The kids are all right
by Hillary Adams
Image by Cottonbro Studio for Pexels
TW: Suicidality, depression
We’ve been here before. Maybe not this exact waiting room couch, but another just like it, an unaggressive taupe one with a stone fountain trickling next to us. I flip through Mindful magazine glancing at the pictures and he stares at his phone. I think I prefer the indulgence of People or Us when I must contemplate my child’s mortality. These Mindful covers tell us “Resilience: You Have the Power to Thrive,” and “Find Calm in the Chaos”—if only it were that easy.
Five years ago when we first split, we would choose opposite sides of the waiting room and I’d watch his jaw clench and unclench as he stared off into space. Today he’s close enough to hand me something and ask me to read it because he doesn’t have his reading glasses, but it’s bittersweet.
The kids are all right. They’re beautiful, in fact. We have three poised, intelligent girls who can articulate their desires and debate you on the environmental impact of eating meat or human rights violations in China with facts and dates and data. Our two sons might both be future engineers like their dad. They’re doing great, I always say when people ask how the kids are doing. Do they really want to hear that the oldest daughter has panic attacks like me, and the second struggles with sometimes crippling OCD? Are they ready to hear that our sixteen-year-old daughter wants to kill herself? She’s why we’re here, seeking some medical comfort from a child psychiatrist. I’m also armed with a list of resources as I prepare for the ultimate sales presentation to her father, who believes that exercise is the answer to everything. He’s okay with them being on medication, probably because his life has been upended by loss to suicide. But I’m proposing something more radical. A chance for a reset.
“Remember I texted you that I was looking into some alternative treatments?” I ask.
“Yeah, you said something about that.” He looks up from his phone so I put the magazine down and continue.
“I think we need to look into something beyond medication for her.” I weigh my words, watch his reaction. “I think there’s a genetic predisposition for this, on your side of the family.”
He nods, staring at the coffee table, “There is.”
“Your grandma, her brother, your brother, other family members…” I don’t mention his nephew because I know the family doesn’t talk about his depression. But the kids talk to one another, and my kids talk to me. “I think your grandma was probably suicidal most of her life,” I say. “I don’t want our daughter to live her whole life feeling this way.”
He nods. “So, what’s this treatment?”
“Ketamine—there’s even a clinic in Reno.”
He pulls his phone out and googles. “It says patients usually feel relief in two to three sessions.”
“I can send you the articles I’ve found. It’s sort of new, but it’s effective.”
“Sure, send it my way.” He then asks how my uncle is doing to change the subject, but I’m encouraged. He doesn’t have any bad associations with this drug like many people do—like I did. Maybe it won’t be the battle I imagined.
The doctor appears at the door with our daughter and it’s our turn.
What do you say to a child who is convinced there is nothing to look forward to in this life? When I was her age, I was planning my great escape to Europe and partying with my friends. I believed there was something greater, worth living for, in the big wide world. But I was also self-medicating with weed and anything else I could get my hands on.
Every day I must remind my daughter that I won’t survive the loss of her. I’ll never come back from that devastation. Maybe my mom guilt can tether her to this earth while I search for a cure. It feels impossible to find even a little hope for her to guard while I buy us some time.
We look forward to things one at a time right now. We have a concert coming up this week, but after that, she sees no point in continuing. This is a brilliant girl-woman, profoundly observant, a gifted singer—like Whitney-Houston-chills-down-your-spine gifted. She’s the kind of beautiful that makes you suck in your breath when you watch her at Target picking out a new backpack for school. She signed up for three AP classes this year, including AP Chemistry, because the teacher said she was the most academically gifted student she’s had in years. But my daughter admitted to me yesterday that when she signed up for these classes, she wasn’t worried about how hard they would be because she didn’t think she would still be alive.
What you don’t know is that these kids are often the well-behaved ones. They’re not wearing all black, smoking weed in the garage, and screaming at their mothers, as I might have done. The top risk factors among family history are perfectionism, LGBTQ orientation, depression and anxiety and academic struggles. These suicidal are often peacemakers, politely white-knuckling the edge of the crack they have slipped through. When we parent kids like this we don’t see it until it’s too late. She seemed so happy, the mom will say. She had so much to live for. She always did so well in school. Serious. A hard worker. Always looking out for others, not asking for anything.
Never wanting to cause stress, she doesn’t tell me how bad it is until she’s been ruminating in the suicidal soup for over a year. She has to write it down and ask us to read it because her logical brain can’t say it out loud.
“I have something I’d like you to read,” she says, climbing in the front seat of my car when I pick the kids up from their father’s house. It’s our Sunday evening changing of the guards. She stuffs an envelope in my purse. “Dad read it already. You might want to wait until later.”
“Yeah?” I pick it up and start to open it. “What is it?”
“Something from my journal.” My thirteen-year-old son settles into the seat behind us and rips a gigantic burp that slices the air between our heads, which sends his little brother into a giggling fit, and I agree that I should wait. I want to give this envelope my full attention, although I feel like I should know what’s on the pages.
But I don’t. I know she’s been wanting to die because she’s talked to me and we’ve had her in therapy since fall. I know she’s been tempted to self-harm. But her journal pages admit to an actual attempt, one she didn’t complete. We’ve had her in therapy for a few months now, but half the time she says she doesn’t feel like it’s worth the money because she doesn’t really know what to say. Until she finally writes what she’s feeling in her journal, tears out the pages, and hands them to the therapist. She’s been self-editing her irrational thoughts before she can get them out of her mouth in therapy, but the incessant preoccupation with ways to kill herself persists.
I check in with the therapist. I never know what my kids say in therapy. Are they including the part about trying to choke themselves out in front of the mirror, or do they just say, “school’s fine”? She assures me that giving us the pages is a good sign and says she’ll coordinate with the psychiatrist when we get an appointment.
A few days later at work, I’m struck with an urgent need to call my daughter, a feeling that her suicide is inevitable, a storm rolling in. I call her as she’s walking home from school to her dad’s house.
“I need you to know,” I say, “this will absolutely destroy me. Please promise me you won’t hurt yourself, and if you think you’ll really do it, you’ll talk to me.” I’ve heard that getting a promise from a suicidal person is critical, but this is all I understand. I’ve experienced the murk of depression, where I didn’t want to wake up in the morning, but I’ve never fantasized about making it happen.
“I’m sorry, Mom.” I hear the crackle of wind as she walks, the cars passing, distant voices of kids calling to each other. It makes me feel present even though I’m thirty miles away at my office. “I don’t want you to worry about me.”
“We are fighting an enemy,” I say to her, “and we are going to conquer this bastard together.”
I’m furious at Suicidal Ideation, this insidious brain-dwelling liar who doesn’t want this gifted woman here in the world revolutionizing medicine, or the arts, or anything at all. Prozac seems like a Snoopy Band-Aid that covers the corner of a seeping wound. It’s borderline necrosis. I’m not being dramatic.
Writing about this makes it all more real. I’ve always feared that writing about my worst nightmares would make them come to pass, which kept me from writing my most powerful truths for years. But this is my baby, and hers is not a theoretical desire, which makes me frantic.
I’ve read the stories with the parents who hold a picture of their child in a frame instead of their actual child. I refuse to let this be me. I don’t want our story to be cautionary, after the dreaded thing has happened; I want to explain the answer we found together. She says I can write about it because she wants everyone to know that meds and therapy are pretty common and nothing to hide. But what do we do when the meds and the therapy and everything going right in the world isn’t enough to keep someone alive?
Every morning I go into her room to verify. I find her wrapped in her comforter, scrolling through Snapchat, not hanging by a belt in the corner. I shit you not; this is our life.
“What’s up?” she asks.
“Nothing, just checking on you,” I say. I mask my pinched voice with a laugh, try to sound upbeat and supportive, but I feel like I’m in the middle of a battlefield littered with dead bodies and I’ve been given a toy gun and a plastic sword. This is some bullshit.
“Mom, are you okay?” She’s worried about me, and I feel like this is a good sign. If she can see beyond herself and her depression, we’ve still got time.
“Yeah, I just needed to see you,” I say. Alive, I don’t say. I sit on her bed and smooth her hair. “We’re going to figure this out, ok? I promise.” I want to bury my face in her neck and wail, tell her how scared I am.
“Am I a huge disappointment?” she asks.
“No! Why would you say that?”
“Because I’m dumb for one.”
“Your brain is a liar,” I say. “You are brilliant, and kind—I couldn’t be more proud of you. Please know this.” I make her look at me now, with those old soul eyes that came out of the womb looking like they knew everything.
“Do you hate me?” she asks, and hugs me hard. We always punctuate our anxiety with that question in our family. Always. It’s probably my fault.
“Never,” I say, “You’re the reason I get up in the morning. The reason I’m on this planet. You don’t get to leave me here.”
It takes six months from the time she hands us the journal pages to finally get an appointment with the child psychiatrist to look at other medication options. Another reality of our mental health system—the wait. Although the same doctor treated her sister, when I try to explain how dire the situation is the admins ask me if we’ve hospitalized her. Isn’t the point that we want to avoid hospitalization? But we wait for a referral and an appointment, and in the meantime her pediatrician prescribes Prozac, which makes her numb and sleepy.
I’m jolted into researching alternative treatments after reading the work of a woman who has struggled with suicidal ideation since she was a child. She’s now forty and bravely sharing the struggle within her brain. When I think of my daughter sobbing and telling me, “It doesn’t get better. Everyone says it does, but it’s not true. It never gets better,” I know I need to find a solution beyond anti-depressants, beyond therapy and exercise.
Within ten minutes of beginning my research into alternative therapies, I’m down a K-hole, which is fun to say, but what it means is that I spend a day in my pjs reading about ketamine. Known as the party drug Special K, it’s now used for “treatment-resistant” depression. It was designed to be used as an anesthesia in minor procedures like resetting a bone, especially in children and the frail because it doesn’t suppress respiration; but I’ve only known ketamine as a horse tranquilizer and a rape drug. I’ve seen headlines recently about ketamine being used for persistent depression and PTSD, but didn’t consider it because we’re not dealing with trauma. We are dealing with genetics.
While I’m researching, a friend texts me and asks how grad school is going. It’s great…I’m doing some research. Have you ever taken ketamine? I ask.
Yeah, I had some at Burning Man this year.
Really? What was it like?
It’s kind of like booze without the slurring. I had a small dose. Nothing like what they call a K-hole. I’ve seen people do that and it’s creeeeepy. Like they’re catatonic.
Ketamine is called a dissociative anesthetic because it produces a trance-like state, a feeling of detachment, which could be helpful when resetting a broken bone. It can also cause hallucinations in larger doses. Although I have no personal experience with this drug, my kids joke about K-holes because it’s such a part of their popular culture—even Bob’s Burgers has a joke about the dad Bob being in a K-hole. But how does this heal the depressed brain, beyond making someone not care what’s happening to them?
It’s not the trance, but the neurological change ketamine creates on NMDA (N-methyl-D-aspartate) receptors in the brain, a chain reaction of receptors and neurotransmitters that ultimately results in synaptogenesis—the formation of new synapses, new pathways, between neurons—which in turn affects mood, thought patterns, and cognition.
Ketamine therapy is so new that no insurance companies seem to cover it. I call the local clinic and speak with a soothing nurse coordinator who answers all my questions: Yes, they will treat an adolescent. Their youngest patient is fifteen. Normal course of treatment, five intravenous sessions. Each session costs $525, and no insurance providers cover it at this time, but they do offer special financing.
I never would have considered $500 treatments not covered by insurance until now. I’m recently unemployed and trying to make a small savings account last for my first year of grad school, but healing and relief for my child seems worth any price tag.
When I mention ketamine to the therapist she says, “We’re not quite to that place, are we?”
How bad do we let it get before we use the big weapons? I wonder. Do we wait for a failed suicide attempt before we hospitalize? Get to the point of hospitalization before trying a treatment like ketamine? I think of Sylvia Plath’s gruesome descriptions of electric shock therapy in The Bell Jar— “something bent down and took hold of me and shook me like the end of the world…with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant.” (Plath, 167)
It seemed like medieval torture, obliterating a brilliant brain, and was it to bring relief or to pacify? In the end, the result was the same. When I think of Plath and Hemingway, Wolf and Wallace, I wonder if suicidal ideation is just part of an intelligent, artistic brain. This reasoning doesn’t stand with so many who continue to live and tell stories though. The psychiatrist told me that ECT is actually a safe and effective treatment, nothing like it used to be, but it works by shocking the brain into convulsion, something I can’t stomach for my child.
By the time I finally hear from the psychiatrist’s office, I’ve forgotten we were waiting for a referral. But I make the appointment anyway so we can see if there’s a medication that won’t make her so sleepy at school.
When it’s my turn to meet with the psychiatrist I say, “This isn’t just regular depression. I’m battling a genetic monster.” I pull out the details of a great-grandmother my children never met because she died by suicide when my oldest was only a year old. Great-grandma’s younger brother also died this way years before, and at least two other people from that side of the family have been suicidal or attempted, but the family doesn’t speak of it.
“I don’t think that was her first attempt either,” I say. “There were other times. She delivered my ex-husband’s mother with two broken arms, used to tell the funny story at the family dinner table. Can you believe that? She would ask. Picture me nine months pregnant, my arms in casts out in front of me like a mummy. The story was that she had fallen from a two-story window and then had the baby. That was no accident,” I say.
“God, that just gave me chills,” she says.
“Me too,” I say. “I don’t want this to be my daughter’s whole life. I want to find a solution. So I’m looking into ketamine.”
I expect her to shoot me down. Everyone else laughs when I mention investigating ketamine and magic mushrooms for my kid, but this doctor tells me it’s a legitimate option and a wonderful help for a lot of people.
“Really?” I ask. “I thought you would tell me no.”
“It’s actually a really good option for cases that don’t respond to medication.” She says that the FDA has just approved a ketamine nasal spray, prescribed by the doctor and administered after the initial therapy. All I can think about are the people who would abuse this, but I still leave with some hope.
We decide to try a different anti-depressant, one that won’t make her feel as numb, and for a while things are good. She finds a few new friends at school, and then a boyfriend. One night she flops on my bed after a night out with her friends and says “Thank you so much for keeping me alive Mom, for not letting me kill myself, because I’m so happy. I’m really really happy.” It feels like we’re out of the woods.
She likes the new drug Lexapro because she can cry again. She feels all her emotions and doesn’t want to sleep all the time, but after several weeks she’s crying more, and with the stress of finals, she’s struggling not to self-harm.
I take the scissors and lighter out of her nightstand. We are back where we started.
Maybe we go down this K-hole together. Or we get a pediatric weed card if that’s a thing. I don’t care what it takes. I don’t want to face a lifetime with a ghost of something I could have prevented instead of the cherished human I fought to bring into this world.
I carry a lot of guilt from the genetic soup I passed on to my kids. Sometimes I get to shed it, but usually I feel like it’s part of my training. I’m understanding myself and my own brain more. As a young girl I stared out the window watching for the end of the world. I had a constant churning in my gut that something bad was about to happen. When I told my father he said, “That’s your guilty conscience. You must have done something.” It was actually anxiety.
My children all struggle with varying levels and types of anxiety. Their father’s brain genetics brings the suicidal ideation to the mix. We’ve sought treatment for each as they’ve needed it, counseling and anti-depressants, nothing really “solving the problem.”
“Should we look at a different therapist?” their father asks when I tell him the cost of ketamine therapy. “All three of our girls have gone to the same therapist, but nothing has changed.”
“Maybe we’ve had the best possible outcome, given the circumstances.”
“Maybe,” he says.
There’s resistance, for each of us in a different way. My daughter says she doesn’t think she needs the ketamine therapy yet, but I know that she doesn’t feel like she’s worth the expense. I wonder if the treatment will be expensive and ineffective, but I’m willing to risk it for a chance at hope. Her father seems more hesitant now too, probably influenced by someone who says it’s addicting, dangerous.
And so we wait, but I don’t know what we’re waiting for. Tonight I fold laundry on my bed, and she talks to her dad on the phone in my bathroom. I overhear him asking when she last cut herself. She confesses a few days before, and explains that the therapist says her brain is practicing. I wonder if he’s seen the razor cuts on her hip, or the ones she hides under her bra. Does he hear the subtext, that she’s practicing for the big finale? I’ve always been the one to help him see things more clearly, but I think he sees it too. This time we’re not kicking tires or deciding if a house is too much for us. Our indecision could be fatal. Neither of us knows what to do or when, and I hope we’re not waiting for the inevitable storm rolling in.
Hillary Adams (she/her) writes creative nonfiction and personal essays. She holds an MFA from Sierra Nevada University where she also worked as managing editor for the Sierra Nevada Review. Her work has appeared or is forthcoming in Entropy, The Normal School, and This Is Not a Punk Rock Anthology.