Tear Stained Cheeks

The drive home was quiet. My phone had died and I couldn't call for help, even if I wanted to. There was no need for the radio- my thoughts said too much and I craved silence. I didn't bother emptying out my pockets before leaving work, and my equipment jammed into my leg. My badge was positioned funny and jammed itself into my breast. I didn't care about either of them.

My mind went to the long talks with my buddy Travis, about how stupid patients are. "If you are going to cut, go down the river, never across the street!" He would always exclaim, shaking his head and laughing. As I pulled my car up to a red light, I looked to my wrist and studied the sting from the wound by the glow of the street light.

I felt enlightened as suddenly I realized patients aren't stupid after all- they don't want to die-they are trying to cure the pain.
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Charlotte was the sweetest woman I have ever known. She had long grey hair and big blue eyes, and even at 94 she loved to whistle- or at least, try to. While I worked a long-term care facility I was always assigned to be her aide- and I was just fine with it. Her son came to visit her every night- he was a big, strong, teddy bear. Before too long we became friends, and I became family.

I quit the care center not long after I turned 18, but I still went to visit Charlotte often. One night after about two months I got a phone call from her son. He was crying. He asked why I hadn't been at his mothers funeral.

Words couldn't fix what had happened and tears formed in my eyes. I sniffed softly and we stayed on the phone with each other. We didn't say a thing, we just sat until the other hung up. I haven't seen nor heard from him since, but I think of him every day.
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I've had roughly 700 patients in my care alone this year. That does not count the patients that I shared with other aides or the ones that didn't require much care. Out of those people, 22 of them have lost their lives. In my opinion, that is far too many.

Susan died alone, her family nowhere to be found or contacted, at the age of 73.

Frank died while getting Dialysis. He told me he was going to die three minutes before he did. The doctors were too late and he couldn't be revived. He was 56 and top of the list for a transplant.

Johnathan died of Leukemia after two long years of treatment. He was 8.

Maya died of heart problems after staying in the hospital for 6 months. It was sudden and unexpected. She was 32 with two young children.

Do people seriously wonder why we struggle with depression? Why we crack twisted jokes? Our jobs are amazing, but don't kid yourself, it's the hardest job in the world to do.
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I wish I was lucky enough to say these last 20 years were easy on me. More than anything I wish I could admit how high school was a breeze full of only good times and that the cops were only involved when it was funny.

I wish I could say that things were always amazing and wonderful- that I'm not a 19-year-old divorcee, or a girl who had to re-invent herself three times just to keep her head above water. I wish that I was lucky enough to say that I made it through all that hell with a smile on my face.
But I've been beaten bloody over all of it.
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Hot tears stained my cheeks, goosebumps covered my body. I sat on the floor in an empty patient room, hiding. I stared at my wrist in shock, in disbelief. I couldn't believe I had done it, but there they were, two cuts. My mouth fell open and I stared helplessly at it; what had I just done? That wasn't me, I was the professional, not the patient. Scared, and shaking I placed a gauze pad to my wrist and dabbed away the blood.

As I sat there I felt it-the realization of it. Just moments before my world was crashing, my pain was out of control and I could hardly breathe. Nothing could help the pain and all I could think about was wanting real pain. Suddenly the emotional pain had disappeared and the physical pain was all I could feel. I sniffed softly and touched the cuts, suddenly I felt like I could make it. The physical pain was nothing in comparison.
Finally, I understood.
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Two days after the first incident and I still hadn't taken off my leather wristband. My cut was covered in neosporin and topped with gauze and a tegederm, then nicely hidden for the world to never see. After a long shift at the medical unit I collapsed into my car and sat there numbly. After thirty minutes of debating I turned on my car and called Travis.

It took everything I had to even tell him the truth- that I was calling for help, for advice. And once I said it, I regretted it. Surprisingly, he shocked me. "Let's talk about it." He said. "And lets start off with why you're calling me about it."

I waited for the typical 'cutting is a cry for help, or attention' line, but it never came. Instead comments like 'your not stupid, nor incapable, your human' came up. By the time I got home I felt better and a plan was in place. From that point forward I was no longer allowed to keep my feelings bottled in. I was to carry tissues everywhere and try to let my emotions out (where appropriate). I was to call either him or my fiancee and get it out there- to avoid that unbelievable emotional pain at all costs.

Two people were on my side. And for me, that was enough.
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By no means am I to say that my depression is cured.
It is on hiatus while I am here at home recovering. The cold weather, the snow, the trips up to work remind me of what may be waiting for me once I do return. It scares me shitless.

But I have to talk about it, I have to face the facts. I need to tackle this son of a bitch and figure out what causes it to think it can control me. And then I need to take control all over again. It's a long, hard, miserable battle that will drive me to insanity, if it hasn't already.

No one would've known if I hadn't told them how bad it was. Sure, my fiancee knows I have crappy shifts. He knows there are nights I come home and cry myself to sleep. There are days that breathing the next breath seems impossible by all odds, but I seemingly pulled through. If I wouldnt've said anything it would've been my secret, and all they would've seen was tear stained cheeks.

Depression

This week has been full of this topic, starting with my trip to the ED on Sunday night. A friend called Sunday afternoon asking questions about a visit to the emergency room about crisis evaluations and how she should know when to take her 'sister.' I answered all questions dutifully and left it at that. Knowing her family, including said sister, it was a plausible story. Three hours later she called me in tears asking to be taken in to the ED. As I stated in an earlier post, it was a long night and by law I had to take her in. It's not the same scenario if you call the cops, and I knew calling in the cops wouldn't help her. So, we loaded up the car and took her to whichever hospital she chose.

It ended up being mine.

Because my hospital is the only level 1 Trauma center around, we got the joys of sitting out on a gurney in the hallway until they could find time for a measly crisis evaluation. GSW's to the face, stabbings, heart attacks, MVA's and MCI's rolled past us from the helicopter pad. I tried to be supportive to this person who I sat with, but we weren't that close and I wanted to see these traumas.

Because of what happened Sunday night I think I caught something from a patient in the ED, because I got sick. However, when I am down I have time to think about things. One thing I got to thinking about was depression.

During report today I caught myself rolling my eyes and sighing, making a comment similar to 'everyone has depression and anxiety'. It was wrong of me to say. I shouldnt've said it, i shouldnt've thought it. But when we work in medicine we seem to overlook that diagnosis. We seem to look for anything better when in reality, depression is a serious illness.

Everyone has had a down point in their life. A bad day, week, or month. A time where that damn raincloud follows them everywhere. The thing about depression is that alot of the time people don't realize they have it, and once they find out they do, they are over medicated and treated. Sometimes the treatment s appropriate other times its inappropriate. Either way, depressed people get help. That's a step.

I have sat in many 1:1's. Many suicide precautions and many depressed people. We roll our eyes at the 21 year olds who claim they don't want to live anymore, we sigh at the thirty-one year olds who are loosing their minds in a mid-life crisis. But what we don't realize is that their pain is real.

This post is not just an information post. I want to send out a challenge to everyone to quit overlooking depression. Shame on me for not watching the girl with the crisis evaluation. Shame on me for what I said. Shame on the doctors for not taking time to really look into someones depression and their medications. Shame on us, for not knowing enough about this totally painful and out of control disorder. Let's do better y'all.