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.

Suicide Grief is Complicated Grief

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

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

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

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

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

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

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.

10250055_10203272594276268_1270630082124332443_n

September

Oi vey. September. Here again already.

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

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

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

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

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

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

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

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

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

There is no thought involved whatsoever.

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

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

Feeling okay is a miracle.

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

 

16

Wow. Pierce just turned 16.

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

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

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

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

That isn’t my reality, though.

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

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

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

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

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

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

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

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

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

IMG_20190525_1944451.jpg

 

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

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

 

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

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

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

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

 

 

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

 

 

 

 

daily grief

Even though I don’t talk about it as much as I used to, my grief still looms large. I really like the grief model with the idea that you learn to grow around your grief. I resonate with that fully. I feel that at first my grief was my entire existence. Slowly, ever so slowly, I started learning how to allow myself to feel other feelings alongside the grief. Over the past 3 years since Oscar died I have become so much bigger than I ever was before- energetically. I feel like my energetic footprint takes up at least twice as much space as it did before I began to grow around my grief.

Doesn’t change the fact that sometimes, some days, there will be some sort of catalyst event and I am moved straight to tears. My grief swallows my energy and I am in that darkness without. The sucking without-my-beautiful-boy darkness. I love Angela Miller (A bed for my heart) and how she speaks strongly about how, as a bereaved mama, you learn to mother not only your living children, but the ones who have died, as well. I deeply resonate with that truth. Every. day.

Yesterday, at lunch, in the middle of the employee lounge, I am eating my leftover hungry root (just started that meal delivery service and so far it has been an excellent experience- I’ve tried many and this one is my favorite) focused on staying balanced and focused with my Kangaroo totem energy and the green calcite in my pocket along with my doTerra Citrus Bliss mixed with Frankincense aromatherapy and I open Facebook. There is a memory from 6 years ago of my sweet sweet daughter, Vivian, and her pink kitchen. Her pink kitchen was her very favorite toy for about 3 years or so and when we moved from Washington to Kansas it was a very very big deal when it was finally shipped to us. It was about 6 months after she moved down here that she was reunited with it. Of course I took a picture of her with it as soon as it was unpacked! Well, there was a comment from her dad. Grief started rolling in. There was a like on the comment and I clicked to see who liked it. Oscar. The tears just started. Just like that. Thank God my dear friend, Emily, was sitting at the same table. I showed her what was up and she scooted close to me, gave me a big hug and I had a few seconds of sobbing. My grief overwhelmings don’t usually suck as much time out of my day as they used to, but only because I have learned how to breathe through them. I breathe through them, feel them and consciously shield them with my entire self. It has taken a tremendous amount of diligent spirit work to get to where I am in my relationship with my grief.

Screenshot_2019-01-08-13-27-48.pngScreenshot_2019-01-08-13-27-52.png

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.

20181222_161241.jpg

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