On Suicide

When my mother was fifteen, she tried to kill herself. This happened in the 1950s. My grandparents, who lived on Long Island, took her to a residential treatment center, where she was eventually diagnosed as bipolar, though they called it manic-depression back then. What came through most clearly to me in her telling was the profound shame and disappointment of her father. His mother, Lucia, had sailed from Sicily to New York as a teenager. She’d never finished her education, but she and my great-grandfather managed to put three sons and a daughter through Brown University.

“No child of mine is going to Hofstra College,” my grandfather (one of those sons) told my mother. But that was where she went, unable to return to Brown after another manic episode early in her freshman year.

I first heard this story as a teenager, living in the small town of Sterling, Colorado, where my father grew up with his stoic but loving Swiss-Scots-Irish relatives and where he took my mother when he completed Yale Law School. (They had met at Yale, where my mother earned her Master of Arts in Teaching degree.) Even though I knew intimately of the vagaries of my mother’s disease—all-night escapades emptying every drawer and closet in the house, marathon record-playing sessions where she seemed to assume the identity of a Broadway star, a hair-trigger temper that left my brothers and me wild-eyed and trembling—I was still shocked.

She was incredibly ill throughout my childhood. Psychotic episodes, long hospital stays, paralyzing depressions, medicine and therapists and, when nothing else worked, electroconvulsive shock treatments. As little kids, my older brother, Christopher, my younger brother, Stephen, and I were farmed out to various families, usually without one another. The adults around us behaved as if nothing was wrong, and it felt as if I went for long stretches without seeing my parents. Add to this the oftentimes bleak, windswept landscape of Colorado’s eastern plains and my own too sensitive nature. And like many girls who in adulthood find themselves attracted to other women, I was also accompanied through those chaotic years by a ghost self, a kindly spirit whose task was to shepherd my inchoate longings.

As a teenager, I often listened to my mother talk about her difficulties. I didn’t know how to deal with her grief, so I ingested it whole, the way some organisms grow pitted, the walls of that dimpled area simply engulfing their food to digest over time (http://www.youtube.com/watch?v=MdR9ctxzab4).

Which made me a pretty sorry twenty-something. I remember that in my junior year at Whitworth University, in Spokane, Washington, I wrote a paper explicating Milton’s poem “On His Blindness” (http://www.poetry-archive.com/m/on_his_blindness.html). The poem is quietly devastating, the poet struggling with his own despair. Even that last line, which is meant on some level to comfort, is existentially awful (how does one feel good about God—or life—not really needing us?). My professor gave me high marks and stopped my best friend, who was one of his brightest students, in the hallway of the English department building. “He wants to know if you’re considering a graduate program,” she told me. I smiled, but in all honesty, I felt like a fraud. This is not literary brilliance, sir, I wanted to tell him. This is, quite simply, dark knowledge from the center of my life.

I never followed my mother’s path, but suicide was something with which I lived.  When I awoke in the morning, the very air was thick with it. I looked over my shoulder and waited, wondering when her disease would overtake me. In graduate school at the Iowa Writers’ Workshop, I remember sharing a portion of the novel I was writing, and one of my fellow students complained about the narrator’s endless cataloguing of detail. But the director of the program, Frank Conroy, was ecstatic. “I think we’ll learn that this narrator has a reason for doing that.” When pushed to explain, he said, “It’s like she’s schizophrenic.” I had not wholly intended this effect and went home stunned. Great, I thought, now I not only have to worry about becoming bipolar but also schizophrenic. But the truth was simpler than that: careful watching for one’s own madness induces a kind of non-madness madness. If you live that way, you might not technically be sick, but you won’t be well either.

However, I was not overtaken by mother’s illness, and eventually, the heavy air of suicide lifted. At least, for me. My mother tried again to end her life when I was in my thirties. I don’t know the details—I don’t really want to—but I remember standing in my kitchen, holding on to the wall when my brother Chris told me. I knew I wasn’t ready to lose her, but fortunately, she was okay. And continues to be.

I don’t write about this to be melodramatic, to elicit pity, or to be overly self-disclosing but to provide background for an experience I had many years later when I worked as a certified nursing aide for a Boulder, Colorado, hospice. During the year I spent there, I worked two twelve-hour night shifts per week, sometimes at our residential care clinic and sometimes in nursing homes or people’s houses. The job allowed me to be at home in the afternoons with my twins, both of whom have special needs. The younger of the two, named Aidan, I’d sat beside for weeks as he fought valiantly against death following open-heart surgery. He’d been put on a heart-lung machine called ECMO—extracorporeal membrane oxygenation—not once but twice, back to back, which no one in the medical literature at the time had ever survived. He emerged with some brain damage from an intercranial bleed as well as mild cerebral palsy in his upper body, and was later diagnosed with autism spectrum disorder. But for the brain hemorrhage, Aidan might have been a typically developing child—a deep grief for my partner and me, but our love for him has no bounds. Luca, his much-cherished twin, also has autism. I originally got my CNA license so as to provide some of their special care.

When the boys’ issues were less consuming, I took the part-time job at hospice. During my year there, I cared for no fewer than four failed suicides, one woman and three men. But the experience I mentioned had to do with one in particular. He was in his late twenties or early thirties, and I stayed overnight with him at a nearby nursing home where he’d lived since not long after his failed suicide attempt. I had heard about this man—I’ll call him Dylan, though that wasn’t his real name—on my first day at hospice. A young CNA had told me that he was paralyzed and nonverbal as a result of his attempt, but he was responsive and able to breathe without the help of a ventilator. I could tell from how she described him that he emanated a great sweetness.

The nurses at our hospice who perform twelve-hour continuous-care shifts send out mid-afternoon reports, which is how I learned that Dylan was failing. It wasn’t my night to work, but I remember wishing it was. For some reason, I wanted to meet him. Then, late in the afternoon, I got a Blackberry message from work asking if I was free. I felt as if I had called out for Dylan and the universe had answered.

When I arrived at the nursing home, around nine that night, his room was packed with family members and friends, all eating and talking and laughing. These were people who had grieved his death-in-life for many years, so laughter was good (besides, no one can grieve every moment of every day).

Dylan was tall and soft-looking. He appeared to be asleep, propped a bit to one side with pillows. Nursing home staff came in and out, dosing him with scheduled medications, and around midnight the room emptied. Before they left, I assured his parents, who were amicably divorced, that I would call them if I thought their son’s death was imminent. When they had gone, I sat down at Dylan’s bedside and took his doughy hand.

“I know you can’t speak, but you can hear me. If there’s something you need—if you’re in pain or discomfort—you signal me, and I’ll do my best to help.”

He had been unresponsive the entire evening, but suddenly his eyelids began to flutter. He looked at me for several seconds, very much aware—not that unseeing, animal-in-pain kind of stare you sometimes see with the critically ill and dying. Then he shut his eyes and opened them again. I could see that this took great effort.

“It’s okay,” I told him, squeezing his hand. “I’ll be here all night.” I retrieved my computer and sat at the bedside to chart, and when I wasn’t writing, I watched Dylan breathe and checked for mottling on his skin. As I sat there hour after hour, a curious thing happened. The room began to expand, and a part of me arose and looked down on us—two individuals in a nursing home surrounded by a world of sleeping people. As if from a distance, a wall clock ticked away the seconds. Dylan became more apneic. I felt a deep, heavy feeling in my throat when I looked at him. I had a sense that he would die before my shift ended.

I am not of the “what doesn’t kill you makes you stronger” ilk. Not that it can’t. Often, what doesn’t kill you makes you mean, bitter, and small-minded. I’ve seen plenty of that. Still, as I sat there, I thought about my mother, my children, and everything I’d lived through, and the thought came to me that maybe I had gone through the experiences I had so that I could be here this one night. What surprised me more was that I was okay with that. I moved through the following hours with that same heightened awareness, adjusted Dylan’s position gently when necessary, took his pulse, monitored his breathing, sang.

A staff nurse who came in around four thought our patient was very close to death and that we should call his parents. I didn’t think it was time yet—I’d become proficient at watching for certain signs—but my job required a fair amount of acquiescence, especially under the circumstances (I was both of lower rank medically speaking and not in my own company’s facility). So I called. The father and his wife arrived within the hour, then Dylan’s mother and grandmother. We waited and watched for a couple of hours while Dylan’s limbs cooled and his skin slowly collapsed into the bones of his face. Eventually, Dylan began taking agonal, or “fish out of water,” breaths. His family looked at me after the final, shuddering exhalation, and I nodded to indicate Yes, he’s gone.

I made the necessary calls and reassured the family about what would follow. I wanted to do the postmortem care for Dylan, but I had to respect others’ wishes. Most people outside hospice cannot fathom why anyone would want to do postmortem care, but personally, I love it. Removing subcutaneous lines and the foley catheter—all that necessary but invasive medical nonsense—washing the body then redressing and repositioning it in a comfortable-looking position. I especially like washing the person—to me, that’s very sacred. And it’s a wonderful way to say goodbye.

For reasons I will not go into, I did not get to participate in this ritual, though I was allowed to add some clove-scented water to the tub his caretakers used. I comforted myself that, in the end, he had eight or nine nurses and CNAs around his bed to do the honors. He was much loved, and the tasks were done with great solemnity and care. I wondered to myself what it was about Dylan that made us all feel drawn to him? How was it that he managed to make us feel special? That’s a mystery I’ve yet to understand. Even in his death—how amazing!—there was enough of Dylan to go around.

When the staff  was finished dressing him and the room had mostly cleared, I packed my things and went to stand at his side. “Thank you for letting me be here,” I told him. I kissed my fingertips and touched them to his forehead.

What I didn’t say aloud was: I understand now. You finished healing me.