Happy birthday, Michelle.

Today, my friend Michelle would have turned 44. When she died on November 5, I felt like her death was reported in hushed tones. No one wanted to mention HOW she died, which is that she took her own life.

I'm still experiencing the stages of grief. Losing someone to suicide is so different than any other loss I've experienced. Now, I feel periods of anger and oftentimes, blind rage. Since Michelle's death, I've read countless books about mental health...trying to make sense of something senseless. All I can ascertain is that like many things in our country, the mental health system is absolutely broken.

Michelle suffered for two years with treatment resistant depression, coupled with occasions of debilitating anxiety. She did EVERYTHING she was supposed to do to get better. She saw her therapist weekly. She saw her Psych NP and psychiatrist weekly. She tried over 15 different medications with different dosages over those two years. The medications were sometimes in different classes or in the same class with higher dosages. Her doctors seemed exasperated that nothing worked, almost surprised. They continually functioned within their required "protocols", which were absolutely useless to Michelle. She tried cognitive behavioral therapy, ketamine injections, and transcranial magnetic stimulation. She reached out to multiple clinical trials and despite her own university system having a specialized depression clinic, they didn't take her insurance, which was through the SAME university system.

I took Michelle and sat with her through her attempt to get inpatient care. They said she didn't meet the criteria. They referred her to another behavioral health clinic in town and she went there for outpatient treatment. I sat with her in that center as she was admitted on an outpatient basis. She sat there, terrified. As someone with treatment resistant depression, the system will put you in the same facility with people who are there because they tried to kill someone. What I mean is that while we were waiting to go through the admissions process, another patient, a man around 19 years old, was brought in, shackled and with a police escort, because he attempted to kill his mother. He recounted the entire story in the waiting area as he rocked back and forth in his seat. I tell you this because it made things worse for Michelle. She wanted help. She wanted to be "normal" again. She didn't want to die.

At this point, Michelle's mom would come up from Texas to stay with her because she couldn't be alone. Michelle's mom and sister bore the brunt of Michelle's illness. Michelle would shift time between CO and TX. Her mom was living with her at the time of her death.

Michelle lasted one day in outpatient treatment. I can't blame her. The discomfort of being tossed into hours of group therapy with people experiencing varying degrees of mental illness, coupled with individuals suffering with addictions, the distress and discomfort was more than she could handle. She saw a psychiatrist for 15 minutes and he ended up taking her off one medication and added another.

The next few months were hard for Michelle. She did start to get better with ketamine injections, which was an out-of-pocket cost. You could see and hear the old Michelle. I always knew she was feeling better when she would slip in sarcastic jokes in our conversations. I also knew she was feeling better because she wanted to FaceTime. When Michelle was sick, she would call or text, but she never wanted you to see her.

She was doing so well until the pandemic hit. Again, she went on FMLA leave and went to TX. We talked or texted weekly. She ended up on a 72-hour hold at the same facility where she was an outpatient. She sent an e-mail to individuals letting them know what was happening and what to do with her work and classes. Her therapist drove her to the facility. She texted me where she was going. I spend 24 hours trying to contact her in there. I left messages and finally, I decided to call every nurse's station until I could reach her. We talked for a little bit and she mentioned how uncomfortable she was. She was scared. As everything was being monitored, the only thing I remember her saying that stood out to me (which she reiterated multiple times after the hospital) is "I'm never coming back here."

Three weeks before her death, Michelle called me because she wasn't sure about going back on FMLA. Losing her job while being sick terrified Michelle the most. As a single woman living on a university staff (not faculty) salary and still paying off student loans, the anxiety of being unemployed was palpable. At this point, Michelle couldn't make decisions. She ruminated over every decision she had to make. She had analysis paralysis to such a degree that it was a rabbit hole she couldn't escape. Her mom had to make sure she was eating. She overcompensated for every work conversation, work e-mail, and work meeting. She was always asking, "do you think they can tell something is wrong?" "Do you think they know?" Some people did and by the shock of her death, some people didn't. The latter was surprising because even on her best days, you could still tell she was off. I heard there was a rumor that Michelle was drinking to self-medicate. Let me put that utter bullshit to rest. She didn't drink while on her medication. She had researched everything that would contraindicate her meds whether it was alcohol, food, and even vitamins. She researched every treatment ad nauseam. She worried that her ketamine shots had caused brain damage as it was buried as a side-effect in a study that she had been reading. Michelle in this state was like dealing with an individual who suffered from late stage dementia. Her hippocampus and prefrontal cortex weren't damaged, but certainly weren't working.

I always told Michelle that the world was better with her in it. Her absence has left a void that I can't ever replace. When I received the call that she took her own life, I was so angry. Not at Michelle, but at the system. She would always tell me that she wanted relief. "I just need relief." I suggested ECT, but with all that she had researched, she feared brain damage. As an academic who had worked so hard to get where she was, I can imagine I would be afraid of that, too.

I harbor intense guilt. In her last weeks, I had compassion fatigue. When I did finally text, she didn't return the text. Two weeks later she was dead. Michelle and I openly discussed death. I know she had researched ways to die. I sat in sessions with her where she told doctors this information. The juxtaposition of how she took her own life versus what we had discussed absolutely proved to me that she did it as a last resort. As weird as this sounds, I wish I was with her so she didn't have to die alone. I know her mom was in the house, but I mean that I would have been willing to hold her hand as she passed.

I'm still angry. Angry at the system. Angry at the university. I feel that her university was really good about mental health as it related to students, but when it came to their own faculty and staff, their empathy was non-existent (as indicated by their reactionary response to her death). We treat mental illness like it is this outer-body disorder. Last time I checked, your brain is very much a part of your body and mental health need not be separated from physical health. I know not every therapist and doctor are bad, but what I saw in CO gave me zero hope for anyone like Michelle. There can't be a "one size fits all" approach to depression or mental illness. People are far more empathetic to people suffering from cancer, but lack that same empathy for people struggling with mental illness.

Michelle would have been 44 today. I would have called her, sent a video of Thea singing happy birthday, and would have sent flowers or something else. She would have made plans with her close friends or neighbors. The system failed her. I failed her. I shouldn't have to write this post.

Rest, Michelle. I hope you are finally without pain. I miss you...every...single...day. xoxo