The Things We Don’t Say: A Short Story

By: Em Quiles Editor

Trigger Warning: This post may contain material that is triggering for some.

It was a little past 5:00 p.m. on a beautiful Spring day. The sun was shining, the weather was breezy, birds were chirping. Inside, I was wrapping up my workday. I grabbed my cellphone, hesitated for a moment, then proceeded to call my primary care provider’s number. “I need help,” I said in a tempered voice with tears roaring down my face as the receptionist urgently sought a medical professional. I didn’t know what that even looked like – ya know, getting help. All I knew was that whatever I was doing up to that point was not working. As I waited for her to get a Nurse on the line, a barrage of “I’m beyond help” thoughts flooded me, and I hung up the phone. I sat at my desk and sobbed. I felt so hopeless.

The truth is, I have battled depression and anxiety for as long as I can remember. It is one of those things that I can’t imagine how it would feel NOT to have. Like hemorrhoids, it shrinks and enlarges whenever the hell it feels like it. Aggravated by quite literally anything – seasons changing, life challenges, planets aligning inconveniently – it is something that I have to regularly re-learn how to live with. Managing my mental health can be incredibly difficult in and of itself. Still, it is even more challenging when you come from a cultural background that has conditioned you to perceive mental health issues as that beggar in front of the corner store – everyone sees him, but everyone pretends he doesn’t exist, thus leaving you with little to no resources to help you manage. Living with depression and anxiety is like going on a lifelong road trip with your asshole friends. Some days you are in the driver’s seat leading the way while they’re in the back eating their snacks quietly, and other days you’re bound and gagged in the trunk, battered and bruised, crying helplessly for no reason and for all the reasons while they’re recklessly driving under the influence. But no matter what, none of you can ever get out.

Not that I endorse violence, but I fully support the idea of kicking people in the shin that ignorantly suggest to just get over it. It is like they’re yelling at you to just swim to the shore when you’re drowning while they are standing on dry land. Just because we’re drowning does not mean we don’t know how to swim. In fact, the majority of drowning victims know how to swim. But I digress. 

I looked down at my phone: 2 missed calls from Reliant Medical Group. I lowkey regretted calling them. In my mind, I replayed all the times I’ve received treatment for my depression, and I didn’t feel like going through it all over again would be of any benefit. Not wanting to be rude though, I finally answered their call. “This is Nurse Practitioner So and So. What’s going on?”

I couldn’t articulate what I was going through because when it comes to mental health, it is difficult to sort out your symptoms from your emotions since your emotions kinda are the symptoms but not really. It is easier to say I’m in pain because I broke my arm versus I’m crying because I feel like a failure when in reality, it is because your ancestral DNA came in like Maleficient and gifted you a brain that doesn’t know how to balance its chemicals from time to time.

On the phone still, I began to explain my symptoms as best I could. “I cry, all the time” while crying seemed like the obvious starting point. After giving an overview of my mental state, she prescribed me Lexapro – an antidepressant, and immediately sent it to the pharmacy. “A behavioral health clinician will follow up with you tomorrow,” she kindly advised me as we wrapped up the call. I still felt very overwhelmed, but making the call somehow felt like a small accomplishment, and I felt slightly better. Understanding that antidepressants are similar to vitamins in that you have to take them every day in order to see long-term results, I began taking the medication right away. It was the best thing I could do for myself at the moment. 

The following day, Matthew from Beacon Health met with me via Telehealth video. I felt that I needed to be as transparent as possible if I wanted my treatment to be successful this time around. So I laid it all out. I had been severely depressed for several months and progressively worsening. My anxiety was so bad that my chest would hurt with every thought that came into my head. I often felt like I was having a heart attack. It felt like I was hyperalert in a painful way and had an overwhelming feeling of impending doom. Everything just felt loud. By that point, my diet consisted of coffee in the mornings and over-the-counter sleeping aids in the afternoons, causing me to lose an alarming percentage of my body weight and would later cause significant hair loss. I cried every waking moment and would go to sleep praying I wouldn’t wake up. I would have recurring nightmares. I had difficulties falling asleep and staying asleep, but I tried to sleep as much as I possibly could because it was emotionally painful to be awake, yet despite sleeping so much, I felt like I hadn’t slept in months.     

“This may not be what you want to hear, but given the gravity of your mental health, I have t–” I didn’t let Matt finish because I already knew where he was going. Every state has its own version, but Massachusetts’ laws allow mental health providers to pretty much commit you against your will to a minimum 3-day stay at a mental health facility if you present a risk to your own safety. Not unlike anything else in this country, people of color are more likely to have coercive responses to their mental health crises by healthcare professionals and are involuntarily hospitalized at higher rates than white people. Nothing like a bit of racial disparity with a side of systemic oppression to get your motors running, amirite. 

Despite my inability to function at my fullest, I still had the presence of mind to advocate for myself. “Matt, I guarantee you that I’m not going anywhere against my will. If you want to commit me, you will have to send the police and they will have to drag me out kicking and screaming.” After stating my case, I continue, “So, do you want to fight me or do you want to help me?” Resigning to the fact that I wasn’t going down without a fight, he opted for the latter. Because even though I wasn’t sure about what I needed explicitly, I was absolutely certain about what avenues would not work for me.

How did I know? Because this wasn’t my first rodeo. Being previously committed against my will only resulted in my compliance to do my time and get the fuck out with no follow-up. The fear of this very situation is what made me reluctant to reach out for help in the first place. The way I saw it though, me reaching out and being fully honest about how I was feeling spoke to my ability to make decisions that were in my best interest. I also wasn’t about to drop everything to go stay at a hospital somewhere just because this guy who doesn’t know me from a hole in a wall said so. “It is going to be very hard to find a psychiatrist that is taking patients right now,” he says. “I bestow upon you my confidence in your abilities to figure it out,” I replied. Alas, Matt would eventually end up spending three hours on the video call with me, ensuring that I was safe while at the same time trying to find me help. I don’t know why, but I was oddly at ease by the distressed look he had on his face while frantically calling everyone and their momma trying to figure it out. 

Regulating: What’s the Plan?

Matt and I managed to work together on a treatment plan that would work for me. We compromised on a Partial Hospital Program (PHP) at Saint Vincent, which I would be starting within the next few days. Because I wasn’t just snatched away into a psych ward, I was able to discuss my leave options with my employer in order to prepare to take the necessary time off adequately. Thankfully, I was able to take medical leave through the Massachusetts’ Paid Family and Medical Leave (PFML), even though I was not eligible for FMLA. 

The day before I was to start the PHP, I did an intake with a Clinician via Zoom. We went over the administrative side of things to make sure everything was all set. “You’ll be in the program for 2-3 weeks, at which point we will re-evaluate and either extend the time or discharge you, as needed,” she advised. The PHP would run Monday through Friday, 9:00 a.m. until 1:00 p.m., all virtual. I was all in.

The following day, I joined the Zoom meeting and felt a little relief that I didn’t recognize anyone. There were about ten or so other patients. We were all strangers but would soon discover we shared a lot of commonalities. After doing my daily check-in, I left the group meeting to meet with a psychiatric-mental health nurse practitioner, Cheryl Kemp. We went over my symptoms, medications, and medical history in full detail. She was very thorough and made me feel at ease. She adjusted my medications to increase the dosage of the Lexapro and added Mirtazapine, another antidepressant, to help with my sleep and appetite. 

After meeting with Cheryl, I headed back to the group Zoom meeting. “I don’t want to be here; this is stupid,” the little voice in my head would scream. “STFU already, I’m trying to pay attention!” I would eventually shout back (internally, of course) because nothing was going to impede my wellness journey, not even myself. 

The PHP is a form of group therapy held through Zoom, making it a little challenging to be engaged and present, but somehow it works. Each day, we would do check-in at 9:00 a.m., where we would go one by one discussing what we did the day before, what we struggled with, how we coped, and our intention/goal for the day. Then there would be two workshops afterward about varying topics, such as learning different coping mechanisms, dialectical behavior therapy, ways to identify trauma responses, etc. Then we would end the day by doing a check-out, where we again go one by one, making sure everyone is safe and discussing what we’ve learned and our plans for the afternoon, etc.  

In addition to the Clinician staff, interns would sit through the programs and sometimes run the programs themselves. New patients were coming and going nearly every day. Everyone had their own journey, which was part of the beauty of the program. Some of us were just starting, and others were on the tail end of their partial hospital stay. They respect your privacy, so no personal details are shared; no last names, place of employment, details about your traumas, stuff like that. It is designed to give you the tools you need to identify and cope with your traumas in a healthy way outside of the program. 

It was incredibly healing to be in the same room with other people who struggled with a lot of the same things I did. In many ways, we bonded, and holding space for each other to cry and be vulnerable helped nourish my soul in ways I didn’t expect. 

Reckoning: You Are Not Your Trauma

Group therapy helped me realize a lot of things about myself and my trauma. Not that I didn’t already know, but it allowed me to gaze within in a healthy way. At the core of my mental health struggles is that I inherited my parents’ greatness. I also inherited their demons. 

My father was a musician. He was in a salsa band, which was popular with the ladies at the time, my mother being one of them. If I had to name three things he loves, it would be baseball, music, and himself. From what I remember, he spent some time in jail. We never had a relationship. My mother was a very gifted woman in her own right. Her life was maintained by her ability to create. She was highly creative and very crafty with her hands. She sometimes taught arts and crafts at the Boys and Girls Club, and sometimes she would work in beauty salons as a hairstylist but was always creating and selling her crafts. She made the best food I’ve ever had – her rice pasteles were quite popular. She also loved to read and was an incredible salsa dancer. With a fourteen-year age difference, my parents married and then divorced after four children, myself being the youngest. 

It was the 70s and 80s in Chicago. Their marriage was fueled by endless party nights, drugs and alcohol with a splash of domestic violence, which would be no different than any other of my mother’s subsequent relationships. Left to care for us alone after the divorce, we moved with our mom to Puerto Rico and would later hip and hop to and fro Trenton, NJ. She tried her best with what she could, which wasn’t much. She wasn’t very proud of herself and self-medicated with alcohol and cocaine. She was the life of the party, but as a parent, she was very neglectful and didn’t know how to be affectionate. We moved around very often due to unpaid rent, which would result in me attending a different school for every grade, eventually dropping out of high school as a pregnant teen. We lived in rough neighborhoods; not the worst but not the best either. You name it; I saw it – violence, drugs, gangs, etc. A lot of things that are too painful to share, many things too painful to remember. And yes, even #MeToo. I grew up having a conflicted love/hate relationship with my mother. The woman in me understanding her pain; the child in me resenting the neglect.

My mother passed away in 2006 at the age of 45 due to complications from AIDS. She was alone with my sister while I was miles away in New Jersey. I visited Puerto Rico shortly before her passing and then later for her funeral. It would be another 14 years before I would go back to the island in December 2020. Returning to the home that held so many painful and beautiful memories, along with the memories of the last few moments I shared with her, would reopen many wounds that I was not prepared to face. Visiting her grave, I realized that I never properly grieved her loss. I don’t know that I ever will. 

I sometimes wonder what I would say to her if the person I am today were friends with the person she was when I was growing up. It is true that as adults, we try to become what would’ve healed our parents. 

I’m still trying to work through it in therapy.

The Things That Worked

In the midst of this, I also happened to have a pinched nerve in my neck, causing me distressful pain that wouldn’t go away after several weeks. I tried everything for the pain, including cortisone injections and CBD cream, and nothing worked. As a last resort, I decided to give edibles a try hoping to reduce the inflammation and ease the pain. So I marched down to New DIA (now Cookies) on Cambridge Street and snatched up some goodies. Sheesh! I can’t say for sure that the edibles healed my pain, but my pain went away after I started taking them, so you do the math. And because I’m not a regular marijuana smoker, it didn’t take much for me to feel the effects. I got a cookies N cream chocolate bar made with a Sativa strain, which gave me a full-body high a/k/a put me to sleep. I also got some energizing peppermints made with an Indica strain that gave me more of a head high while still leaving me with an energized feeling. Both made me feel relaxed, which helped with my anxiety and with my sleep. And as an added bonus, it gave me crazy munchies, which also helped me gain my weight back and then some.

The THC, antidepressants, and PHP group therapy were the trifecta I needed to get back on track to managing my mental health. However, none of it would have been successful without the essential factor to make the formula work, and that was my commitment to healing. 

Fully committing myself to my wellness took a lot of strength. Things had to get worse before they got any better. The same way caterpillars turn to mush before they become butterflies, we have to cut into ourselves to let the ugly ooze out. Recognizing that mental health management is a lifelong journey is also important. I hadn’t realized it then, but picking up the phone to ask for help was an incredible act of self-love. Especially when you’re a strong person like myself that doesn’t know how to ask for help in the first place. Just as important is recognizing signs that your mental health needs tending to before getting to that dark place where many don’t come back from. 

Everything Will Be Okay.

It was a breezy Spring night. As I sat on my bed, I reflected on my life. I thought about the different ways I was loved and how my mental health sometimes gets in the way of me accepting it. I thought about the handful of friends who would check up on me knowing I wasn’t doing well; the one that would answer the phone when I was drowning in tears and just sat on the other end quietly, allowing me the space I needed to break down; the one that took me hiking when I didn’t want to; the ones that would pray for me; the ones that showed me love in their own way; the family members who would cook for me because that is the way we say ‘I Love You.’ I practiced forgiveness for all the times I didn’t feel like I was worth it; for all the adults that failed me when I was a child because it was never my fault; for being so close to giving up. Then I promised to love myself unconditionally, through thick and thin. Grateful, I smiled and whispered, “you are enough.”

As the rain crackled against my window, I closed my eyes and drifted off to sleep, fortunate to live another day. Many people are not lucky enough to make it out alive.