Will's Choice

by Gail Griffith

  Until now I was only peripherally acquainted with personal tragedy and I was utterly unprepared for the depth of emotion I felt. It is the overwhelming force of grief; none of us is ever adequately prepared.

  A sound that I can only describe as primordial surged up from the base of my throat before it burst forth into a baleful, foreign wail. The noise was accompanied by a noxious taste in my mouth. I wanted to vomit. I was trapped in someone else’s bad dream.

  A nurse moved us to a “quiet room” down the hall, and there I sat doubled over and wept uncontrollably until I was numb. Jack tried to comfort me, but I withdrew to such a sorry place, not even he could reach me.

  After a short while, Will’s suicide notes in hand, we reentered his hospital room like soldiers returning from a bloody military defeat. There he lay, twitching and mumbling. Perhaps the Haldol was finally beginning to grab hold, or maybe he finally wore himself out; at last he was starting to wind down like a busted toy.

  I stared at him from the foot of his bed, arms folded across my chest, face swollen and wretched from crying. “How could you have done this, Will?” I whispered. “How could you have done this to us?” I knew he couldn’t hear me. Just as well—my voice was full of reproach. And even though I was engulfed by a profound sorrow, I sensed the oscillations of competing emotions—anger and relief—germinating somewhere down deep.

  Now we knew. Now the medical team could work to make sure we didn’t lose him.

  The overdose triggered a condition called serotonin syndrome, the result of Will’s ingesting an estimated 1,300 milligrams of the drug mirtazapine (trade name: Remeron). One of the newer classes of antidepressants, mirtazapine is akin to serotonin selective reuptake inhibitors, or SSRIs, a cluster of drugs assumed to be less toxic in an overdose than older antidepressant medications.

  Nonetheless, complications of serotonin syndrome include seizure, coma, hypotension, and metabolic acidosis (a disruption in the normal alkalinity of blood and body tissues), which can lead to organ failure or cardiac arrest.

  If I thought about any of the negative outcomes for too long, I became catatonic with fear. So I turned to the task at hand: it was time to make the calls—a telephonic chain letter of bad news.

  “Could you please get in touch with so-and-so [grandparents, uncles, aunts, family friends] and let them know?” It was a mournful undertaking, each person reacting to the news with a mixture of shock and grief.

  Will’s father was somewhere in the air, winging his way across country. My heart ached for him and I realized he must’ve been over-wrought in transit limbo. He checked with Jack between connecting flights and learned about the suicide notes.

  Jane, Will’s stepsister, was on the road, halfway to her college in Charleston, South Carolina, when she got the news. She wanted to turn around and come back, but Jack talked her into sticking to her journey. “I saw him really late last night,” she sobbed. “He was just joking around with me and I thought he was writing stuff in his journal.”

  Doctors and nursing staff continued to come and go. Every few hours a new clinician would be on the scene and we were forced to replay the episode—what happened and how we got here. No one at this juncture engaged in prognostications. The physicians in charge were in touch with the National Poison Control database and researching the literature available on overdoses of Remeron. But there was no reliable information on the drug’s lethality—it was too new, we were told. And from what they knew of mirtazapine, Will’s reaction to an overdose was atypical.

  Will’s vital signs were stabilizing, but the staff was still on alert for any sign of organ failure or hyperthermia. It was too early to assess whether or not he would suffer permanent damage to his body or his brain as a result of the overdose. So we sat there, in the dimming light of early spring, in his hospital room, communicating in hushed tones with various anguished family members who called via the hospital switchboard as soon as they got the news. We were wretched and spent.

  At around 6:00 PM, Will’s aunt and uncle, who live in the nearby suburb of Silver Spring, Maryland, joined Jack and me. Will’s cousin Stephanie, their fifteen-year-old daughter, was one of three friends with whom Will spent Saturday night bowling.

  Saturday night, Will had come home just before 11:00 PM, reported that he had a good time, and appeared to be in good spirits in the hours leading up to his overdose. My in-laws told Steph what had happened on Sunday afternoon; my poor niece was devastated. I was anxious to ask her what had gone on Saturday night. Did something wacky or unpleasant happen that would have prompted Will to try to kill himself? Did he and Megan have a fight? Nothing in Will’s behavior the night before indicated he was feeling awful. Like the rest of us, Stephanie was utterly stupefied. Will had fooled us all.

  As he lay unconscious in the hospital bed next to my chair, I decided to open his suicide notes. I counted on them to offer clues.

  Will wrote four notes: one addressed to his father and me, one to his brother Max, one to his girlfriend, and one addressed to “friends and family.” He was thorough and meticulous, ticking off all of the relationships he valued. I opened the letter he wrote to Bob and me first. After my first read-through, I was astonished. The note was shocking—not because of what it said, but because of what it didn’t say.

  Will wrote that we were the “best parents in the world,” and that he couldn’t have been happier. He thanked us for all we had done for him and signed off with love and a postscript asking us to give the monies in his savings account (a total of nine hundred dollars) to Harry, the wasted vagrant who hung out next door to our neighborhood Safeway.

  Feverishly, I opened the others. They were identical in tone. To his girlfriend he wrote, “Don’t worry, there’ll be blue skies around the corner” and “I’ll always be there for you—watching you from somewhere up above,” and he instructed his older brother, “When you have cute little kids of your own, Max, be sure to tell them about their uncle Willy.”

  My God, he had written the frigging Hallmark card version of suicide notes. The writing was sentimental and flowery—and not the least bit revealing. They were surreally horrible. What made him think these would be an adequate apology for his exit? I was disgusted and disturbed. “How could he have done this without a good reason or a clue?” It was chilling. Did he think that was all there was to his life?

  He even went so far as to write a blanket acknowledgment for “all of you I may have not mentioned by name,” in the note addressed to “friends and family.” “This isn’t the Academy Awards ceremony, Will,” I chided him mentally. “These are suicide notes!”

  I shared the letters with Jack and Will’s aunt and uncle before I stuffed them into my purse. Their reaction was the same. “What on earth was he thinking? There’s nothing here.”

  It was 7:00 PM. We hadn’t eaten all day. My clothing reeked and I didn’t know what to think anymore. Will lay unconscious, but his breathing sounded normal and his heart rate had gone down. Hospital protocol in the aftermath of a suicide attempt required a duty nurse be stationed in the room to monitor him twenty-four hours a day. We could break away for a while without leaving him alone. And there were details we needed to attend to.

  It was 2:00 PM on the West Coast when my son Max phoned his father and heard the news of Will’s suicide attempt from Melissa. He immediately rang me on the hospital phone in Will’s room. Gagging on sobs, Max pleaded me to allow him to fly to Washington immediately. “I’ll even pay for it myself,” he implored. Since he was in the middle of midterm exams in his first year at Berkeley, I hesitated momentarily before consenting. It was devastating to hear him so torn apart. The boys were very close; it would do Max good to be able to be with his brother—and it might do Will some good, too.

  Max had plenty of time to pack and hitch a ride to the airport for a red-eye flight from San Francisco later that night. I called United Airlines, explained the situation, and drained my frequent-flyer account to cover a round-trip ticket, but of
all things: now we needed to rush to the United Airlines counter at National Airport before closing time so that they could issue the ticket in Max’s name.

  Details of modern life were beginning to mingle in the midst of our grief—frequent-flyer accounts, conversations with airline agents, where to lodge family and how to feed and transport them, hastily assembled plans—going through the motions as though it were a death in the family, a funeral.

  Bob was due to arrive at our house sometime after midnight and Max would arrive at Dulles Airport at 7:00 AM Monday morning. Both sets of grandparents were deliberating whether to fly out from Southern California; John would spend the night with Charlotte, at her house in Glover Park, but he wouldn’t be going to school the next day. Jane made the eight-hour drive back to Charleston, South Carolina, shaken and distraught, and we decided it best that she remain at school for the time being.

  Wearily, I gathered up the debris scattered about Will’s hospital room—empty Styrofoam coffee cups, orange peels, a half-eaten bag of Fritos from the vending machine, a section of Sunday’s newspaper, and hospital admission forms. I kissed my son on the forehead and tried to smooth his hair.

  “I love you, Will. You have to know I love you,” I whispered. He emitted a low growl and struggled briefly against the wrist restraints.

  I glanced back one last time as Jack and I crept out of the room. It was dark outside now. The bile-green numbers emanating from the heart monitor were all that lit the hospital room. Tubes snaked in and out of Will’s body, weaving their way into the stringy, worn fabric of the cerulean cotton blanket. Here was my child, my son. Any mother’s son.

  7:00 PM, March 11, 2001

  Only nine hours measured in real time, but, oh my…I had traversed a galaxy’s worth of light-years from the sobering instant when I opened the door to Will’s room. The cataclysmic events of the morning and afternoon settled over me like a thick, wet mantle. I felt heavy, dirty, cold, and slow.

  Will’s suicide attempt forced me to reevaluate all of the fundamental precepts: love and family ties, parenting and relationships, wellness and treatment. I had trusted my instincts and, boy, I could not have been further off the mark. Would I ever feel grounded again? Would any of us?

  Jack and I trudged up the iron stairs, up to the deck and the back door of our townhouse. Odd, everything looked just as it had when we tore out of there for the hospital at 10:30 AM. Since my life had been rearranged during the course of the day, shouldn’t we have been returning to an altered physical structure? Same pictures on the walls, same houseplants in need of watering—even dirty dishes the kids deposited in the sink sat collecting soap grunge and caked egg yolk from breakfast that morning.

  I plopped down at the banquette in the sunroom off the kitchen with a cordless telephone and address book open in my lap, but I could not bring myself to make another phone call. Here, at this table—not even twenty-four hours ago—Will and I had our last conversation.

  “We should eat something,” I murmured, and Jack asked if I would eat a pizza if he ordered one.

  “I don’t care. Go ahead.” I poured myself a glass of red wine and went upstairs to take a bath.

  As I lay in the bathtub I was roiled by recollections of the previous evening: Will left the house at around 6:00 PM to go bowling with his friends. When he returned, I heard him park our Jetta in the carport off the alley and climb the back stairs of the deck. I was sitting at the banquette off the kitchen, reading. He opened the back door, flashed me a smile, and folded his gangly limbs into the banquette and sat across from me. I put my book down and we chatted for a few minutes while he fiddled with a laminated salt shaker that needed refilling. His voice was even and upbeat. With evident glee, he boasted that he bowled in the hundreds two games in a row.

  I gazed across the table at him and it struck me what a great-looking kid he had become. At six feet and still growing, he might have evinced the awkwardness that comes with that age, but his usual demeanor was one of quiet confidence, and his steady, clear blue-eyed gaze made him appear open, honest, and older than his seventeen years.

  He was an easy kid to love, an easy kid to be proud of. Still, after the hellishness of the last few months and his struggle with depression, I watched him with the intensity of a feral cat, always looking for signs of vulnerability, points of weakness—tiny markers that would point to depression.

  I threw out a cautious line of inquiry: “You seem like you’re feeling better, sweetie. How are things going for you?”

  In the last ten days his mood had improved visibly and I was hopeful that the antidepressant medication was finally bringing him some relief.

  “Yeah, no…I do feel better. Yeah, I really do,” he offered with a reassuring smile.

  I beamed at him and he kissed me on the forehead before joining Jane and her friends in the living room to watch the NCAA Tournament. A few minutes later, I went upstairs to bed buoyed by our exchange and his apparent progress. I thought he was on the road to recovery.

  How do you recognize a suicidal teenager? What are the characteristics of an adolescent at risk? There are a surfeit of markers, and for better or worse a teen who may be actively contemplating suicide exhibits the same indicators as a teen who is diagnosed “depressed.” Depression symptoms include

  change in eating and sleeping habits;

  withdrawal from friends, family, and regular activities;

  violent actions, rebellious behavior, or running away;

  drug and alcohol use;

  unusual neglect of personal appearance;

  marked personality change;

  persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork;

  frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, and fatigue;

  loss of interest in pleasurable activities, not tolerating praise or rewards.1

  Similarly, according to the American Academy of Child and Adolescent Psychiatry’s Teen Suicide Fact Sheet, a teenager who is planning to commit suicide may

  complain of being a bad person or feeling “rotten inside”

  give verbal hints with statements such as “I won’t be a problem for you much longer,” “Nothing matters,” “It’s no use,” and “I won’t see you again”

  put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings;

  become suddenly cheerful after a period of depression;

  show signs of psychosis (hallucinations or bizarre thoughts).

  If you are parenting a teenager and reading these lists for the first time, you will be confounded by how many of the symptoms listed—not all, perhaps, but a fair number—are manifestations of “normal” adolescence. Low self-esteem? Disregard for authority? Mood swings? No kidding. These characteristics go with the territory of adolescence.

  How does a parent determine when a child is depressed or just behaving “age-appropriately”? Are these lists of indicators helpful? Are they even accurate predictors of suicidal impulses? If you were attentive to all of the indicators, symptoms, and markers, would you have enough information to preclude a son or daughter’s suicide attempt? I am not so sure, but it is a start. And that, in and of itself, is disturbing.

  Noted adolescent psychiatrist Dr. Harold S. Koplewicz, in More Than Moody: Recognizing and Treating Adolescent Depression, goes deeper and explores the “factors” underpinning a suicide attempt. Koplewicz looks for

  an impulsive personality;

  biological factors such as neurochemical imbalances;

  lack of strong family ties;

  social factors such as social isolation, a recent suicide by someone close or in the same community, or absence of strong taboos about suicide;

  easy access to and familiarity with guns

  agitated mental state.2

  But Koplewicz reminds us, “Little can be said about diagnosis that is hard and fast. There i
s no gold-standard medical test for depression.”3 The same can be said for a teenager on the verge of suicide.

  Parents are left in a precarious limbo, forced to evaluate a sweeping range of qualifiers, weighing “normal” adolescence against the slight deviation that crosses the line into “pathology.” And we are forced to undertake this analysis bereft of solid guidance or support from the experts and institutions best qualified to come to our aid.

  2

  PULLED FROM THE WRECKAGE

  “What the hell happened?” I puzzled. I lay immobilized by exhaustion and despair in tepid bath water. A cloud of suspicion floated to the surface of my consciousness: Could Will have disguised the depths of his depression, horded his meds, made peace with friends and family, and plotted a permanent escape? Or maybe this was the dreaded “rollback phenomenon” psychiatrists see in some patients, who, in the early stages of recovery, experience a sudden surge of renewed vigor and energy—and, perversely, an uptick in suicidal thinking. As bizarre as it sounds, a person previously incapacitated by major depression and lacking the energy to act on suicidal impulses suddenly feels good enough to commit suicide.

  “Suicide euphoria”—a term bantered around in the therapeutic literature—characterizes this sudden mood shift, which transforms a person in the throes of a serious depression, making him appear brighter, calmer, and more positive in the days or weeks leading up to a suicide attempt. A “tip” for families concerned about a suicidal teen on the American Psychiatric Association’s Web site offers:

  Teenagers who are planning to commit suicide might “clean house” by giving away favorite possessions, cleaning their rooms or throwing things away. They may also become suddenly cheerful after a period of depression, because they think they have “found the solution” by deciding to end their lives.1