There is literally shit on the walls of the bathroom. There’s no seat on the stainless steel toilet bowl, no paper holder, nothing that could be removed and used as a weapon or to hurt yourself. Not even soap. I’ve visited multiple prisons, but this emergency room at Western Psych is worse. A guard had to unlock the restroom door for me, and now he’s banging on it to see what’s taking so long. I’m trying to unclench enough to go, looking at the brown smears on the tile, and stifling great heaving sobs. My youngest son, my baby, my beam of summer sunshine, is suicidal.
I’m used to emergency rooms. I’m good at them. How many times have I bundled up this little cherub in the middle of the night, as he struggled to breath with an attack of croup, and hurried off to Children’s Hospital? Or taken his brother for an x-ray. You pack books, work to do, toys, a snack. You know you’re going to be there a while, but the lobbies are bright and colorful, full of iPad stations, fish-tanks, interactive displays, and comfy furniture.
This place has armed guards, bulletproof glass, metal detectors, body wands. They took my bag at the door with my computer and notebooks. Made me remove my scarf. Can’t even have a pen. We’re escorted beyond more locked doors to a place with no windows, and walls in repugnant shades of green and beige — did someone choose these colors to maximize human misery? The furniture in the adolescent waiting area is cast offs, broken, uncomfortable, draped with half-asleep kids wrapped in thin hospital blankets. I can’t believe how many teenagers are here alone.
Maybe we reek of privilege with our whiteness, our shocked faces, the fact that our son is accompanied by not one, but two parents. A receptionist opens a small room for our trio to wait in with nothing but a table and chairs. The outlets are sealed shut, an old television sits behind Plexiglas with no way to turn it on, and the peeling wallpaper with the faded 1980s print of hot air balloons is long past its cheerfulness expiration date. The entire place screams disparity: Children’s and Western Psych are both operated by the same large hospital chain, but the state of our mental healthcare system is on vivid display. It’s more like a mental health we-don’t-care system.
We wait for hours and no one ahead of us appears to move. Every once in a while, the guard walks by. With nothing to do, we’re climbing the walls, and the experience is clearly traumatizing our son, making things worse, not better. The receptionist tells us it will be several more hours, and we decide we’ve had enough. I demand that they let us out. Insist they unlock the doors so we can go free. I’m adamant, unwavering, a mama bear protecting her cub, one of the few times I will feel powerful and certain of what I must do for my son in this moment as we navigate his depression.
Mostly, this disease leaves me completely unsure, lost and without a clue. These are not feelings I’m used to: I’m an academic and more comfortable finding answers, researching until I have enough data to make confident decisions. But since we learned the diagnosis of severe depression, there’s just been ambiguity. Even the doctors seem to be shooting in the dark. What medication should we use? Try Zoloft. Most kids are good with that. The pediatrician recommends one dose, a physician friend another. The dose is ramped up and he hits a new low, now yearning to cut himself. We finally get an appointment with a psychiatrist, who switches him to Prozac. He gets accepted into an intensive treatment program and starts weekly therapy sessions. Who can say if any of this is working?
We’re relying on the self-awareness and self-reporting of a fourteen year old. Every day we ask him where he is on a scale of one to ten. I live in fear of the ones and twos. That’s when he tells us he wants to end his life. At three or four, it’s more of what the doctors call a “passive death wish,” like maybe he would prefer to just not wake up tomorrow. Below three, it becomes more active, and he has to enact his Safety Plan. This plan consists of him calling me. I’m the plan. I’m supposed to keep him safe. I’m his mother and all my animal instincts tell me this is right, but I’m a historian, not a psychologist. I don’t know what I’m doing.
The first time he tells me he is actively contemplating suicide I’m tucking him into bed. I react by running to get my phone and dialing the crisis hotline number on the little card the doctor’s office has given us. A kind voice asks me if we want a team sent to the house to evaluate him for referral to the emergency room. No, not really, I don’t think we need that, thank you, I didn’t know what services you provide, but now I know and I don’t think we’ll do that tonight. Before I hang up, the voice asks me if I’m OK.
Are you kidding? I can feel myself experiencing physical shock, the adrenaline coursing through my body, heart pounding, I could lift a car off my baby right now if I had to, like in those stories of parents performing inhuman feats of strength to save their children. I could also throw up, I’m shaking, and I want to laugh at the question and sob at the very same time. My husband lays down in bed with our son to keep watch over him through the night, and I retreat to our bedroom, crying so hard I add another worry to the pile. I’m pretty sure the kids don’t need to see me this distraught.
So no, I’m not OK. And neither is my “little one,” who just grew six inches taller than me in the last year. The pain of watching him experience this disease is like having my heart ripped out through a hole in my stomach. A throbbing agony in my chest, piercing right down through my belly button.
He’s failing most of his classes. He’s made no friends at the new school he started this year. He just wants to play video games and sleep. Some of this stuff seemed like “normal” teenage behavior, until we figured out what was going on. Now Facebook tells me what is normal among his old classmates, as I watch other families boast about their kids. From the photos they post, I learn about the parties our son is no longer invited to and the school’s winter dance he didn’t even mention. Meanwhile, on doctor’s orders, I’m hiding the bleach and searching the house for pills I should lock in our new medicine safe.
I decide I hate Facebook. It also plays cruel tricks, showing me memories of my beautiful boy from two years ago, six years ago, jumping on the beach, eating a marshmallow, all smiles from the time before. Before now. Before this horrible brain disease changed him, told him he was worthless, took away his sparkle, dragged the muscles in his face down making it flat and erasing his mischievous grin. Sometimes Facebook does a sucker punch, shoving up photos of my brother-in-law who died a long, slow, horrible death, his depression preventing him from managing his physical health; or a snapshot of our dear family friend who took his own life last summer, an utterly brilliant, marvelous man who was in so much pain despite doing everything possible for years to treat his depression.
I’m supposed to be reassured that our son has a Safety Plan and he’ll be OK, but I read that up to half of all people who attempt suicide make that decision very quickly, within just minutes before they act. Suicide is the third leading cause of death among kids my son’s age. Teen suicide rates are going way up, doubling in the last decade. There’s lots of new evidence correlating mobile phone use with adolescent depression and suicide. As a scholar, I usually like data, but these facts make our Safety Plan feel like an illusion. Nothing but words on tissue paper.
I realize I’m completely ill-equipped for the most important mothering job I’ve ever had. It’s not like when he was tiny and sick, and we would rock and rock and rock while he fell asleep in my arms. Or the year he got strep throat eight times in a row and practically lived on that sticky pink medicine. I have no tools in my mommy toolbox to deal with a child who thinks about killing himself. At night I scour Amazon for books on parenting teens with depression and at lunch I read research articles, trying to make sense of the medical literature. I absorb a sea of acronyms — SSRI, CBT, a 504 — an unwelcome new language I never wanted to learn.
I’m still not ready when the first call comes, enacting the Safety Plan at 8:55AM one morning from school. I’m stepping off the elevator about to walk into City Council chambers to be interviewed for confirmation to a new mayoral commission. Not exactly something I can duck out of, and my husband, who is number two on the Safety Plan, is leading a dissertation defense for his graduate student. I make sure the school counselor can keep him for an hour while I finish my interview, and then run across town in my dress shoes, reminding myself that the flare-ups of this disease are never going to be easy or convenient.
At least the school has been supportive. At least we have insurance to pay for medication and therapy. At least we live in the city near doctors and hospitals. At least we have flexible jobs. At least my mother can help, the third person on the Safety Plan, and his brother has been amazing. At least our son has shared everything with us, wanting to get better, not hiding his symptoms, not resisting treatment. I’m grateful for these things, but I hate this language of “at least.” Friends, trying to offer comfort, say, at least you caught it early. At least he hasn’t tried to hurt himself yet. At least he has you for parents.
Well meaning colleagues ask, are you sure it’s depression, it sounds like this other thing I read about, here let me send you an article. Or, yeah, my daughter has been a little blue, too, lately, and isn’t high school hard for everyone, ignoring the fact that you just said your son is desperately struggling not to draw a razor blade across his skin so he can feel something, anything. I’m keenly aware of how stigmatized mental illness is, and I try to be very open about this diagnosis. But there’s nothing like sharing that your child is suicidal to stop a party conversation. I begin to wonder if I will ever talk about anything else when someone asks, how are you?
This is his first episode of major depression, which the experts say can last an average of 36 weeks. That’s nine months. I hate this math. A lot of kids have just one episode, but if they get a second, they are more likely to face the disease for life. Depression and bi-polar run in my husband’s family, and I don’t like thinking about the odds. At our last appointment the psychiatrist explains we want to be seeing eighty-percent good days on the medication, and since we’re not there, she increases his dosage. I do the mental calculation and realize that 80% is still one in five days with a flare-up. That’s at least one day a week he’s missing school, falling further and further behind in most of his classes, not making friends, not showing up for rehearsals for the spring musical he’s been cast in. At what point does a student have to repeat a grade?
Everyone says, don’t worry about that, his health is the most important thing. Of course it is. I just wish we knew how to keep him safe, let alone get him healthy. Yes, we’re doing everything the doctors and therapists tell us, but it feels so insignificant. I keep my mobile phone with me at all times now, his ring tone instantly twisting my gut into knots. When he’s suicidal, he can’t tell us what he needs, can’t make any decisions; recently on a day with temperatures in the single digits, that sweet, sweet boy called from a city street to say he thought he would just lay down and stop moving. That’s all he could do. Later, when he was back to a five on his mood scale, he told me, mama, when I’m at a one, and you’re trying to make me feel safe, I just need to be with you, and to pet the dog, and a cup of tea.
Tea. I can do tea. This might have to be our Safe-Tea Plan.