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.

 

Long time coming

In December I finished my BSN. What a relief. I showed up to the  Avila University Administration Building to pick up my diploma the day campus re-opened after Xmess break and when the nice lady behind the counter handed it to me and asked me to check the spelling of my name to make sure it was correct the tears started flowing. Joy, sadness, relief, pride. It was all in those tears. And the missing. Missing Oscar, missing Nick. I can hear Nick telling me how proud he is of me. I can feel Oscar’s arms around me squeezing me tight in hugs only he could give. Thinking of that moment brings the tears to my eyes and goosebumps to my flesh even now.

My life seems to have been moving a million miles an hour for the past several years. Really since I got clean eight years ago. Change is always constant. Not just subtle changes like needing to change the brand of your coffee because the one that you like has gotten too pricey or your usual store has stopped carrying it. My changes have been life or death, literally. Navigating big change is hard. Nothing easy about it. I have found that the way to stay (mostly) productive is to focus on the small bits that make up the everyday. Breathing. Breathing is a big deal for me. Meditation daily is part of my routine, but it hasn’t always been. At first, it was simply remembering to take deep cleansing breaths whenever the uncomfortable vibrations of emotional pain would start creeping in. Then drinking enough water. For real. Water is a big deal. After that comes nourishing foods. All with a focus on mindfulness. Staying square in the middle of the moment you are in.

In the last semester of my BSN, I had a realization. The truth of my realization is that I am a nurse whose calling is surgery. This has been a difficult truth for me to embrace since Oscar’s death.

I studied mental health- depression, and suicidality- for all of my individual projects while completing my BSN. How confusing to study mental health so intensely if your calling is surgery. I thought for a while that I should try to change my specialty area and I did for about three months beginning in the late summer of 2018. I worked in primary care for those three months and I learned very quickly that it wasn’t for me. Nick died in September of that year and I couldn’t try to make the transition to primary care work any longer. Thankfully, I was welcomed back to the OR at Menorah I had been working in since I left KU in 2016. It was really good to go back to surgery after trying something different. This was a big clue to me that my calling is truly surgery.

Fast forward to last summer, 2019. It became glaringly clear to me that Menorah was no longer a good fit for me. Not because I was grating with personalities or anything like that. Menorah OR has been a wonderful family for me. I love all of the staff there dearly and it took me over six months to make the final decision to leave for another OR. I was not aligning with the foundational ethics of HCA. Over and over again I would see the same problems happening and I was powerless to do anything about it. I had ended up back in a board running position and was denied the opportunity to advance to management, so I was in this strange and very uncomfortable position of seeing exactly what needed to change to make our department more efficient and safer for staff and patients with no power to make change happen.

I applied for other OR staff nurse positions after I was denied the promotion to OR Manager at Menorah- and I turned down two very strong offers from organizations with very positive reputations. I wasn’t sure if my motivation to leave Menorah was coming from a place that was purely emotionally reactionary. What if this just meant that I really did need to change my specialty area? That was the lingering question. I felt like I wanted to try a little longer at Menorah (and finish my BSN). Ensure that I was truly doing everything I could to continue my career at Menorah. There were several conversations with my director about burning out in my board running position. That it was too stressful to make an impossible schedule run smoothly every day. What we needed to change to make our department more efficient. My concerns fell on deaf ears. I tried at Menorah. I really did.

I explored the question of whether I was really meant for surgery because of all of the heart and soul that I gave to Menorah with no reciprocation. I decided to apply for any and every job that sounded interesting to me that wasn’t in surgery. Looking back I feel like I was testing God. My job hunt included many different community health type positions from school nurse to county emergency coordinator to public health. I applied at UMKC, Cerner, Johnson County, Shawnee Mission School District, even Tyson Foods! ZERO interest from these employers. My resume went nowhere.

Swirling in the back of my mind, the entire time since I had turned the offer down in September, I kept thinking of one OR staff nurse position in particular: CVOR at Saint Luke’s Hospital. When I had interviewed there in late summer last year I was so impressed. I asked the manager more questions than she asked me. All of her answers were spot on. I shadowed there and was completely enthralled. The way the nurses practiced, the care I saw given, it was all world-class. Truly world-class. And the cases themselves! I had always had a little piece of me that wanted to learn CVOR, but I felt like I wasn’t good enough.

I had first been exposed to CVOR at KU. One of our robot rooms for main was in the CVOR and I would peek in the windows of those heart cases and I remember saying to my work wife at the time how much I wish I could just be a fly on the wall in those rooms. What if I was meant to grow as an OR nurse in a way that I never thought I would have the opportunity to? What if I could grow my OR nursing practice to include this pinnacle of OR nursing knowledge- open hearts? Those were the questions that began to make themselves regulars as I would contemplate my next career move.

The day after I finished my BSN course work in December 2019 I looked to see if the position at Saint Luke’s CVOR was still open. It was! I immediately reached out to the manager and to the HR recruiter I had worked with previously. I went through another round of interviews. I felt a sense of home during those interviews. I was extended a second offer that I accepted.

I have been in my new position learning the rooms as a CVOR staff nurse for about a month now. I’m not going to lie, it was pretty rough at first. The cases are the highest acuity and that is challenging to me because of my own personal trauma, but I feel confident that I am able to process these new experiences appropriately and bring my highest level of professional performance to the table. Also, fitting in with such a tight-knit team… They are the tightest-knit team I have ever seen, and each and every one of them holds each other to the highest practice standard. And me, coming from a leadership position where I had been on the outside of staff camaraderie- I am sure it seemed like I was either super stand-offish or a snob. Transitions have always been hard for me, but I feel like especially over the past two weeks or so I have started figuring out my spot on this team. I feel like I have so much to learn even though I have been an OR nurse for the better part of ten years. This specialty area should not see me bored for a very very long time, if ever!

I have been feeling so much of myself change since I started at Luke’s. The organizational atmosphere at Saint Luke’s is amazing. I have never felt so supported in my nursing practice. What I have had the blessing to witness caring for our patients is truly humbling. Somehow being with these patients is different than all of the other surgical patients I have cared for. It has been very powerful for me on the deepest level of spirit.

My career finally feels like it is exactly where it needs to be. And that has been a long time coming. My new understanding is that I can pursue the career that I have always dreamed of and simultaneously honor my firstborn son, Oscar. I don’t need to fundamentally change what has always excited me about nursing in order to fully honor his memory. The way that I carry myself as I do the work that I love is what matters. That I keep talking and keep sharing openly and honestly about my experience and all that I have learned about mental wellness is the purest way for me to honor my beautiful boy, Oscar.

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So I’ve made it through September, and almost all of October, but…

It just doesn’t really get any easier, not at the base, at the foundation of it all. I still feel his absence to the absolute marrow of my bones, all the way down to the molecular structure of my DNA. I keep dreaming about him and his dad and Washington- the other night I dreamt that I was with him, close to him, touching his beautiful face and staring into those incredible deeply perceptive eyes. I woke up and picked a huge wound on my own face, which I haven’t done in years. Great. I have been keenly missing his dad lately, too. All I ever wanted was to be happy with Nick. To get along with the most amazing partner I had ever had- but to do that he would have had to completely change. Addiction is a cunning enemy of life, goddamnit. And it sure was a destructive force on my life, on our lives, all the way around. The root cause of all of the tragedy that I have endured in my life is addiction. I work hard, daily, to make peace with that fact. To accept it, to let it be. And to never let it happen again. This Lane family curse stops with me, stops with this generation. No more. Enough.

Here I am almost through October. This year has actually been pretty okay. I have been utilizing a mental wellness product that is all-natural and it has been helping me to be pretty okay, which is tremendously improved from my typical level of functioning this time of year. It helped me get through Nick’s funeral- of that, I am certain- and helped me to make the most of my time in Kitsap County. It was so incredibly healing. We called it #healingweek. And it lived up to its name in every way. I realized during my time in Washington that the geography there, the land there, the people there, the rain there, the trees there, the water there, the everything there is always going to be half of who I am. Half of who I am. I felt a mission in my life, a pull that was beyond words when I was a teenager running from everything I knew in the Midwest. And it took me straight to Nick Lane in Bremerton, Washington. What a journey it has been. There are so many things that I would have done differently, of course.

One of the things that I have learned just recently is that the people that I had hoped I could rely on for support don’t get it. When the people that you thought supported you no matter what tell you that you are not trying hard enough when your grief overwhelms you with such force that it takes your breath away it is time to find new people. So I took that truth and have been looking for my tribe. I am very hopeful that I will find it in yoga. And I am very grateful that I have the opening of a new studio to look forward to next month. November is hard because it is Oscar’s birthday, so having something to look forward to next month is key.

Something wonderful did happen to me at the end of September- while I was at Pierce’s home debate tournament- I literally felt my holiday spirit float back into my body. At the exact spot where my heart is. This is huge for my family. When I asked Viv and Pierce if they would be okay with staying home for Christmas and decorating the house together they were both very excited! I usually take the kids and run away somewhere for Christmas because it is just too hard to tolerate. Great Wolf Lodge has been key for those getaways. I am not ready for any family ornaments yet- I don’t know when I will be- so this year we are decorating with a beach theme! It is fun to look forward to the happiness it brings to Viv especially. I am certain my youngest little spitfire, Phoenix, will appreciate it, as well. He is only two.

Viv and I had a lot of fun decorating for Halloween- Halloween used to be my absolute favorite holiday with Oscar. He loved to carve pumpkins. The year that he died I had been so looking forward to sharing Halloween with him because we hadn’t carved pumpkins together for two years… he was always so good at carving pumpkins. I took pictures the last time we carved pumpkins together in Bremerton, the year before the divorce. The problem is, I don’t know where those pictures are… I am almost ready to start going through the old pictures. I have so many from when he was little, thank God. They are waiting patiently for me in the hutch where I keep all that is left of him. There will never be enough of him. Not ever.

All of these feelings and all of my experiences spill over into my professional life. How could they not when I am a nurse? Since Oscar died I have felt a need to affect change on a larger scale than I do in my current position. I have experimented with all kinds of different ideas: working in primary care (that was a no-go), having my own intuitive healing arts business (still too small), staying in surgery and working my way “up the ladder” (my current director doesn’t agree that I should advance to manager), simply staying in surgery as a staff nurse somewhere other than where I work now (surgery just doesn’t feel right anymore). Over and over again I feel like I am not fitting. I keep working over all these different scenarios in my mind about how I could stay where I am and just volunteer more, I would very much like to be more involved with the Johnson County Suicide Prevention Coalition, but I am so tired after working shifts at my current position. It is so incredibly draining. The hours are so long and I see how it affects Viv negatively. Another good reason for a different path- different hours.

And I am still finishing school- it is almost over!!! December is my graduation date. I keep thinking maybe when I am done with school it will be different. And it will, but it won’t change how tired I am after a shift running the board in my OR. So I have started applying for positions in public health-related environments as they come up. Basically, if it looks interesting to me and it is something I have never done before as a nurse because it is on a macro-level instead of a micro-level I am applying. It is scary to think about leaving the specialty area that I wanted so much to be apart of for so long when I first started as a registered nurse fourteen years ago. Scary for a variety of reasons. Not the least of which is money. I am finally making more now than I did on the west coast- it took several years to get here. But just how important is money? Very. Sure. But so is affecting change to a system that is broken. And I can’t do that from the boardrunner position in surgery. I really want to work with healthcare issues on a larger scale- so perhaps at Cerner working on developing solutions for population health electronic medical records or working for the Johnson County Government to coordinate and manage emergency preparedness or how about as a middle school nurse?

My point is these are all things I think about, that I experience, that I face on a daily that I never would have if Oscar hadn’t died. I was happy at KU in the Main OR working as a circulator. It was all I ever wanted. The life I was building was going so well, I had finally gotten custody of all three of my Lane kids and everything was finally going to be okay. We were all going to be happy because we were finally going to be together. And it was going to be everything we ever wanted, our family life was because I had gotten clean and was doing the work to heal and be healthy. To be the best mom I could be. But then Oscar died and my world disintegrated. Our world disintegrated. Here we are four years later and it only sort of looks “normal” again. Because I am sort of okay and can decorate for the holidays again. I miss him. More than I have ever missed anything in my life. And it hurts. More than words could ever describe. And it always will. Period.

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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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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 

 

 

 

3 years

At this time three years ago I was reeling with the new reality that my oldest son, my sweet beautiful prince, was dead.  His time of death was pronounced at 0523 this morning three years ago.  There is so much about that time I cannot remember.  My friend, Sara, who is also a bereaved mama saw all of the spirit coincidences that were happening all around me all the time and she told me I should write it all down because I wouldn’t remember if I didn’t.  There was no space for writing.  At that time the only things I could tolerate were the work it took to keep my house running and coloring.

Occasionally I’d have the extra capacity to read a little bit and after I got through a couple of short grief-centered, other-side-centered books I turned to fiction, which is so rare for me.  I have a preference for non-fiction, always with my nose in some kind of self-help book, especially since I got clean in 2012.  This was different.  So different.  My brain could not tolerate real.  I had just gotten the ultimate and unwanted dose of real.  I even thought I couldn’t be a registered nurse anymore for awhile.  I channeled that energy into returning to school, where I am now almost finished with my BSN.  The series I managed to get myself lost in right after Oscar died is called Abarat.  I’ve been thinking eventually I will revisit those books.  Perhaps when I finally finish school…

I remember there was always some sort of amazing and seemingly not possible coincidence happening right after Oscar died.  I think he was manipulating things from the other side to help us adjust to his death.  I still feel him all the time with me, guiding me, an unseen friend.  Everything from a penny from heaven with my birth year on it that seemed to appear out of nowhere when I was taking Vivian roller skating on Sunday to my nursing career.

Today I have found a niche in nursing far far away from the operating room, which is where I spent the better part of ten years.  I loved surgery, but when Oscar died and I wasn’t sure I could even continue being a nurse I knew I needed to change.  Recently I began working in a primary care physician office.  It feels like the absolute right fit.  The physician I work for is like minded and extremely supportive of my work in suicide awareness, prevention and loss support.  Today I am diligently working to make a difference for patients with mental illness through education and support, as only a nurse can.  It is a very special niche and one that I am hoping to expand.  The class I am taking this semester is evidence based practice for nurses, and of course, true to form, I am researching how nurses can make a difference at the place where primary care and mental health meet.  This is such an important focus.  For so many reasons.

So today, three years after my oldest son Oscar’s death I have hope.  My mantra is, “I am healing and I bring love and the energy of love to every shadow.”  All for Oscar.  I miss you, I love you, there will never be enough of you, my sweet sassy first born son.

 

Depression and Suicide as Chronic Inflammatory Disease Processes and the Effect of the Standard American Diet versus the Mediterranean Dietary Pattern for Treatment

Depression and suicide are very personal for me. On September 11, 2015, my oldest son, Oscar, died of pediatric suicide after being diagnosed with depression in April of the same year. He was 15 years old when he died. We had followed the widely accepted formula of therapy (weekly even) and antidepressant medication to no avail. In the months following his death I was devastated and confused, yet motivated to find answers. The language commonly used when people talk about others who die of suicide didn’t sit well with me, I felt myself revolting at a cellular level every time I heard someone try to comfort me by saying that “he had a choice”. I had seen how hard he had tried to live. I had seen how he had treated his little brother and sister so kindly and with such concern and compassion, I would often refer to him as “my little mother hen”. He was always so concerned about everyone around him and their safety and well being. And as I started to research depression and suicide more deeply, both scholarly articles and the lived experiences of other suicide loss survivors and suicide attempt survivors, I became more and more convinced that he didn’t have a choice, that suicide is a disease process not understood.  

Earlier this year I read an article online that approached depression and suicide as a chronic inflammatory disease process and I was fascinated! I felt a complete eureka moment and decided to buy the cookbook mentioned in the article, Anti-Inflammatory Eating for a Happy, Healthy Brain by Michelle Babb, MS, RD, CD. I felt a difference in not just my mental health, but in my body as well, after implementing the suggestions and recipes in the cookbook on a limited basis (my family has been slow to adjust to and embrace the new lifestyle recommended by this cookbook). Research repeatedly states variances of: “The Western dietary pattern…has been associated with higher cardiovascular disease (CVD) risk and worse levels of biomarkers of endothelial dysfunction and inflammation. Moreover, physiological and biological links between CVD, inflammation and depressive disorders have been repeatedly suggested. Therefore, it is plausible that some mechanisms implicated in the genesis of CVD could be also shared by depression.” (Sánchez-Villegas, Almudena, et al.) Moreover, the standard American diet (SAD), is, indeed, making us not just sad, it is making us suicidal. The SAD is known for high amounts of inflammatory producing ingredients, namely refined sugar, saturated fat, sodium and processed grains, i.e. easy to eat processed foods. And who can blame us when it is cheaper and easier to go through the drive through at a fast food restaurant than it is to grocery shop and cook at home? One of the characteristics of our Western culture is the desire for instant gratification and nothing is as quick and easy as the SAD. The SAD provides us empty calories which are low in antioxidants because it is a dietary pattern that lacks fresh fruits and vegetables. The result is inflamed brains that are depressed and suicidal. “In one study, researchers discovered an association between oxidative stress and suicide attempts. Those who had attempted suicide had significantly higher levels of oxidative metabolites in their blood as well as lower antioxidant levels.” (Babb, Michelle) A very recent study utilizing positron emission tomography (PET) shows a positive correlation between markers for inflammation and depression with suicidal ideation. “…we have replicated the first PET findings of increased translocator protein (TSPO) availability…in the anterior cingulate cortex (ACC) of medication-free patients in a major depressive episode (MDE). Our findings add support for the presence of a neuroinflammatory process in major depressive disorder (MDD) and for TSPO as a therapeutic target. Trials of anti-inflammatory agents in MDD have indicated that they might be most effective in a subset of individuals with heightened inflammation, suggesting that a more targeted ‘personalized’ strategy might be a successful approach to treating depression.” (Holmes, Sophie E., et al.) It seems obvious that our diets affect our brains.

An anti-inflammatory diet is basically the Mediterranean Diet Pattern (MDP), and so that has become the lens through which I frame educating my loved ones about the changes we are making to our diet. The Mediterranean Dietary Pattern (MDP) emphasizes the consumption of vegetables, fruit and nuts, cereal, legumes, and fish. Because of this the MDP has a healthy monounsaturated- to saturated fatty acids ratio of 1:2. “The MDP is associated with better glucose metabolism, reductions in blood pressure, and protection against abdominal obesity, the metabolic syndrome, and higher high density lipoprotein cholesterol levels.” (Sánchez-Villegas, Almudena, et al.) The importance of omega-3 fatty acids for protection against inflammation is profound. Omega-3 fatty acids are polyunsaturated fatty acids (PUFA). In Western countries over the past one-hundred years our intake of omega-3 fatty acids has declined significantly. Currently, our intake of omega-6 fatty acids (which are found in abundance in processed foods and vegetable oils) is twenty times that of our average omega-3 intake. “Given that approximately 20% of the dry weight of the brain is made up of PUFA and that one out of every three fatty acids in the central nervous system (CNS) are PUFA, the importance of these fats cannot be argued. Considering that highly-consumed vegetable oils have significant omega-6 to omega-3 ratios, it is quite plausible that, for some individuals, inadequate intake of omega-3 fatty acids may have neuropsychiatric consequences. While far from robust at this time, emerging research suggests that omega-3 fatty acids may be of therapeutic value in the treatment of depression.” (Logan, Alan C.) This is more evidence that we are on the right track to changing our mental health by changing our diets.

Further research is needed to verifiably correlate the SAD with TSPO in the human brain to diagnose suicide. This is my main focus of interest considering my personal experience as a suicide loss survivor. Once TSPO has been isolated and identified in brains of those with suicide reliably, forward progress can be made in researching specific modulations to those individuals’ diets and the effect of the MDP on what we expect to see as a decrease in TSPO, and therefore, a decrease in the symptoms of suicide. I think it is important to focus on TSPO since it is possible to isolate that particular protein and visualize it via a PET scan. It is important to choose one diagnostic criteria and utilize it until a standard of care can be established with the evidence provided by repeated clinical applications. 

Another point that needs to be addressed is education. When we are constantly bombarded by mass advertising campaigns showering us with all of the latest techniques in marketing it is impossible to resist grabbing that soda, hamburger, or candy. This is why a massive public health education campaign must be developed to combat the modern advertising efforts of major corporations who are more interested in their bottom line than the health of the general public. These efforts will change the conversations we are having about depression and suicide. It has never been more clear to me that depression and suicide are chronic inflammatory disease processes. How exciting that we have the opportunity to treat these diseases of chronic inflammation with simple dietary changes! By choosing vegetables, fruit and nuts, cereal, legumes, and fish we are choosing a happy, healthy brain.  

My favorite cookbook is Anti-Inflammatory Eating for a Happy, Healthy Brain by Michelle Babb, MS, RD, CD. One of my favorite things about this cookbook is that the author wrote it with the symptoms of depression in mind and how they would affect a person as they are attempting to make such a massive change in their life. She did this by rating each one of the recipes in the cookbook on a difficulty meter of one to five. Most of the recipes in the cookbook are on the low end of the difficulty meter, which puts a large number of different recipes at your disposal right away. One of my favorite recipes from this cookbook is Southwestern Burrito Bowl  (Difficulty Meter of 2). It has quinoa and black beans as the main protein ingredients, baby kale (or spinach), fire-roasted peppers (which I was able to purchase at Costco!), frozen corn, green chiles, pico de gallo, shelled pumpkin seeds, and an avocado.

Another reason I love this cookbook is because she gives you a complete guide in the first pages of the book on not just why an anti-inflammatory diet is important to brain health, but how it works to change your brain. She discusses the benefits, uses and also storage tips of each of the ingredients she suggests for your pantry. And then to top it off she offers three different menu plans with shopping lists, each for a full week of happy, healthy eating!!  The following recipe is easy, incorporates fairly common ingredients, and it tastes great. What do you have to lose by trying it?

References

Babb, Michelle. Anti-Inflammatory eating for a happy, healthy brain: 75 recipes for improving depression, anxiety, and memory loss. Sasquatch Books, 2016.

Holmes, Sophie E., et al. “Elevated Translocator Protein in Anterior Cingulate in Major Depression and a Role for Inflammation in Suicidal Thinking: A Positron Emission Tomography Study.” Biological Psychiatry, 2017, doi:10.1016/j.biopsych.2017.08.005.

Logan, Alan C. “Omega-3 fatty acids and major depression: A primer for the mental health professional.” Lipids in Health and Disease, Biomed Central, 9 Nov. 2004, lipidworld.biomedcentral.com/articles/10.1186/1476-511X-3-25.

Sánchez-Villegas, Almudena, et al. “Fast-Food and Commercial Baked Goods Consumption and the Risk of Depression.” Public Health Nutrition, vol. 15, no. 3, 2012, pp. 424–432., doi:10.1017/S1368980011001856.

Sánchez-Villegas, Almudena, et al. “Association of the Mediterranean Dietary Pattern With the Incidence of Depression.” Archives of General Psychiatry, vol. 66, no. 10, Jan. 2009, p. 1090., doi:10.1001/archgenpsychiatry.2009.129.

Halloween, Signs from the Other Side and an Exciting New Study, “Machine learning of neural representations of suicide and emotion concepts identifies suicidal youth”

Holidays really suck when you are a bereaved mother.  My ability to “buy in” and fully participate with the general public, let alone my own family, is differing levels of non-existent.

The year that Oscar died I was unable to carve pumpkins.  Halloween was our favorite holiday.  I remember when Oscar was really little how we would plan his costumes for weeks.  He was Spiderman, Frodo from the Lord of the Rings, he was Link from Zelda. Each costume with it’s own special story.  The last year he dressed up for Halloween he created the character “Sir Edward of Hoppington”, he was almost 13 at the time.

This year, the second year into life without Oscar, and the third Halloween since he died, I tried so hard to do little things for myself starting at the end of August to make this fall season less terrible.  I bought pumpkin spice soap and pumpkin spice lotion because aromatherapy is very helpful for me.  I didn’t pre-judge what I was going to feel.  I started with a new therapist.  I pushed myself to get out into the garden by planting a memorial garden with my family on Oscar’s deathday.  And even though last year I was able to buy pumpkins and carve them with my other children this year I could not even look at pumpkins.  No.  I pushed myself past them every time I was at the store.  Even now I feel the little swirl of grief inside my chest as I think about pumpkins.  Such is grief.  Of course, I apologized abundantly to my daughter, who is 9.  She understands, or she says she does.  “It is just too hard,” I tell her.  And she nods her head yes and rubs my arm and gives me her sweet little hugs.  She replies with, “It’s okay mama.”  Oh the life of a bereaved mother.

Oscar sends me little messages from the other side on a regular basis and yesterday morning, Halloween morning, he sent me a new study.  I woke up to find an alert on my twitter feed about a new study that was just published in Nature Human Behaviour. (https://www.nature.com/articles/s41562-017-0234-y?platform=hootsuite) I took a glance at the article, “Machine learning of neural representations of suicide and emotion concepts identifies suicidal youth” and I immediately felt a rush of curiosity.  I could not wait to read more.  This study is so incredibly exciting because it uses functional MRI to actually look at and identify definitively the brains of youth with suicidal ideation!!!  Of course we need to recreate results using larger study groups, and do all the good things we do in science to prove things over and over in order to declare truth, but oh my goodness, what a huge leap forward!!  They even had a brief story covering this new study on NPR yesterday morning!

I started reading the study in full this morning, All Saints Day.  As I was taking it in the tears rolling down my cheeks, I felt not like a little glimmer of hope, but like a full ray of sunshiney, warm, bright hope was parting the clouds for all of us suicide loss survivors. Hope that with a test like this to determine suicidality biologically, instead of relying on self-report, that we can save more lives.  If only Oscar had been able to sit for an fMRI so we could know exactly his risk for suicide… he was such a brilliant mind, he knew how to play the system.  It was impossible to tell if he was teenage angsty or truly suicidal. With this, we would have known beyond a shadow of a doubt and we could have treated him differently, more aggressively, for his suicidality.  I am excited to see this diagnostic tool be studied more.  Deepest gratitude to the clinicians behind this ground breaking study who recognized the need for a biological indicator to identify suicidal youth.

Oscar

My name is Jessica Lane, but everybody calls me Jes.  I am a mother, a recovering addict, an operating room nurse and a bereaved mother.  My oldest son, Oscar, died of pediatric suicide when he was 15 years old.  I found his lifeless body the morning of September 11, 2015.  It was a Friday.  The Friday that changed everything.  Time is not the same for me anymore.  Life is not the same.  Neither is death.

Shortly after Oscar died it became very very clear to me that suicide is not a choice. Suicide is a disease process that we don’t understand.  Oscar’s death motivates me to understand and educate others about what I learn related to suicide, death, grief, and mental health.

Since Oscar died I have been researching suicide.  At first I could only look at grief support groups for suicide loss.  The Alliance of Hope for Suicide Loss Survivors was my first home after Oscar died.  I have participated in local suicide grief support groups.  I have returned to school to finish my Bachelor’s of Science in Nursing.  All of my research projects are through the lens of suicide loss.  One of my favorite grief activities was participating in Megan Devine’s writing course this past spring.  She inspires me in so many different ways.

Nothing was ever easy about Oscar.  He was always challenging, he questioned everything.  He was gifted and he had transitional disorder.  He was diagnosed as depressed at the beginning of May the year that he died.  His first words were, “why” and “wow”.  He was always manipulating his world, building with Legos, building model aircraft online, folding paper into origami or airplanes, and he was a puzzle master.  He had an incredible spatial awareness and relationship with his environment that was genius.  His depression was existential and was refractory to standard treatment: medication and talk therapy.

I will write when I can and share my research regularly.  In fact, I will be posting my final paper for my nutrition class shortly titled “Depression and Suicide as Chronic Inflammatory Disease Processes”.

This blog is for the love of Oscar and all kids like him; dead too soon of a disease that is not understood.