LAUSR

The last time I saw my friend Rachel the sun was setting below the hill, yellow and orange light filtering through the trees. She was sitting in the porch hammock with one foot tucked under her body, the other resting bare against the warm wood. I knew she’d been struggling with depression—we all did. For months we’d been going back and forth, taking her to the hospital when she was suicidal and to our college’s student health services when she could not muster the energy to get out of bed. We called administrators, therapists, once even the police, trying to find someone to help our friend stay alive even for just one more day. But every time we reached out, Rachel pushed us away. At the time I could not wrap my head around why. Why would she not accept help?Why did she want to die in the first place? Why would some adult, some hero who knew what to do, not show up with a magic answer? Why was it up to us, a bunch of clueless, scared kids, to figure all of this out? The whys do not really matter anymore. When I remember Rachel, I do not think of the fear and the frustration. I remember those last moments I spent in her company in the cool evening air, sitting next to her on the hammock. We did not talk about anything important. There were no big revelations, no inspirational messages or words of wisdom. It was quiet. She showed me a new way to braid hair, demonstrating the method on her own curls so that I could see. Her red nail polish was chipped where she’d been chewing on her fingers. When she left I did not say “goodbye,” I said “I’ll see you later.” I did not. In the wake of her death, Rachel’s pain rippled outward, tearing through everyone who’d loved her, with a brute force like the shock wave of a grenade. We were, all of us, plagued by maybes. Maybe we had not done enough. Maybe there were more things we should have tried. Maybe if we’d tried harder, listened better, thought of just the right thing to say, talked to the right people.... Of course, it does not really work like that. But what did we know? Even though it felt like it would not, the world moved on. It had always been my plan to become a psychiatrist and what happened to Rachel only fueled my fervor. I graduated college. I got into medical school. I could not help my friend but maybe, with training and knowledge and resources, I could help someone else. I met Michelle on my psychiatry rotation, on the child and adolescent unit. She was fifteen and she wanted to die. The universe had not been kind to her and she knew it—“I feel like God hates me,” she admitted to me during one of our conversations. Her parents, desperate to support their family, had sent her to an adult man who made her his “wife.” She was sexually, physically, and emotionally abused for more than a year before she managed to escape, alone, knowing that no one was going to help her. She went through the unimaginable and saved herself as best as she could. And then, because she had no other options, she went back to her family and she tried to make do. With a story like that, I could not blame her for feeling alone. For wanting to give up. But even at her lowest point, there was something about Michelle that shone. She had a bright smile and a brighter spirit. Even as she felt on the verge of giving up, she reached out to the other kids on the unit with her. When her roommate had a hard day in therapy, Michelle drew landscapes on the chalkboard in their room, nature scenes entwined with heartfelt words of encouragement. She told me about her favorite music, her best friends at school, and the dance club she loved The Association for Academic Psychiatry annually hosts a medical student essay contest under the theme “The Art of Communication in Psychiatry: Connecting with the Patient.” The author of the winning essay receives free registration to the association’s annual meeting and up to US$1000 in reimbursement for travel and related expenses. Academic Psychiatry congratulates the 2018 winner, Allegra Condiotte, NYU School of Medicine Class of 2019, who presented this essay in Milwaukee, Wisconsin, September 5–8, 2018.