At Hell's Gate

I emerged from my shower to hear the familiar “oh-oh” of an ICQ message. My sister had just come online from her home in Arizona. Clad in my robe and a towel fashioned into a turban over my wet hair, I rushed over to the keyboard to respond. We chatted about this and that; not much was going on for either of us that day.

The doorbell rang and I almost jumped out of my skin. Who would be visiting me in the middle of the day? I peered out a window toward the parking area to see a white car parked behind my Mirage. Lights flashing, red and blue…a police car.

Fear gripped me as I recalled spending sprees from months earlier. I had made good on most of the checks, but there were still two or three outstanding.

The doorbell shrieked over and over and eventually stopped. I stood, frozen, for a few minutes, then tiptoed over to the window. The white patrol car was still there. I could see a female officer standing by the open car door, talking on the radio. She glanced toward my car, probably reciting my license plate number over the wire.

Well, that wouldn’t get her very far. The vehicle was not registered to me. I was convinced that once she got that information, she would leave, assuming I was not home. But that’s not how it went down.

The officer returned to the doorbell, persisting until I finally yanked the door open. She saw me in my robe and turban and said, “I’m sorry to get you out of your shower, but you need to call this detective in Madison.” She offered a slip of paper with a name and phone number printed neatly on it.

“It’s about your daughter,” she continued. “She is in the hospital and it’s serious. I can come in and sit with you while you make the call, if you like.”

“What happened?” I asked quickly. “Has she been in an accident?”

She responded, “I don’t have details, but she is in critical condition at University Hospital.”

Then I remembered my hassle of the previous day with the phone company…they had disabled my phone for long distance effective that morning. “I can’t call Madison,” I said. “My phone bill is overdue, so I can only make local calls, no long distance.”

The officer offered me her cell phone. I couldn’t dial the number, so she took the slip of paper, punched the keys in proper sequence and handed the phone back to me.

“I regret having to tell you this,” came the voice over the line. “Your daughter attempted to take her life with a handgun.”

“A…what? …gun? It can’t be! My daughter hates guns. When did this happen? Is she…?”

“She is in surgery,” the detective responded. “But it’s very serious. It is likely she won’t make it. You should get to Madison as soon as you can. The 911 call came in at about ten-thirty this morning. I left the hospital at one o’clock and she was still in surgery.”

I began pacing, talking in fragmented sentences about how my daughter has suffered from depression for almost a decade, about how we had tried to get help for her on numerous occasions, but were unable to get effective treatment for her. I told the officer that she would never have a gun, that someone must have brought the gun to her apartment. I asked where the gun had come from, if they had traced it. I begged the officer to call the hospital for me to inquire about my daughter’s condition.

“Please try to calm down, Barbara,” the officer said. “Is that your car out there?”

“Yes, it is,” I responded. “But I can’t drive to Madison today. The car is not registered. Can I drive it like that?”

“I would,” the officer replied. “But it might be best if you could have someone drive you. You really are in no state of mind to drive. Do you have a friend who can take you to Madison?”

“Yes,” I said. “I’ll call Charlene. She can drive me.”

I dialed Char’s number. Busy. I tried again. Still busy. The officer offered to go to Char’s house and tell her I needed her.

I got dressed and waited. The phone rang. It was the police officer, calling to inform me that Char was not home but that her husband had promised to have her call me as soon as she arrived home.

I sat, then paced, tried to calm myself but was soon pacing again; I was a bundle of nerves for the entire afternoon as I waited. I had years before given up on God as anything more than myth, but on that afternoon in February of 2000, I prayed for the first time in three decades.

My daughter survived surgery and was resting in a curtained cubicle in the Trauma and Life Support Center of University Hospital by seven o’clock that evening. I had arrived at the hospital shortly before she was brought up after surgery. The trauma surgeon met with me in the chaplain’s office.

“We need you to identify her,” he said. “We believe it is your daughter, but we must have formal identification before we can be certain.”

I had a brief moment of hope that it was all a mistake, that it was not my daughter after all. “She is tall and slim,” I said. “She has long red hair.”

“There is no hair,” he responded. “And her face is not recognizable. You must be prepared for what you will see. It is very bad, and you need to know that before you go in. Just keep in mind that all the physical damage can be repaired. We can fix her face, so her appearance should not be your main concern. It’s brain damage that we need to be concerned about.”

I cannot find words to describe what I was feeling at that time. I was in shock, but I understood that my daughter lay in coma, severely disfigured from a gunshot wound to the head, and that she was on a ventilator and her condition was critical but stable.

The bullet had been lodged in her brain above her left eyebrow and I was told that it had actually been relatively easy to remove. Brain damage from the injury itself was not thought to be significant; however, potential damage from brain swelling that could be expected over the next few days was a major concern.

I was somehow able to function that evening, able to ask the right questions and give appropriate responses to questions asked of me. But the entire evening had a surreal kind of quality. It didn’t feel like reality at all; I felt as though I was standing in a corner of the chaplain’s office quietly observing myself interact with him and the various surgeons as they arrived one or two at a time, made their statements, and left.

Throughout the day, I had used my computer to place long-distance calls to my cousin Kathy, as she had always been close to my daughter, but I had been able to do no more than leave messages on her answering machine to the effect that my daughter was in trouble and was at University Hospital.

Alone in the chaplain’s office, I attempted once again to reach Kathy by phone. I had no way of knowing that she had arrived home, had listened to my phone messages, and was at that moment in the hospital, one floor below me, where she was being told by emergency room staff that “no patient by that name has been admitted to this hospital.”

The reason for that, of course, was that positive identification had not yet been made, because I had been unable to enter my daughter’s room. I had tried several times to do so, accompanied by the hospital chaplain, but each time my legs felt like rubber and my heart raced to where I was certain I was about to have a heart attack.

It was well after midnight before I finally spoke with Kathy on the phone, and I told her I was about to see my daughter for the first time since she had been admitted to the Trauma and Life Support Center. At Kathy’s insistence, I waited for her, and we went in together at three o’clock in the morning.

She looked like an alien being, with her predominant feature being bulging purple-black eyelids. Her head was enormously swollen, her shattered skull wrapped in gauze. They had been unable to open her eyelids due to the swelling, but I was told that she no longer had eyes, that “the orbs simply could not have survived the trauma.”

Somehow, though, I knew better. The doctors were going on what they knew from similar traumas, but what they didn’t know was that I had been praying and receiving answers. When they said her eyes were gone, I knew they were wrong, though it is impossible for me to explain how I knew. I have since referred to it as a voice in my head saying not to worry, but it wasn’t really a voice - it was just a serene imparting of knowledge.

Three days later, the chief ophthalmology surgeon came to her room and was able to open her eyelids.

“Well, it’s quite amazing that her eyes have survived,” he said. “But the line of fire was straight up, directly behind her eyes, and the optic nerves cross in the middle. Her optic nerves have been shattered. She is totally blind.” I knew he was mistaken, but I said nothing.

Four days after her injury, my daughter suffered a brain bleed. It required emergency surgery and, if the injury itself had not damaged her brain, the bleed and the accompanying extremely high cranial pressures were certain to cause significant permanent brain damage.

I listened calmly to the neurosurgeon as he informed me that my daughter had absolutely no chance at life. He said that if she survived, she would be “apathetic, blind, deaf, mute, and so brain-damaged that she will never again have cognition of who, what, or where she is.”

Again, I knew better - somehow.

Two weeks after the injury, doctors suggested I remove life support, and I agreed to do so. My daughter and I had spoken previously about the issue of life support, so I knew that she would not want to be kept alive by machine. I told God that I would accept her dying if it was His will. However, I told Him in no uncertain terms that if it was His will that she live, it had to be a life worth living, that I would never accept her surviving to a life without joy, a life of apathy.

With the ventilator off, doctors expected her to die within minutes. However, the minutes that she breathed on her own became hours, hours became days, days became weeks.

The weeks have now stretched to over a year and a half, and she is still recovering. She has full cognition, is not blind, is not deaf, and once surgery is done on her face, she will be able to speak. She communicates by writing and by a modified form of sign language which she has taught herself since her injury - quite an accomplishment for one who was never expected to have cognition of who, what, or where she is. She has all memories except of the shooting itself, several days leading up to it, and the subsequent weeks in coma. She has her sense of humor and a mischievous sparkle in her eyes! She is learning to walk again. However, she has yet to have reconstructive surgery.

Because she had been predominantly depressed, my daughter had always been treated as unipolar, even after she began to show manic symptoms. She was not depressed at the time of the shooting. I knew she was manic at times. Her friends had seen it, too. But since her symptoms were not those of classic mania, her psychiatrist never noticed and, because she was legally an adult, I had no voice in regard to her treatment.

So now she sits almost two years later, pleading again for proper medical intervention. She waits for surgeries that were promised many months ago. “We can fix her face,” they said. But so far, that has not happened for her.

I am doing what I can to advocate on her behalf, and I will admit that patience has never been one of my virtues. Her case is in the hands of surgeons with phenomenal skills and expertise, and I know she will get her surgeries in time. But I also know all too well that persons with mental disorders are often held liable for their illness. And that prompts me to ask: Could it be that my daughter is no surgeon’s priority for reconstructive surgeries only because her injury was self-inflicted? Could this be stigma rearing its ugly head once again?

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Discussions

Anonymous (Oct 25, 2001): My brother shot himself in 1992, and died. We have only now realized that he had BP. Back in the early 90's we common folk weren't so informed about mental illness. Now my son has been diagnosed with it, and I am scared to death. However, I am so thankful that people like you are speaking out for the mentally ill. Now that we know mental illness is a MEDICAL issue, we must spread the word. Those who suffer from it should not be treated any differently than those who have diabetes or cancer. Keep writing! Keep talking! Shout if you have to, but just don't stop. May God bless you and your daughter. I know she survived for a reason.

Barbara (Oct 25): Hi Anonymous...Your son is in good hands, because you know what to look for. With all the good meds and therapies around today, I believe that everyone can be stabilized. If one therapy or medication doesn't do the trick, try others. Just remember that you have to be in charge to make sure he gets proper treatment. Always stay informed about new treatments/meds as they become available. Don't rely on medical professionals to always do the right thing. If you are fortunate enough to get him in with a doctor who listens and who values opinions that you and your son offer, he will do well. If you don't have such a doc, keep looking! There are some good ones out there, but it might not necessarily be the first one or two you see. Good luck, and God bless you both.

Julia (Oct 31, 2001): I have bipolar disorder and two of my children do as well. I have another two children who I also believe are bipolar. I recently quit work and am now looking to go on disability so that I can better manage my own bipolar and I am very concerned about my daughter. My youngest daughter, age 13, has often spoken of wanting to kill herself. This has been happening since she was 8 years old. She has had at least seven hospitalizations on a "5150" involuntary hold due to being a danger to self.

Why would a 10 year old want to die? They have so much to live for. Recently she told me that she wanted to die in September the day after the attack at the world trade center. She was again hospitalized. I'm frustrated and angry. I am also concerned with how I can help her. I just picked up a book a few days ago called, "Helping Your Child Cope with Depression and Suicidal Thoughts." The book is by Tonia K Shamoo and Philip G. Patros.

I have come to think that many of her attempts are just to get my attention, but in the back of my mind I'm not quite sure. Last August, my 15 year old daughter went to the funeral of a 20 year old who drove his car into a semi-truck. He had written a suicide note. My daughter said he talked a lot about wanting to die but she never took it as being serious.

I want to thank the writer of this article for being able to share her story. It has made me think about the importance, once again, of being aware of the signs to watch for in our children.

jlablackbird1@aol.com

McMan (Oct 31): Hi, Julia. I just came across this from the Oct BMJ:

"Who is to blame for this situation? Those with depression think it must be them. Pointlessness and self loathing govern them. So the natural final step is suicide. People with depression don't kill themselves to teach their families a lesson or to frighten an errant boyfriend. They kill themselves because it is the obvious and right thing to do at that point. It is the only positive step they can think of ..."

Please take your daughter's talk of suicide very seriously and don't be afraid to talk it out with her. Giving your daughter a chance to air her feelings can be a safe way of discharging a lot of her negative urges. I'm sure the book you got will help you. My thoughts and prayers are with the two of you.

D Martel (Nov 10, 2001): I read your article about your daughter talking of committing suicide. My daughter is in college and talked of committing suicide by way of pills because her boyfriend broke up with her. I suffer from Fibromyalgia, but also from Bipolar and can't help but wonder how much I have passed on to my kids. My 21 year old son has talked about suicide since 8 - he's had counselors at three times in his life but none seemed to help. Along with my depression which keeps me from working and therefore adds to my depression I don't know how to help them or myself.

Jennifer (Nov 14, 2001): I too was treated for unipolar depression for years before a psychiatrist and her psychiatric nurse practitioner started to think that maybe I might be bipolar after all when they saw my lengthy medical history full of failed treatments. I never had a wild mania that made you say, aha! You're bipolar! But none of the antidepressant therapies were very effective at best, and at worst they made me edgy, jittery, irritable, or induced what I thought was serotonin syndrome, but may in fact have been hypomania. Now that I know what hypomania is, I can see it in my past - the irritability, racing thoughts/ideas, compulsion to speak my mind, less need for sleep/inability to sleep (although insomnia is often due to depression.) It is too bad that when all those antidepressants didn't work to relieve depression, it didn't occur to the first three doctors that a mood stabilizer might need to be tried. It took 7 years to get the right diagnosis, now it is just taking time to find the right meds (and I think we are close!) to keep me functioning and that I am able to tolerate. Depression runs in my family, but bipolar, that isn't ever a one- or two-time episode and you're through with it. I didn't want to admit that I was bipolar. It sure is complex, and so sad when people are not getting the help they need. My friend's husband killed himself with a handgun. He never sought treatment for his depression, he thought he could handle all his problems on his own, and his friends didn't think his talk (It's stupid to leave a note, etc.) was serious. Your story is very moving and thought-provoking. Thank you for sharing with us.

Barbara (Nov 16, 2001): Jennifer, my daughter never had classic manic symptoms, but she was manic nonetheless. All her friends have seen it a number of times, and I have as well. She would cry and scream, throw things, talk a mile-a-minute, laugh inappropriately, things of that nature. At first, I thought she was high on drugs, but once I determined that she was not, I began to compare her behavior with how my mother behaved sometimes many years ago. I think a person's personality plays a big role in how symptoms manifest, and DSM-IV doesn't give proper consideration to that; in DSM-IV everything is either black or white, with no shades of gray allowed. I suffer not from bipolar but from clinical depression and believe me, that's not just once or twice and it's done with either. The episodes run their course even if left untreated; eventually I do come out of the depression on my own somehow. But my depression is atypical, so I sleep a lot and can thus avoid much of the pain. It's the mood swings when going down and coming up again that I find intolerable, and when on antidepressants I have more of the mood swings to deal with. I get mildly hypomanic (irritable and jumpy, racing thoughts, agitation) on antidepressant meds and it is not considered bipolar disorder if it's just a reaction to a medication. But in my case, and in my daughter's case, I really don't care what they call the thing, I just want it treated appropriately. Good luck to you on your treatment--having a proper diagnosis should open new doors for you.

Annie (Jan 21, 2002): My mother was diagnosed to be bipolar when I was in seventh grade, two and a half years ago. She wasn't getting any sleep, and when she was supposed to take medicine for it she got hysterical and wouldn't take it. We had to take her to a mental hospital for two weeks, and for one week we weren't allowed to have contact with her. I was eleven, and I had to be the mature one because my twelve-year-old sister couldn't deal with it. I don't know very much about the illness, and I am never sure how I should deal with it or act toward her. I want to let her know I love her and that I am there for her. She is rarely depressed anymore, but it still comes and goes. My parents never clearly told us then that my mother was bipolar, but we knew she was depressed. A couple of weeks ago my sister got upset and was yelling at my mom. She wasn't thinking and said, "What's the matter mom? Are you bipolar?" and that really hurt my mother. I don't know exactly what I am asking for, advice or just knowledge but if anyone wants to email me and let me know more about this, I am trying to learn all I can. My email address is pony11girlaw@netscape.net. Thank you very much.

Ginger (Oct 1, 2002): My heart goes out to this mother. I too have a daughter that is diagnosed with bipolar. At Hell's Gate is an appropriate title for those who go through bipolar and those who are family members.

My ex-husband is in denial of the fact that our daughter has a significant mental illness. Despite the fact I have done every thing I can to inform and educate him on the issue, he continues with the belief that she is just a spoiled brat. My immediate family has been very supportive but my daughters highs and lows leave them wondering what to do or say when she is around.

I moved 1/2 way cross country when she suffered one of her breakdowns and her husband filed for divorce and custody of their child when she was in the hospital. This illness has definitely affected my life and has had an impact on everyone in my family. I send a prayer to those who are struggling to maintain a "normal" life. May God bless those families that are searching for answers.

Anonymous (Oct 25, 2002): My brother shot himself in 1992, and died. We have only now realized that he had BP. Back in the early 90's we common folk weren't so informed about mental illness. Now my son has been diagnosed with it, and I am scared to death. However, I am so thankful that people like you are speaking out for the mentally ill. Now that we know mental illness is a MEDICAL issue, we must spread the word. Those who suffer from it should not be treated any differently than those who have diabetes or cancer. Keep writing! Keep talking! Shout if you have to, but just don't stop. May God bless you and your daughter. I know she survived for a reason.

Purplepassion (July 10, 2003): My first experience with bipolar was three years ago with my ex-husband. I know first hand that this illness can and most likely will alter your lives in a most horrible way. I feel bad for this mother who had to endure hell. I have been there and still to this day I deal with it for I have four children that I fear may get this illness.

Mis_girl (Aug 23, 2003): The big diagnosis book may be wrong. Doctors may not know the right medications or the right diagnosis. I've been taking medication since I was 14, because I took a test with wrong answers. Been diagnosed with 'schizophrenia' since I was 16. I was really shy, had a fear of people, I'm a nervous person, I had odd behaviors, I had no idea about social interactions. Now I found a med that helps stopped taking anti-psychotics, they caused voices, paranoia, and more nervousness. Now the voices have stopped, my moods are in control, my father had bipolar and alcoholism. I try to tell my mom I'm bipolar and because she knew my dad she thinks she knows I don't. My doctor has diagnosed me with atypical psychosis, which I believe is caused by depression. When I don't feel good, I don't act normal. Recently I've had a nurse who told me I was schizophrenic because of the games I play. I play games because I'm trying to get things I want because I feel people are taking it (freedom) away. Like my independence, I have never been given the chance to live independently. I am very smart and impress people every day with how I can take care of myself. I have been told by the court system that I am unable to care for myself. But will find out in a couple weeks my situation. My mom will disown me, she won't let me live with her anymore, I guess she's planning to ward me to the state, but it may be easier for me to prove my independence. I have done it the wrong way in the past then tried to make it right, then tried to do it the right way now I'm doing it the wrong way which seems to be the only way, but I may be into trouble but I'm getting what I want.

Estelle (Feb 4, 2004): Seven years ago my 21 year old daughter, a senior in college, hanged herself. When the police showed up at my door, somehow I knew what had happened. In retrospect I can see that she was bipolar and had been that way for many years. At the time I only knew that her father had died 13 months prior and her boyfriend had hanged himself 4 months prior. The stress was too much to bear. On top of this there are issues with Accutane, the acne medication which has been implicated in, although never clearly linked to suicide. I am still numb after all these years and only on occasion am I able to cry. I live with the fear that my other daughter will succumb to a similar fate. I have witnessed the ravages of mental illness first hand and my heart aches for all those touched by it.

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