I didn’t stop crying after they left. I sat in a chair feeling like I was going to stop breathing at any second. The man who had checked me in sat with me briefly, half-heartedly comforting me. I remembered that somewhere here Will was in the same building and I asked if I could call him. The attendant said no and left me to begin waking up the residents.
Slowly people began to emerge from their rooms, and those who were sleeping on the floor were harshly instructed to put their beds away. According to hospital policy, when you first arrived you had to sleep within sight of the desk, until the staff determined that you were not a threat to yourself or anyone else.
I was moved to a living-room type area. I sat on a couch and continued to cry for the next few hours, although I barely remember what happened, I just remember crying. Most of the other kids operated as if I wasn’t there, but a few stopped and introduced themselves. One kid told me cheerfully that there was “another girl like you here,” and when I asked what she meant she pointed to the only other white person on the unit.
I started to doze off and as the kids watched television I laid down on the couch and fell asleep. One of the nurses came over and told me to sit up. I hadn’t been assigned a bed, introduced to any of the staff, or even shown where the bathroom was. I felt like no one knew I was there.
It was already lunchtime. I was still crying. The food looked awful and I refused to eat any of it. People started asking why I was there, and I pulled up my sleeves. Immediately I became the center of attention. Even nurses told me they had never seen anything that bad before. I began to feel better, my pride in my work brightened my mood. A girl who had befriended me in the morning told me she was there because her dad used to rape her. When she finally stood up to him, he beat her. She pulled up her shirt and showed me where he had whipped her with a chain—every individual link was visible. She said also that she was pregnant but fairly certain it was her boyfriend’s baby and not her father’s. The majority of the other girls added that they, too, were pregnant.
In the afternoon, some of us were selected for art. I sat quietly, hung back and watched the group leave. One of the nurses noticed me and took me with him in the elevator to the class. I asked him, “When am I going to be able to go home?” He motioned to my arms and told me I had a lot of work to do.
All of a sudden some weird survival instinct kicked in, and I decided to do whatever I needed to do to get the fuck out of there. I would bring back the old bullshit, and I ticked off for him some basic and easily “attainable therapeutic goals.” He cocked his head as we got off the elevator, as if I had said something startling and during the art class I was participatory, upbeat, and desperate to convince everyone I was fine. Going back to the misery of my life at home was better than being here.
An hour later another nurse came downstairs and said my parents were upstairs waiting for me. I was relieved, but also worried since this was a surprise visit. Perhaps they weren’t planning on taking me anywhere. I had learned not to place too much hope in quick fixes.
The nurse stood too close to me as we walked towards the elevator, which was directly across from the entrance to the adult unit, the “Mood Disorders” floor, where Will was confined. Suddenly, through the glass behind the ward’s locked door, I spotted Will sitting in a chair reading a book. It was like a scene out of a movie or a play. Everything had come full-circle.
I stared at the boy I had considered my salvation, who was now locked and monitored behind a door that required a code to open. I realized then that I hadn’t really had anything—or anyone—to fall back on. Not only could we—Will and I—not help one another, we couldn’t even live safely on our own. Even so, I felt a rush of false comfort, and wished I could enter and curl up on his chest.
Will glanced up from his book and was stunned to see me watching him. He looked shocked, then gave me a half smile and a little wave. After the darkness of our conversation the night before, he was probably thankful to see me safe. I was an alarming sight though, my face swollen with tears and fatigue, un-showered and wearing dirty, rumpled clothes. The nurse shook her head as she glanced from me to Will and back at me and loaded me onto the elevator.
Upstairs my parents looked ragged. They said, “We’re leaving,” mysteriously, but we moved fast. Just before we exited the building, we walked back past Will’s floor and I got one last backward glace at Will. My mom let out an exasperated sigh and we quickly shuffled past.
When I got in the car my mom explained that I would be going to another hospital, Dominion, in northern Virginia, near my dad’s house. He was planning on meeting us there. My mom said, “There’s no way I could leave you at a place like PIW,” and she had been trying to find some place else from the moment they dropped me off the night before. I didn’t really care, as long as I wasn’t going back to PIW.
We reached Dominion. My parents and I said goodbye and I was led upstairs to the adolescent ward. The head nurse, a blonde, severe woman sat me down behind the desk and explained the rules of the floor. There was a basic hierarchy of privileges based on good behavior. When you got into the upper levels you could get as much as fifteen minutes of phone time a night.
I was assigned to a room and my name went up on the whiteboard next to my roommate’s. I couldn’t help it; I began to cry again. This place with all these locking doors, medications, and rules would be my home until someone deemed me healthy enough to leave. A girl in the common living room who had sat and watched me during the whole check-in process smiled at me and waved.
By the end of February 2001, one month after his first hospitalization at PIW, Will had dropped out of high school and was working full-time at my office doing data entry; he was a favorite of the twenty-something women who supervised him and it pleased him to be earning his own money. He dreamed of buying a Ford Mustang convertible and he downloaded print versions of various models, which carpeted his bedroom. We wanted him to gain a realistic sense of what it would cost to make his way in the world, so we stipulated that he pay a small amount of rent and contribute to the food budget.
He followed through on his pledge to sign up to take the GED test and made inquiries about apprenticeships with trade unions. He always made it to his therapist’s appointments with Drs. Salerian and Ainsworth, and I thought I detected a subtle uptick in his mood. And, for better or for worse, he and Megan were still seeing each other.
Megan spent two weeks at Dominion Hospital, in northern Virginia, in an in-patient program for adolescents. Not long after her release, she returned to school and talked about having “gotten a handle” on her depression. She had a new psychiatrist and was taking medicine, but that was as much as I knew.
Will was circumspect about their relationship. I had spoken to Megan’s mother and stepfather more than a few times. Clearly, they regarded Will as a threat and a hindrance to Megan’s recovery. Who could blame them? I would feel the same if I thought my child was being infected by a kid with toxic issues.
One afternoon I got a call at my office from Dr. Ainsworth: “Gail, I don’t want to alarm you—and I have an agreement with Will that I will not disclose anything he tells me in our sessions, unless I think it potentially harmful…”
“Oh, man, what next?” I thought to myself.
“What is it, Vaune?” I could feel the roots of my hair start to tingle.
“Has Will talked to you about wanting a baby?”
“Oh, Jesus. No. Definitely no. What on earth…?”
“I think it’s a fantasy, you know, a way of soothing himself, or to give himself a purpose, a project, a chance to get it right.”
“Oh, God. Does he talk about wanting to have a baby with anyone in particular?” I hoped this was just conjecture. I knew Will was sexually active; by seventeen, he had had more than one physical relationship before Megan. Mercifully, he and I were able to talk candidly about sex and the responsibilities that go with physical intimacy. But conceiving a child was not on the agenda—fantasy or otherwise
—as far as I was concerned.
“Vaune, I’d like to talk to him about this, if you don’t mind. I’m afraid he’s over the edge.”
“I think that’s a good idea. I will tell him I told you myself when I next see him and I’ll tell him why I broke the confidence.”
I confronted Will that evening.
“No, Mom.” He reddened with embarrassment. “I told her I wanted a kid to love and she took it too seriously and got all worried. I was just kidding.”
“You know, Will, if you were thinking about having a baby, it would be a huge burden, not just on yourself, but think of what it would do to the mother. You have no skills, no resources, no way of supporting a baby.”
“I know, I know,” he replied with mild indignation, as though I had offended him by pointing out the obvious.
From Will’s journal, midwinter 2001:
I don’t know what I want. I think I want a kid. Maybe just a minime. Someone who looks like me and acts like me. I guess I just really want someone who thinks like me. Someone who makes jokes that I think are funny because it’s the joke I would have made if I had thought of it first. I think I want my little cousin Kate. I’ll file for custody as soon as I can.
I also want a truck that drives in front of me wherever I go and digs a canal, followed by a truck that fills it with water. Then I could go wherever I wanted in a motorboat. And don’t tell me to move to Venice, because I don’t want to hear that shit. Don’t be retarded.
I think when I’m old I’m going to sing for money. I’ll wear a hat—an old person’s hat, and a suit (probably an old person’s suit as well). One of those suits that you can’t tell if it’s brown or gray. And a tie. A tie that would look ugly on anybody but an old man. And I’ll stand on the sidewalk, rain dripping from the brim of my hat, slowly seeping through the thick wool of my suit, and sing as businessmen hobble by, hunched under umbrellas and folded newspapers.
That’s when I’ll be laughing. Laughing because…I don’t even know why. Laughing because I can sing while CEOs, industrial and commercial tycoons mumble about stocks, mergers, cards, girls, anything into cell phones and walk carefully, trying not to wet their shoes, phones or raincoats. Laughing because I can’t help but notice their irritated faces as my singing temporarily drowns out whatever they find so important on the other end of their phones. Laughing because…Laughing because I can.
It’s 3:00 AM. Do you know where your depressed teen is?
In Dr. J. Raymond DePaulo’s authoritative Understanding Depression,1 he claims that more suicides happen between 4:00 AM and 7:00 AM, when, he says, “depression is often at its worst.” I am amazed that parents aren’t informed of this, but perhaps not many clinicians are aware of the statistic either. Too bad. If more parents knew, safeguards could be enacted to monitor depressed teens more closely in the early morning hours.
Practitioners who treat suicidal teens suggest that there’s much anecdotal evidence to support the conclusion that nearly half of teenage suicide attempters aren’t thinking of killing themselves even fifteen minutes prior to the attempt; it’s unplanned. It may be an impetuous, irrational, and impulsive snap decision that propels a teen over the edge. Clearly, if we could get at that trigger, if we could keep them from the tipping point by any means necessary, it could be the magical lifesaver.
Dr. David Fassler, an expert on child depression, suggests that two elements need to be present for a child to act on a suicidal impulse: “an available method—for example, access to a gun, poisons, pills, or sharp objects such as razor blades—and opportunity, that is, the privacy to attempt suicide.”2
On the surface, efforts to counter “available method” and “opportunity” seem easy to put into practice; these measures are no-brainers. But in actuality, parents of a depressed child may be embattled, just struggling to keep their son or daughter close to home. Too often, families in crisis do not know with any certainty where their children are, not out of lack of concern but because the family dynamic and structures have disintegrated. The child may have fled to a friend’s house, or, worse still, be living on the street. Nor do parents learn, often, until after the fact that their child had easy access to all of the tools necessary—drugs, guns, poison, even an automobile driven at dangerous speed—to carry out a suicide attempt.
Beginning in December, at the onset of Will’s depression, we imposed an early curfew of 10:00 PM weeknights, 11:00 PM on weekends, as a precaution to ensure that he kept regular hours and got enough sleep. And absolutely no drugs or alcohol. I knew Will occasionally smoked marijuana; he owned up to it when asked but offered that he smoked with friends no more than once or twice a month. I believed him. With less frequency, he drank an occasional beer; he claimed he did not like the way alcohol made him feel.
To state the obvious, marijuana is an illegal substance, and at seventeen, Will and his friends were too young to legally purchase or consume alcohol. I talked to Will’s buddies. I urged them to help me out on this: Will was on a lot of medication for depression. Drugs and/or alcohol would only “mess him up” further. If he either drank or smoked marijuana he risked worsening his depression. And a kid with depression, one who may be suicidal, becomes, under the influence, even more likely to engage in risky behavior, to say “fuck it all” and give up. We repeated the prohibition each time Will left the house and hoped it stuck.
Who knows what Will’s last thoughts were before he downed the contents of a month’s worth of sedative antidepressant drugs late at night on Saturday, March 10. Perhaps he didn’t know what prompted him to do it.
Suicide is inexplicable, “intensely unknowable and terrible,” as Dr. Kay Redfield Jamison underscores in Night Falls Fast. To the perpetrator it seems like “the last and best of bad possibilities and any attempt by the living to chart this final terrain of a life can only be a sketch, maddeningly incomplete.”3
Gonzaga High School counselor Bill Wilson’s reflections, November 2003:
As I look back I realized now that Will was carrying around more pain and discouragement than he was willing to or could communicate. I think he had great courage, but I also think that he did not want to burden others with the complete picture of what he was facing or feeling. I think he was genuinely grateful to the people in his life who really cared for him and who supported him and perhaps, did not want to let people down. I wonder if Will had a bit too much of a tendency to want to please people. I also realize that sometimes when depression is relentless and keeps pounding you that sometimes you can reach a point where hope is lost and you just want the pain to go away.
After Will’s suicide attempt I had to get to the bottom—to the “unknowable,” as Dr. Kay Redfield Jamison describes it, of his devastating act. Moreover, I was determined to divine a way to preclude it from ever happening again. Finding our way back proved to be a Sisyphean endeavor.
“Consultation record: Dr. James Griffith, Chief of Psychiatry, George Washington University Hospital.” Discharge report:
[Patient] has a number of risk factors for lethality: male gender; adolescent; some substance abuse; organized plan with suicide note. He is at risk for a recurrent suicide attempt and needs psychiatric hospitalization.”
Letter from Will’s grandfather, Clayton Griffith:
San Diego
March 19, 2001
Dear Will,
Maga and I are so happy that you are now out of danger. I want to tell you about a near death experience I had about five years ago because I learned from the experience and you should also.
I had a cerebral hemorrhage and was in intensive care for several days. After I knew I was going to survive and had a “new lease on life,” I felt I had been given a huge gift and I thought long and hard about what I might do to make the most of that gift.
I urge you to take advantage of your new lease on life and to think about the many opportunities and goals that lie before you.
You are now possessed of a unique opportunity. Please seize it.
/>
We love you so much.
Pop
Will spent three weeks from March 13 to April 2, 2001, at the Psychiatric Institute of Washington, miserable and confused, while we scrambled to piece together a long-term plan for his recovery.
Everyone was aware that Will was at extreme risk of making another run at suicide. Given the risk factors, it would not be unusual: the most likely candidate to succeed at suicide is a young male in the aftermath of a prior attempt.
I was scared and exhausted, running on fumes of anxiety. What more could we have done to prevent Will’s suicide attempt and how could we prevent him from doing it again? We looked to everyone for advice about next steps: to Dr. Salerian, Dr. Ainsworth, and the psychiatric social worker assigned to his case; they all offered different strategies. It was not their intention to confuse. Rather, we were about to plunge headlong into the institutional chaos and lack of treatment options inherent in our mental health care system.
“Alen, what should we be looking for? Where do we go next?” Dr. Salerian and I spoke a few days after Will was back at PIW.
Ten years ago, standard treatment for an adolescent after a suicide attempt would automatically entail a six-month stay in an inpatient facility, as a matter of course. Anything less was not considered sound medical practice. As it was, Dr. Salerian battled our insurance companies every single day to recertify Will’s need for continuing hospitalization.
“I don’t know, Gail,” Dr. Salerian offered. “There’s not much here in this area. There used to be a residential facility, Chestnut Lodge in Maryland, but they’re shutting down. You could try McLean in New England or perhaps Menninger in Kansas. I hear good things about them but they might be merging with Baylor University, I’m not sure. But I’ll be interested to find out what you learn. There’s not much out there that’s appropriate for teens.”
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