Posted by: Kate | March 27, 2008

It Happens.

The jumble of noise, conversations weaving in and out and changing participants, continued well after the meeting had officially begun. A few people were diligently, even aggressively, trying to hammer away at specific agenda items, while others were discussing vacation plans and celebrity gossip. The appearance of the supervisor only caused a slight reduction in the overall noise level, because the group had long ago accepted that she chose to attend these meetings, chose to take the supervisory role, for her own amusement. It’s a varied and intense group of people, and she enjoys watching them ebb and flow in such predictably unpredictable ways, even though the actual tasks of managing them or placing their needs above the company’s strategic goals are distasteful and avoidable for her.

In the midst of the confusion, the supervisor began a conversation with a coworker, one who had questions regarding a recent incident. The specific words were hard to make out, but in time it became clear that their conversation was compelling and perhaps even relevant, so the others tuned in. They had moved past the introductory phases of the topic and were discussing specific procedural details, and were somewhat reluctant to take the time to back up and explain just who they were discussing, just why it was an issue. “Oh,” said the coworker, the sanctimonious and vaguely sinister one. “Just some stuff that came up after a psychological autopsy from the other week. You were away.” A psychological autopsy sounds all intense and cool; it’s basically a big meeting held after a client dies, especially by suicide or overdose, to verify that there weren’t any major errors or lapses in the system.

They were set to launch back into the administrative details, but something felt wrong. Something held my focus. “I understand I was away, but who was it for? Which client?”

The coworker sighed, and said, “No one you know. She was a new client, 16 years old. Jessica something.” He turned back, ready to once again delve into the really important part: when and to whom to email copies of a certain file.

The supervisor paused, and looked at me. “Oh. Right. Yes, she was a new client, but she was seen by Emergency Services in the hospital once. You saw her. Don’t worry about it, she had been assigned a therapist and psychiatrist, she followed up with them. You did everything right. It happens.”

As I started my slide into shocked silence, I managed to ask, one more time, “What was her name?”

“Jessica Lastname*,” she said.

I sifted through my memory, and came up empty. No Jessicas, or derivations thereof. I couldn’t picture her face, couldn’t remember her story. I don’t have a perfect, eidetic memory of all clients, but with a few clues (hair color, age, general circumstances) I can usually recall our interactions fairly well. This time there was nothing, no glimmer of recognition. I tried to ask another question, and got brushed off again – “We really need to get this policy hammered out before the CEO comes in for his presentation today.” – so I left the room and logged on to the laptop in my office.

I ran a quick search on her last name, and found her immediately. Her first name wasn’t Jessica. It was Rachel.*

Rachel, with the intense blue eyes and smudged black eyeliner.  Beautiful and disheveled in the way that only a 16-year-old girl can be.  She’d only been in the tiny emergency room for two or three hours, not long by mental health crisis standards, but had been up all night and was exhausted and apathetic. She had tried to hang herself in her closet the night before, she admitted, but insisted it was only to see what would happen. “I never meant to die,” she whispered, a little hoarse as the bruises around her neck slowly darkened. “I just thought no one would miss me, and I needed to feel like I could do something to change.”

Her mother had heard noises, and had gone upstairs to check. By the time she made it into the room, Rachel had already stood up and was untying the scarf from the closet rod. It was late, by this time; after 10:00. So they decided to just sleep at home for the night, and then take her to the emergency room the next morning to straighten out all this suicide nonsense.

It struck me as odd at the time. It strikes me as horrifying now.

Rachel didn’t want to go to the hospital that day. “I’m fine now,” she whispered. “Really. It was stupid. I thought no one would care if I was gone, but now I see that my mother cares. I see that I would hurt people. I won’t do anything stupid.” The idea of therapy, of spending time with someone whose job it was to listen to her and help her sort out her problems, was intriguing to her. She asked how soon she could start.

Her mother was adamant. “I will not have my child going into a place like that, with crazy people. She’s just looking for attention. She doesn’t need to be locked up somewhere. I don’t need that. We’ll be fine at home.” She was less enthusiastic about agreeing to call a therapist, but at both Rachel’s and my insistence that it was important, she agreed to call that afternoon. The first available appointment was three days later.

They left. It was, by and large, a routine sort of assessment. Another teenager feeling misunderstood and unappreciated, acting in upsetting and unpredictable ways because she feels upset and unpredictable. She was smart, and seemed to appreciate some of the things I had to say, though once her mother was back in the room she curled up on the bed and pretended to be asleep.

Apparently, after they left, the mother did call and get an appointment, but not for three weeks. At that appointment, the therapist was worried enough to get Rachel an emergency psychiatry appointment, which was rescheduled twice before the family could make it. Then, about six weeks after their visit to the emergency room, her parents decided to go away for the weekend. Rachel stayed home alone. They found her on Monday morning.

I’m having trouble sorting out my reactions. There’s the misery at her mother’s nonchalance, from her attitude in the hospital to her choice to leave the girl home alone. Shock at the unsurprised anguish in the comments left on Rachel’s MySpace page; many have said they can’t believe she’s really gone, but none have said they were surprised that she did it. Dismay at a society that can tolerate so much pain that hers barely stood out. Disappointment at a system that, for all its psychotherapeutic techniques and medications, can’t rescue a child from herself. Outrage at the callousness and insensitivity of a coworker and supervisor who assumed I could be as nonchalant as they about a person with whom I spent so little time.

I’m working very hard not to feel guilty. My brain knows that I did everything I could, that I could not have prevented this loss, especially six weeks later. My heart, though? It isn’t so sure yet.

* We know I’m not using real names here, right? Right.


  1. They left her alone after emergency psychiatric appts? They never deserved her, they obviously did not get her. This shreads my heart. She could have stayed with me.(Metaphorically and all that) I hope Rachel is now in a place where people notice and live her.

    That big crack in my heart just got wider……..

  2. How tragic, for all concerned.

    You cared. That was surely something, and in that moment it was enough.

  3. It’s tragic and heartbreaking. May someone who reads this post learn to pay attention to their own teen in a new way, in hopes that this girl’s death help another live.

  4. *SIGH* how sad to think that she had to test her parents to see if they cared and they not seeing that she needed help. People like thta really don’t deserve parents.
    Kate, the fact that you do care who she was and don’t brush her existance off makes you a good person to do this. Guilt, plays no role in this, I can understand why but at the same time the parents just didn’t get it.
    I really want to slap her parents though…they seem to be very selfish.

  5. What everyone else said. And my heart hurts thinking about this, too.

  6. This is breaking my heart, for a number of reasons. Two of them being my own 13-year-old and 16-year-old. How could that mother dismiss her daughter so readily? How could those parents leave her side for an hour, much less a weekend? You’re not the one who should feel guilty. I’m glad you do what you do, Kate. I think you are an asset and a gift to the profession. This post should be a public service announcement.

  7. Be gentle with yourself while you work out how to feel, won’t you?

  8. Oh, honey, no, you did. . . this one wasn’t your dropped ball. But she was, so tragically, dropped. Ugh ugh.I’m going to go hug my kids.

  9. […] work Yesterday was tough.  Perhaps tougher than it should have been, since realistically the little girl lost was well out of my realm of influence and I certainly couldn’t have saved her, and my grief […]

  10. You did help. I am so sorry!!

  11. Kate I hope all practitioners in your field have the level of depth and compassion that you feel for your clients. I understand that to some degree you must feel helpless when this happens but it certainly isn’t your fault. Telling someone not to feel guilty is like asking them not to worry . . it’s the fact that you do care that makes you an asset to your profession. I wouldn’t be too hard on her parents either, denial is a coping mechanism and kids can be very convincing in persuading parents that they’re just fine when their world is crumbling. I couldn’t do your job but I admire you for it nevertheless.

  12. Welcome back from Jamaica –

    Not such a nice welcome back. That poor girl. I think it must happen a lot. The parents were in denial? Were they too busy? It breaks my heart.

  13. Hi Kate,

    I am so very sorry. I didn’t know until just now. If you want to talk about it, you know how to get me. I am so furious with that team of “mental health” workers who didn’t even stop to process this with you or check-in or debrief. Or feel . . .


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