The Acceptance of Not Knowing

Working in mental health isn’t about saving people. It’s about doing the work despite not always knowing the answers.

Father’s Day is this Sunday. This year it coincides with what would have been my sister’s fortieth birthday. Emily was technically my half-sister. We shared the same father, though she never knew him and I was only seven when he died. They shared many of the same qualities, my father and Emily. With too much energy and nowhere to focus, each fell into the trap of alcohol and drugs. Both of them seemed to possess an absolute lack of fear as well as a violent streak. Both were gregarious, charming, and attractive. Each had spent time in a psychiatric hospital in the weeks before completing suicide and convinced their treaters that they were well enough to be discharged. Each ended their lives tragically and violently. And much too young. My father was only twenty-nine and Emily was thirty-eight.

I’ve spent years ruminating on the topic of how their deaths could have been prevented. Some would say their suicides were inevitable, but I stubbornly refuse to believe this. Sobriety could have helped in Emily’s case. She was a different person when she was sober. She’d been drinking and using before she died. I wonder if she would have scaled the chain-link fence and jumped off the highway overpass stone-cold sober.

My father may have lived had he not had access to a gun. His hunting rifles were removed from the home before he was discharged from the hospital. He went to my grandfather’s house and used his instead. Perhaps he could have worked through his wish to die if he’d had more time. Perhaps he might have changed his mind if he’d spent more time in the hospital.

I work as a nurse in a psychiatric hospital caring for people who, like my father and Emily, struggle with mood and personality disorders often complicated by substance abuse. Some of them are grateful to be there. Others are angry about being locked in and feeling like they have no control. Many are intensely craving the comfort they find in drugs and alcohol. Sometimes they’re downright mean and nasty when they don’t get what they want. I once had a woman tell me she hoped someone in my family would have to go through addiction so maybe then I’d have some empathy. I bit my tongue and choked back my fury as I struggled to maintain my composure.

Suicide is an impulsive act; even those that are carefully planned. It is in a single moment that a person swallows the pills, pulls the trigger, or steps off the ledge. A million permutations of circumstance can occur to disrupt the chain of events leading to the completion of suicide. A tiny disturbance in one link of the chain may change the entire outcome. My job is to be a disturbance.

No matter how frustrating my work is, I have to believe that what I’m doing has a purpose beyond the paycheck. Otherwise, it would feel meaningless. Some days it feels like I’m kicking the can down the road. Lending hope to buy people a little more time. That used to bother me. “What’s the point?” I wondered. I realize now that a little more time might make a difference. And it might not. The secret lies in accepting that I will never know the answers yet doing the work despite this.

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This was first published by Wendy Arena in her blog here on June 17, 2020. It is re-published in The Havok Journal with the permission of the author and originally appeared in The Havok Journal on June 30, 2020,

Wendy has been a registered nurse for 22 years, currently works on an inpatient psychiatric unit, and is pursuing a writing career. She is married to a combat veteran who works in a prison. They share some very interesting dinner conversations.