Against Medical Advice
Updated: Jul 1, 2018
Listen to the Episode Here >> http://podcast.ameequiriconi.com/109574/739542-1-6-against-medical-advice-a-personal-story-about-teen-suicide-attempts
We all know that life moves in waves. Some flow at you gently, with barely any amplitude and you are rocked into a calming submission that life is good. Smooth sailing so to speak.
And then there are times as storms rage, where the waves keep crashing down, one after the other and you feel like you are going to drown.
This is how it's starting to feel now in this last month.
Not only did I have to set a heartbreaking boundary on my relationship with my ex that included leaving behind a shared business with him that I truly loved, but off the radar for the last couple of weeks, our tiny family has been dealing with teen suicide.
A little over a month ago, my daughter had a friend from grade school kill herself. It left my daughter wounded and grieving, naturally. It also opened the doorway to have conversations about when kids need to reach to adults for help if they have a friend they are worried about, which would be important in more ways than I'd realize soon. You see, because children are not immune from waves either and in less than a month, I would get a text from her during school that said she was gravely concerned about her best friend from her old middle school. Her friend was talking about killing herself, and my daughter believed she'd do it.
I told my daughter that it is likely that what happens next – what I end up doing – could soil her friendship. My daughter replied that she didn't care as long as her friend lived. So, I called the middle school this girl attended and spoke to the counselor there. I told them that my daughter believed her friend was in imminent danger and asked the school to intervene. I knew that the school was obligated to report this incident to the State as well if they believed there was a chance she'd do anything to hurt herself, or she was being abused at home. My daughter and I hoped that would help and I hoped she could see that adults can do things kids can't.
But in just a little over a week, I'd get another grief-stricken text from my daughter only 1 hour into her school day telling me she'd heard that her friend was hospitalized after attempting to overdose with pills from the family medicine chest. Suicide had now shown up on our doorstep for the second time in a year.
For almost two weeks, my daughter's well-being was slowly eroding. She wasn't sleeping, and as a result, her mental state was weakening, getting her caught up in a swirling cycle of a flood of thoughts at night, keeping her awake and wearing her down. She told me that she is worried that when her friend is home, she'll do it again. And that she's going to succeed because it turns out this was the fourth time she's tried, and she's been getting closer with each attempt.
I tried coaching her through it by giving her ideas on how to diffuse the thoughts. How to distract herself from them. I pointed out that the feelings weren't helping her friend at all – because they were trapped in her head and instead were only hurting herself. Rationalizing with her at times would set her off, and she'd go into a moment of rage. I could see that she was walking a thin line between being okay and being consumed by the cortisol being sent from her brain instigating, along with adrenaline, her "fight or flight" responses.
I was patient and resolute. I offered to take her to see my therapist with me. She countered that therapists don't work. When she'd reach out in the middle of the night to let me know she wasn't sleeping, I'd offer a place next to me in my bed. But she'd refuse with a courteous "It's okay. I'll be fine."
And so, each morning, I'd check in on her, close the door to her room, report her as absent for school and wait for her to get up on her own. I knew that having her well-rested and in the best state of mind was far more critical than an agenda or school schedule. This went on for days until Thursday.
Thursday morning seemed normal-ish. She hadn't slept much the night before, but she was up and ready to go to school by about 9 am. I drove her in, and she was in high spirits. She loves her new school and has lots of friends. In fact, she has said over and over again how happy she is now here with me in Snohomish. I waved goodbye that morning, told her I loved her and headed back home.
Now, again – shit has been sideways for me as well this whole time. I have been beaten by waves for weeks and doing my best to keep my head above the water for my kid's sake and mine. But also on Thursday, I was already dealing with the stress of not having enough money to keep up with life.
The change in my living situation left with me double the household expenses and half the income. And being self-employed has been a blessing and a curse. One, I have been able to have the flexibility needed to be there for my kids when they have needed me – and they have needed it as they are adjusting to a new life in a new town. But on the other hand, every minute or hour I'm spending for them, I am not working. And unlike other parents who are salaried and have vacation or sick leave to help fill in the gaps – for me, not working is not earning anything. There is no backup plan or second income. And my retirement savings I moved out to Snohomish with years ago, had been absorbed by the life and people I was now presently leaving behind.
I am also living in the aftermath of poor financial choices rooted in my prior baseline thinking of needing to prove myself to someone by buying them things I couldn't afford. Sadly, the only "proof" I received was the growing credit card balances and the same indifferent attitude.
So, one month, after I pay the mortgage for the house, food, auto insurance and my student loan payment, I pick up health insurance and my car payment. Then the next month, after I cover my basics again, I skip health insurance and car and go for making payments on my credit cards. And then swing back the other direction the following month, leaving me perpetually one month behind on something. But the new addition to the picture is the impending legal expenses as a result of enforcing my rights with my ex and our business relationships which started to roll in this week too.
And so, there I was on the phone, negotiating with the second credit card company of the day when my phone kept getting text and phone call interruptions. I didn't check or respond because I needed to finish my call first. But when I hung up, I saw a text from my daughter's middle school counselor. And she was pretty direct – my daughter had told friends she was going to take some pills the night before to kill herself and a classmate reported it to the school. So, now she was in the office, and I needed to come pick her up.
That's when the next wave came crashing down on me, and I let it push me under for a minute. I could taste the salt water in my mouth and the burn in my eyes. That's when I realized I wasn't drowning. I was crying.
I got in my car and headed straight to the school. I felt disoriented. I was knocked off my feet. "Of course this would be today." I had said before in another post that the walk down the mountain was going to be treacherous. Well clearly, I was only partly right because the Universe was going to throw a storm at me along the way.
The meeting with the counselor was tense. She recommended I lock up all of the alcohol, medications and sharp objects right away. And I thought to myself "Lady, have you seen my house? I don't have a fucking empty safe to put all that shit in!"
She also recommended that if I was concerned about my daughter again, to take her to an emergency room or call 911. And she said that this was serious because my daughter apparently had a plan. I looked over at my daughter and asked her to tell me what happened. She said she'd taken a bottle of pills out of our closet and had them with her in her room. I asked where they were now, and she told me they were in the gap between her mattress and the wall.
We all sat quietly for an eternity while I was trying to understand what I was supposed to do next. I never thought or wanted to be in this situation. I finally stood up and announced we were leaving. My daughter grabbed her things and stormed out ahead of me.
When we got outside, I called for her to slow down – I just wanted to hug her. She was pissed because one of her friends violated her trust. When we got to the car, I tried to explain the irony of that since someone did exactly what she and I had done for her friend in Sammamish. But irony and rational thoughts had no place in the conversation at the moment.
As we drove home, I had more questions. But my daughter had a lot of "I don't know's." I told her that I had been asking if she was okay this whole time and she was telling me she was fine. She replied, "Clearly, Mom, I'm not fucking fine!"
As we neared our home, I finally said to her "I don't know what I'm supposed to do now." And she replied in her well-practiced caustic tone "Well then just take me to the hospital." That's when I made that split-second decision to drive right past our house and on to Monroe to the emergency room.
I expected some protest from her once I figured she'd realized that is what I was doing. But I was wrong. It was somehow relieving and unsettling at the same time. Here was my daughter that I couldn't coax into going with me to meet my therapist for days and now she seemed comforted by the fact we heading to the hospital instead. I didn't know if I should be happy or terrified.
We check in, and I texted my daughter's dad to tell him where to meet us and why. I also texted my son to let him know I wasn't going to be around for a part of the basketball game that night – an evening he & I were looking forward to spending together. March had its own madness in mind it seemed.
We are told by the attending physician that a social worker will come by to speak with us and do an assessment. And when that happens is unknown. As it would turn out, we waited hours for a Behavior Specialist to arrive. We checked my daughter in at 2 p.m., and the specialist didn't come until 10 pm that night. Aside from our own issues, I became incredibly disenfranchised with the state's mental health programs through this experience.
At 10 pm, our assessment began. And then we waited again. When the social worker came it at about 11:30 pm to tell us she recommended checking my daughter into a facility in Marysville, the room erupted in rage and tears, and the sonic boom struck us all. Her dad. Her brother. And me. After the social worker left the room, I moved in to hug my daughter, but she pushed back, jumped off the bed and ran to the bathroom, locking herself inside. We all sat in silence as she sobbed.
Through the door, I could feel her body and chest lurching as she struggled to inhale and exhale. Her cries echoed off the walls, and I sat there, transformed from her mother to me, at her age. And I felt her loneliness. Her betrayal. Her abandonment. I sat there and then realized – she doesn't just need me to hear her. She needs me to feel her.
Now I heard her finally. And it became intolerable to me.
I got up from the folding chair I had been presently occupying and started searching for a long, narrow object – something I could put into the bathroom door & unlock from the outside. My son asked me what I was doing and when I told him, he pulled his headphones out from his phone and offered them and said: "Will this work?" I looked at the jack end and hoped it would.
I moved to the door and started to talk to my daughter through it, assuring her I loved her, all the while jimmying the lock with the end of the headphones, hoping should couldn't hear me trying to break in. I wasn't sure it would work until I felt the button push in and the door handle turn. Before she could stop me and block the door, I tossed the headphones away and quickly moved into the room, shutting the door behind me and blocking it. It was only about 3'x5,' and the only way to see her eye to eye was to sit on the floor next to her.
She tried to shrink herself up into a small ball while telling me she didn't want to be around me right now. But she begged me not to send her away. And she assured me it would never work and that she'd hate me forever. I asked her if she would talk to me some more, privately. And she agreed she would.
I asked everyone to leave the room while I talked with my daughter alone. I sat on the edge of the bed and let her yell at me. Tell me she hated me now. And I violated her trust. I was the only person she trusted, and now she couldn't believe anyone anymore. I could see, hear and feel the desertion rising inside her. Yes, she'd let dark thoughts and a lack of sleep intrude into her brain in the middle of the night, but she wanted me to know that clearly, she doesn't want to kill herself because in the end, she hadn't tried.
My daughter told me that therapy never worked for her before because she doesn't feel like she can talk to anyone about what's going on. And when I said that I'd be there with her, she countered that it wouldn't matter, using that day as an example. Apparently, when the school counselor asked her to come into the office to talk about the reported attempt, my daughter requested a friend to be with her, thinking it would help her relax and speak but it didn't.
My daughter told me "Mom – I only trust you. I can talk to you about everything. One hour a week talking to you would be better than anything else." And all she'd wanted out of going to the hospital was for someone to tell her what was wrong with her and why she couldn't sleep and then we'd all go home together.
Listening to all this was painful and familiar. And I sat there on the edge of her bed and thought to myself – what would I want right now if this was me?
Serve and Return
From the moment a baby is born, the interactions between a child and parent or caregiver are how their brain forms and develops. This fundamental process, called serve and return, is how communication and social skills are formed. Babies serve with a cry. A parent returns with food or coddling – both equally important to proper development. Plus, serve and return forms a child's understanding of how relationships should be and generates inside them their core sense of stability. So if a child reaches out (serve) and is not met with a response or the response is inappropriate (return), especially during times of stress, this stress becomes toxic.
Because responsive relationships are both expected and essential, their absence is a severe threat to a child's development and well-being. Healthy brain architecture depends on a sturdy foundation built by appropriate input from a child's senses and stable, responsive relationships with caring adults. If an adult's responses to a child are unreliable, inappropriate, or just absent, the developing architecture of the brain may be disrupted, and subsequent physical, mental, and emotional health may be impaired. The persistent absence of serve and return interaction acts as a "double whammy" for healthy development: not only does the brain not receive the positive stimulation it needs, but the body's stress response is activated, flooding the developing brain with potentially harmful stress hormones.
Once our children become more capable on their own, parents begin to think that "returns" are less necessary if at all. It is the idea that we have to teach our children independence and that we can't always be there. But I think this is where we are failing right now. A child will naturally seek their freedom, it doesn't have to be thrust upon them. We see babies struggling to free themselves from their parent's laps so that they can crawl. Children run defiantly towards the slide one more time when we want to go home. Or teenagers stay up late at night on their phones with friends even after you've told them to go to bed. So, when they are asking for us, albeit indirectly at times, it is a firm signal that they still need something from us, not a time to neglect their bid for our attention.
Therefore, it's important to understand that a thirteen-year-old girl is still in the brain building stages of life, but more so. In fact, after the age of eight years old, a child's experiences not only form new neural connections but, if a support system at home is missing, these experiences can also degrade or weigh down the existing links. And this isn't "New Age psychobabble" – this is biology and neuroscience. And with a frightening increase in the number of suicides of girls between the ages of 10 and 14, it's visible parents are not getting this. In fact - brain architecture is still being built into our early twenties!
However, I did have to wonder if I am projecting my own feelings onto her? Or were these her own? The "rational" adults around me said it's possible she's being manipulative and only saying what I wanted to hear. Was this true? Or was this cognitive dissonance at play here – an adult confronted with something that violates their view or opinion of how things should be and can construct a defense of that position?
I know that both of my kids have told me that trust in them has been one of the best things they have gotten out of living with me in Snohomish. I have given them the space to be themselves without judgment or interference. We've set acceptable boundaries together, and they have been given the freedom to roam within them. And so, here I was deciding if I could afford to trust her at her word?
So I thought: what if this was her ultimate "Serve" – a pitch out into the world of extreme despair and hopelessness at being trapped in this cycle of negative thoughts and no sleep. What is the right "Return" from me as her mother?
A year ago, my daughter believed I didn't want her. She was unhappy with her life with her dad but didn't think I'd ever take her in. I know this because she told me so several times. And what evidence had I given to the contrary? I divorced her dad eight years earlier and moved out by myself and left them with him. And that is why when the confronted with the decision last year to take her and her brother to live with me full time; I knew that no matter what happened to me and my relationship with John (which I predicted would fail as a result) I could not let her live her life thinking her mother didn't want her. I decided I would say yes at any cost.
Doing so changed the direction of my daughter's life in profound and positive ways but I have not been naïve to understand that for the eight years we were only together on weekends, that my absence in her life did not have a lingering effect that would take time to heal.
And here in the earliest hours of a Friday morning in March, sitting in an emergency room, I understood from listening to her that sending her to an inpatient facility would show her that when she calls out for help, I won't be there to answer. But instead, I'll leave it to someone else. Again.
And so I knew I couldn't send her away.
Her dad and I spent a couple of hours in the hallway outside our daughter's room. I knew in my gut it was wrong to send her to inpatient. I sat on a gurney while he leaned against the wall across from me and we agonized over this together.
"You know you don't have all the tools to do this, especially with what you already have going on in your life, right?" he said.
"Maybe. But instead of making excuses for that, I see a therapist every week because I need to have them for myself and the kids."
"You know that love is not enough, right?" he said.
"No. I think that's exactly what she needs to keep getting right now which is why I'm doing this."
"How do you know? You know you're taking a gamble here, right?" he said.
"Perhaps you think that. But you have to trust that I'd never wager on my child's life and I believe the real gamble is sending her away."
I then told my ex-husband something he never knew about me. About a time during my freshman year in high school when I had a bottle of my mother's Canadian Mist in one hand and was staring into the medicine cabinet, looking for something to take with it. It was another one of the many nights I was left at home to take care of my brothers while my friends were hanging out together having fun. And so, on this particular night, I was exhausted from not being "heard."
But I didn't do it. Because I really did want to live.
I told my ex-husband if there was anyone in this world who understood our daughter at this moment in time – it was me. Because I did understand the difference between the thinking & the doing. I wasn't looking for attention but on the other hand, I didn't actually need to be talked out of doing it. I just needed to be heard by someone to confirm I mattered. Anyone. And that night it was one person on the phone that I was talking to.
For my daughter, she'd had the same experience as I had. While no one knew until the next morning that there were pills stashed away next to her in bed, that night my daughter had several classmates coaxing her through the night with their love and support via SnapChat – all while I slept in the other room. And so by the time morning, came, it all seemed beautiful and I was none the wiser. Just like my parents never were.
We gathered up the social worker so that we could tell her our decision. But first, we asked her what inpatient looks like. She listed off daily group therapy sessions with other kids her age experiencing the same issues. Medication to regulate her emotions. And that the parents would be able to come in from 6-7: 30 pm each day to visit.
My ex focused on the medication part – something that made us both bristle with uncertainty, but it was the factor that made him finely strongly reconsider the decision to send her away. But to me, it was the limited visitation and not for the selfish reasons you might presume I was feeling. It was the thought that how could my daughter get better if the one person who will matter the most in her emotional well-being and development for her life is kept at arm's length from her during an extremely poignant time for her? Who would be there to comfort her, hold her and tell her she is loved?
In the cases of emotional and physical abuse, that condition makes complete sense. But in this case – my daughter's case – the one size fits all approach felt like it would be worse for her than beneficial. And I asked the behavior specialist this directly – "Sometimes doing this has the opposite effect, doesn't it?" To which she replied "Yes."
AMA –It means "Against Medical Advice." That's the conditions she was discharged from the hospital under. Her dad and I chose to buck the advice to send her away, medicate her for 5-10 days, keep her away from her parents and family and let other adults attend to her. Is that the right choice for some families. Absolutely. Was it for us? No, not this time.
Because all I could think about was after spending the time I did with my daughter in that emergency room for almost 10 hours was "What if this is not the right way after all?" What we do know is that suicide is steadily increasing and people still kill themselves in staggering numbers as compared to homicides. Yes, despite "Medical Advice" – more Americans die at their own hands than by murders. By double! And its not getting better but worse.
Maybe "Medical Advice" only suspends the possibility – hits the pause button for a bit – but never completely goes away. And am I not my kid's parent for as long as they are alive? Am I not responsible for parenting them today but also for their future? Maybe, just maybe, "Medical Advice" is not always the answer. If she had taken the pills – made the enormous leap from the thinking to the doing – I would have had a different opinion. But in this particular situation, my mother's gut was telling me something else.
As a natural-born systems thinker, while we talk about looking for "triggers" or "triggering events" that can spur on a person to kill themselves, I think about the word "trigger" and that a trigger is useless without a gun and a bullet.
If I can dismantle the gun and take away the bullets, then the triggers – the inevitable stresses we all will face in life, won't have the power to kill us because the chamber will be empty. Or the gun won't exist at all anymore. And I think that starts with remembering that children (including teenagers) need from us unconditional love to build their security upon. And what that looks like is different for every child because their experiences have been different from everyone else. What an unclear and daunting thought huh?
For me, I had to trust my daughter and son along with myself that I can hear what they are really saying to me. And how do I know if I'm doing that? It's easy. I ask them.
It's not to say I didn't bring my daughter home without any conditions. I told her she violated my trust too when she didn't come to me when she was feeling low. And she'd have to earn that back if I was to ever feel like I could sleep again.
She'd have to sleep in my room until she was back to sleeping through the night on her own. And it was no longer an option as to whether she came to therapy with me. And if that didn't work, we'd find a program for her that didn't require her to be hospitalized. She agreed to it all. And without a fight, she crawled into bed next to me at nearly 3 am and fell right to sleep. And the next night we went to bed earlier together, and she fell asleep again.
Nothing has changed in our society since I was my daughter's age. My friends knew more about my own struggles than my mom or grandparents ever did. And that is the same with my daughter.
But do you ever wonder why kids prefer to talk to each other than adults? I think it's because they all speak the same language. And that is not in the literal sense necessarily. Instead, they are all operating on the same wavelengths of this unconscious dialect of feelings, emotions, and thoughts. "I wish my parents would just listen to me" is not what we think it means but other kids know exactly what it means.
I think as adults; we lose that ability to remember what life felt like at that age as we become more cerebral and less emotional. We approach life more "practical" or "productive" and get agitated that our teenagers don't think that way. But we are disregarding the fact that they are just not there yet. And we need to remember to meet them where they are at, not force them to join us before they are ready. The long-term impact is ironically the opposite of what we want for our kids – they will grow into emotionally uneven and possibly immature adults at best. Depressed and suicidal at worst.
So, as parents, we have to be instead bi-lingual. And that is something many of us were never taught to do. When my daughter kept telling me I wasn't listening to her, and I kept reciting back everything she'd said to me and more, that wasn't what she meant. She just can't say it yet. She needs me to feel her. And when I can show her I understand her, she trusts me and shares more. Instead as adults, we use our experience to tell our kids that it "doesn't matter in real life" or that what they are feeling is "not that big of a deal." Or asking them to stop being so emotional and be more practical.
We have to figure out what "listening" really means for each of our kids. Because their life truly depends on it.
This week, they meant something different to me. This week they were the power I needed to rise for my children.
Presently I am dealing with a legal "fight" with my ex boyfriend and business partner. It has caused some obvious financial strain for me, especially as a single, self-employed mom. My work podcasting & blogging and sharing my experiences and stories are not a revenue-generating activity at this time. I hope someday it will be. So, I ask - if you have received value or even entertainment from watching my videos or reading my posts, I ask you consider contributing, even a small amount, to my GoFundMe campaign that I set-up to help offset my legal bills. Thank you.