The Valedictorian of Being Dead Read online

  Advance Praise for Heather B. Armstrong’s

  THE VALEDICTORIAN OF BEING DEAD

  “Breathtakingly honest, this story is a bridge to empathy and a bright beacon of hope. I’m telling everyone to read this book.”

  —Lisa Genova, New York Times bestselling author of Still Alice

  “A story of courage, hope, love, and science overcoming the despair of depression. It is a must-read for mental health professionals and those touched by depression—their own or that of a loved one.”

  —Barbara Arrowsmith-Young, internationally bestselling author of The Woman Who Changed Her Brain

  “I cried and cried; it was so beautiful and honest and scary and real. This book will be so helpful for a lot of people living with depression, especially parents.”

  —Grace Bonney, New York Times bestselling author of In the Company of Women

  “Fascinating journey out of the abyss of depression, intricately weaving the threads of family, suffering, and scientific breakthrough. This touching memoir manages to shock, educate, and inspire.”

  —Alex Korb, PhD, author of The Upward Spiral

  “I was moved by this real, raw, hilarious, and deeply personal story of one woman’s epic battle with major depression and found myself cheering for Heather and her entire family.”

  —Wendy Suzuki, PhD, author of Healthy Brain, Happy Life

  “As the lead anesthesiologist on the study, it was emotional for me to hear of Heather’s experience. She helped me to gain some understanding about what folks go through when they are sick, what the experience was for her and her loved ones, and what the treatment now means to her.”

  —Scott C. Tadler, MD, University of Utah School of Medicine

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  In loving memory of Minnie Ann McGuire

  PROLOGUE

  “MY MOTHER MARRIED SATAN, and when he’s here next time you’ll see exactly why she divorced him.”

  My words were a bit slurred—they often are when you’re coming out of anesthesia—and I looked around the room to find my mother’s face so I could nod furiously in her direction. I wanted her to confirm this statement of fact to the three nurses in the room. They needed to know. This was the most important thing we could possibly talk about right then. I was insistent that we discuss this, like I’d had a few too many bourbons at a party and was convinced that if I screamed, “BUT I AM NOT DRUNK!” people would stop dismissing me and say, “You know, if you’d only screamed that three times, I wouldn’t have believed you. It was the fourth time that did it. That fourth time changed my mind.”

  Instead, she cleared her throat and asked how I was feeling. How the hell did she think I was feeling? I’d been almost brain-dead for fifteen minutes. I felt fantastic! When you want to be dead, there’s nothing quite like being dead.

  And boy, did I do dead well. Dr. Mickey would often tell my mother that of the three patients in this study so far, my brain went down and stayed down better than anyone else’s. I didn’t hear him tell her this—I was almost dead every time they had this conversation—but my mother would tell me about what would happen while I was gone, about the discussions she had with him concerning the history of depression in our family. When she told me about my dazzling performance, I reminded her that when I want to do something well, I become the valedictorian of doing that thing.

  No one does dead better.

  That wasn’t the craziest thing I would say when coming out of anesthesia. Discussing my mother’s doomed marriage to Satan was the topic I brought up after the seventh treatment. A little crazier than that was after the initial treatment—the first time in my life I had ever been under anesthesia. I angrily and breathlessly yelled, “The girls will miss their piano lesson!” My vision was blurry, and while trying to blink my way through it I could see the outline of at least five people in the room. They were strangers to me in that intoxicated state, and they were laughing at me.

  That was the only time I had a dream while coming back from death, that first time. It was a very short dream, but its significance was not lost on me or my mother. My mother doesn’t have much experience with angry drunks—she is an active Mormon who surrounds herself with other active, Diet Coke–drinking Mormons—but she immediately told the room that what I had uttered was very serious, that they should ease up on the laughter.

  Dr. Mickey had told me during my consultation that it might take anywhere from twenty minutes to an hour to come out of the anesthesia, and in my dream it had taken so long that I was late to take my girls to their weekly piano lesson the following night. I was panic-stricken, seized with terror like I had been every afternoon for the previous six months when I would sit down to practice piano with my younger daughter. Marlo was seven at the time and had begun taking lessons in the fall of her second-grade school year. She had shown interest in music throughout her life and would dabble at the keys on our piano because her older sister Leta had been taking lessons for years.

  I would never blame my wanting to be dead on my daughter’s daily piano practice. It was a turning point in this eighteen-month-long bout of depression, but it was one of many. Each of them was in the downward direction. However, Marlo’s ability to bruise her forehead on the keys of the treble clef took me down a few more notches than anything previous, past a point of no return. To a place in my closet where I would hide from the girls when I called my mother to scream. I tried so hard to conceal my pain from my children, and my closet was the most secluded space in the house. I always hoped that my clothes would muffle the sound. Sometimes I would scream words, and sometimes I would just let the sound of the pain erupt from my throat. (Imagine the noise a pig makes in a barn fire.) Sometimes after she said hello I would utter without any emotion, “I don’t want to be alive anymore.”

  I had given my older daughter the gift of music in her life, the ability to read notes and play those notes on a piano. I wanted to give that same gift to Marlo; it only seemed fair. However, I don’t play the piano very well, and her father, who is a classically trained pianist, had moved 2,200 miles across the country. The help I’d had when Leta learned to play piano was no longer available. Now, I’d been a full-time single mother working a full-time job for over three years. It was up to me to get Marlo through her required practice every day. One more knife to juggle, and I was already juggling so many. My mother begged me to let it go, to look at the bigger picture and know that Marlo would lead a fulfilling life without piano.

  But that wasn’t a fair request. When you’re depressed and no longer want to be alive, it’s kind of impossible to let things go. Her father’s leaving had left a gaping hole in Marlo’s heart, and I didn’t want to let his absence rob her of this as well. I wouldn’t allow it. And in pursuit of that principle, I was willing to want to die.

  Which is why my outburst of “The girls will miss their piano lesson!” hit my mother in that hospital room and almost knocked her against the wall. How appropriate that I would reference piano, That Which Made Me Want to Be Dead, while coming out of an experimental anesthetic procedure that would hopefully make me not want to be dead anymore. My mother shushed the room. She begged them not to laugh, remembering me begging on the phone, “Please, please
let me be dead.”

  ONE

  CALLING ALL ANGELS

  ONE MONTH BEFORE MY first treatment, I had a face-to-face appointment with my psychiatrist. He required this before he would agree to refill my medication. Normally, his secretary would call my pharmacy when I needed more Valium or Neurontin or Trazodone, but I had not been in to see him in over nine months. I’d been busy, I told him, when he asked why I hadn’t made an appointment. That’s the answer I give to every single person who cannot possibly comprehend what day-to-day life is like for a full-time single mother who also has to work full-time. “I cannot get coffee with you, sorry. I cannot have lunch with you, I cannot go to book club, I cannot volunteer at the second grade Halloween party. I’m busy; incomprehensibly, bafflingly busy.”

  Turns out, though, that “I’ve been busy” is not a good enough answer for Dr. Lowry Bushnell, the head of the electroconvulsive therapy (ECT) clinic at University Neuropsychiatric Institute (UNI) on the campus of the University of Utah. I was sitting across the room from him, my body an upright corpse, when he set down his notepad with a thud and cocked his jaw angrily to the side. He explained that the longer you let a depressive episode go untreated, the harder it is to climb out of the hole. He was mad at me and shook his head. How could I have let this go on so long? Why had I waited over a year to seek his help? Why hadn’t I called him when the symptoms of my depression reappeared?

  The answer to those questions was long and complicated, so I summed it up with one sentence: “My ex-husband will try to take away my kids if he knows I’m this depressed.”

  I had finally said those words out loud to someone who wasn’t my mother or talk-therapist, and usually when I said them to my mother I was screaming. Every moment of the morning routine and the afternoon routine and the bedtime routine and All of the Things Needing to Get Done was haunted by the memory of the very real threat he’d made to take away my kids. My “ongoing suicidal ideation,” he said, made me an unfit mother, but before he could argue that in front of anyone with the authority to strip me of custody, he moved to New York. I’d managed to balance raising two young girls alone while running a full-time business for over three years. I imagine that anyone who does this has once or twice or many, many times thought, It would be nice if I didn’t wake up tomorrow. Not because we’re suicidal or want to kill ourselves. We know that’s not an option. We’d never do that to our children. We just want a break, and sometimes the desperation for that break is terrifyingly bleak.

  “It doesn’t matter what your ex-husband will do if he finds out, Heather, especially if you’re dead. He’d certainly find out then!” Dr. Bushnell said. I hadn’t told him that I’d very much like to be dead. Medical professionals have certain obligations when it comes to hearing that word and words like it from a patient’s mouth, and I didn’t want to end up unwillingly committed to any sort of facility. But I didn’t have to say it.

  “I would ask you how you’re feeling, except you don’t have to tell me,” he said. “It’s all over your face. It has stolen your eyes.”

  Suddenly he got up from his seat and walked over to his desk to pick up his phone. He brought it back with him to sit across from me once more and said, “I have an idea and I want you to consider something.” I remained perfectly still as he called his colleague, Dr. Brian Mickey, to see if he was looking for any more patients to participate in the experimental study he was conducting at the ECT clinic. Dr. Mickey was investigating an alternative to electroconvulsive therapy that may have fewer side effects that result from the electrically induced seizure at the core of that procedure. He had heard about a study conducted in Austria in the early 1990s that used the anesthesia isoflurane to mimic ECT. Dr. Mickey’s study, however, would be the first ever to use propofol anesthesia, a less intense drug.

  With this treatment, Dr. Bushnell explained, a patient is simply put to sleep with the intravenous anesthetic approximately three times per week for ten treatment sessions. The study is designed to determine if “burst suppression”—quieting the brain’s electrical activity—can alleviate the symptoms of depression. “Quieting” here is the polite way of saying “taking down to zero” or “almost brain-dead.” Dr. Bushnell likes to call it “a really deep induced coma that makes you feel better about yourself.” The anesthesiologists called it “the abyss.”

  “She’s sitting in my office right now, yes,” Dr. Bushnell told Dr. Mickey. “Good, then. I’ll let her know all of that.” He talked me through the details of the study after hanging up the phone and asked if I would consider looking over the official paperwork.

  “You’re the perfect candidate for this study, Heather,” Dr. Bushnell said. “You have a history of depression. Your family has a history of depression. This latest bout of depression has lasted more than a year. You’re young and healthy and . . .” He then paused and moved toward the edge of his seat and put his hands on his knees. “. . . and most importantly, I know it will work.”

  I left his office with a handful of papers, including a release form I would eventually sign. It ensured that the hospital and those working on the study would not be held responsible if I suffered any of the side effects possible from dying ten times. This treatment would take place just down the hall from Dr. Bushnell’s office in the ECT clinic on the south side of UNI, a building that sits on a winding road called Colorow Way. I drove out of that parking lot and headed to the grocery store to buy two gold Mylar balloons—a giant number 1 and a giant number 3—for Leta, who was turning thirteen years old that day. I was hosting four of her friends for a sleepover and thought the balloons would complement the festive atmosphere.

  “I didn’t realize how big the numbers would be once they were filled with helium,” I said to the woman helping me with my order. I wondered how in the hell I was going to fit these things into my car while processing everything Dr. Bushnell had just told me.

  “No one does!” she said as she tied off the end of the number 1.

  “I’m going to walk out of here with the numbers reversed so that people will think I’m turning thirty-one,” I said, “because I could totally pass for a decade younger.” I made a dramatic sweeping motion with my hand from my head to my torso, as if presenting a great beauty wearing a tattered gray hoodie, black yoga pants that had been slept in the night before, and hair that had not been washed in six days.

  “Honey,” she shot back as she filled the number 3, “I’m pushing sixty, so I only wish I looked as good as you.”

  After she tied a ribbon to the end of each balloon, I paid and attempted to wrangle the enormous numbers as elegantly as possible. They filled the entire backseat of my SUV, and I had to adjust the rearview mirror and stick my head out of the window in order to maneuver my way out of the parking lot. My daughter is becoming a teenager today, I thought. If I hit anyone or anything, they’ll have to forgive me. When I successfully pulled out of the strip mall, I breathed a heavy sigh of relief and could feel myself smiling.

  Twenty minutes later I arrived home and texted my mother and asked if she could talk. This is how my mother and I communicate, and it is the only acceptable way of calling someone on the phone today. Yes, I grew up in a home that had only one landline and routinely beat my fists on my older sister’s bedroom door, the coiled cord of the phone strung taut underneath it. Thankfully, we no longer have to live through that kind of hell. She immediately texted back, “I can.” I wondered how many texts I had from my mother from the previous eighteen months that said exactly that.

  “I just joked around with an employee at the grocery store,” I blurted after my mom said hello. “I just found myself doing it; it just felt normal and easy. I can’t remember the last time I did that. I interacted with a stranger and smiled at a stranger. I can’t remember the last time I wanted to do that.”

  When I wasn’t in my closet screaming into the phone about my desire to be dead—whenever I was having a calm or technical call with my mother, I would walk around the living roo
m in a giant circle. As I passed by the piano for the third time, I started to cry and she asked if I was okay. And I was. I was okay. Actually, I was more than okay. I was okay and yet simultaneously torn. It was this tension that made my eyes fill with tears. Because of course I would be the one in the family who is so crazy that she has to get some scary procedure done in a hospital. And not just any hospital: a procedure done at that clinic. You know the one. Where they shock people because of their mental disorders.

  Of course I am the craziest one in the family. The black sheep. The one who left the Mormon faith and registered Democrat. The fuckup.

  And yet . . . for the first time in over a year I felt hope. I felt like maybe I wouldn’t feel like this forever. I’d been certain I would live the rest of my life wanting to be dead. I had resigned myself to wanting to be dead. But what if it didn’t have to be that way? What if what Dr. Bushnell said was true? What if this treatment worked?

  “Let’s do this,” my mom interrupted my winding stream of thoughts, to assure me that we were in this together. Her words were firm and forceful and conclusive.

  “But you will have to drive—”

  “I don’t care what I have to do. I will fly to the damn moon and back if I have to. We’re doing this.”

  What I explained to my mother about the procedure was only what my psychiatrist had explained to me. Even though she said she didn’t need the details, I asked her to listen to me talk through it so that I could gain confidence in the hope that I felt.

  First, I’d had to meet a relatively rigid set of requirements in order to qualify for the treatment. I couldn’t be suffering from an addiction or a personality disorder. I couldn’t be experiencing a manic episode. I had to have been going through a bout of depression as severe as mine for over a year, and it had to have been treatment-resistant depression. My depression qualified, as my antidepressants had stopped working after twelve years and a few modifications made a year prior had produced no positive effects. Yes, I could still fall asleep at night, but my meds had stopped enabling my ability to cope with life. Second, ECT has proven to be the most effective way to combat treatment-resistant depression, although other chemicals such as ketamine have been used to some good effect as well. ECT works by shocking the brain and producing a seizure. This seizure causes the brain to flatline temporarily, and it is this flatline that some believe is the benefit of the entire apparatus. It’s like rebooting a computer. And anyone who has ever had problems with a computer knows that sometimes you have to turn it off and on again several times to fix whatever glitch was causing all your applications to crash. This is why most patients undergoing ECT endure anywhere from ten to twelve treatments. Each time the brain is reset, it gets a little better. Third, previous studies using an anesthetic called isoflurane had shown significant promise, although that drug was difficult to recover from and caused dysphoria in many of the patients. It almost always caused nausea as well. Dr. Mickey had tried to get a more controlled and randomized study funded for isoflurane, but when that failed, he had to come up with something more novel and interesting. And because both propofol and isoflurane can induce a burst suppression state in the brain, he picked up the idea for a propofol study and managed to push it through. Propofol as an anesthetic had proven far easier on surgical patients than isoflurane. All of this is why I agreed to ten rounds of Dying in Front of My Mom.