The Choices of Brittany

I was so happy to read that Brittany Maynard has chosen to live a little longer.  Brittany has terminal brain cancer and decided to engage in either physician assisted suicide or some other right to die method of her choosing.  She has recently chosen to put off her scheduled departure. 

She is an inspiration to both those who wish to have the right to die on their own terms and also to those such as my mother and sister who fought against death to the very last breath.

My mother fought a very long battle with COPD and was not afraid to die.  At the very end, she fought very hard to stay alive.  Her last three weeks of life were spent in a morphine induced coma and I slept on the floor beside her bed every night and taking care of her every day.  As painful as the whole experience was, I would do it all over again.  The whole experience was a blessing that only those of us who have given our lives to a loved one could understand.

My sister died from brain cancer which had originally metastasized from breast cancer.  She too wasn't afraid of death but fought to the very end to live.  She decided not to take morphine for her pain management and opted for other herbal methods (we need to vote in politicians who understand this).  Despite being bed ridden, my sister insisted upon going on a camping trip and the family carried her and her bed out to a campsite near a lake and a few days later, that is where she died, peacefully watching a sunrise. 

Both experiences have taught me two lessons which can be summed up in these two quotes by Henri Nouwen:

“The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing... not healing, not curing... that is a friend who cares.”

"Blessed are those who suffer.  Not because suffering is good but, because they shall be comforted."

Regardless of the path Brittany chooses, she is an inspiration for both those who wish to have the right to leave this world on their own terms and for those who fight to stay as long as possible. 

If Brittany decides to fight the battle to the bitter end, she won't be a burden to anyone, but a blessing and they wouldn't have it any other way. 

Have You Been Thinking About Suicide Today?

The whole world is in pain over the completed suicide of Robin Williams.  Robin was very sick and despite reaching out for help countless times, he wasn't able to find the help he needed.  I'd like to talk about suicide and some thoughts about it.

Have you ever been dumped by someone and found solace in a torchy break-up song?  Breaking up with someone can hurt so much that you think no one else could possibly understand how you feel.  But break-up  songs understand, they feel your pain, they say exactly what you are thinking and feeling, they don't say the wrong things and they comfort you because they resonate with you. 

In Dusty Springfield's song "You Don't Have To Say You Love Me" she desperately sings;
Don't you see that now you've gone
And I'm left here on my own
And that I have to follow you
And beg you to come home

You don't have to say you love me
Just be close at hand
You don't have to stay forever
I will understand

Phil Collins sings in "Take A Look At Me Now;"
So take a look at me now, oh there's just an empty space
And there's nothing left here to remind me,
just the memory of your face
Ooh take a look at me now, well there's just an empty space
And you coming back to me is against all odds and that's what I've got to face

I wish I could just make you turn around,
turn around and see me cry
There's so much I need to say to you,
so many reasons why
You're the only one who really knew me at all

Who hasn't felt those feelings over a love lost?  If we have, how many of us have found a comfort in those songs and listened to them over and over simply because they explored our feelings?

Henri Nouwen once said, "The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing... not healing, not curing... that is a friend who cares."

When someone is thinking about suicide, chances are they want to talk about it, about their feelings, about their pain.  They just don't know how to start the conversation and most certainly, many of us don't know how to, either.  It is very easy to say the wrong thing and many people do.

Every fifteen minutes, someone in this country completes suicide.  Many have given warning signals and have even reached out for help but all too often the people they reached out to may not have been listening.  It's not their fault, they just don't know how to listen or are uncomfortable with the topic.

We should never be afraid to talk about suicide because the person thinking about it isn't and we need to engage them and encourage them to talk.   Getting them to talk means listening to them.  Re-read the Henri Nouwen quote.  That is how you listen, by not talking. 

For example, if someone is depressed because they lost their job, here are some things NOT to say: You'll find another one;  I lost a job once; You're better off not working for them; I know someone who is hiring; I'm sorry; Get over it; I know exactly how you feel; it's only a job; You'll be able to collect unemployment now; How dare they, you should write them a nasty letter; What did you do wrong?

Instead, with careful listening, like a good torch song, you should steer them into their pain where they can explore that pain.  You can achieve this by asking questions.  These questions will get them to talk about their pain and like a good torch song, help them to understand their own feelings and heal. 

So someone tells us that they lost their job.  You can ask, "How have you been dealing with that?"  An open ended question such as that will get them to talk further about how they are feeling.  Again talking about their issue is for them, not you.  They may pause and the silence may be uncomfortable for many of us but resist the urge to fill the uncomfortable silence.  Re-read Henri Nouwen's quote.  In that silence, they may be thinking and feeling and working through how they are feeling and your discomfort and urge to fill in the silence could destroy all that.  Be patient and silent and present. 

If they are not responding, here are some other questions you may ask:
What is most difficult about losing your job?
Tell me what happened.
Tell me more about that.
What is it you want from your job?
How do you feel about what happened? 
Do you feel comfortable talking to me about this?
Have you told anyone about how you are feeling?
What do you think you can do?
What may stand in your way?

These kinds of questions establish rapport and define the problem.  Your job is to guide them or steer them into the pain.  If you can't find a question to ask, there are statements you can make which may spur their thoughts and conversation:
Say more about what happened.
It sounds like you are going through a difficult time.
I can see why you feel that way.
Take your time, I'm here to listen and support you.

After exploring feelings, don't be afraid to ask the suicide question.  If they are not thinking about suicide, there is no harm done.  If they are, chances are they will be willing to talk about it.  This is very important because if they are willing to talk about it, it is because they are ambivalent and your talk, honesty and presence can actually save their life.

Go ahead and ask questions like:
Have you been thinking about suicide?
Do you have a plan?
Do you know how you would do it?
Do you have the means to act on your plan?
Do you have a time set for doing this?

If they answer "yes" to any of those questions, help is critical.  If you can get them to give you or lock away the means (drugs, gun, knife, rope) that is what is called a protective factor.  The point is to get them through the moment.  If you can get them to live another day, tomorrow they may feel different. 

While answering a local suicide hotline, I discerned that the caller was safe for the night because she locked her gun in a box and put it in the basement.  I made her promise to call me tomorrow to let me know how she was doing.  She did.  She told me the only reason she didn't go back down into the basement to retrieve her gun and kill herself was because she promised to call me back the next day and she wanted to keep that promise.  At the very least, I got her through the moment and to live another day.  While speaking with her the next day she made a comment to her cat which jumped on her lap.  I asked her what would happen to her cat if she were not around anymore and she paused for a moment and said, "I don't know.  I could never leave my cat alone."  The cat was another protective factor.  A very powerful one.  She had a reason to live.

Before leaving someone, we need to make sure they will be safe.  We can achieve this by exploring their protective factors and distracting activities.  Getting someone to prepare a meal, go shopping, take their dog for a walk, cuddle with their cat, take a shower, take a nap, draw, write, watch TV or exercise, we are giving them a plan which can be enough to get them through the day.  

"The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing... not healing, not curing... that is a friend who cares."
-Henri Nouwen.