for the mouth speaks what the heart is full of

Right now I feel like writing all the time. Certain topics seem to bubble up more easily than others. I know I need to keep writing about my time with Nick, but every time I think about it or look at it I think about how drained I was after the first, and only, time that I wrote and I push it away. Writing about my dreams was as close to writing about Nick as I have come since that first installment of my not-a-memoir. The blog that I wrote about those dreams helped me quite a bit. Mostly reminded me that I need to give it up to God. Turn it over as I first heard in 12-step. So I started praying about it. And I feel better. I felt a little bit self-conscious about my last post. What keeps resurfacing for me is that blogging is apart of my process, I find it cathartic, and transparency is one of my hallmark personality traits. I do question, though, whether or not my blog could be considered gossip. I didn’t understand until very recently that gossip is a sin. And I have been a gossiper my entire life. I had no idea that what I was doing was a deep sin, but now that I know that to be true, I can see how this part of my personality must be surrendered to God. I know Jesus will help me to understand where the line is if I can get quiet enough to hear Him. Also, I am not making anyone read this stuff.

Lately I have been thinking a lot about Oscar’s death, well I always think about it, it is hard to explain, but lately it has been surfacing in a more vibrant fashion. It ebbs and flows, like all things in this existence of ours. The thoughts have mostly been details about finding his body. And my screaming. I have never screamed like that. I hope to never again. Blood curdling, “NO, NO, NO, NO, NO, NO,” as I was pumping on his chest too fast for CPR because my adrenaline was hurling through my veins. My sweet, beautiful boy. I remember his eyes after he died. How badly I wanted life to flicker back into them and for him to gasp for air and say, “Mom, Mom, I am so sorry, thank you for saving me.” Alas, that was not my reality that fateful morning. My experience finding Oscar dead has been kind of on a constant playback in various forms and various intensities since it happened. Visions of the basement and how it looked. What he was wearing. The way his body was positioned. It hurts. It is the deepest, darkest pain that you can’t ever imagine. I still cry a lot, well, at least I think it is a lot. I remember when I first saw his body lying there and immediately thinking, “Oh honey, I probably won’t be able to get you out of this one.”

I have been off my self-care game lately. I had gotten into this amazingly vibrant routine that included running at least once per week, but when I was really on it I was running three times a week three miles per run, regular journaling and reflection with my Silk + Sonder, reading my bible daily (my mom and I are reading an incredible plan by the BibleProject that will get us through the entire book- you can find it on YouVersion), and deeply studying the bible at least once or twice a week. And by deeply studying I am referring to a mix of weekly online church services at Vineyard Overland Park, Vineyard Institute classes, Esther Dorotik materials (this is where my focus on gossip has come from, I have deep gratitude for Esther, I am sure I will mention her more in future posts- you can find her shop, EstherDorotikShop, on Etsy), and a program called Churches That Heal by Dr. Henry Cloud. I have been generally surrounding myself with Christian resources- I even joined Nurses Christian Fellowship. These activities have become my spiritual foundation. If I take good care of my spirit I can take good care of my life. When my self-care routine is not on point my spirit suffers and so do the people I love most.

I blogged about it my first blog back a week or so ago, but the reason I am currently off my self-care game is because Grant, Phoenix, and I spent most of June together. Since Grant decided not to move in and we have started couples therapy I suggested that we go back to following the parenting plan and slowly start seeing each other more, but with stronger intention of actually seeing each other, as in on dates, instead of him and Phoenix spending loads more time here like he has already moved back in. There has been some discomfort around my insistence on this tack, but I feel really good about it because I am getting my alone time again! Oh how I missed taking good care of myself and my spirit. As we continue to heal our relationship we will need to find ways for me to consistently and regularly get time alone to spend on journaling, exercising, and bible study. I think finding alone time is a common problem for mothers today, but in my case it is absolutely devastating if I do not get the time I need for self-care. It just is. I think those of us who have a strong and prevalent history of trauma need more time for self-care. Looking back over the past nearly five years since Oscar died all the times that were the most chaotic and turbulent can be directly correlated to a lack of consistent and regular self-care. It just is.

If I don’t take care of myself with a diligent self-care practice my heart fills with the dark memories associated with Oscar’s death and with Nick’s death, for that matter. Grief begins to take over my path. I have been working hard for the past almost five years to be able to walk next to my grief. It has taken a lot of effort to deeply understand that even though grief will be a constant companion for the remainder of my life, it does not deserve to overwhelm my life.

This is the statement that Jesus made at the end of Luke 6:45, “For the mouth speaks what the heart is full of.” The entire verse is as follows, “A good man brings good things out of the good stored up in his heart, and an evil man brings evil things out of the evil stored up in his heart. For the mouth speaks what the heart is full of.” This is such an amazing observation, isn’t it? This is the kind of stuff that makes me so excited to understand the bible better and to become closer to Jesus. I love this idea, that the mouth speaks what the heart is full of. When I write about my grief experience and the memories that fuel my negative reaction to the events that have happened in my life, like my memories of finding Oscar dead, it is because that is what my heart is full of. Sharing my experience helps to release it from my heart and actively hand it over to God. I also hope and pray that through sharing my experience as a bereaved mama and a suicide loss survivor others will feel less stigmatized to share their experiences. We need to open up about suicide and suicide loss in our culture. We need to make this conversation that nobody wants to have into a conversation that can be easily discussed. It is simple to share our truth, not easy. I want to encourage all of my fellow suicide loss survivors to share the truth of your experience!

The picture is of me and Oscar I think about two years before he died. My sense of time since 2012 is a little skewed, and it is hard for me to remember when certain events occurred. We were at my parent’s house on Foster in Bremerton, Washington. I miss those big eyes. You can see how sad he was. Looking back with hindsight being what it is I wish I had done so many things differently. I pray a lot about those things and the only relief I have is when I let God carry it for me.

let’s get into it

For real I keep dreaming about Nick. I really don’t understand it. I know there is a lot that I still need to process about our abusive marriage and it is a lot different working through it while he is dead, but seriously, what gives? My psychologist and I spoke about it a few weeks ago. I told her that I keep dreaming about him and I know I need to work through some of the roughness between us, so she suggested that I write about it. She suggested I write him a letter, which is so cliche, but it is a very common tool when you are working through problems that you have with dead people, I have discovered on my grief journey. Kind of funny, right? But, hey, it must work, or it wouldn’t be a cliche. I know after Oscar died I wrote a letter to him almost immediately. I was so distraught and raw. Just raw. Nothing felt like I thought it would. After Oscar died it was like my feelings got turned inside out. Completely strange how deep grief changes you. Anyway, back to Nick. I keep dreaming about him. I dreamt a lot about him when he first died. I actually dreamt that he died before I knew he was dead. That was weird. And we’ve had other dream time sessions, too. We made quite a bit of progress, actually, but now I feel like we are stuck. So after my psychologist recommended that I write to him, I actually started just writing about what happened between us. A historical account. It is funny because during my session when my doc and I talked about this I immediately said, “Oh, it could be the start of my memoir!” Goes to show you how I am always trying to make something out of nothing. She brought me back to reality by reminding me that I just needed to let it flow. After that first (and only) time I have written about my life then I was so exhausted!

And I keep dreaming the same sort of dream. We are together, even though we shouldn’t be, and he is his happy-go-lucky-I-want-to-have-fun-and-get-laid self. Nick loved sex. It was one of the things that kept us together for so incredibly long even though the abuse and dysfunction was so uncomfortable. It isn’t like we did too much that was wild and crazy, we just had a routine that worked for both of us that we would always fall into. And when we first met it was like fireworks between us. Our chemistry was like no chemistry I have ever felt before or since. That is what I though was love between us. We didn’t really know how to love. On my journey following Jesus (this is sort of new- it has been a push pull my entire life, it is just that about three months ago I finally really committed to Him) I have learned that love is so much more than a feeling. It is an action. A choice that you make to accept someone despite all of their faults and do positive things for them. Nick and I had trouble with that. And he would sometimes seemingly flaunt his faults. Looking back with what I know now and my own experience with grief and how incredible hard it is for me to maintain my okay with a lot a lot of self-care I can see how grief shaped Nick into the reluctant-to-change addict that he was. He used to tell me that the deaths of his brother and sister felt like emotional amputations. I was so cruel. I would tell him he needed to make a choice to move on and get healthy. That is so easy for someone who had never been bereaved to say. I have learned through my own grief that you never really move on. There is always a piece of you that is in the moment that someone you love dies. You are changed irrevocably forever. For the duration. Never the same.

In my dream that is the same, yet slightly different every time, Nick and I are together and we shouldn’t be and we are hiding out from our families trying to have sex. There is always some reason that we need to hide. In the dream I am always adamant that no one see us or know that we are together and he isn’t really worried about it at all. He is so focused on taking my mind off of being worried so I can relax and let him have his way. Our marriage and our home life was a lot like that. We hid our drug use from a lot of people. I wanted to quit from the time that we got pregnant with Oscar in 1999, but he plain told me that he would never stop using, that it was a deep part of who he was and how he managed to deal with the trauma that he had packed away. What would have been more accurate would have been for him to say that his using kept him from having to deal with the trauma that he had packed away. He stuffed it deep down and avoided it for as long as I knew him. It was so rare for him to talk about Jimmy or LouAnn. He was always passing me a beer or a pipe and telling me to relax.

That was what I needed to see. In my dreams Nick is trying to get me to relax so he can have his way. There is something he wants to show me. And here I thought that he was the one not letting me get through to him. I wonder if the next time I dream about him if I can let myself go back to the Jes who would let Nick completely dominate her? That is a scary thought. Makes me want to run. If I can just sort of allow myself to go down that path enough with him I wonder if we can get to the deeper level we need to get to in order to sort through some more of the rough between us?

Working through issues with dead people is hard.

too long

THERE IS SO MUCH!!

It has been way too long since I have written. I feel like I have been through at least two lifetimes in the past few months. My new job is pushing me to grow in ways I didn’t realize I needed to grow. It is interesting, as I have been adjusting to my new unit and the culture there, I have been turning inward. I have been reluctant to share my inner journey with you, which had become such a big part of who I was and what I needed to do to stay healthy before my transition to the CVOR.

After my therapy yesterday with my treasured psychologist it became very clear to me that I need to reach inside and determine what I need to do to stay healthy and then do those things. I need to fiercely guard the time I need to do those things. I am saying that as if it is some incredible realization when really it is a well-known fact, the problem is simply that if I spend too much time away from what I need to do to keep myself healthy my grief comes out sideways.

This is what I have been doing too much lately and not paying attention to myself because of: healing my relationship with Grant. There, I said it. Well, not to mention Covid-19 (learning how to live the new normal with the rest of the planet). Grant always pushes me to be so quiet about what we have going on with each other, and I get it, he enjoys privacy, but I am not a quiet person when it comes to my life. I like for things to be out in the open. Transparent.

I lived a long time in the dark during my youth. I really had two lives then: the life on the outside that looked mostly okay to everyone looking in on us (the mask) and the one at home that was full of anger, alcohol, and marijuana with an abusive husband who had me convinced if I tried to get help for my addiction he would lose his job. Back then I was just trying to keep it together enough to get through school and maintain a job. I have started a writing exercise that my psychologist recommended might help me integrate those traumatic memories. It takes so much emotional energy to do it I can only face it in small bits.

Right now Grant and I have reached a point where we want to live together again but there are some major issues that need to be figured out. The first is that I get virtually zero alone time when we spend a lot of time together. This is because Phoenix prefers my care to Grant’s care when the two of us are together. I have been encouraging Grant to try being more assertive and maybe that will help if I also stop stepping up right away. This kind of change takes time when you are working on this sort of reintegration. Another issue is that we do need couples counseling. And, of course, we seem to be attracted to completely different types of therapists. Of course. Another big issue is our motivation: are we doing this because we are in love with each other or are we doing it for Phoenix?

Another big issue that Grant and I have is our reluctance to share our journey with our friends and family.

I can only speak for myself here, but I feel like we have been through so much and reached such a very low point together that our friends and family were very happy and relieved to see us separate when we did. I mean we went through the whole deal for a proper separation with lawyers and parenting plans and all of it.

Since I started working in the CVOR I have changed in ways I didn’t predict. I have been through some major ups and downs during my transition to my new unit and I finally have started to feel like I am finding my place. This is great because for a few days there I thought I had made a big mistake! One of the things that has come out of my experience caring for this patient population is a renewed and deepened Christian faith.

This is an issue for Grant because he does not vibe with Christianity. He also tells me that he doesn’t think I will maintain my Christian faith for long. I have tried explaining that this has been a lifelong dance and I have finally reached a point where I am comfortable in it and so I am feeling the strength to own it and ground myself in it like I never have before. This will be a sort of living amends for me to Jesus. And time will tell. I will say that a very beautiful realization and discovery has come from my renewed faith: chaplaincy. Becoming a healthcare chaplain as my long-term career goal makes sense and every time I think about it I feel deep peace.

All of this and the churning of difficult times of the year for my grieving soul: Mother’s Day, Pierce’s birthday, Father’s Day, Vivian’s birthday, Phoenix’s birthday, and on Friday, Nick’s birthday.

Here is the good news: Grant and I settled on him not moving in for at least six more months and I am refocusing on my alone time. I think it is best for us to honor our parenting plan and spend time alone together on dates. Certainly, plan time to spend together with Phoenix and my Lane kids as a family, too, but mostly focus on alone time getting to know each other more intimately. No more spending time together like we are living together. There are too many unhealed hurts and I need to spend time alone doing things like writing updates to my blog.

No more hiding.

 

Suicide Grief is Complicated Grief

Well. Here I am on the other side of Thanksgiving. Many wonderful things have happened to me in the past week. I met someone. (I met someone!) My Lane kids and I celebrated Oscar’s birthday in a natural flow. It was truly a joy-filled day, which feels so good. I love that I was able to celebrate Oscar and all of the things that made him so incredible, so special, and not be completely overwhelmed by grief. Thanksgiving was unconventional and very chill (this was due to me being so focused on exercising healthy boundaries in all of my relationships this year). We had a day filled with meeting our new dog (who is also a suicide loss survivor- I am sure I will talk more about her at a later time) and eating fried chicken for dinner before I spent a few hours in the later evening with my new love interest on a very unique first date. We vibe on so many different levels, even the really deep ones. It is a new feeling to be truly seen by a man who is interested in me romantically. I have hope for this budding new relationship, but I am also scared. Scared because I don’t have a track record of positive outcomes in this arena for various reasons, not the least of which is grief. Which leads me to last night.

Through a set of circumstances and motivation that was of purest intent, I found myself listening to live music at a bar. It was so much fun to see all of the people up dancing and having a good time, so many smiles. I found myself smiling and bopping around in my seat, which was enough for two different older gentlemen to ask me to dance. I accepted, mostly because I wanted to allow a full experience of the environment, but also to get closer to the stage in order to see the musicians with increased clarity. I danced two or three times with the younger of the two gentlemen to the point that he wanted to start a conversation. He started that conversation by asking my age. Then he told me he was fifty-two. 52. That’s how old Nick would have been if he were still alive. The gentleman asked if he could sit with me and I politely declined, telling him I was with someone. (Working those healthy boundaries again!) We had a bit more conversation. He told me he doesn’t ever go out, but he did tonight because when he got home from having drinks downtown with friends he didn’t want to be home alone, that he lives just around the corner, but he never comes here and he should come here more often. Then he sat back in his seat, which was just in front of me. And I couldn’t help but watch him drink beer after beer after beer. I did what I could energetically to surround myself in a shielding bubble and send whatever energy-sucking tentacles he had sunk into me back to him, but it was too late.

My world began crumbling into a wave of grief. Nick would have been fifty-two if he were still alive. I haven’t quite learned how to negotiate my Nick-sized grief. Our relationship was so incredibly dysfunctional and he was abusive. Terribly abusive. I have just begun working through that in therapy. I feel like sometimes with the grief that I feel as a suicide loss survivor I cannot help but feel a glimpse of the pain that my loved one was feeling when they died. And that really hurts. That is hard to allow. It is very difficult for other people to be around, as well, when I am feeling that way.

There is so much in that environment- the bar- that I haven’t really dealt with, as well. I haven’t been to a bar since before Oscar died in 2015 and even then I was going to the Green Lady Lounge to listen to jazz, which is a much different environment. Nick’s natural environment was the bar. I remember when we first met he was a regular at the Manette Saloon. Everyone knew him. Everyone called him “Nicky the Mayor”. The mayor of Manette. That was the little neighborhood we lived in East Bremerton, right down on the water there. Looking back, hindsight being what it is, that should have been a red flag for me- that he was a regular at the local bar, but his charm and his smile and his eyes outweighed any red flags you could throw at me. Even the shower of red flags that happened the night before we got married was not enough. There was something in Nick Lane that wrapped itself up tight around my heart and my soul. I fell deeply and madly in love with him.

Our first date was a drive to the ocean. He used to tell me that he could see how incredible I was and he knew he would have to plan something really really special to get my undivided attention. We had such a whirlwind romance. He sucked me right into his orbit. He was so smart. I used to tell him he had a sexy brain. Our good times didn’t last long. His true colors came out the night before our wedding. Then the next thirteen years of my life were spent trying to figure out how to get out. We had three beautiful children during that time. I’ve talked before about how each pregnancy I had hope would be catalyst enough for him to change, to quit using and get healthy with me. It was never enough. He only had glimpses of recovery after our divorce. The pain of the grief that he carried was too much for him and he died of suicide just last year. Just last year. That first wave of holidays was tolerated on a wave of adrenaline and shock. This year it is settling in.

So this is the grief that I carry that is Nick-size. This grief doesn’t feel like an old friend yet. This grief feels like unresolved business mixed with deep disappointment and the only truly madly deeply romantic love I have known to this point in my life mixed with the stark realization that it was a farce. Truly madly deeply romantic love does not verbally, emotionally and sexually abuse you. This grief that I carry surrounding Nick is forever complicated. If I have learned anything about grief the past four years I have learned that the only way to accept it is to allow it. Pain like this is hard to allow. Especially this time of year when we are supposed to be joyous and happy, always looking on the bright side. I wish it could be different, but it isn’t. This is my journey. And I will honor it to the best of my ability. I will keep talking and I will keep sharing. I will continue to have the conversation that no one wants to have, the one about suicide.

September

Oi vey. September. Here again already.

September used to be my favorite month. When asked my favorite season I used to say fall. When asked my favorite time of year I used to answer with September, the month of my birth.

When Oscar died September 11, 2015, that all changed. How could it not?

This year over the deathday week I am taking my Lane kids to the Pacific Northwest, where their lives all began, to bury the ashes of their father, Nick.

Last year, on September 16th two Overland Park police officers knocked on my front door with the news that Nick had died. It was revealed the next day when I spoke with the detective assigned to his case, that he had died of suicide.

We believe he died on Oscar’s deathday, September 11.

It took the better part of six months for Nick’s family and I to decide what/ how to best honor his memory. At the end of April, we all finally came to an understanding that his memorial service needed to happen during the deathday week- it was my suggestion that we honor him on the deathday itself. Since then all of the arrangements have slowly been coming together.

We are attempting to frame this week not as “grief week” but instead as “healing week”. The Lane family is going to once again attempt to put the “fun” in “fun”eral…

I have felt myself pulling way way in over the past several weeks. It started at the first brush of cooling fall air on my skin during August. This round of grieving has once again made it clear who is with me and who is against me. That is an extremely simplified expression of what is a somewhat complicated human response, but it seems fitting to me. When someone tells you that “you are smarter than that” when it comes to having your grief hijack your emotions it seems fairly obvious that the person is not with you. Truly that last thing you need to hear when you are suddenly overcome with grief is that you should somehow “know better”.

Grief is a visceral response to an impossible change in your reality.

There is no thought involved whatsoever.

That experience has helped me, though, once again, to understand myself alongside my grief with a touch more clarity. This is truly something that I feel my way through. And I feel that I am becoming a little bit better all the time at navigating it.

I have been focusing on my self-care more than usual. The basics: exercise, eating nutritiously, sleep, prayer, meditation, bathing regularly. I have also started a new course of mental wellness products which are focused on balancing the Gut-Brain Axis. I think they are helping because instead of feeling completely emotionally spent with zero energy constantly (which is usually where I live this time of year- all the way through until after the New Year) I feel… okay.

Feeling okay is a miracle.

This year I am giving myself permission to enjoy Fall. It is worth a try.

 

16

Wow. Pierce just turned 16.

Oscar died about 2 months before his 16th birthday, so this was huge.

Nick wasn’t here. Nick’s death from suicide in September 2018 has completely thrown me out of orbit. Any of the patterns or rhythms of living that I had just started to re-establish since Oscar’s death in September 2015 were all erased when those two police officers rang my doorbell.

I have had so many difficult emotions since May 23rd, which is Pierce’s birthday. I want to be happy and celebrate and feel joy for Pierce that he made it! He did it! Look at what a strong, beautiful, and amazing young man you are!! He had straight A’s this semester and he aced his pre-calculus final. And I couldn’t share that with his brother or his dad.  I know, I know, they are here even though we cannot see them and sure, we have my folks, and they are wonderful support. They encourage and nurture and teach and set excellent examples of how to be successful in life.

But I really missed Nick yesterday during our family dinner. Because I had gotten used to the idea of not having Oscar at these events, but this was the first big event that I really missed Nick. He would have had a sparkle in his eye and that goofy grin on his face- so proud of his living son. See, in my hopes after Nick moved here when he had hit what I wanted to be his rock bottom in 2017, I saw a future where he was in recovery from addiction and we had made amends to each other and we were co-parenting Pierce and Vivian successfully. So he would have been invited to Pierce’s family birthday dinner.

That isn’t my reality, though.

My reality is that half of my family is dead from suicide. First my oldest son, Oscar, on September 11, 2015, and then his dad, my ex-husband, Nick, on September 11, 2018.

Since we set the date for Nick’s memorial, the burial of his ashes, on September 11, 2019, I have been slowly processing what it is going to take for me to get through that week clean. I have been in recovery from addiction since February 20, 2012. I haven’t been back to the Pacific Northwest since I got clean in 2012. I will be faced not only with impossible grief when I am there, but legal marijuana and lots of old friends who I used with. I am aware enough of how addiction works to know that is a recipe for relapse.

The past year I have not been actively going to 12-step meetings or doing what it takes to really work my recovery. I have been staying clean, focusing on group grief therapy for suicide loss survivors and talk therapy with an amazing psychologist. I have been working full time, in school part-time and figuring out how to be a single mom with the complex emotional needs of my two older children and a very physically active toddler who is nearly two.

As I have turned my face back toward being active in recovery all sorts of things have started to happen. I have spoken with the woman who was my sponsor more than I have in over a year. We are not formally in a sponsor-sponsee relationship anymore, but it is nice to just be speaking with each other again. I have re-connected with some wonderful women who I know will be key in my network moving forward. I have gone to two meetings in the past week. I picked up my black key tag for the 7 years that I celebrated on February 20th.

All of this because I sent a Facebook message to an inspiring man a week ago today after he posted a picture of himself on Facebook graduating from college. We met around the time that Oscar died, he was new to recovery and had just moved back to KC. I have been making an effort to be active on Facebook as part of building my networking skills to help me grow my business. I have been sending messages on Facebook to people I haven’t spoken with in ages to reconnect.

He has been an amazing addition to my life this past week. Usually, people shy away from my pain and my grief and end up relying on platitudes that just make me feel worse. As a response, I shrink away from interaction with them. Maybe because he has had trauma in his life and he carries his own heavy grief he seems to always know what to say.

When I was having a hard time shopping for Pierce’s card (since Oscar died I have not put so much effort into these types of seemingly mundane tasks that make up the little- read that big- celebrations that we take for granted in life) I texted him and he said of course you are feeling pain, you are growing and you know as well as I do Oscar is right there picking that card out with you. No one says things like that to me! It was amazing. There are so many other little ways he has been an amazing support for me over the past week and I am grateful.

This is the other side of 16. Life keeps on going whether we want it to or not. As much as I would love for time to just pause, just for a few minutes, it is not going to. I have almost become a graceful expert at choking back the tears. There were a few times last night that Pierce and I met each other’s gaze knowingly and our hearts acknowledged each other and how incredibly difficult it felt to move forward. Those are the moments I live for now.

As I discover my new pattern of recovery and I begin actively applying the principles of the program to my life it won’t be easy- the program is simple, not easy. I have fear about how the intimate awareness of my character will intertwine with my grief. The steps are in the order they are in for a reason and if I let myself go at the pace my heart dictates and I don’t use, no matter what, everything will be okay. More than okay.

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This One is for School and it is all about Social Justice and Social Justice Warriors (Workplace Diversity at Avila); April 6, 2019; I deeply wish Oscar was here to discuss this!!!

This week in my current class, which is Workplace Diversity, our instructor is having us absorb a lot of different information about the term Social Justice Warrior. This class, as most of my other classes at Avila, has been eye-opening, to say the least. Right after Oscar died and I knew I was going to finish my Bachelor’s of Science in Nursing in his memory, I knew I was getting myself into a challenging mind-growth situation, especially considering how grief like mine rearranges everything about yourself that you used to think was true. My last couple of classes I have been referring to as “mind-stretching”.  Uncomfortable at times because I feel deeply irritated, almost angry really, that we are WASTING OUR PRECIOUS TIME as a species on using our mind power to argue about issues that are not real.

What is real is that there are millions of people who die on our planet every day because they do not have nutrition to nourish their bodies. What is real is that in this county, the United States of America, suicide is now the number one killer of kids who are middle school age (now above accidental deaths for the first time ever) and we are not funding research accordingly so we can understand this disease process and save lives! There are plenty of other real issues that come to mind, and as I sit here rattling them off in my mind (all issues revolving around equality and equity, at their roots), I realize that this makes me a Social Justice Warrior. And damn right. I would like to see any right-wing conservative live through what I have lived through and not care about Social Justice issues deeply. And so lies the trap that I see so many people fall into. The name-calling and the “my-story-makes-my-opinion-more-valid-than-yours” defensive stance. This is where I see this Social Justice Warrior concept taking us online as I have completed the required readings and viewings for this week’s course work. It is a fancy game of name calling and refusing to take responsibility. On both sides.

Social Justice and Social Justice Warrior are different concepts, and to understand the term Social Justice Warrior it is important to understand Social Justice. Social Justice was first defined by Luigi Taparelli in 1840 in his Theoretical Treatise of Natural Right Based on Fact, “Justice due between associations on the same, or at greater or lesser levels of the social hierarchy.” Important to understand that this subject has roots in religion, Catholicism specifically, and it has only been in very recent years that it has become politicized. This ideology has influenced Marxist and Communist theory and also influences most social welfare programs. The problem with this term and with this concept is that it is not strictly defined. It means many different things to many different people and, as such, some would argue that it means nothing at all, such as F. A. Hayek. Hayek’s well-published opinion, that Social Justice cannot be defined, has been fuel for the fire for this to become a hotly contested political issue. So, Social Justice evolved from a theological and philosophical concept into a raging political and public opinion argument.

The UN threw more fuel on the fire in 2006 when Social Justice in an Open World was published. In this publication, the UN defined social justice: “Social justice may be broadly understood as the fair and compassionate distribution of the fruits of economic growth; however, it is necessary to attach some important qualifiers to this statement. Currently, maximizing growth appears to be the primary objective, but it is also essential to ensure that growth is sustainable, that the integrity of the natural environment is respected, that the use of non-renewable resources is rationalized, and that future generations are able to enjoy a beautiful and hospitable earth.” In my mind, why don’t we just stop there?

The term Social Justice Warrior has only been in existence since the end of the 20th Century. Social Justice Warrior means different things to different people, just like Social Justice. When someone applies this term to themselves it is a term that implies a willingness to fight for what is right, to fight for equality and equanimity. On the other hand, when it is applied by someone who does not agree with the concept of Social Justice it is meant in a derogatory and insulting manner to describe someone whose only aim is to censor speech and remove power from the privileged. Shout out to Dr. Layman for the informative youtube video on the history of Social Justice and Social Justice Warriors: A brief history of Social Justice and “Social Justice Warriors”.

The key players in the Social Justice Movement today are really any person or any group who advocate for the rights of historically marginalized people. I recently started following an Instagram account @lilnativeboy, Allen Salway, who I would consider a Social Justice Warrior. He is Native American and I have learned so much about myself as the descendant of white colonizers by seeing my privilege through his eyes. It is humbling and also embarrassing, to be sure. From everything to the physical ground that I live on and that it once belonged to the Navajo to understanding our American holidays like Thanksgiving through the eyes of those who were trampled on to establish such a “holiday”, this man is opening my eyes to the injustice that our country, founded by white Americans, is deeply engrained with. Another key player is a pediatrician named Dr. Rhea Boyd. She utilizes photographs, powerful images through which to view our current state of cultural affairs. Through these images, she feels that the story of social injustice is best told. Awareness of the issue is the first step to change. Further, change is really about integrating historically marginalized people into positions of power in our society. That is how lasting change toward equality and equanimity will happen.

The more awareness is generated regarding the current issues of living in our society as experienced by historically marginalized populations the swifter change must happen. It is a grassroots effort, a grassroots revolution of thought and action. When I understand my role in our society intimately, I naturally change the way I see, talk and interact with those around me. I actively seek relationships with those I might not have before my understanding was expanded. As a white woman with roots in her ancestry back to the American Revolution, I feel compelled to use whatever power comes from my privilege to lift those around me who have been trampled on by my ancestors. I want historically marginalized people to see me as a strong ally. The more I learn the more I want to hear the experiences of those around me who are different from me. I feel that through talking and sharing with one another we will become a united force for the revolutionary change that needs to happen in our government and to health policy specifically.

I feel that Social Justice Warriors are mostly helping to diversify our culture, including our workplace culture, by raising awareness and increasing the need for, at the very least, sensitivity. I feel that this has become such a provocative battleground politically because the issues that Social Justice Warriors speak about and rally around are all issues that we have never spoken about openly in our culture. Never. Change like this is uncomfortable. We must keep talking and sharing, though, it is the only way to #breakthestigma.

I think, at the core, the issue of Social Justice is really about human rights. As a culture, we must decide what constitutes human rights and then mold our policies and laws around those agreed upon human rights. This, of course, is also a hotly disputed arena- I think it is amazing that it is so difficult to agree on what human rights are and that they should be fought for and supported universally!!

What I see happening to our species currently is an evolution from individual pockets of existence separated by geographical barriers to a global existence where we are all united by our humanness. A revolution in thinking from what separates us and makes us different, to what unites us and makes us the same. I feel that as Americans we have a unique opportunity to use our privilege to lead this global revolution toward equality, equanimity, and unification.

How powerful to think that the way you speak to the people around you in your everyday life and the topics that you bring to your interactions can influence our collective existence as humans?!

My instructor wants us to respond to the Dove ad where the black woman turns into a white woman turns into a brown woman. My initial response to the ad was, “oh that is too bad, this would have been a tremendously successful ad if the white woman had turned into the black woman or the brown woman.” There probably would have been some sort of backlash then, too, honestly, maybe surrounding starting the ad with a white woman. I don’t know. It kind of pisses me off that I have to dissect this when I feel like I have better things to think about. But that is part of my own trap, isn’t it?

“JUSTICE WILL NOT BE SERVED UNTIL THOSE WHO ARE UNAFFECTED ARE AS OUTRAGED AS THOSE WHO ARE.” ~ Benjamin Franklin

Health care policy and reform- this is what I am doing this AM

As I have said before, this blog is not just about the pain and grief of being a bereaved mother and suicide loss survivor, but it is also about sharing my thoughts on the research that I do as I go through finishing my BSN. I have been a practicing registered nurse since 2006 with an Associate’s Degree in Nursing, but after Oscar died I felt that the only way my voice would truly carry and give strength to my opinions regarding health care reform is if I had a Bachelor’s in Nursing. So, in Oscar’s memory, I started back to school the fall a year after he died and I am on track to finish after fall semester this year. It has been a long, hard road, especially now that I am newly grieving for the loss of Oscar’s dad, my ex-husband, Nick, also to suicide. Here is what all of my research and thought processes keep boiling down to: we need universal health care and a universal electronic medical record. Period, end of story. I wrote the following paper for my Public Health Nursing class this morning and I wanted to share.

 

The recent article I found is, “Rebounding with Medicare: Reform and Counterreform in American Health Policy,” by Paul Starr of Princeton University.  From my research on the topic of universal health care in the United States, it became clear that Mr. Starr has a strong voice on the matter with a history of several articles and books pertaining to the subject of health care reform in America.  Mr. Starr proposes that we have an opportunity to expand Medicare through a program he refers to as “Midlife Medicare” in response to the Trump administration’s recent setbacks on our progress to provide every one of our citizens with basic health care.

My personal experience as a suicide loss survivor and my professional experience as a registered nurse inform my passion for health care reform.  One thing has become clear to me as I grapple with the disabling pain of suicide loss- our health care system is the root cause of our ills.  And how extremely infuriating!  Here we are in one of the world’s richest countries and we cannot afford to provide universal health insurance for our citizens?  Mr. Starr analyzes the history of health care reform in the United States and notes that all important reform has been made on the rebound from the failure of more progressive proposals.  He acknowledges that the Affordable Care Act (ACA) has had very limited success in fulfilling its goal of ensuring all American citizens have health insurance.  The ACA has been a downright failure in some respects.  It has forced the price of premiums up while not guaranteeing basic coverages to patients.  In other words, just because someone is insured doesn’t mean they can afford to get care, which does nothing to solve the problem of health care for all.

The devastation of not having health insurance or not having adequate health insurance is heart breaking.  There are so many stories to illustrate the social injustice that not having universal health care causes.  It seems that each of us has been directly affected or is only one person away from being directly affected.  The implications on nursing of universal health care are tremendous.  I believe that the positive effects of universal health care are all encompassing.  If we had universal health care, as a nurse and mother, I would have been able to get the care my oldest son needed without traumatizing him with mental health hospitalization.  I would have been able to guide my ex-husband to the care he needed so he could have received the care he required for the treatment of Crohn’s disease without worrying how he was going to pay for it.  I believe, deep in my heart and soul, that if I had been able to make those two interventions my family would still be complete.

I have thought a lot about how to help our citizens who die unjustly, and I am not just talking about suicide, I believe that many deaths in our society happen that could be prevented with adequate access to primary health care for prevention.  My thought processes always boil down to two issues: universal health care and a universal electronic medical record.  At the core of these ideas is patient safety.  Patient safety is the heart and soul of nursing.  I appreciate Mr. Starr’s work and am grateful I found him.  His suggestion of “Midlife Medicare” as a rebound reform to our health care system is right on target.  A positive step in exactly the right direction.

 

 

Starr, P. (2018). Rebounding with Medicare: Reform and Counterreform in American Health Policy. Journal of Health Politics, Policy and Law,43(4), 707-730. doi:10.1215/03616878-6527996

 

 

 

 

Where Primary Care Nursing and Mental Health Nursing Meet; a labor of my deepest love

Here is the research paper that is the culmination of a course filled with so much deep, confusing emotion. I dedicate this to all of us that have lost loved ones to suicide. May we see the changes in our lifetime that it will take to save the lives of millions more who suffer from the worst antagonist: suicidality.

Abstract 

An area of concern in nursing practice is where primary care and mental illness meet.  Suicide is a disease process requiring an urgent and exponential increase in attention from all members of the community, and where primary care nurses can make a lifesaving impact through education and frequent follow up phone calls.  In 2016, 45,000 Americans died of suicide.  “Research indicates that during 2012-2014, an estimated annual average of 30 million mental health-related physician office visits were made by adults aged 18 and over” (Cherry).  Educating patients on best practices for a healthy lifestyle including mindfulness, diet and exercise has long been a primary treatment for chronic disease processes.  In patients with mental health related office visits, is education on healthy lifestyle including mindfulness, diet and exercise in combination with regular follow-up phone calls every other week from primary care nurses effective in decreasing symptoms of mental illness as indicated by lower patient health questionnaire 9 (PHQ-9) score, fewer office visits and emergency room visits over a 12-week period?  Research was reviewed from four articles found utilizing EBSCO-CINAHL Plus with Full-Text.  Four types of research studies including quantitative, qualitative, mixed method and meta-analysis were reviewed and analyzed. The quantitative and mixed method samples were obtained randomly.  The qualitative method sample was obtained purposively.  The meta-analysis was a review of six randomized controlled trials.  The quantitative and mixed methods articles utilized longitudinal data collection.  The qualitative study utilized cross-sectional data collection.  Sample sizes ranged from 5 patients to 696 patients.     

Introduction 

Nearly one in five adult Americans experience the effects of mental illness ranging from depression to suicidality.  Suicide is a disease process requiring an urgent and exponential increase in attention from all members of the community, and where primary care registered nurses can make a lifesaving impact through education and frequent follow up phone calls.  In 2016, 45,000 Americans died of suicide.  “Suicide is a leading cause of death in the US….Health care systems can provide high quality, ongoing care focused on patient safety and suicide prevention” (OADC).  Lack of mental healthcare resources places primary care clinic registered nurses in a position to fill the gap.  “Research indicates that during 2012– 2014, an estimated annual average of 30 million mental health-related physician office visits were made by adults aged 18 and over” (Cherry).  Treating mental illness as a chronic disease process is where the key to change lies.  Educating patients on best practices for a healthy lifestyle including mindfulness, diet and exercise has long been a primary treatment for chronic disease processes.  “In 2014, there were an estimated 885 million office-based physician visits in the United States” (Ashman).  This illustrates the tremendous opportunity for impact primary care registered nurses can make through patient education. 

Most current nursing research revolves around the role of the psychiatric mental health nurse practitioner instead of the role of the office-based ambulatory care registered nurse.  The gap between primary care nursing and mental health nursing would be further closed if there was one electronic medical record (EMR) to unite all EMRs.  This would also assist the registered nurse as case manager, which is the role supported as most effective in integrating primary healthcare and mental healthcare in current research.  Mental health patients are being lost in the United States healthcare system because registered nurses are not involved in patient care at the primary care level to the degree that they could be and should be. 

The role of registered nurse in bridging the gap between what is considered classic disease management processes such as diabetes mellitus and hypertension, and mental health processes such as depression and anxiety, when it has been studied, shows repeatedly that patients respond with comfort and ease to the registered nurses at their primary care physician’s practices which increases their success in treating the symptoms of their disease processes.  Registered nurses are an extremely important key to a patient’s care.  No other healthcare team member treats patients as an entire human being the way registered nurses are trained to do.  Registered nurses address not only a patient’s physical symptoms, but also a patient’s mental, emotional, spiritual and environmental symptoms, as well.  Because of this, registered nurses are poised at an excellent vantage point to understand a patient’s complete care needs, which makes them especially qualified to intervene on multiple levels to ensure a patient is receiving needed therapies to maximize quality and quantity of life.   

Methods 

Research was reviewed from four articles found utilizing the Cumulative Index of Nursing and Allied Health Literature (CINAHL) through EBSCOhost.  Limitations set for the searches included utilizing EBSCO-CINAHL Plus with Full-Text as well as setting search parameters for the past five years only and searching keywords which included nursing education, nursing, depression, mental health, suicide, machine learning, mindfulness and primary care. All articles were published in the English language. All articles were reviewed and analyzed utilizing Avila University’s Nursing Department Literature Review Protocol for each of four types of research studies including quantitative, qualitative, mixed method and meta-analysis. The quantitative and mixed method samples were obtained randomly. The qualitative method sample was obtained purposively. The meta-analysis was a review of six randomized controlled trials. The quantitative and mixed methods articles utilized longitudinal data collection. The qualitative study utilized cross-sectional data collection. The sample sizes ranged from 5 patients to 696 patients.  

Results 

The first article reviewed was a quantitative study, “Collaborative nurse-led self-management support for primary care patients with anxiety depressive or somatic symptoms: Cluster-randomised controlled trial (findings of the SMADS study)” authored by Thomas Zimmerman, Egina Puschmann, Hendrik van den Bussche, Birgitt Wiese, Annette Ernst, Sarah Porzelt, Anne Daubmann and Martin Scherer.  This study was published in 2016 and took place in Hamburg, Germany in twenty general practitioners’ practices with a total of 220 patient participants.  The patients that participated in the study were chosen by, “a biometrician (AD), not involved in field work” (Zimmerman, Puschmann, van den Bussche, Wiese, Ernst, Porzelt, Daubmann, Scherer).  The sample was obtained utilizing certain eligibility criteria including “a) age: 18-65 years old, b) literacy (German), c) fully able to give consent, d) sufficient auditory and visual capabilities, e) currently not in psychotherapeutic treatment, f) Patient Health Questionnaire (PHQ) scoring 5 points or higher” (Zimmerman, et al.).  Patients were divided 1:1 to either participate in nurse-led care or routine care.  Nurse-led care involved case management and counselling techniques to encourage patients to lead their care plan through self-management.  By the end of the study patients who were in the nurse-led intervention group reported increased self-efficacy as measured by several different scales, including the General self-efficacy scale (GSE scale), PHQ, EQ-5D quality of life and the Freiburg questionnaire of coping with illness (FQCI).  Data collection was longitudinal.  The main barrier to implementing this type of intervention across the board in Germany is lack of economic resources and lack of education of healthcare professionals related to what a registered nurse is capable of in the primary care setting. 

The second article reviewed was a qualitative study, “Feasibility of training practice nurses to deliver a psychosocial intervention within a collaborative care framework for people with depression and long-term conditions” authored by Lisa A. D. Webster, David Ekers and Carolyn A. Chew-Graham.  This study was published in 2016 and took place in the North of England with ten clinicians—five general practitioners (GPs), three practice nurses (PNs), one health assistant and one mental health specialist and five patients (four of which completed the interview).  “Recruitment of clinicians…was by personal invitation from the research team to those participating practices who took part in the service development project.  The invitation was made after two months of working within the collaborative care framework in order to explore the implementation of the intervention within the practice” (Webster, Ekers, Chew-Graham).  The recruitment of patients to participate was also by invitation, which was sent about two months after the patients had received the intervention with an offer for a “love to shop voucher” (Webster, et al) for those willing to give their time for an interview.  Demographics of the patient sample were predominately female diabetics with some form of arthritis or back pain in addition to being depressed.  Demographics of the clinician sample were also predominately female.  Practice sizes ranged from 4,402—25,386.  Data collection was cross-sectional and was completed utilizing semi-structured interviews which were face-to-face for clinicians and via phone for patients.  The results of this study also support the integration of mental health services in the primary care setting, but with one important caveat: tending appropriately to the mental healthcare of the registered nurses who are the leaders in providing and coordinating that level of patient care. 

The third article reviewed was a mixed methods study authored by Brenda Reiss-Brennan, “Mental health integration: Normalizing team care.”  This study was published in 2014 and focuses on nine primary care clinics of Intermountain Healthcare in Salt Lake City, Utah.  Three clinics from each phase of mental health integration were included: potential, adoption and routinized.  Even though this study utilized a mixed methods approach, it is primarily a qualitative study.  The sample included both clinicians and patients.  Fifty clinical staff were selected for balance among team members including physicians, clinic managers, nurse care managers, mental health specialists and medical support staff.  Patients were randomly selected who had received care for depression from their primary care provider (PCP) in the previous twelve months, for a total of 59.  This study tested the effectiveness based on objective and subjective criteria of mental health integration (MHI) which is “a team-based approach where complementary roles include the patient and family and are operationalized at the clinic improving both physician and staff communication” (Reiss-Brennan).  MHI is a standardized approach to incorporating mental healthcare into the primary care setting.  The data collected was longitudinal and was collected via self-report, observation and interview.  Again, the data collected, which included a decrease in emergency department visits and patient-reported decrease in mental illness symptomatology, as well as positive provider reported reactions to MHI, support implementation of mental healthcare via the primary care setting. 

The fourth and final article analyzed was a meta-analysis authored by Kathleen Barrett and Yu-Ping Chang, “Behavioral interventions targeting chronic pain, depression, and substance use disorder in primary care.”  The study was published in 2016 and reviewed a total of six articles with a total of 696 participants.  Four electronic databases were searched including CINAHL, Medline, PsycInfo and Google scholar.  Key words included in the search were as follows: chronic pain, depression, depressive disorders, behavioral interventions and primary care.  Limitations set on the search included articles published during the years 1995 to 2015, available in English, original randomized controlled trials (RCT), adult population and studies that contained a behavioral health intervention.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used.  The patients in the study had an average age of 45, with 316 men and 380 women.  Three of the six studies were conducted in the United States, two in Australia and one in England.  All study participants had at least two of the three diagnoses (depression, chronic pain and substance used disorder) during the time of the study.  Two of the six studies were conducted strictly in primary care.  The results of this meta-analysis showed, again, that integrating behavioral healthcare in the primary care setting had a positive impact on patient care through decreased mental illness symptomatology. 

Discussion 

The changes that need to happen to better serve our country’s mental health patient population revolve around nurse-led mental health integration of primary care.  The resources it would take to influence the people who could make this change are tremendous.  The changes that need to be made to standardize mental health integration have already been successfully implemented by Intermountain Healthcare in Salt Lake City, Utah.  To make these changes across the country there will need to be a change in healthcare law.  This begins with one EMR that acts as an umbrella for all EMRs.  There needs to be a way for each of the many pieces of the care puzzle to fit together so that each piece of a patient’s records from different providers can be viewed by each of the team members on the patient’s care team.  This would also allow application of machine learning algorithms to accurately predict suicidality in patients.  In some cases, before the patient is aware of the imminent danger facing them.  “In an effort to contribute to the development of one such method, we applied machine learning (ML) to electronic health record (EHR) data.  Our major findings included the following: (a) This method produced more accurate prediction of suicide attempts than traditional methods, with notable lead time (up to 2 years) prior to attempts; (b) model performance steadily improved as the suicide attempt became more imminent; (c)model performance was similar for single and repeat attempters; and (d) predictor importance within algorithms shifted over time” (Walsh, Ribeiro, Franklin). 

The changes that are needed are possible, but only with the help of big money to lobby lawmakers in the community on a local, state and federal level.  To find funding for this type of initiative nurses would need to contact major non-profit organizations that study mental illness such as the American Foundation for Suicide Prevention (AFSP), the National Alliance for Mental Illness (NAMI) and perhaps the countless of other small non-profits started by parents, family members and friends of those who have died of suicide.  Bringing these voices together as one voice would provide the power needed to move legislation.  This is the tip of the iceberg and would eventually lead to a massive healthcare system reformation.  The first step, though, is to have one medical record that unites them all.  Ideally this medical record would be fluid enough to communicate with most of the EMRs already in existence.  

So many lives are lost every day to suicide.  If the resources were in place to address mental illness where it meets primary care, it is certain that the number of sons, daughters, husbands, wives, ex-husbands, ex-wives, mothers, fathers, brothers, sisters, cousins, aunts, uncles, friends, neighbors and other community members that we lose to suicide would drastically decrease.  The evidence uncovered in this research review supports this without a shadow of a doubt.  “Most patients with behavioral health needs use the primary care office as their main source of care, and given the nation’s shortage or behavioral health providers, this may be the only setting in which behavioral health problems can be broadly recognized and treated” (Crowley, Kirschner).  Bottom line is there is a huge need for nurses in primary care who are able and willing to implement changes once they are legislated either as part of health care law or part of their health care entity’s updated care standards at the place where primary care nursing and mental health nursing meet.   

References 

Ashman, J. J., Rui, P., & Okeyode, T., (2017). Characteristics of office-based physician visits 2014. National Center for Health Statistics Data Brief (no 292). Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db292.htm 

Barrett, K., & Chang, Y. (2016). Behavioral interventions targeting chronic pain, depression, and substance use disorder in primary care. Journal of Nursing Scholarship,48(4), 345-353. doi:10.1111/jnu.12213 

Cherry, D., Albert, M., & McCaig, L. F., (2018). Mental health-related physician office visits by adults aged 18 and over: United States, 2012–2014. National Center for Health Statistics Data Brief (no 311). Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db311.htm 

Crowley, R. A., & Kirschner, N., (2015). The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: Executive summary of an American college of physicians position paper. Annals of Internal Medicine,163(4), 298. doi:10.7326/m15-0510 

National Center for Health Statistics., (2016). Depression. Retrieved from https://www.cdc.gov/nchs/fastats/depression.html 

Office of the Associate Director for Communications., (2018). Vital Signs: Suicide rising across the US, more than a mental health concern. Retrieved from https://www.cdc.gov/vitalsigns/suicide/index.html 

Reiss-Brennan, B., (2014). Mental health integration: Normalizing team care. Journal of Primary Care & Community Health, 5(1), 55-60. doi:10.11/2150131913508983 

Walsh, C. G., Ribeiro, J. D., & Franklin, J. C., (2017). Predicting risk of suicide attempts over time through machine learning. Clinical Psychological Science,5(3), 457-469. doi:10.1177/2167702617691560 

Webster, L. A. D., Ekers, D., & Chew-Graham, C. A. (2016). Feasibility of training practice nurses to deliver a psychosocial intervention within a collaborative care framework for people with depression and long-term conditions. BMC Nursing,15(1). doi:10.1186/s12912-016-0190-2 

Zimmermann, T., Puschmann, E., Bussche, H. V., Wiese, B., Ernst, A., Porzelt, S., Daubmann, A., Scherer, M. (2016). Collaborative nurse-led self-management support for primary care patients with anxiety, depressive or somatic symptoms: Cluster-randomised controlled trial (findings of the SMADS study). International Journal of Nursing Studies,63, 101-111. doi:10.1016/j.ijnurstu.2016.08.007 

 

 

 

Nick

This season is hard for me. My oldest son Oscar’s deathday is September 11, 2015. This year I was working hard through it. I posted about how much better I felt this year and how much hope I had for my new nursing position as a triage nurse in a primary care clinic. And I made it through Oscar’s deathday and the week surrounding it and I did okay. The most okay I have done since the year he died.

I was beginning to start thinking about the rest of the holiday season and how Nick (my ex-husband and the father of my oldest three– Oscar, Pierce and Vivian) and I would work out some sort of new parenting schedule in court soon that would be focused on the kids’ safety. How good it would be to have that settled and with hope that Nick was doing the work to get clean again and be a healthy example to the kids. That is all I ever wanted from Nick, truly, was for him to get clean and sober.

Instead, on Sunday, September 16th, in the late afternoon, two police officers knocked on my front door. I picked up my little Shih Tzu, Andy, and answered the door. I invited them inside and they stepped in gratefully as it was one of the last of our hot days here in KC, but when they saw my daughter, Vivian, sitting on the living room sofa they said maybe it would be best to speak outside. My heart dropped. We went out front and they told me that one of Nick’s neighbors had called for a wellness check and Nick was found in his apartment deceased. All of the physical ways that I had responded to Oscar’s death happened. My knees got weak, my stomach immediately tied itself up into knots and I had to sit. I sat on the front step and the tears came. I knew deep down what had happened. Nick died of suicide on Oscar’s deathday. And that is what the investigation has revealed thus far. Swirling horrid nightmare.

Over the next several days, when I had to face this gaping hole in my family’s life with zero grace from the world around me (no bereavement leave for an ex-spouse– not even when you have underage children that were fathered by that ex-spouse), a shining light has been shone on what I have been doing since Oscar died. I have been doing what I know how to do as a scientist (that is the core of what a nurse is): researching to make sense of the way my oldest son had died. And I have learned so so much about mental illness and suicide. I have come to a place of solace and understanding related to suicide.

Now that Nick has died of suicide I need to be able to put it in a box and walk away from it. I need to be able to have days where it doesn’t come up in conversation, especially about and with patients. So I made an extremely careful, well-thought out and thoroughly discussed with my nuclear family members decision to go home to the operating room. I crave the feeling of family and support that I have in the operating room, as well as the standard of care that goes along with caring for surgical patients. The first month that I was away from the OR in primary care I dreamed about the OR nearly every night! Luckily for me my OR family needs me as much as I need them and so I will be starting at Menorah again on October 22nd. My last day in primary care was yesterday. Even though I cannot afford financially to take the next week off from work I absolutely need the time to regain my sense of balance and my own mental health. I won’t do anybody any good if I push myself so far that I cannot work because I have a mental breakdown.

School has been a real struggle since Nick died. I have been heavy into researching where primary care and mental healthcare meet and the results are humbling. I need to put it all together in a research paper over the next couple of days and I am not going to lie, I am procrastinating it. Thinking about suicide and mental illness and how it tears people’s lives apart and away from them and how simple it would be to fix the problem makes me kind of queasy. The disconnect is that the change starts with one electronic medical record (EMR) that is like an umbrella over all of the varying different electronic medical records currently in existence. This umbrella EMR would translate each patient’s multiple medical records into one place where clinicians could view all of the symptoms and interventions that the patient has experienced. This would also allow the application of machine learning algorithms to predict suicidality in patients and allow for early intervention, in some cases before patients might even understand themselves the danger they are in. Such a simple change, but a change that will only happen with roots in change to healthcare law. That feels like moving a mountain to me.

Nick’s death has made it clear to me that I need to take care of myself and get back to living for me. Whatever that means. Right now that means focusing on my children and our health. When our family celebrates Nick’s life it will be in the summer, at the family plot at the cemetery on Sand Hill in Washington state. The weather will be beautiful, we will release butterflies and listen to Death Cab for Cutie’s song “St. Peter’s Cathedral” (Nick always told me he wanted that played at his funeral) and maybe share a meal together at Pat’s Little Red Barn. We will focus on hope and love and what it takes to make healthy choices in order to lead our lives away from the darkness that consumes our family members all too easily and causes them to die of suicide.

Rest in peace, Nick.