today is my birthday

September 11th came and went. The five year milestone has come and gone.

And now the next biggie day during full on grief season: my birthday. This day has been absolutely miserable for me since Oscar died. It just has. There is so much there and I think the main point is how can I still be here and he is dead? Out of order death, especially from suicide, is one of the hardest to bear. For whatever reason the reality and truth of Oscar’s death is especially stark on my birthday.

I have realized since the 5 year milestone that I am ready to start talking more about other things in my life and not focus so much, completely, entirely on my grief and how it has changed everything.

And this morning, miraculously, I woke up feeling grateful. My heart was full. I have an amazing family (my kids are beyond incredible), I have super supportive parents who only want to see me doing the best I can (whatever the best I can is), I have an amazing career, I have a beautiful home, a new car, I have a vibrant dating life, I have a truly fabulous support system of friends and colleagues, the list goes on and on. I love the path that I am on. I am grateful for my journey.

I am grateful I have been doing the work with consistency to stay healthy in my body and mind leading up to this grief season. I have been very focused on exercise, writing, eating well, and sharing in everyday conversation when I have the energy to share. Another fabulous healing modality that I have utilized with regularity leading up to and into this grief season is massage. The energy work that I have been doing has been on a deeper level than I have ever been. And, man, it has been so enlightening!

September 12th I realized exactly what I want to do with my career. I want to work part time in the OR and work part time in private practice as an Integrative Health Practitioner. I am in the process of applying to a graduate program through Drexel University online that would have me beginning my Master’s of Science in Complementary and Integrative Health the Fall of 2021.

Since I had this realization, it is like I have felt a great sigh of relief from the universe. I feel my path aligning for my higher purpose; my ultimate opportunity to give back to the community.

42 isn’t looking too bad.

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.

 

Every year I relive Oscar’s last year

Facebook. Thanks to Facebook each and every year I relive Oscar’s last year through reminders of memories.

The cycle of my grief has hit a rhythm that I seem to be flowing with fairly well these days. I have begun to feel gratitude for my experience as a bereaved mother (that is a place I never thought I’d be). This morning on my drive into work I listened to my Calm app daily meditation, which I have been doing for the better part of the past year. It helps. There are many cliches and platitudes that I don’t buy so easily since Oscar died. Sayings like “there is always a silver lining” or “everything happens for a reason”. It so happens that the daily meditation today was about resistance and how our suffering increases as we resist things in our lives, especially the things we cannot change. Okay, I can vibe with that (which is progress for me, by the way). Then at the end of the meditation the cliche was dropped about seeing the silver lining in each situation that we cannot change. Just a few short weeks ago I would never have been able to say that there was a silver lining to my son’s death.

Even now it feels sort of uncomfortable admitting that I have reached a point that I can see a silver lining out of what I hope was the darkest time of my life. What is the silver lining? The silver lining is that I finally went back to school and finished my BSN. I had no plans to go back to school before Oscar died. I was making as much as I could make in my nursing career as a staff nurse in the OR. And I loved my job at KU. But after Oscar died I needed to feel like my voice carried more weight. ADN wasn’t enough anymore. I also wanted to do it for him. In his memory. So I did.

Today’s Facebook memory was my excited and hopeful declaration that I finally had full custody of all three of my kids. My heart is breaking because I had no idea what 2015 had in store for me and my family. No idea. I completely trusted God to care for all of us and show me the way to heal all of my beautiful children, especially Oscar. I am finally to a point in my grief journey where I am beginning to open back up to healing my relationship with my higher power. It isn’t easy; it is simple, but not easy. I am trying to allow myself to feel comfort in faith again. And trust. Trusting is the hardest.

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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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

Christmas 2018

Christmas sucks.

This is Christmas number four without Oscar and Christmas number one without Nick. There was no way I could bear the thought of being at home today, so a few weeks ago I did what Nick would have liked for me to do: book a room at Great Wolf Lodge. We have an incredible room! We got an upgrade, so I have my own room. So wonderful. I am so grateful to be able to do this for the kids and for me. But this is one of the conundrums of grief: feeling two opposite feelings equally as strongly at the same time. I am grateful for the now, spending this time with my kids and having a break from it all, but the pain of loss is especially poignant right now.

Christmas used to always be proceeded by a sleepless night for me and Nick when the Lane kids were all little. I remember Nick used to say, “Christmas should be a good time for us, we deserve to have one good time a year, Jes.” And so every year we would splurge on the kiddos. So many gifts! The tree would always be bursting and the stockings overflowing with all sorts of fun stuff. We went broke each year a little more at Christmas, but the smiles on the kids’ faces were so worth it. I didn’t know that then. The crushing debt was one of the issues that broke our marriage. There were lots of reasons we were dysfunctional and needed a divorce, don’t get me wrong, but the debt added a level of stress that was smothering.

This year, since Nick died, I have been struggling. Truly. Just to see what his death has done to our kids and to feel that heartbreak and also my own in a world that will. not. give. has been exceptionally exhausting. All of the same levels and types of emotion and pain as when Oscar died, but without any grace. None. The world shrugged it’s shoulders and laughed while saying, “let’s see how you make it through this one.” So many emotions. How do you stay focused on the good in a set of circumstances like that?

Lots of ways. I see Oscar everywhere, and this helps me. Sometimes it is unbelievably sad and painful, but mostly it makes me smile and fills my heart with warmth. I stay connected spiritually by taking care of myself. Aromatherapy every single day if nothing else. It’s funny, I take that shit to work and sometimes I feel like I am pedaling drugs because I offer to share my aromatherapy with co-workers who are stressed out. Lately I have been taking aromatherapy and a crystal of some sort to work. And it helps. Oh does it help.

I have also been working with my shadow self to understand what she needs. First I had to free her (see my starsprae intuitive healing arts blog for more about my day to day healing work). Now I am working with her to help her find her voice again. Lots of years of suppression has not worn well on her. She is wild and free, full of inspiration and amazing life. I have seen glimmers, we are working to make it easy for her to be seen. A morning routine of a tarot reading has been part of my healing process for about a month or so now. I love tarot! It is fun and intuitive and it is helping me stay focused.

The hardest work I have had to do recently is in the area of romantic relationships. I think Nick’s death has influenced this quite a bit if I am completely honest. Since he died I have been mourning the loss of so much- the potential of a healthy father for my older children, the only other parent to Oscar (all of those memories that Nick was the only other person who was apart of!- now I am the only bearer of them), the potential for healing our relationship- I would have liked to be friends with Nick again. The feelings are complicated and deep. It will take quite a long time to get through them. Years and years. All of this has made it harder to tolerate relationships in general, let alone the romantic relationship with my youngest’s father that I have been trying to heal. I gave myself permission to set a healthy boundary with him a couple of weeks ago. I could hear Nick’s voice in my head- “The timing, Jessica, the timing! You always have the worst timing!” Yes, just a couple weeks before Christmas and I set a strong friendship-only boundary. I cannot try for anything else right now. I need space.

Space to remember. Space to be the mother to my children that I feel I need to be. Space to grow my talents as an energy healer. Space to make my own home. Space to spread out. Mostly space to remember. So much remembering lately. I love my psychologist. At our last session she encouraged me with this idea, “You are ready when you are ready.” This applies to so many different things! I am ready to remember. I am ready to let myself go to those spaces. I am ready to stand up for my needs. I am ready to forgive (even though that is going to take me a long time to do completely, Nick!) I am ready to live as who I am.

I cannot believe we have to do Christmas this year without you, Nick. I do wish you were here to spoil the kids and share your jolly Christmas spirit with them. It was the one time of year that you always made into the best for us, for them. I know you tried so so hard.

Oscar, there was a three pound Hershey chocolate bar at Walmart this year! I would have bought it for you if you were still alive, no doubt! I miss you so so much. You would have been on your first winter break from college. I wonder what you would have been studying? You would be here with us. On the pull out sofa. Ready to splash and play and have fun with your brothers and sister. You were always my mother hen. Taking care of everybody. I wish I could have done better teaching you to take care of yourself. I know you are still here with us, I feel you here with me right now, but that doesn’t change how much I miss you.

Christmas sucks as much as it is wonderful when you are a bereaved mama and divorced widow.

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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 

 

 

 

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.