I wasn’t enough.
When she came for her first counseling session, everything about her screamed a hard life. You could see it in her slumped shoulders, how she shuffled her feet, the weary sigh when she collapsed in the chair, the emptiness in her eyes. Her deeply lined face with its weathered features belied her chronological age of 37. If that wasn’t enough, it was confirmed in the ankle bracelet that peeked out from the ragged cuff of her jeans.
“Tell me why you’re here today.”
“My parole officer sent me.”
“How can I help you?”
“I don’t know if you can.”
She was under house arrest, her license had been suspended, and she’d been through this before.
That’s how our therapeutic relationship started. Trust was going to be difficult. I asked for her patience while I got through an initial history, since she hadn’t been through this before with me. Polite but distant, she waited for whatever was to come. She’d get through it; she’d been through a lot worse.
Family history is important; we are the sum of our experiences. A therapeutic tool known as a genogram is something I perform with every client/patient – it is a family tree that shows marriages, divorces, step-children, siblings, relationships, suicides, substance abuse, imprisonment, mental illness – all important ways to know where the person is coming from, in order to determine where they need to go, and how to get there.
Hers was a very common story for the general population our county mental health clinic served – never knew her father, had an alcoholic mother and several half-siblings, had been sexually abused by an uncle and physically abused by a stepfather, dropped out of high school, had her own child when she was 15, battled alcohol and prescription drugs off and on for the past 20 + years, and was married to an alcoholic. She had several arrests for DUI and shoplifting. Her teen-aged daughter was pregnant and living with an abusive boyfriend.
Oh – and she always wanted to be an artist.
She was depressed. No surprise there. Whether she got depressed when her life fell apart, or her life fell apart causing her depression…her use of alcohol and other drugs only complicated matters. It’s hard to know which came first, but depression and addiction go hand in hand far too often. And they were tough to beat…
Textbook – depressed mood, hopeless, helpless, emotional withdrawal, difficulty falling asleep, but sleeping excessively, weight gain, trouble concentrating, not interested in any social activities. The fact that she had been clean and sober for almost a month was wonderful, but terrible at the same time – these feelings were raw and painful; unwanted and unfamiliar; after all, for most of her life, her feelings had been numb from the drugs.
“I’d like to make a deal with you,” I said to the eyes that grew more wary. “How about if I hold onto your hope until you find it again yourself?”
“Okay,” came out softly, along with a slight sense that perhaps I was the one who needed help, rather than her.
Her parole officer wanted her to talk with someone about how to deal with her husband, who wouldn’t stop drinking with his buddies at their house several nights a week. It was too much of a temptation for her; she craved the alcohol even though her husband put a combination lock on their keg; she desperately wanted the Oxycontins and Vicodins and Percosets that her daughter offered her, but still found the strength to refuse. But she was losing ground…
Where to even start? Here, it was one day at a time, one hour at a time. By the end of the fourth session, she had managed to get her husband’s beer nights moved out to the garage, along with the keg, and to tell her daughter to not bring any of the meds when she came to visit. They were giving her some grief about it, but she stood firm.
Baby steps? No. In actuality, they were huge. She took control of those two things in her environment, and her sense of empowerment brought a smile to her face and a slight squaring of her shoulders.
“I’m so proud of you!!!”
She covered her face with her hands, sobbing. “No one ever said that to me before.”
“Well, they should have. You are a strong, courageous woman; a survivor. Right now, as is, you are enough…”
Her blue eyes, glistening with tears but clearer without the effects of the drugs, met my gaze with something different, something lost that was slowing being found.
For an instant, I saw the beautiful young girl she would have been had all of the terrible things not dragged her down and worn her out and bruised her soul. Innocent, expectant, full of hope for the future. It was staggering. It was humbling.
Sacred ground. She felt it too.
She missed her next appointment, but when I called to reschedule, I could tell she was excited about something. She had just gotten off the phone with her parole officer; he arranged an interview for her at a local family run convenience store that took part in a county program for ex-offenders. It was part-time, but a start. Plus, it was in walking distance from her house. The interview was next week.
Hope. There it was again, tinged with a girlish excitement.
We spoke briefly about what she might expect from the interview, and what she planned to wear. I congratulated her again, wished her luck, and assured her she would be fine. She signed off with a breathy, “See you next week.”
And that was the last time I ever heard her voice.
When I came in to work on Monday, my supervisor showed me her obituary in the local newspaper. Dead, at 37 years old.
Why? What happened? I was in shock as I relayed our last conversation in full.
I called her husband, looking to offer my condolences, and hopefully, for some answers.
They had some friends over for a party to celebrate her job interview. She cooked lots of food and seemed happy and excited. He remembered drinking too much and falling asleep on the couch. His daughter woke him up and asked if he’d seen her mother; she was nowhere in the house, and the keys to the truck were gone. At first, he didn’t understand.
When they found her, she was already dead. By her own hand.
A. Successful. Suicide.
I couldn’t speak.
He mentioned how much his wife had liked coming to her appointments at the counseling center, and that she seemed to be doing better.
I asked him if I could help in any way; he said no, but thanked me for calling, and for helping her.
I hung up. Helping Her? Hardly.
Suicide meant that at that moment, for a reason that we would probably neither know nor understand, she had been in such emotional pain that she just wanted to stop hurting; she just needed to escape. She hadn’t been thinking clearly enough to realize that the feelings of hopelessness and helplessness would pass; that they were only temporary; that she would get through it and survive, just as she always had.
Survive and thrive. Clean and sober. Perhaps at a new job. Or so we had hoped… Or so I had hoped…
The tenents of good practice dictate that involved staff and supervisors hold a “psychological autopsy” for any patients who suicide. We sat around a conference table on speaker phone with administration at our other office. I presented her history, from start to finish, along with treatment plan, progress, appointment schedule, recommendations, contact with her parole officer and family, patient compliance. Every detail.
Why? What happened? What could we have done differently?
Nothing. But she committed suicide. Everything? No, I knew that wasn’t true. Delayed it, perhaps. But change takes time, and there hadn’t been enough of it…
After about 25 minutes of this, I started to cry. In front of 2 supervisors, and over the speaker phone “in front of” the CEO of the county mental health offices and two attending psychiatrists.
“She has a name; she’s not just a case.” I struggled on. “And for just a brief time in her 37 years, she felt good about herself. It wasn’t long, and it obviously wasn’t enough, but it was something.” Silence in two rooms filled with people. “And she was important…”
I couldn’t sit there with it being so impersonal. We health care professionals do that so often by necessity; we need to retain distance and objectivity in order to do our job well. It’s not about us, but rather always about the patient.
But I had to remind them, and myself, that she lived and loved and hoped and dreamed and fought as long and as hard as possible. And I admired her for that. And I loved her for that. And I would remember her for that.
Be well, lovely lady. You touched my heart. I know that you are free of any of the torment that weighed so heavily upon you, and that your eyes and thoughts are clear. And that you have hope again…
Paint with bright colors, with abandon, with your heart…and paint outside the lines, without limits or restraint.
My time with you was too short, but it was my privilege.
And remember – right now, as is….you are, and always will be, enough.
Eternal rest, grant her, O Lord, and perpetual light shine upon her.
May the souls of the faithful departed through the mercy of God rest in peace. Amen.