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Mental illness kills.

It kills with heroin overdoses and self-inflicted gunshot wounds and anorexia induced cardiomyopathy and obesity induced sleep apnea and girls who take risks they shouldn’t with dangerous boys.

And when it does, there are usually kids left behind. And that is the worst tragedy.

When I was a resident, we would admit patients overnight who had failed at killing themselves with drugs. We needed to make sure they were medically stable before being sent to inpatient psych. The ER  had saved them but we were the ones to run fluids and monitor them and fill out the paperwork once the psychiatric hospital was ready for them.

It was the job of the residents to go see these patients at two in the morning and complete an H&P, a history and physical exam. We would ask the questions we asked all patients: chief complaint, onset, duration, intensity, chronology, exacerbating and remitting factors, associated symptoms. In this case, the chief complaint was not shortness of breath or fever. In this case, the chief complaint was, I wanted to die. So I tried.

Sometimes onset was a long time ago, often it was right beforehand. Intensity was of course always a ten. Sometimes they told you their story freely. Sometimes only the bare minimum. (we would write “history limited by non-cooperative historian)

I remember one patient in particular. She was a mom. She had three kids around the same ages as my three kids at the time.  She told her story of how her boyfriend had hurt her. Hurt her so badly she decided to die. I asked where her kids were when she took the pills. They were home with her. Maybe they’re the ones who found her and called 911. Maybe it was the worst night of their lives after many other bad nights. She didn’t know whether they’d found her or not. She didn’t care. She never asked us where her children were now. Just went on about the boyfriend and how he’d hurt her and how hurt she was. And I tried very hard to have compassion for my patient, but all I could think of was her kids. Of how badly a successful suicide by their mother would have wounded them.

I have never been the type to lack compassion for those so hurt inside they feel killing themselves is the best solution. I have heard good Christians say they will go to hell. I have heard people call them selfish for hurting their families and thought, do you have no grasp of how much pain they must be in?

But by this time, at the age of 34, I’d lived a bit more of life and had a more nuanced view, you could say. I still think its’s awful to say they’d go to hell. But I do not think, when children are involved, we can simply say they were ill, they were in pain, and so it was.

When I was 28, I had a boyfriend too, just like my patient. He broke my heart too, just like my patient. And I decided to die too, just like my patient. I planned out which pills I would take and when. I’d just had pharmacology before Christmas break had begun and knew which ones would be most effective. It was Christmas. The tree was up. I hadn’t given my kids their presents yet. We were alone in Erie for break. I decided I would drop them off with their dad. He would take them to his parents house for several days for New Years as he did each year. No one was expecting to hear from me. It was time to die.

I was in a depression as deep as any I’d been in many times before. But this time was different. I was 28. I’d been battling depression since I was ten. I always held out hope I would get better one day. Life held so much possibility. But at 28, I thought, here I am again. I can’t keep doing this. I can’t. I sat on my floor crying as my three year old and two year old asked what was wrong and brought me Children’s Tylenol to try to make me better. I hate that I did that to them. I am sorry that I did that to them.

I kept pulling presents from the basement and giving them to them one by one to keep them occupied. I fed them leftovers from the Christmas eve party at my family’s house I’d brought back. I suppose I changed their diapers. I don’t remember.

I planned out how to die and thought, they will go live with my parents and be so much better off without a worthless mother like me. But then it happened.

I entered into rational thought long enough to realize they wouldn’t go live with my parents if I died. They would go live with their dad. And their dad, luckily, was a tremendous asshole at that time. And I thought, I’m really worthless, but he’s even worse. Thank you God he was such an asshole. I couldn’t do that to them.

I remembered when my oldest son Soldier Boy was a baby and I didn’t know if he would live because of a genetic disorder they thought he might have. I remembered sitting in the glider in the nursery wailing a gutteral wail from as deep down as a person can, begging God not to take my baby. Put me through the pains of childbirth for all eternity, I said (I’d just finished a 32 hour natural birth so that’s no small statement). Put me through hell, I said. Just save my beautiful baby.

And he did.

And I thought to myself, I am in so much pain. It hurts so much to live. I am in hell. But now it seems I must do what I told God I would. I must walk through hell for my babies. And so I did. One step at a time.

When you are that depressed, finding the will and the energy just to get out of bed in the morning is excruciating and exhausting. But I did. I got out of bed and I took care of my babies. I went to class and studied. I called a psychiatrist’s office and was told they don’t take Medicaid. That about did me in. But I made myself call another. And I got a psychiatrist appointment for a month from then and a therapy appointment in a few weeks.

I kept breathing. I kept living. Every breath hurt. My heart ached. My muscles ached. My soul was not in my eyes if you bothered to look. Luckily no one looked.

I wanted to check myself into inpatient psych but I knew if I did it could ruin my career and I could get my kids taken from me. I was right. I’m glad I didn’t. But it hurt. It hurt so damn much.

It was in this time, this darkness, this exile, waiting to see a psychiatrist that I entered into the relationship with the man who was my trauma, who was my Ordeal. I was in hell, so I laid with a demon. I suppose.

There in the midst of my Ordeal, I made my way through hell. I chose to live each and every day in every decision I made. When I did not feel like getting out of bed,  I would say to myself, you either live or die. If you stay in bed, you are choosing to die. When I didn’t want to go for a walk to get exercise and fresh air, I would say to myself, you have two choices, life or death. If you do not go on this walk, you are choosing to die. And that is not an option. Your babies need you to live. This is hell. Get walking.

I do not know how it is that a part of me found wellness inside the trauma, the Ordeal. Sometimes I think it’s that a part of me, a version of me, broke off and endured the trauma while the rest of me went on with life as usual. Sometimes I think it was the adrenaline. Sometimes I think it was God. Maybe a little of each.

I know that with my therapist and my psychiatrist I got to a point where I could do a load of laundry without exhausting myself. Where I could study and enjoy neuroanatomy and feel proud of myself for rocking the exam. Where I could play with my kids.

Then came PTSD, but that’s another story for another time.

And so this is what flashed through my mind and heart when I stood there collecting this patient’s onset and chronology. For her chief complaint of choosing to die. This is why I could not lend her more compassion.

When we choose to have children, certain choices go away. Dying is one of them. Even when living is hell.

And to not die is not enough. We must choose to live every day in every choice we make. We must fight for our children. Even when we can’t bring ourselves to fight for us.

They are innocent. We are not. The body is weak, but the will is strong. Must be. For them. This body, this mind, this pain, is not endless. It will all fall away. Ending it a little sooner is not worth the price of their innocence.

It is not a choice. That choice is gone.