Looking Up

A suicidal young woman turns to Mary Greeley, and by doing so, opens her family’s eyes up to her mental health crisis.

By Steve Sullivan

She was a silhouette in a window.

They couldn’t be with her. They couldn’t tell her face-to-face how much they cared. They couldn’t take her in their arms and comfort her.

But they were there, standing outside on cold November days, looking up at that silhouette in the 6th-floor window of Mary Greeley Medical Center.

Looking up at their daughter, their only child, who just hours ago was contemplating carrying out a suicide plan she’d had for years.

They looked up with concern. They looked up with hope. They looked up with love.

THE PLAN

For much of her young life, Rachel had measured her self-worth in terms of her accomplishments. In high school she was an academic high performer and had a schedule packed with sports, school clubs, and work.

“The busier I was, the more I accomplished, the better person I was,” she said.

On the surface, she seemed fine, though for years she’d been silently struggling with stress and anxiety. While in high school, she saw a therapist under the guise of getting help with time management, but it was really the only step she’d taken to get mental health support. Nobody knew she had thoughts of suicide. Not her parents. Not her friends.

In fact, she had a plan to end her life since she was 15. She had the method, the place, and the time all sketched out. Early morning. A highway interchange in her hometown that wouldn’t be busy at that time of day. A swerve into a guardrail. Done. Everyone would suspect she fell asleep behind the wheel. They’d never know the truth.

“A car accident,” she said. “It was nobody’s fault. That was my plan.”

When Rachel came to Iowa State, the plan came with her. An engineering student with a double major, she had a solid freshman year. Sophomore year was different. She was struggling in some classes, something she’d never experienced before. She also was in an increasingly controlling, toxic relationship. Between classes, clubs, and work, not to mention boyfriend troubles, she was spread thin, barely eating or sleeping.

“I didn’t understand it—all of a sudden I just can’t handle everything I’m going through,” she said.

Still, she told nobody about what she was feeling.

“I’m the mom of my group of friends. I am the person everyone comes to when they have problems. I’m the one who has everything together. I didn’t want to ruin that image,” she said.

This behavior isn’t unusual, said Jody Robinson, a mental health nurse practitioner with Mary Greeley’s Behavioral Health Unit who worked with Rachel.

“In my experience, especially in high performers, they do not notice the level of anxiety that they are tolerating,” she said. “It is also often managed by those activities that they are participating in. In those types of patients, it is often felt that asking for help or admitting they are not feeling well is a failure. They often hide it from others.”

One night in November, Rachel decided to carry out her plan. Unlike back home, though, the interstate was too busy at night.

“I couldn’t find a place in Ames without property damage, without putting people into danger,” she said. “I pulled over, sobbing.”

Rachel brought more than the plan with her to college. She also brought something her therapist from back home had given her: a phone number for a suicide hotline. She looked it up on her phone and called. A person on the other line told her to call an ambulance and get to a hospital. Instead, she drove herself to Mary Greeley. She knew the way because, ever the mom of

her peer group, she’d brought friends here, including some who needed mental health help.

Calling a hotline in times like these is a vital—potentially lifesaving—step because it connects a person experiencing trauma with “a human who can listen and help advise the next steps to safety,” said Robinson.

HOSPITAL

Rachel was placed in a special area of the Emergency Department where behavioral health patients are safe while being evaluated. Gus Hocker, the crisis nurse on duty, encouraged her to call her parents. She had texted them earlier to ask if their insurance was up to date, not explaining the reason for the question. She called home from the ED, but Gus ended up doing most of the talking.

“He talked to my parents for quite a while,” she said. “It was too much for me to handle. It was the first time they heard I was having suicidal thoughts.”

Getting the call “was a shock,” said Rachel’s mom, Anne. “We sensed something was brewing though. She had been acting out of character, a little mean and overwhelmed.” The call, she said, “woke us up about the state of her mental health.”

Gus explained to Rachel’s dad, Jim, that they wouldn’t be able to visit her due to COVID-19 visitor restrictions, so it was best if they came the next morning. They drove in from out of state, checked into a local hotel, and came straight to the hospital.

“It was heartbreaking that we couldn’t see her,” Anne said. “It was my husband’s idea to find a window where we could catch a glimpse of her.”

For several days, all of them cold and some wet and windy, they stood outside of Mary Greeley looking up at Rachel’s silhouette in the window. Rachel had cell phone privileges periodically during the day. When she did, her parents would be outside, but connected to her over the cell phone. They’d talk about what she was going through and reaffirm, “that she was important to us and that we were going to get through this together, that she wasn’t alone,” said Anne.

Anne and Jim went to a local store and bought art supplies. They made signs that read “We Love You” and “You Are Our Sunshine” and held them up so she could see them from the window.

“She’s our only child and obviously everything revolves around her,” said Anne. “She’s always been independent and didn’t talk about things bothering her. We trusted her and didn’t always bring up personal things. We’re talking more now and being more involved in each other’s lives. It’s a work in progress.”

Personally, Robinson was touched by Anne and Jim’s actions. Professionally, she saw the benefit of it.

“It has been increasingly more difficult with COVID for families to be supportive to loved ones when they are hospitalized on the Behavioral Health Unit,” said Robinson. “Families’ and loved ones’ support is so critical in the healing process, and the fact that this family was present and willing to take the time to travel to Ames and show up outside each day to have a ‘distance’ call with her was so helpful in her care.”

BETTER

Rachel spent five days on the Behavioral Health Unit. The first night was tough, but a group of nurses helped get her settled in.

“All the nurses nurturing me made me really comfortable,” she said. “I could trust them and could tell they were looking out for me.”

The staff “were very good. They took great care of her,” said Anne. “They also did a good job of keeping us informed. We’d call in to talk to the nurse who would give us their take on how she was doing.”

Rachel did group sessions and met one-on-one with Robinson—“I love Jody,” she said. Ever the high-performing student, she insisted on doing homework though wasn’t allowed a calculator.

“I gave the nurses hell because I wasn’t allowed to have a laptop or calculator and was doing calculus homework by hand,” she said.

Behavioral Health staff helped connect her to university officials so she could work out school matters. They referred her to an outpatient therapy service that she can use at home, on campus, and this summer when she does an internship out west. They also connected her with a nutritionist at Iowa State.

At school, she worked with her advisor to reduce her class load. It’s still challenging, but she has more time and energy to meet it. She quit some of her student clubs, and that boyfriend is history. She’s “super-stressed” sometimes and those dark thoughts still appear—just not as frequently. She’s got the coping skills and works on positive self-reinforcement to handle it now.

She admits that by not alerting her parents to her feelings, she never really gave them a chance to help her. Now, though, she feels validated and understood and supported.

“We communicate a lot better now than we used to. Our conversations are a lot calmer. They have a better understanding of what I was going through,” she said. “Our relationship is exponentially better, and our communication style is exponentially better.”

Rachel still thinks about her parents outside of the hospital, looking up at her in that 6th-floor window. She remembers fondly those messages they made for her. She doesn’t hesitate to talk about how that made her feel.

"Loved."

Editor’s Note: Names have been changed for the purpose of this article.