When I was in my undergraduate program to become a nurse, I was so excited to start my psych rotation. I knew going into nursing school that my goal was to work in mental health. I was so grateful to have such amazing teachers who guided me through the class. My clinical instructor gave me so many opportunities during clinical to truly practice my skills and allowed me to continue to explore my passion for mental health. I remember specifically a lecture we had where we talked about suicide. It’s always difficult to talk about, but we need to. We need to stop pushing suicidality under the rug and pretend it doesn’t exist, because it does. I’ve heard so many people say that it is a cry for attention. That’s not wrong; it is a cry for help. People with suicidal thinking are in desperate need of someone to reach out to them. They need someone, anyone, who is willing to take them by the hand and remind them that they’re not alone. It’s a difficult cycle to break. Suicidal thinking doesn’t just go away. It takes time and therapy and support and medication. It takes motivation and trust and the ability to love yourself. It truly takes a village.
Our instructor was talking about the warning signs of suicide. If you don’t know them, I’m going to stop here and tell you. It’s so important that everyone be aware of the warning signs of suicide because we need to be able to address it when we see it; because almost one million people die each year world wide by suicide. NEARLY ONE MILLION PEOPLE!
1. Withdrawal. They will often start to pull away from people that they usually enjoy being with and start to isolate themselves, especially from things that previously brought them joy.
2. Irritability. The smallest things will make the person irritated. There’s a true difference between an angry, impulsive irritability and a sad irritability. More on that later. Just take away from this point that little things may seem like big things to these people and their reactions and emotions may seem extreme.
3. Giving away possessions.
4. Talking about suicide or death.
5. Feeling helpless and/or hopeless.
6. Feeling like a burden to others. Those with chronic physical health conditions are at an increased risk to feeling this way.
7. Behavior that is out of their norm, often dangerous, such as drinking and driving.
8. Increase in self-harm.
9. A sudden change in mood from sad to happy. They might tell you this when they start a new antidepressant, so watch for a change in mood from sad to happy that quickly happens. It might be because they have enough motivation and energy to carryout their suicide plan.
10. A sudden change in mood from sad to happy, even cheerful, after long periods of withdrawal and/or sadness, not due to an antidepressant; often happens after they have obtained the means to carry out their suicide plan and have made a final decision to carry it out.
That’s exactly what happened here; number 10 on the above list. He had decided that it was the day. This was going to be his final attempt and he knew that it would work.
I walked onto the unit that morning to pass medication. It was like every other morning on the teenage boys unit: chaos. Fighting over who was going to shower first; arguing about not wanting to get out of bed and go to school; refusing to take their medications.
I have never been a morning person. In fact, I utterly hate them. But no matter how tired or irritable I was to be up so early, I walked into work with a smile on my face. I wanted to bring as much happiness as I could to these kids who had so little. I smiled as I walked on the unit like usual and told the boys good morning as they scrambled around the unit. I walked down the little hallway and into the medication room to set up for med pass as I heard this boy, let’s call him Thomas, yell my name.
“What up, nurse Brandy?” It caught me off guard because I recognized the voice, but the tone was different. It was excited and vibrant. Nothing like I was used to from him.
I’ll back up a little bit.
This kid broke my heart when I first met him. He was so depressed and full of anxiety that he would rarely look up from the floor. He had multiple suicide attempts in the past and a vast variety of treatments, but nothing had seemed to truly work. He was on multiple medications and had tried nearly every option. He had seen multiple therapist and participated in groups. His eyes were empty and I could look at him and feel his pain. He was broken.
I always tried to make him laugh when I would see him. Every now and then I would be lucky enough for him to crack a little smile. He would always tell me hi and when I asked how he was doing he would always respond with, “the same as always.” He never really did tell me what that was.
As previously talked about, I ran a dance group in my free time while working in residential. I have been teaching dance and tumbling since I was twelve and loved every second of it. So many of the kids in residential were talented and never had the opportunity to show it. I wanted to be able to help them do that while giving them some confidence and most importantly, something fun to look forward to. It was something for them to focus on outside of their treatment. For one hour a week, they got to spend time with me and other kids who loved to dance. For one hour a week, they were able to do something normal.
One day I invited him to come to dance club. He shook his head no. I told him that he would have fun and he rolled his eyes but smirked at me. I was blown away that night when he actually showed up to the practice. He didn’t participate. He sat down in the gym where I held the practices and he watched. I caught him smiling a few times and continued to invite him to try it, but he wouldn’t. I was okay with that. I was more than thrilled that he even showed up at all. I like to think that he had a good time that night watching the practice and if only for a moment, his mind was on something other than his depression.
He was tall and thin with brown hair and brown eyes. He actually had a good family and his mom would visit often. She wanted so badly for him to be happy. We all did.
He was sad but was able to focus enough in school to get straight A’s. He was effortlessly smart. He had so much going for him and I could only hope that his time in residential would help him to see that.
Everyone has heard about residential horror stories. Staff hurting kids. Kids hurting each other. Sexual misconduct. Yeah. It happens. But you can’t believe everything you hear and truth is, stuff like that is rare. The majority of the people I’ve worked with in residential were fabulous. They are truly there to make a difference and to help these kids live up to their full potential. These are some of the most incredible people I have ever met. I’ve worked with some staff who have worked weeks in a row without a day off to cover when the units are short staff because they don’t want the kids to be negatively impacted. I’ve worked with staff who have stayed hours past their shifts to help with crisis situations. I have worked with multiple staff who spend money from their own pockets to buy things for the kids like new shoes and backpacks so they don’t have to go without. These people care so much and put their whole life into providing care for these children who often have no one. I know I’ve already said it, but we all make mistakes. We all overlook things. You would be lying if you told me that you were perfect; that you’ve always done absolutely everything right.
So many of us have spent so much time questioning this situation. We should have known. What did we miss? What could we have done different? Was this our fault?
I turned the corner out of the medication room with his medication and small cup of water in my hands. He was smiling. Genuinely smiling. His brown hair was still wet from the shower, which he didn’t take often. He was dressed in probably the nicest clothes he had. He was so happy.
“Wow, it’s great to see you smiling this morning!” I told him as I put his meds in his palm. He was making eye contact with me as he took his usual medications.
“I know! I feel great today. It’s going to be a good day,” he said with a smile as he handed me back his empty cup of water. “Have a good day, nurse Brandy! It was great to see you here,” he said with a smile as he strutted away from the door and over to the table where he helped another kid on the unit with his morning chores of cleaning the tables and chairs.
Maybe he was just having a good day. Maybe someone had said or done something that made his outlook change. This was great to see, right? He was smiling and happy and hopeful. He was getting better!
Right?
That morning, or maybe even the night before, he had made up his mind that he was going to do this. He had known that he was going to kill himself. And he was happy. He felt a sense of relief that he had come up with a plan and a way to carry it out.
He wasn’t getting better. He was getting worse.
This is one of the things they don’t tell you about in nursing school. Just because someone seems happy doesn’t mean that they aren’t thinking about killing themselves. Some people are able to put a brave face on during the day. People are able to pretend they are fine when around others, but no one realizes how hurt they actually are. Another reason why I try so hard to be nice to every person I meet no matter how rude or mean they seem. You never know what is going through someone’s mind. They could be having the worst day of their life and you wouldn’t know it if they didn’t tell you.
In cases like this, I find myself asking what am I supposed to do? I want so badly to help those who are hurting, but how do you do it when they won’t tell you about it? I think it goes back to being patient and kind with everyone you meet. Some people are truly assholes and I’ve met quite a few but I try to remind myself that people are usually good hearted. Usually. You never know who you could run into that is thinking about suicide. You never know how one kind word or a simple smile could make a difference in someone’s life.
I constantly go back to thinking about what I could have done differently that morning. I should have said something to someone about him being too happy; that something was going on. We should have noticed that he was different. But he was smiling and happy. He wasn’t crying or staring at the floor like he usually was. Most would see this as a good sign, right?
One of my favorite youth leaders called over the walkie that Thomas was trying to AWOL and that he was heading for the fence. Multiple people started to call on the walkie that they were heading out to help. I remember instantly thinking that they said the wrong name. It was the wrong kid. Thomas had never tried to run away before. He never got into trouble while being in residential. They had to have said the wrong kid.
A few second later we heard static on the walkie and then a staff saying that he was jumping the fence. A few staff were able to follow over the fence and run after him. We waited and waited to hear something on the walkie but nothing came through. We assumed for a brief moment that it was fine and that staff were able to get him back to the unit.
We had kids try to run away all the time. Hearing stuff like that over the walkie about stuff kids AWOLing was nothing new. I went to go finish documenting my medication pass when my cellphone rang. It was the staff who had jumped the fence and tried to follow him.
I’ll never forget the tone in his voice. The way it sounded. His normally upbeat voice was shaking and anxious and full of tears. It took me a few seconds before I was able to calm him down enough to tell me what was going on. I can still hear his voice in my ears as my entire body filled with panic.
“I tried to stop him. He jumped. He jumped in front of the semi. In the traffic. You should have heard it. He’s dead. He’s dead. You should have heard the sound. The squad is coming.”
My heart started racing and my hands were sweating. My eyes filled with tears. What in the world had just happened?
As soon as I hung up my phone, my boss walked in and said that her friend had heard a kid was hit and killed by a semi. News travels fast. Especially inaccurate news.
But it was true, that he ran out onto the highway. He jumped right in front of a semi. Multiple staff members were there and saw it happen. They couldn’t get to him fast enough. There was nothing they could do about it.
When I think about this situation, I can’t help to be thankful that I wasn’t there to see it. I honestly do not think I would have been able to continue practicing as a psych nurse if I seen that happen. My stomach hurts as I’m typing this thinking about it.
The youth leader who had called me to tell me what had happened, the one who chased him over the fence, the one who watched a teenage boy jump over the barrier and throw himself in front of a semi on the highway… I will never forget the look on his face when I seen him later that day. All the color was gone from his face and eyes were full of fear. I’m so happy to say that this youth leader, who no longer works in residential, still is working in a position where he has the opportunity to take care of children. What an amazing, resilient, caring person who wants the best for these children. My heart forever goes out to him for seeing what he saw.
They said his head was nearly squished by the tire. His arm was shattered. All of teeth were knocked out.
But he was alive.
At that moment, my heart stopped. How in the hell do you jump in front of a damn semi and live? There was a reason he survived. There had to be a reason for his life. If this didn’t prove that to him, then nothing would.
He was transported via squad to the ER and never returned to residential afterward. He ended up having multiple surgeries and a ton of physical and occupational therapy. He was so beyond lucky to be able to physically recover from being hit by a damn semi. He had to know now that there was a meaning to his life!
Whatever that meaning is, he has yet to find it. He ended up having to have ECT for his depression and it helped! But not long ago he was caught stealing and breaking and entering and heading again down the wrong path. It was interesting to me that he started acting out such behaviors when before he had not. I wanted so badly for him to be able to be okay and go on to do something incredible. Maybe one day he will. He’s still young. He has time as long as he can make it. I mean, if you live to tell your tale of being hit by a semi, then you’re pretty damn invincible in my book. Hopefully when he gets out of jail, he’ll get back on the straight and narrow path. I at least hope that he is happy. Even if he is in jail, I hope he’s not constantly planning another suicide attempt. I hope that instead he is thinking about his future goals as an adult. I hope he can go to college and get a good job and get married and have a family and most importantly, I hope that one day he can be exponentially happy.