-based medications and psychotherapies for depression than ever before. Recent decades have brought new brain stimulation therapies such as transcranial magnetic stimulation. Furthermore, refinements of the oldest and most effective brain stimulation intervention in psychiatry—electroconvulsive therapy—have reduced its side effects and established it as one of the safest medical procedures.

  Yet, these various options still leave us wanting. For most of these potential interventions, su
ccess rates remain at or below 50 percent. In addition, side effects prevent many from trying or continuing these treatments. Adding insult to injury, poor access, inadequate reimbursement, stigma, and public misunderstanding are barriers that we encounter every day. These various challenges amplify each other, leading to lengthy depressive episodes that can go on literally for years.

  This situation has inspired scientists like myself to search for new treatments that work in a different way. If these novel interventions are sufficiently different, they might be more effective or better tolerated than current treatments. This is the stage on which the propofol study plays out.

  Clearly, Heather Armstrong is no ordinary study volunteer. She brings her individual story to life with her own unique and compelling voice. Heather does, however, have two things in common with the other participants of the propofol study. First, she was struck by this debilitating illness whose causes remain mysterious. Second, despite the illness—or perhaps because of it?—she bravely volunteered to undergo an unproven intervention in the hope of advancing medical science.

  It is important to emphasize that Heather knew that proven treatment options were available to her—albeit with the limitations described above. She was also well aware that propofol had never been tested in humans for this purpose. Although our team had reasons to believe that propofol might have antidepressant effects, we were essentially working off a scientific hunch. And she was aware that, while we considered the procedure to be quite safe, there was still a small risk of serious injury or death.

  Put in a similar situation, would you volunteer? Perhaps you would feel inspired by the potential to generate new knowledge that could someday help others. It is possible that you would trust the study team, the scientific institution, and the sponsor. Maybe you would be able to push through your symptoms, or push them away long enough, to sign that consent form and bravely step into the unknown, as Heather did.