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I knew something was wrong when she was late for work. She hadn’t called out and hadn’t texted anyone where she was. I peeked into her office. I wasn’t looking for any clues about where she was or anything; I was looking for her in an empty room. What struck me was how neat the otherwise messy work place was. It was as if she was going on a trip and wanted to leave the office orderly in case anyone came in while she was gone. The loose ends were tied up. Thankfully, she was not successful in her suicide attempt.

Everyone claimed to not know anything, but we knew the whole story, pieced together from social media posts. We were all quiet and looking at each other like we were examining each other to see if anyone else was at risk for committing suicide. One nurse said, in typical off-color nursing humor: “We know what we are going through ourselves, but you never know if the person next to you is circling the drain.” We all nervously giggled. The comment hurt to hear…but it was accurate, stripped down to the basic cutting truth. We really don’t listen to the answer of a tossed out “how are you”? We are so concerned with ourselves and our own issues that we rarely take the time to reach out to someone else.

Prompted by what happened, the hospital presented education on suicide prevention. I didn’t want to attend. Why bother? I’d been depressed after my mother died, I’d been through treatment, and you couldn’t tell me anything I didn’t already know, but a friend of mine did attend and she was very moved by what she had heard. She shared with everyone on the unit what she felt was the most important takeaway: do not be afraid to ask someone if they want to harm themselves or commit suicide.

During a private conversation, this friend came right out and asked me if I ever thought of commiting suicide, if I’d ever been depressed. I didn’t look her in the eye when I said that in the past I had thought of what the world would be like without me in it, particularly after my mother had died. I told her that I had felt like I was surrounded by blackness, like I was sitting in the bottom of a well and I couldn’t get out. I had sought help and was diagnosed with depression. When I saw tears in her eyes I immediately regretted what I had said because I didn’t want anyone to know that I had been depressed—that there was a chink in my armor. She told me that she had learned that people who are depressed verbalize that they are in a very dark place, feeling like they are surrounded by nothingness and blackness with no way out. My friend kept looking at me like she was really seeing me and asked me to make her a promise. She made me promise that if I ever felt like that again, that I would tell her. My mental fingers were crossed. Strong people don’t reveal weaknesses and we certainly don’t share feelings—we just tamp them down, deny them, and keep going. I didn’t need help and besides, I was thinking, what could you do for me? But the concern and the tears in her eyes really stayed with me.

The truth was that I was sitting at the bottom of that well. Work and life and just the energy required for living were becoming too much again, but my friend had opened the door to the darkness and a little bit of light had shone in. Several weeks went by and we were talking on the unit about work related issues and I causally asked my friend if she remembered making me promise to tell her if I ever felt like I was sitting in the blackness. Tears filled her eyes again when I told her that I was back in the well again. I watched as she went to the computer, made an entry, and handed me on a piece of paper: the link to the employee assistance program at our hospital. She stayed with me while I contacted them and I was seen by a counselor the next day.

I am aware that we all do not know someone we feel comfortable talking to, but in our busy days of being a nurse and caring for patients and caring for ourselves and our families, we need to be able to recognize when one of our colleagues is reaching out, however silently, for our help.

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Maggie Ciocco, MS, RN, BC

Maggie Ciocco, MS, RN, BC, has over 25 years of experience in nursing education, including as a preceptor, mentor, staff development instructor, orientation coordinator, nursing lab instructor, and clinical instructor. Ms. Ciocco received her master of science in nursing from Syracuse University, her bachelor of science in nursing from Seton Hall University, and her associate degree from Ocean County College in Toms River, New Jersey. She has been an American Nurses Credentialing Center board-certified medical-surgical nurse for over 20 years. Throughout her years as an educator, she has established preceptorship programs in acute, subacute, and long-term care settings. She is a member of the National League for Nursing. Ms. Ciocco was awarded the Sigma Theta Tau-Lambda Delta chapter Hannelore Sweetwood Mentor of the Year award in 2012. As a nursing program advisor, she works with Registered Nurses and student nurses as they continue their education, mentoring and advising them as to career and nursing degree choices. She is the author of Fast Facts for the Medical-Surgical Nurse: Clinical Orientation in a Nutshell, Fast Facts for the Nurse Preceptor: Keys to Providing a Successful Preceptorship in a Nutshell, and Fast Facts on Combating Nurse Bullying, Incivility and Workplace Violence: What Nurses Need to Know in a Nutshell, which was awarded second place in the 2017 AJN Book of the Year Awards in the Professional Issues category.
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