Will's Choice

by Gail Griffith

  I realize that my fantasy treatment setting is more likely to be found at an Elizabeth Arden day spa than a treatment facility for the mentally ill. But I am convinced that some subtle changes could be introduced to the institutional trappings of most mental hospitals, which would enhance patient well-being and, I dare say, reduce the length of stay required for most everyone. It could be a win-win: happier patients, less frazzled health care providers, less ruthless HMOs and more solvent insurance carriers.

  Hospitalization, however, addresses a single urgent need: security. The psychiatric hospital offers a family in crisis a giant time-out. I would hesitate to say I was “parking” my son at PIW after his suicide attempt, but with no other viable options, I was counting on a team of professionals to have eyes and ears on him 24/7 for as long as it took to muster the next steps. No family, not even a family with supernatural coping skills, is adequately prepared for the challenges following a child’s suicide attempt.

  The minutes ticked by as we—Will, Bob, Jack, Max, and I—waited for the intake personnel to process the paperwork. A palpable gloom bounded off the surroundings. Will was being admitted to the same unit in the same hospital where I had spent five weeks for the treatment of clinical depression ten years earlier, in 1991—one of life’s ugly little ironies. For me, it was eerily disturbing to have him in this environment. So little had changed in the decade since I’d been there: the mauve and ivy-green color scheme (decor reminiscent of late eighties Marriott hotels), bland floral prints hung on the walls, functional hardwood furniture with shredding upholstery, and a constant shuffling population of severely dysfunctional people.

  Will too had already marked time in this facility. Following his first weeklong hospitalization at PIW two months prior, Will returned to see a staff psychotherapist, Dr. Vaune Ainsworth, twice weekly, as well as Dr. Salerian, a medical doctor, who monitored and administered Will’s medications.* Dr. Ainsworth, a lovely, lithe, fair-haired woman who looks twenty years younger than her age, exuded warmth and tenderness and had engaged Will in cognitive behavioral therapy (a form of “talk therapy”) for the previous two months, to delve into the issues and stressors in Will’s life that might have triggered or contributed to his depression. This two-pronged approach, medication plus psychotherapy, has been shown to produce the best results for depressed teenagers and children.1

  Dr. Ainsworth’s tiny office was down a corridor off the dim lobby. She spotted me as I was signing all of the family into PIW as “visitors.” We hugged, and the two of us cried.

  “I am so sorry,” she lamented. “I didn’t see this coming.”

  “I know. Neither did we; no one did.” Her evident guilt over misreading Will’s emotions and intentions made me want to comfort her.

  “You know,” she said, “the burden is on us [Drs. Ainsworth and Salerian] to figure out what went wrong with Will, how we missed this.” I appreciated her candor and empathy. Clearly, she was shaken by Will’s suicide attempt.

  Dr. Salerian entered the lobby doors and approached our little family cluster with a pained expression. Without words, I handed him the stack of suicide notes. He glanced through them briefly and turned to Will.

  “We’ll get to these soon, Will,” he said gently. Embarrassed and guilty, Will stared at his feet and Dr. Salerian disappeared through the security doors.

  The admission process dragged on. Volumes of paperwork needed to be completed before we could move Will upstairs and onto the ward; the insurance carriers’ narrow view of what constitutes a “mental health crisis” required submitting detailed histories before Will’s admission could be guaranteed coverage. The hospital’s business office made repeat phone calls to insurers, arguing the medical urgency of Will’s case.

  While we waited in the lobby, the police escorted a woman in the company of her adult child through the doors. The woman was agitated and angry and clearly did not want to be handled by either the cops or her daughter and battled with both.

  We sat on the aging couch, with its busted coil springs, and watched the passing scene with a mixture of resignation and dread. I desperately wanted to find a way to connect to Will so I could have a serious conversation with him about depression and about my own struggles with the illness. I strained to reach for a positive note, a tiny inspiring missive. Will wasn’t buying it.

  Will asked me if I ever wanted to kill myself.

  “Oh, God, sweetie, probably a thousand times over. Some years, not a day went by when I didn’t figure the only way out of the misery was to end it,” I confessed. “Do you remember when I was here when you were little? You were only seven. I was here because I was so depressed and suicidal your dad and Dr. Salerian thought I was a serious risk to myself, and I checked myself in voluntarily.”

  “So, Mom, what kept you from doing it?” Will asked.

  “I couldn’t do it because of you and your brother. I wanted to end the pain—just like you do—but I couldn’t abandon you. It would have been a betrayal of everything I believed about mothering you guys—and I loved you so much. Even when I’m depressed, I know that the two of you are what matters most in my life.” Such is the redemptive power of motherhood. At my lowest moments, the thought of my children kept me alive.

  I had my arm around Will and stroked his hair while we spoke in hushed tones; I was trying to soothe him, trying to soothe us both. I had never seen him look so dejected, so sad, and so trapped. He did not want to be back at the psychiatric hospital; for the past three days the entire family had been handling him with kid gloves, soft-pedaling our opposing emotions of hurt and relief, but these emotions were outsized and I am certain Will was able to intuit our despair over the course of action he chose—and I am also sure he felt guilt and shame. Moreover, now he was back in this pathetic institution, in psychiatric limbo, with no clear end in sight.

  “Will, it’s too early for you to appreciate this insight, but, I know you will recover from depression—it’s a stupid fucking illness, but there are cures.” I told him that I had gleaned some knowledge of depression, which caused me to think more positively about certain aspects of the disease.

  “Oh, right, like what?” His skepticism was warranted. Depression isn’t an illness you would wish on anyone, nor would you suggest it offers ancillary benefits in ways the medical establishment has yet to define.

  “Well, in my experience, I think I am able to see things differently from other people. I don’t know; this seems a little vague, but I think over time, depression has allowed me to sense things with an intensity I don’t think I had before. Do you understand what I’m saying?” I asked. He didn’t look at me, but his body language suggested that he was trying to absorb the conversation.

  “Maybe because you’re more exposed, more raw—more open,” I continued. “I do think I’m a more compassionate person because of the depression. You will be too, Will. I don’t want you to think of this as a total loss. I honestly believe there are some colorful bits to the experience that you can’t get anywhere else. Maybe a better understanding of who you are.”

  Will resisted making eye contact, but his head relaxed on my shoulder.

  “You don’t see it now, Will, but there is a light at the end of the tunnel.” At this, his posture shifted. I could tell he was spinning the metaphor. Several seconds passed, then: “Mom, if I thought there was a light at the end of the tunnel, I wouldn’t be depressed.”

  His insight hammered me. “My God, he’s right,” I thought. That is the crux of depression—how do we conquer the sense of futility that becomes the disease’s inescapable mantle? How do you crawl out of the breach when there is no incentive to do so? A first-time sufferer of depression doesn’t have the inventory to know, “This will pass, I will recover.” And what about a teen, whose limited experience of life consists of a catalogue of expectations about the future? Will was wise beyond his years, but it would be a long time before he learned there is life after depression. But how on earth did he get to this point?
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  Recently I was at my local bank branch making a routine withdrawal when I was invited by the branch manager to discuss ways to optimize my meager certificate of deposit. The bank manager was a man I’d never met, who I estimated to be in his mid-forties, vital-looking and confident—the ideal personality profile for sales. After pitching the bank’s new products, I reluctantly confessed that I was not in the market for new accounts, that I was husbanding the small amount of cash in the certificate of deposit, as it gave me the liquidity I needed while I took the year off to write a book.

  “Really, what about?” he asked cheerfully.

  I always wince slightly when asked and try to gauge how much information to reveal. It’s not like writing a book about historical figures or politics—as everyone is wont to do in Washington.

  “I’m writing a book about teen depression and teen suicide.”

  He sucked in a breath. I had caught him off guard. His posture and demeanor shifted noticeably.

  “My daughter’s fifteen,” he said, slowly punching out the words. “She’s been diagnosed bipolar and she cuts herself.”

  “Oh, my God. I’m so sorry,” I empathized.

  We spoke for several more minutes about his daughter and he unfurled a familiar litany—evaluation, testing, and misdiagnosis; academic failure and poor high school counseling, discovering his daughter’s self-destructive behavior; slogging through the maze of therapy and medication; the effects on the rest of his family; and even, he confided, the toll his daughter’s problems was taking on his marriage.

  We swapped names of doctors and programs and I wished him and his family well before I headed out of the bank, unnerved by his confession and evident pain.

  I do not often elicit casual confidences; I am not that sort of person and Washington is not that kind of town. But I have found over the past year that whenever the topic of this book comes up in conversation, among friends or with strangers, it dredges a bed of sorrows I did not know was out there. Those who are touched most directly morph into atoms of anxiety as they recount a son, daughter, or grandchild who has been caught in a similar downdraft. Not only does the subject touch an exposed nerve, but almost everyone I meet has a story to tell of a teen in serious trouble. And it causes me to ask the obvious: What is happening to our children? What changes has our culture wrought over the past thirty years to precipitate this cataclysmic shift in our children’s well-being?

  I can only surmise that it’s no one thing: it’s not just more drugs, more alcohol, violence on television; it’s not the heightened emphasis on consumerism or the rapid pace of communications; it’s not the surge in single-parent families; it’s not the failing schools nor the lack of community or sense of shared values. Some or all of these factors play a part, but it is no one thing, and to suggest otherwise is both disingenuous and delusional. And as I struggle to make sense of my own child’s history, sorting for clues and causality, I find it is as tangled as a batch of crossed computer wires.

  You look back at your child’s brief history and it is as though you are viewing it through a kaleidoscope; the recollections are fluid and mutate into several variations on one particular episode you thought you knew by heart. If your child is struggling, you are looking for markers from the past: Was it the time we laughed at him when he told us a flying saucer had landed on the playground? Or the time you called to say you missed your flight and you weren’t going to make it back in time from a trip out of town to be there for a birthday? Was it an overly harsh reprimand or changing schools in the seventh grade?

  And then there are the gut-wrenchers, the seismic traumas: You announce to the children that you and your spouse are getting divorced. Or that a sibling is seriously ill or that you are moving halfway across the country and they will be forced to leave friends and family. And if you and your children are still intact by the time they are ten or twelve, their kaleidoscopic histories split into multiple fragile splinters and spin away from you.

  If your teenage child falls ill, or is hurt or traumatized by forces you think you might have handled better when he or she was a child, inevitably you wonder, “What did I do wrong?” But like depression, the answer is that it is probably no one thing—no single event but a combination of events, mixed up with biology, genetics, and social pressures. Nonetheless, parenting today raises the bar on self-inflicted guilt.

  My son was elfin. He had light-brown feathers for hair that flew away from his scalp in opposing directions, and with saucer blue eyes and a Cheshire cat grin, he was impish and adorable. And he played tricks on us from the get-go.

  With all due respect to the medical establishment, everything we learned from our doctors about the baby we were expecting in the fall of 1983 proved to be wrong. First, there was the matter of Will’s sex. Repeated sonograms led our bright young team of female obstetricians to pronounce that the baby in utero was a girl. Baby Susanna.

  We announced the news to Max, who began to divvy up the toys for his little sister-to-be (trucks would be all his; she could have some of the stuffed animals), and I began to contemplate how to introduce a pinkish cast into our household hitherto dominated by brown-and green-hued guys.

  Midway through the pregnancy, our obstetrical team began to show concern because I was carrying higher than normal levels of amniotic fluid. Max had been delivered by a lovely Dutch obstetrician in her sixties, whose vast experience and claim to having brought thousands of babies into the world were a perfect match for a first-time mother. But her practice had expanded to meet the demands of Washington’s baby-boomer moms; she hired a new team of well-educated, eager young doctors and she retired from the practice of obstetrics. The fresh crop of obstetricians rotated in and out of my pregnancy, depending on who was on duty on any day. When flags were raised signaling possible trouble, the prospect sent the obstetrical team into overdrive, but not in a patient-friendly way.

  Given their limited experience, an anomaly—a pregnancy with risks and challenges—was something to get excited about. For them, my atypical pregnancy was intriguing, a medical mystery, and we were sent home from frequent checkups with flyers about spina bifida and hydrocephalus and other developmental abnormalities. The team could not agree on a plan of action. At five months, with a viable pregnancy in the works, termination was no longer an option. Some highly experimental in utero surgical interventions were posited and then taken off the table. As the parents, we were both frustrated and profoundly anxious.

  By the seventh month, I was so unhappy with my doctors and with their lack of clear guidance that I sought out my first obstetrician, the Dutch doctor. With her vast wisdom and experience, she quickly downplayed the risks that I’d been led to believe were evident and reminded me, “My dear, there are no guarantees in pregnancy.” She continued, “These days everyone expects—no, demands—beautiful, healthy, perfect babies. I wish it weren’t so, but pregnancy and birth always carry risk. That’s why we call it ‘the miracle of childbirth.’” She was right. Risk is a given. Bringing new life into the world is the ultimate roll of the dice.

  At the next appointment with my medical team, I announced, “Look, you haven’t given me enough evidence to conclude that we’re up against an elevated risk of a severe abnormality, so we’re not going to entertain the possibility anymore. I’m going to bank on the odds that this baby will be well.” I closed the door to further discussion and awaited my baby’s birth.

  Will was due on November 22, a few days before Thanksgiving. My mother flew out from California and began baking and lavishing attention on Max, our earnest and intense two-year-old. December 1 came and went and still no new baby. In profile I looked like a Volkswagen beetle. I was massive, sluggish, and impatient for the event to be over.

  My doctors and I had agreed that if it appeared we were dealing with a large baby—a baby weighing over eight and a half pounds—we would resort to a caesarean section. Going into the last two weeks of the pregnancy, several members of the medical team assured me tha
t this baby was at most eight pounds. Once again, our Will fooled us.

  The doctors decided to induce labor on Wednesday, December 7—a full two weeks after the due date. I was exasperated; they were increasingly concerned about the baby’s status. Nothing was going according to plan. My mother was scheduled to return home on the tenth. Unless the baby came soon, she would have come and gone without ever having set eyes on her new grandchild.

  In retrospect, once we were past the due date, I wish I had lobbied harder to induce sooner. December 7, Pearl Harbor Day, “a day that will live in infamy.” If dates of birth bestow symbolic meaning, I should have argued for the sixth, the Feast of Saint Nicholas, a jolly sort of day, rather than a day marked by a bloody American humiliation.

  The birth did not go well for either of us. A chemical drip designed to trigger labor guaranteed that contractions went from zero to sixty—full throttle. No gradual warm-up, the way nature likes it to happen.

  “God, I remember now how this feels, and I remember I didn’t much like it the first time,” I told Bob. “Lock me up if I ever bring up the subject of more children.”

  By 7:30 PM, I had demanded and received an epidural, which took the edge off the seismic contractions—but only temporarily. The team doctor assigned to see me through the birth voiced concern that the baby might be larger than gauged earlier. I thought, “Dammit, here we go again. Why can’t they get this right?” There was talk of a caesarean, but at 9:00 PM, we were wheeled into the delivery room to see if a combination of pushing and forceps could manipulate the baby through the birth canal.

  At 9:30 PM, Will emerged—partially. His head exited, but his shoulders were stuck. The doctors had badly misjudged his size. He was a huge baby. The obstetrician wrenched him free by extricating and then yanking his right arm out of the birth canal. There was a snap and what sounded like a small animal gargling. She had broken his collarbone in order to extract the rest of his body.