Thoughts on Grief

I don’t usually like to put information about my personal life online, but I know many people who have lost loved ones recently. I want to share my experience so that maybe it can provide a little hope to someone else. I also didn’t really edit this, so please forgive all of the ways I’ve abused the English language.

mom-teagan-grief

Today is the seventh anniversary of my mom’s death. She was diagnosed with stage three breast cancer around Christmas 2004, and she died just a few weeks after her 51st birthday in 2009. I had just turned 23, my sister was 19, and my brother was 14. She was too young to die, and we were too young to have a dead mother. We still are.

I don’t remember much of the year that followed her death--it was as if my brain couldn’t create memories. I was just trying to stay alive, and anything more than that was too much to handle. During this time, I described myself as “unmoored,” feeling like I was adrift on a rough sea with nothing to tether me to reality. Even though my mom had been sick for years, and I understood that cancer sometimes leads to death, there was no way for me to comprehend what that really meant, that once she was gone I would lose the person who created me, taught me, infuriated me, loved me more than anyone else. I didn’t realize how much she was my constant, the person who I thought would always be around and who had given my life stability. I felt really, truly alone for the first time. 

My friends were amazing. They gathered around me and held me up, literally and figuratively, as my new reality became clear. Some took charge when I couldn’t care for myself, some gave me a home, some were just there. They reminded me that I was still loved, even though the person who loved me most in the world was gone, and that family means more than having remarkably similar DNA. Despite that, though, my heart was still broken. 

There were times in that first year, and beyond that year, when I thought I would never recover. How does a person come back from these kinds of losses? How does a person who can barely get out of bed to go to work somehow feel like she’s capable again? Will there ever be a time when it doesn’t hurt to be around other people’s families or listen to an Eric Clapton song or hear the phone ring? Phone calls were the hardest--they still are--because I got the news of my mom’s death over the phone. I still feel dread anytime someone calls me unexpectedly. The moments between when the phone rings and when I answer are dread-filled. (So please, just text me, okay?)

However, aside from my Pavlovian anxiety response to ringing phones, I finally feel at peace. Today I went to work as usual, talked to people as usual, and will make dinner as usual. I will go to bed at a normal time and get a good night’s sleep. Nothing feels more out of place today than it usually does. It’s not hard to meet other people’s parents or hear my mom’s favorite songs. I miss my mom, but I don’t feel her loss any more today than I did yesterday, or than I will tomorrow. The acute pain has subsided. Sometimes I get sad--really sad--when I think about all of the parts of my life I haven’t and won’t be able to share with her. But the sadness isn’t all-consuming anymore. I feel joy and love and contentedness again, and I feel those good emotions far more often than grief, sadness, and loneliness.

Healing happens. It takes time, and therapy, and self-care, and more time, and distractions, and new adventures, and sometimes there are setbacks when new terrible things happen in your life. But one day, you will wake up and the person you lost won’t be the first thing you think about. They won’t be the last thing you think about. You won’t forget the person, but eventually the grief gets pushed out and is replaced with the happiness of daily life. You will think about the person daily, weekly, monthly, but you won’t be consumed with sadness when you do.

So if you’ve lost someone you love and you think you’ll never feel like a whole person again, please know that, in time, the pain fades away. I know it seems like that will never happen, but it will. Reach out to others to help you, whether that’s a therapist, a grief support group, or a trusted friend who’s also experienced loss. You can, and will, feel whole again. I did.

Suicide prevention gets a new partner: Facebook

If you or anyone you know is having thoughts of self-harm, please reach out to organizations like the National Suicide Prevention Hotline or call their hotline directly at 1-800-273-TALK (8255). If you or someone you know is in immediate danger of self-harm, call 911 immediately. Your life is worth living and you don’t deserve to suffer.


Generally, my Facebook newsfeed is filled with silly photos of people waiting for the subway, declarations of love for a person’s partner, and snarky comments about current events. Sometimes, however, I see comments that make me concerned about someone’s mental health. I’ve been fortunate not to have seen anything that I felt needed to be reported, but I know that’s not the case for everyone.

Facebook announced yesterday that they are partnering with Forefront, Now Matters Now, the National Suicide Prevention Hotline, save.org, and other mental health organizations to create a more effective reporting program for people whose friends are expressing suicidal thoughts on Facebook.

When someone sees a friend's (let's call him Gerald) troubling post, they will have the option to report it directly to Facebook. Right now, at the upper right hand corner of every post, there’s a little downward arrow that, when you click on it, allows you to choose the option to report the post for potential suicidal content. (I haven’t been able to find screenshots of what that screen will look like, and the capability has not yet been activated on my account so I couldn’t make any of my own.)

The post will then be reviewed by “teams working around the world” to determine if the post does in fact imply that Gerald is in danger of self harming. If so, the next time Gerald logs into his account, he'll see this:

Facebook suicide prevention screen 1facebook_suicide_prevention_2facebook_suicide_prevention_3 Source: Huffington Post

One of the things that seems most promising is that Gerald doesn’t seem to have the option to dismiss these screens. He will have to at least click through the resources in order to get to their newsfeed. Hopefully, this will help reach some people who need help but aren’t able--for whatever reason--to ask for it or recieve it.

I also hope that Facebook is planning to critically evaluate this change. There are lots of unintended consequences that could arise from this new reporting system: a drop in posts containing potentially suicidal content, quick click-through speeds that imply users aren’t actually reading the resources, and gross misuse of the capability that floods the reviewing teams, making effective review difficult or impossible.

And when Facebook evaluates the initiative, I hope they make that information public. Because social media can provide a platform for mental health intervention, we need to know if a huge intervention like this is actually successful.

To learn more about this Facebook change, check out the Facebook Safety post explaining what’s happening.

Friday Five: Veterans, birth, ACA, Politifact, #HealthPolicyValentines

It's back by popular demand! (Okay, maybe only Carmen asked if I was ever going to write another Friday Five, but she's so awesome that she counts as at least ten people.) Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Obama signs vet suicide prevention act Yesterday, President Obama signed the Clay Hunt Suicide Prevention for American Veterans Act, legislation aimed at improving the VA’s mental health care and removing barriers that prevent veterans from seeking treatment for mental health conditions. Death by suicide is particularly high among veterans over age 50. While their wish to end their lives may not be directly related to their service, the VA has a responsibility to care for veterans who qualify for VA care and are in need of it. The VA is notoriously problematic, and I hope that the newly-required external audits built into this Act will keep it accountable. After asking them to do what nearly every other American refuses to do, we continually fail our veterans--this Act is just a fraction of what they deserve.

Birth: Home versus hospital A short literature review by Dr. Rikki Lewis reveals interesting findings about the complexities and controversies surrounding home birth.

  • In the US, home births increased by 29% between 2004 and 2009.
  • Among studies investigating the risks and outcomes of home birth, there is little consistency in patient selection and the necessity of reporting infant deaths after transport to the hospital means that those deaths are reported as hospital deaths rather than deaths at home.
  • Policies for deciding to take a woman laboring at home are much clearer in the United Kingdom than in the US.
  • Home births are far less expensive than hospital births, which average about $20,000.

As the hospital versus home birth debate continues, it will be important to use correctly interpreted research as the basis for argument.

ACA open enrollment ends on Sunday The last day to sign up for insurance through the Marketplace is Sunday, February 15. According to the awesome website ACAsignups.net 10.5 million people have already signed up. Originally, the Department of Health and Human Services estimated that 13 million people would receive coverage during the open enrollment period, but later readjusted the estimate to between nine and ten million. If you need insurance and haven’t signed up, do it now...don’t procrastinate! (Also, can we take a moment to wonder why the “marketplace.gov” doesn’t redirect to healthcare.gov? Missed opportunity!)

 

Politifact takes on measles and vaccines One of the best, most useful sites ever, Politifact, evaluated the truthfulness of public statements about measles and vaccines. While their website could use a redesign to make articles like this one easier to read, the information they’ve provided is really valuable. They’re successful in debunking the “vaccines have mercury” claim and Rush Limbaugh’s accusation that Obama’s immigration policy allowed measles to enter the United States through Mexico. Politifact also highlights some of the true statements made by Megyn Kelly and other cable news pundits. While you’re reading their website, take a look at their ratings of statements about health care in general.

Health policy nerds love bad jokes Valentine’s Day isn’t only about romantic love. It can also be a time for you to express your deep, abiding passion for one of the nerdiest arms of public health: policy. Back in 2011, Emma Sandoe started the hashtag #HealthPolicyValentines so we could enjoy gems such as:

and

Groan worthy? Maybe, but totally great anyway.

Have an awesome Friday. I'll be back here tomorrow with a Valentine's Day-themed post!

#32 - What is Codependency? - Action Phase Podcast

Aaaaaand we're back! Text reading January is Codependency Awareness Month Action Phase PodcastIn honor of Codependency Awareness Month, I ask and answer the question "What is codependency?" With its roots in the founding of Alcoholics Anonymous, the term caught on and is commonly used now. However, it might mean something a little different than you think.

Never miss an episode! Subscribe on iTunes.

Or stream it here.

Action Phase Podcast Episode 22

mental health first aid koalaOn this week’s episode, I talk aboutMental Health First Aid–what it is, why it exists, and what my experience was like when I took the class last week. I also look critically at what’s missing from the curriculum (most importantly, eating disorders are excluded) and how the class could be more interactive and applicable to daily life.

Action Phase is on iTunes. Subscribe so you never miss an episode. Ratings help other people find the show and have the added benefit of giving me a little ego boost!

You can also stream the episode here.

https://ia601703.us.archive.org/28/items/22-MentalHealthFirstAid-ActionPhasePodcast/22-MentalHealthFirstAid-ActionPhasePodcast.mp3

Action Phase Podcast Episode 21

Alisen James headshotOn this episode, I talk with Alisen James, MPH, CPH. We cover it all: vaccines, PTSD, breast cancer, and moving from the West Coat to the East Coast and back again. And for all you MPHs out there, Alisen gives me her two cents about the CPH certification and its impact on the job hunt.

Action Phase is on iTunes. Subscribe so you never miss an episode. Ratings help other people find the show and have the added benefit of giving me a little ego boost!

You can also stream the episode here.

https://ia601205.us.archive.org/14/items/21-AlisenJames-ActionPhasePodcast/21-AlisenJames-ActionPhasePodcast.mp3

Action Phase Podcast Episode 8

Boone_photoAntonio Boone is the Program Assistant at Sexuality with Education and Truth (SWEAT), where he works with young men who have sex with men and are HIV+. We talk about shade-free zones, HIV stigma, and how participating in a program gives you a unique perspective on working for that program. Also, Action Phase is now on iTunes! Now you can subscribe and download episodes so you can listen to them any time. If you like the show, please rate it–ratings will help other people find it.

As always, you can listen to it right here as well.

https://ia801005.us.archive.org/23/items/8-AntonioBoone-ActionPhasePodcast/8-AntonioBoone-ActionPhasePodcast.mp3

Friday Five: Merck for Mothers, Gates Foundation, mental health, antibiotics, housing

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Merck for Mothers expands to the US

The US’s high infant mortality rate is often cited as an indicator of our nation’s poor health. However, the maternal mortality rate is often ignored while the number of pregnancy-related deaths has doubled since 1990. Pharmaceutical giant Merck established its Merck for Mothers overseas to help reduce maternal mortality and has just announced it will import those programs to work with expectant mothers in the US. It will provide $6 million in funding for initiatives in ten states and three cities, including Baltimore and Philadelphia. The project will also work to standardize procedures for pregnancy-related emergencies.

Maternal mortality by GDP per capita. I've highlighted a few countries for comparison. While the US does have a comparatively low maternal mortality rate, it is far above other countries with similar GDPs. The size of the circles represent the size of the population, and the color indicates the geographic region. Source: Gapminder

 

The Gates Foundation funds all kinds of new public health ideas

The Bill and Melinda Gates Foundation is dedicated to improving public health around the world, and its Grand Challenges Explorations is a way to promote innovation. This week, the Foundation announced the 81 winners of this year’s $100,000 grants. All of the grants awarded fall into these categories:

  • Increasing the interoperability of good data (ex: improving humanitarian information management in crises)
  • Develop the next generation of condom (ex: condom applicator that can minimize interruption)
  • Labor saving innovations for women smallholder farmers (ex: participatory reality TV show encouraging the use of draught animals)
  • New approaches for the detection and treatment of selected neglected tropical diseases (ex: artificial snail decoy to confuse a parasite)
  • The ‘One Health’ concept: bringing together human and animal health for new solutions (ex: new canine rabies vaccine)

Non-specialist health care workers in developing nations are successful at mental health care

A report published this week shows good news for mental health in low- and mid-income countries. Examining 38 studies, researchers found that non-specialists (such as doctors and nurses rather than psychologists and psychiatrists), who have some mental health training, have been successful in alleviating mental, neurological, and substance abuse issues. Compared to untrained health care workers, patients of trained workers had a positive affect on depression, youth PTSD, and problem drinkers. The researchers caution against making assumptions about what kinds of interventions might work. But the bright side is that training primary care workers to consider mental health needs could help get much-needed care to people who may otherwise go without. You can read the report—and a plain language summary—here.

Tonight’s nightmare is…bacteria that no antibiotic can kill

New Zealander Brian Pool died in July, but the specifics of his death were just reported this week. While in teaching in Vietnam, he underwent surgery and contracted KPC-Oxa 48, a strain of bacteria that is resistant to all antibiotics. That’s right, all of them. New Zealand authorities were strict about quarantine, so there’s little worry that the bug will spread from this particular incident. If you’d like to learn about all the things at risk if we lose the ability to kill bacteria, Maryn McKenna has a terrifying run down.

Why we need public housing

I’ve recently become interested in the importance of safe, stable, and affordable housing as a prerequisite for good health. Ensuring everyone has their basic needs met is perhaps the most important public health issue. How can anyone expect to have a successful smoking cessation intervention if participants don’t know where they’ll sleep tonight? Now that I’m paying attention to the issue, I’m seeing it everywhere. This infographic explains how public housing can be a part of the solution.

public_housing_info

Action Phase Podcast Episode 2

This week, it's all about drugs, violence, and psychology as I talk with Kate Schaeffer. She's the Alcohol and Other Drug, Interpersonal Violence, and Mental Health Coordinator at the Wellness Resource Center at Temple University. You can download the episode by going here and saving the page as an mp3.

Or you can listen to it right here!

https://ia601904.us.archive.org/21/items/KateSchaeffer-ActionPhasePodcastEpisode2/Ep2_KateSchaeffer_Final.mp3

Friday Five: 9/11, tobacco in India, painkiller labels, Chobani recall, child abuse & neglect

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

9/11 responders are suffering from cancer

While we remember the 12th anniversary of the attacks on the World Trade Center, another attack is being waged upon the responders: cancer. So far, 1,140 people have been certified by NIOSH to have 9/11-related cancer. The types of cancer are varied—from non-melanoma skin cancer to non-Hodgkins lymphoma to colon cancer—and thankfully, the September 11th Victim Compensation Fund will cover all related medical and mental health expenses. However, an important deadline approaches: if a person knew of their related medical condition before October 2011, he or she must sign up with the Fund before October 3, 2013 in order to have their treatment covered. If you know anyone who may be eligible for this benefit, please (1) thank them for their selflessness and (2) tell them to sign up ASAP.

 

Tobacco + India = Bad News

Approximately 275 million people out of India’s 1.2 billion population use smokeless tobacco or cigarettes. According to a report from the International Tobacco Control Project, the country could see 1.5 million deaths annually if the number of tobacco users is not reduced by 2020. What’s even more alarming is that 94% of tobacco users surveyed said they had no plans to quit, despite government efforts to curb consumption and self-reported regret for beginning the habit. Citizens groups also advocate for tobacco-free living. This ad from Cancer Patients Aid Association is an example of the kinds of messaging Indians receive.

 

Source

 

New labels for some, but not all, narcotic painkillers

The FDA has announced updates to the labels for extended release narcotic painkillers to remove the idea that the painkillers should be prescribed for “moderate-to-severe pain.” Instead, opiates like OxyContin (oxycodone) and MS Contin (morphine sulfate) should be prescribed only when a patient’s pain cannot be controlled by other methods. These changes do not apply to fast-acting painkillers like Percocet (acetaminophen and oxycodone) or Vicodin (acetaminophen and hydrocodone) because the FDA sees that class of opioids to be less susceptible to abuse and overdose. Hopefully the new label will encourage doctors to think carefully about which painkillers they prescribe. The misuse of these drugs is out of control, and as doctors are the gatekeepers of prescriptions, their cooperation is essential to reducing addiction and unintentional deaths.

 

Chobani yogurt is moldy

Beloved and wildly popular Chobani brand Greek yogurt has been recalled. The problem of bloated, exploding containers is said to be due to contamination by the mold Mucor circinelloides. Although this kind of mold is not known to cause gastrointestinal problems, 89 people have reported nausea and vomiting after eating the recalled yogurt. That said, if your breakfast is fizzing through the lid, please don’t eat it. Let’s have some common sense, okay?

 

New child abuse and neglect report demands changes to the system

A report released this week from the Institute of Medicine described the fractured, underfunded, and unevaluated way the US researches and addresses child abuse and neglect. There are more than three million reports of abuse each year, involving at least six million children. The most common form of mistreatment is neglect, or when a caregiver fails to provide food, supervision, protection, medical care, education, or nurturing and affection. The full report gives a sense of how poorly the US manages child abuse and neglect, and this infographic also gives the basics. Children who are victims of abuse or neglect are far more likely to have serious health problems, including mental health issues, so eliminating violence against children should be at the forefront of public health efforts.

 

This week’s Friday Five is extra-depressing, so I’m going to leave you with a bonus uplifting story:

Wearing a sandwich board may help you find a kidney donor

Larry Swilling of South Carolina has been walking around wearing a sandwich board asking for a kidney donor for his wife Jimmie Sue. A complete stranger, a woman named Kelly Weaverling from Virginia Beach, decided to get tested and was found to be a match. The transplant happened on Wednesday and both Jimmie Sue and Kelly are doing well. Bonus: Larry’s efforts have led to 125 new registered kidney donors in South Carolina.