Thursday, May 21, 2015

Veterans and Suicide

I don't typically bring work home with me. Not literally, not figuratively. But last week I had a tough session with a patient, and it's since been on my mind.

I've been seeing a veteran, we'll call him Mr. S, for over a year, to help him with attention and learning difficulties. He's in his mid-20s, a combat veteran, with a childhood history of ADD/ADHD, and cognitive issues complicated by chronic pain, sleep difficulties, developmental trauma, history of concussion, and likely PTSD/adjustment disorder. If you didn't have access to his medical record, you'd never know there was anything "wrong" with him. Except the ADHD; his hyperactivity is palpable, in a totally endearing way. Maybe it falls outside the bounds of my "professional ethics," but I consider Mr. S to be one of my favorite patients at the VA, or anywhere.

As a speech-language pathologist, our cognitive-communication therapy sessions typically focus on training and practicing time management and study skill strategies, particularly since he returned to school on the GI Bill. Although he is bright with a lot of good ideas, insight, and drive to learn, he struggles significantly in the traditional academic environment. He was technically referred to me because he was evaluated for TBI (traumatic brain injury) in our clinic, which he sustained while deployed. He reported difficulties with attention and memory, and while these symptoms can indeed be sequelae of concussion, it would be unexpected to note several years after the head insult. Instead, these issues are ongoing problems for Mr. S, and with his return to school - the less structured schedule, the distracting learning environment, the quantity and speed of new information with expectations for comprehension and retention - his cognitive deficits resurfaced. 

But last week, rather than work on writing organization strategies, he impulsively confessed to me that he tried to kill himself over the weekend. That in the throes of his ever-increasing panic attacks, he hastily grabbed a loaded gun and held it in his mouth. He said he was ready to pull the trigger. To make it all stop. His girlfriend, fortunately home at the time, was able to kick him in the chest and get the weapon away from him. Mr. S was understandably overwhelmed and frightened by his actions, just how close he got to the edge of the very, very high cliff. This wasn't the first time he'd made such a gesture, he confided in me, but the first time he resorted to such measures in front of someone else. And the first time it drove him to seek help. He promised his girlfriend he would tell one of his providers about the attempt. I was that provider. 

I have been trying for months to get him connected with mental health services. I refer him, they reach out for scheduling, he makes an appointment, and then he never shows or doesn't follow through. He has told me that he knows he needs psychotherapy, but that he doesn't want to "go there." That he has been able to successfully compartmentalize, bury, and ignore developmental and military traumas for most of his life, and that he feels like he should continue to be able to do so now. I tell him that, in my clinical experience, the brain and body just don't work that way. 

I know that mental health professionals regularly deal with these heightened emotions and threats of self harm. I am fortunate not to. Thinking is my area of expertise, not feeling. For a reason. I am ill-equipped to deal with other people's severe expressions of emotion. Cognitive-communication therapy is my bread and butter. But I'm not blind to the issues that many, many of my patients are suffering.

According to one report from 2010, 20+ veterans die by suicide every day. Another 1,000 attempt to do so each month. Apparently the VA system in 2007 initiated extensive efforts to reduce suicide rates, although by what means I am unclear. Another report found that rates of suicide in veterans is 30 per 100,000, compared to 14 civilians per 100,000. One medical study found that not only are combat veterans more likely to have suicidal ideation, they are also more likely to act on a plan. In 2012, 6,500 veterans were reported to have died by suicide. I can only imagine the actual number was higher.

When it comes to assessing for suicide risk, there are three components:
- ideation, which refers simply to thoughts of suicide
- plan
- means, referring to access to weapons or drugs, for example
Therapists will also always inquire about protective factors, such as a support system, religious beliefs, pets, etc.

There are resources. The Veteran's Crisis Line, for one. In fact, a documentary about the New York-based crisis line won an Academy Award in February. There is the VA health system, including giant mental health departments with every team you can think of - the PTSD Clinical Team, Substance Abuse Treatment Programs, Dialectical Behavior Treatment, ACT and PET for PTSD, pain therapy, etc. etc. And there are vet centers all over the country, equipped with therapists who are typically veterans themselves. Not to mention the hundreds of nonprofit organization designed to assist the veteran population with a variety of issues, from complementary healthcare to suicide prevention to providing housing for the homeless.

As for Mr. S, with his permission I conferred with the psychologist on my Polytrauma team, and she met with him immediately after me and together they created a "safety plan." 
He scheduled an appointment with his mental health provider for the following day, agreeing to work hard to develop rapport with her. He also inquired with his primary care provider about psychotropic medication options. And his girlfriend took the keys to his gun safe. As for me, I keep visualizing this tall, strong, typically composed individual, and how his face fell and he broke down in sobs when he told me about his attempt. In front of my eyes he transformed from this stoic man into a weepy young boy. I try not to picture him with that loaded handgun pointed in his mouth, desperate for relief from whatever tortures him. I feel for him, and can only hope that with the right tools he can learn to silence, or at least quiet, the demons he carries.

As Memorial Day is intended to honor those who died while serving in our nation's armed forces (compared to Veteran's Day, which celebrates the service of all military veterans), it's only fitting to provide some information about suicide in the active duty population.

Back in 2012, according to the Department of Defense, troops on active duty were successfully committing suicide at rates of nearly 23 per 100,000, compared to 19 per 100,000 in age- and SES-matched civilian population. In 2013 that number had supposedly decreased, but then was reported to inch back up in 2014. In January of this year the DoD released numbers for 2014 - 288 active duty personnel were reported to die by suicide in 2014. But you know what statistic really speaks to me? The one that reports more deaths by suicide than from combat in Afghanistan since 2001. At one point suicide was reported to be the leading cause of death among active duty personnel. The best article I've seen on both military and veterans suicide rates is from 2014 and here.

I find this all very discouraging. But there are numbers that shed some promise - the statistics that report an increase in both active duty and veteran "help seeking" behaviors. That tells me that, however slowly, the military culture is starting to change from one of scorn for admitting weakness to one that values asking for assistance. I can only hope.

Tuesday, May 19, 2015

(38 Months) - 3 Years + 2 Months

Interrupting, "can I have a turn after Daddy's turn?"
FOMO, especially in the morning, awakes in panic (before 6 a.m.) to make sure to eat breakfast with her daddy. 
Likes to listen to "kid music" - Raffi, Run Baby Run ...
Acting more like a "boy" - rough housing, being a "shooter," punching. 
Obsessive nail picker. Ob.sess.ive.  She gets this one from her daddy. 
Reading the Ivy and Bean chapter book with Mama. Again. 
Wants to be an astronaut. 
"When you sing that to me it makes MY heart so happy."
Running. Jumping. Balancing. "Look how fast I am." "Watch me jump so high." "Look at me balance on the slackline."
Rarely sleeps alone. Wakes me every night and I crawl into her bed with her. 
Starting to play alone in the backyard, with her sand/water table or just exploring around, usually naked. 
First "big girl haircut," and I love it. 
Always chooses her own clothes, but I still dress her. Does do her own socks and shoes and sometimes jacket. 
Still asks almost daily for a baby brother or sister (we're working on it, kid). 
Tells me she doesn't like my glasses, "I just don't like your face with glasses on."
First fillings - two cavities, our fault (fluoride is important, brush at least twice daily, and don't graze). But she was a champ. And the sedatives made her more feisty rather than calm. A peak into her future intoxicated self.

"I'm a shooter." Umm, where'd she learn that boy talk?

Naked slack-lining. Must be sprummer.

I love me some Bean cuddles.

Astronaut wannabe.

Two fillings. Followed by ice cream for her drunken self before 9 a.m.

Haircut. Baby bob. And apparently a makeover?

I've always wanted to play the piano. Maybe she will instead?

Backyard pedicures.

Playing alone (and probably naked, peeing) in the backyard sunshine.

Helping Daddy build stuff, like his router table.

"I'm driving the train. Choo choo."

Six called and wants her hat back. Amiright Blossom?!?

Saturday, May 16, 2015


I expected anxiety, or maybe humiliation. What I got was the boob equivalent of getting your blood pressure checked. Seriously. My first mammogram was And I was headed home a minute before my actual scheduled appointment. 

Here's how it went: 
In the Radiology department on a Saturday, a lady escorted me back to a changing room, told me to disrobe from the waist up, and put on a gown with the opening in the front. A minute later another woman, presumably the radiology tech, introduced herself and walked me to a dimly lit clinic room with a few unfamiliar contraptions. She asked me some questions about my Kaiser chart, whether or not I could be pregnant (nope), when I last took birth control (4+ years ago), my personal history with breast cancer (none), my family history of breast cancer (mom diagnosed around 40-42 years old), and personal or family history of "reproductive" cancers (none). Then she talked me through the four pictures she would take. Gloved and groping, she shimmied my boob on top of a flat surface at the level of my ribs, then lowered a flat plastic piece - it kind of reminded me of the bottom side of a baking dish - on top of my boob, and went behind the desk to push a button and take my picture. Four photos in total. No pain. It barely even registered as discomfort. All that said, I did avert my eyes because I didn't want to see my boob squished into a dinner-plate. No one needs that image of themselves. 

The referral to the mammogram all came about because I read in Real Simple - you know, my resource for all things female - that women should get their first mammogram or breast ultrasound or MRI at the age 10 years younger than their immediate family member (mom or sister) was first diagnosed with breast cancer. Given my family's lengthy history with a variety of cancers, my primary care doctor first referred me to a genetic counselor (side note: seems like a cool job!) who crunched my numbers and determined no increased risk of carrying the BRCA gene. She then did recommend I obtain a baseline mammogram. And a week later I was scheduled. 

So other than feeling aged (don't old ladies get mammograms and colonoscopies and the like?), my first mammogram was benign (no pun intended) and hardly memorable. My only wish is that they are always so lame. 

Tuesday, May 12, 2015

Mother's Day 2015

Last Mother's Day Alex inspired envy in all husbands who also didn't get shit-faced the night before the holiday and then somehow pull off an elaborate home-made scavenger hunt of sweet Bean notes (see last year's blog post here).
This year, I wasn't as set on having a special day, so he was off the hook a bit. On Saturday, the weather was AMAZING, and we spent the better part of it as a family puttering around the backyard we have come to adore. And I finally caught up on all my spray paint projects that have been on my list for a few years now. The dining room chairs are no longer a chipped brown, but now teal and light blue. I love the instant gratification of spray paint! On Sunday we were tentatively planning for a longer family bike ride, even considering the Vernonia-Banks trail, but when we woke up to overcast, we were less inspired. Alex promised me a "family on demand" day, meaning that I could hang out and cuddle my peeps when I felt like it, but also do my own thing as I wanted. It was perfect - all the benefits of a house and family, but no responsibilities. I slept in until 8:30, Alex made me a latte just the way I like it, and I snuggled and played with the Bean while entertaining fantasies of how I wanted to spend my day (Should I see a movie? I could read in bed. Maybe I'll finish some more spray paint craft. We could go shop for a new computer. Do I want to do a family activity? I definitely don't want to go grocery shopping. What about a nice walk?). I ultimately decided that I wanted to spend my morning with a visit to Mary S. Young State Park in West Linn - a visit to my mom's rock/bench, and a "flamily hike" for at least a little activity/exercise. The Bean donned her best killer whale dress, in honor of Mimi, and ran around the park where I also ran some thousands of miles in my youth. We then ate lunch at Einstein Bagels, per my request, despite the fact that their food sucks - and Alex even paid the $11 bill with his very own wallet money. I do love me some bagels and cream cheese. I took the rest of the day "off," puttering around with more spray paint projects (finishing my bedside table and some frames for our room), went to a gentle yoga class (like a massage you give yourself), and helped Alex with an interactive dinner of BLT salad rolls. I had thought I might rent an iTunes movie and binge-eat the Swedish fish Alex bought me while Alex played more with his new router, but instead we watched "Rabbit-Proof Fence" so he could show it in class this week. Aside from having a "family on demand day," the best present I received was that Alex went grocery shopping. I was totally off the hook for all things involving responsibility for the day. Ah, to be young again.

Mother's Day was a big hit on social media, everyone professing their undying love for their perfect mothers, or those relishing in the spoils of their own children. I was no different, proclaiming my adoration for this Bean on Instagram, confessing how she's filled a profound void in my heart and soul. But I was also pensive this year, thinking of the the people for whom Mother's Day sucks. Not everyone has/had a good mom. I mean, some people are shitty, and therefore some moms are shitty. Some people may never have even had a mom at all, whether related to a death, a split family, or a foster care experience. Other people maybe have experienced the tragedy of losing a kid. Others are maybe hoping to be moms, or have endured miscarriages or infertility issues. These sad facts don't undermine a great opportunity to honor our mamas, as we should, whether on the holiday or just any other day - but this year I was reminded that I'm a motherless mother, which is sad and sucks, but at least I'm a motherless mother with the very best daughter a mama could hope for.

Sunday, May 3, 2015

(Stuff Jo Made/Just Pics) - Felt Ballz & Numbered Onesies/Showering Baby Girl May

I've spent the last month rollin felt balls. You heard right. Rollin balls. 

Thanks to "Bloodline" and "House," I finished the felt ball baby mobile just in time for one of my BFF's, Katie, baby shower. She had pinned a similar item on Pinterest, and I thought I'd get my craft on. For once I was actually happy with the results. So often things do not turn out the way I intend. And there was no room in my life for a #pinterestfail right now.

I also successfully DIYed Velcro felt numbered monthly onesies, for which I also patted myself on the back.

In order to hand deliver the non-registered and non-functional gifts, another 1/4th of the BFF posse (recently dubbed "Talls and Smalls"), Rachel, and I flew from PDX to SoCal to meet up with Katie and Erika. We stayed at her and her husband's new place in Costa Mesa, where we ate pizza, laughed,  ate ice cream, laughed more, watched the Bruce Jenner interview special, ate even more ice cream, went to the grocery store, baked cakes, watched the Kardashians, went for pregnant-speed walks, got pedicures, did a "bikini body workout" with no intention of ever donning a bikini, ate cake, opened presents, organized baby clothes, went to the bagel shop, and ate even more ice cream.

I was sad to the leave the Bean for a long weekend. Except, I knew I'd get to sleep in until I wanted. And that she would have more fun at home with Mimi anyway. But I do get serious separation anxiety, so I made her take a pic with me to stare at to ward of flight anxiety.

Laugh til you cry.

Kind of a blur.

Thank you, Erika, for always fulfilling my fantasies.


The mama-to-be and her deliciously baked lemon cakes.

Quilted by Rach.

Talls bookend the smalls.

Proof we were at the ocean. Nary a bikini in sight (thank god!)

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