Stinker cat forever

The righteous perish,

and no one takes it to heart;

the devout are taken away,

and no one understands

that the righteous are taken away

to be spared from evil.

Those who walk uprightly enter into peace;

they find rest as they lie in death. —Isaiah 57:1-2

“I have some really bad news.”

My wife called just as I was submitting a letter to the Journal of the American College of Cardiology. I was already upset. The online submission editor kept rejecting the figure I had created to accompany the article. The figure had two panels, one a graph and the other a table of the graphed data with statistical analysis.

“Figures are allowed two panels, but tables are allowed only one” read the email from the editor. I was trying to figure out how to put the data in the figure without using a table so as not to run afoul of what seemed a ridiculous, arbitrary rule. In the moment this seemed important, even very important. It would only be later, what felt to be a lifetime later, that I would complete the submission.¹

“Are you sitting down?” I could tell that Andrea had been crying.

For several months I had prepared myself for this call. Now it had come. Our 15-year-old miniature poodle had been getting more and more feeble. Blind and arthritic, he could no longer climb stairs and he depended on us to carry him outside when nature called. I imagined my wife returning home from work to find him cold and motionless, perhaps lying on his customary pillow next to our bed. I thought to myself that “really bad news” was a bit dramatic. But the dog had been an important part of our family, growing old as our two sons had grown from children into young men. Now he was gone. It was sad, but I didn’t think I would cry.

“A police detective is here.” There was a pause.

“Greg killed himself this afternoon. Workmen found his body. He jumped from a cellphone tower.”

I am surprised that I remember these words. More likely I don’t and have just made them up. I just know that is what she said.

All the air left my body. I took in one giant breath slowly and then screamed for the first time in my life. The neighbors probably thought I was being murdered, slowly, and with a very dull knife. My wail steadily increased in volume and intensity. I stood up and walked into the living room of the small home near the hospital where I stayed when attending on the cardiovascular intensive care unit (CVICU) service. I walked into the living room and doubled over on the couch. I took in another deep breath and let out a sound like all my life force was leaving my body. All I could do was to stammer “no, no, no” over and over and over.

I carried on for a good 5 to 10 minutes before collecting my thoughts enough to ask Andrea if she was okay. She was not. Her mother and sister were on their way.

I called the chief of medicine. John came to the house, hugged me, and did his best to calm me down. He then drove me home to Austin. I didn’t even think to call Denise, the CVICU fellow on call. Suddenly, I was just gone. Steve, the CVICU director, stepped in to take over my service. Death, forever present in the ICU, had breached the walls of the hospital and entered my own life.

I was gone, utterly and altogether, for 3 weeks. I don’t have a chronology of that time. I remember that many, many friends and family visited. My sister flew in from California; friends came from near and far. A high school friend I had not seen in over a decade flew in from London. I know that so many people came to our home that Andrea said she was going to kick the next person who tried to hug her.

Our oldest son, Brent, was in Japan on a solo trip after graduating from college. We had planned to fly out with Greg and meet up with him near Tokyo later that same week for a 2-week family vacation. Now that trip would never happen.

And worse, we had to tell Brent.

Andrea called the American consulate in Osaka. Perhaps they could contact Brent and have him come to the consulate where he could be with other people when he got the news. Unfortunately, they couldn’t help. Certain rules had to be followed, and they were understaffed. We learned that things like that only happen in movies, not in real life.

I texted Brent telling him he needed to call me. He texted back that he was on the subway heading to a youth hostel in Tokyo. I desperately wanted him to be with somebody, anybody, when we talked. I texted that I had bad news and wanted him to be someplace safe when we talked. He rode on, confused and worried, almost missing his stop.

Twenty minutes later he texted that he had arrived at the hostel and was not alone. The manager was there, a small reserved elderly woman who spoke only Japanese. But she was a person and she was there. That would have to be enough.

I cut straight to the news, telling him that Greg had died.

After we hung up, I shelled out an obscene amount of money for a one-way first-class ticket home on the next available flight. It was the only comfort I had to offer. Only later did Brent tell me that he had flown seated next to a dog, who had its own berth.

The world is absurd at times. Your brother dies, and you spend that night trying to sleep in first class on a jumbo jet with a dog barking and whining in the next seat next to you. Brent never saw the owner. Perhaps the dog was flying solo.

We buried Greg in a cemetery within walking distance of our home. It is a beautiful space, with stone walks set among trees and flowering plants. A spring-fed stream runs through it, creating a waterfall next to Greg’s marker. I had never noticed the Remembrance Gardens in the two decades we had lived in the area. Now I am not able to miss it, seeing it on each and every drive to work or trip to the grocery store.

At the internment, my brother-in-law George played “Wish You Were Here” by Pink Floyd. It seemed appropriate, having been written as a tribute to Syd Barrett, who struggled with mental illness that derailed his career. We wrapped up with “Amazing Grace” and all cried. My father-in-law stepped forward to remind us that Greg’s great, great, great, great, great grandfather, “Singing Billy” Walker, had been the first person to put Amazing Grace to music. It had been published in a songbook called Southern Harmony printed in 1847. The book, in various forms, has been in print ever since.²

Four years later, my mind remains a house divided. Reason tells me that Greg died of depression. He had seen psychologists and psychiatrists. He received both counseling and medications. Like other teenagers, he had self-medicated as well. Reason tells me he died of an illness and that he died from a disease beyond his control—little different than the death of a patient admitted to my ICU with a heart attack. Yet my heart remains broken, shattered and in pieces. And I blame myself every day. Why did I spend so many days and nights in the hospital caring for others and fail my son in such a profound and irreversible way?

Greg fought so many battles in his 19 years, and I was so proud of him. But I felt helpless, sitting on the sidelines trying to balance a respect for his autonomy with a parent’s desire for control. He had dropped out of college in his first semester the previous year. He had found work and an apartment on his own initiative. He lived and supported himself without our assistance but came home each weekend for a family dinner. I told myself he was going through a phase and was reassured by the tales other parents told of children who experienced setbacks before getting “back on track.” Absurdly, when he died, he had a balance of $8000 in his checking account.

He was a good, kind, and conscientious son, who ran errands for his mother and walked our 15-year-old dog every day, even on the very morning of his own death.

As a child, Greg had invented an alter ego he called “Stinker Cat.” Stinker Cat could be unpredictable and outrageous. He played pranks and served as a mask behind which Greg could overcome his natural reserve and shyness. In kindergarten, his best friend Shawn once asked to be Stinker Cat, to which Greg loudly exclaimed “No! Only I can be Stinker Cat!” We had all laughed, marveling at his independence and imagination.

Government statistics report that in 2018, 6211 boys and young men aged 15 to 24 died by suicide, a rate of 22.4 per 100,000. This number is almost certainly too low, given social and religious taboos surrounding death by suicide. Many more are likely described as accidents, with deaths being attributed to car crashes and overdoses. The death rate is highest among White and American Indian males, 30.4/100,000 and 34.8/100,000, respectively. Suicide is the second leading cause of death for this age group. And these represent just the tip of an iceberg of pain and suffering. Nearly 12% of individuals aged 18 to 25 reported suicidal thoughts in 2019, and nearly 2% made suicide attempts that same year.³

Death by suicide, and the suffering that surround it, often goes unspoken and unacknowledged. Yet it deserves attention and recognition as the major health threat that it has become. Immediate action is needed to improve access to mental health services. Urgent and emergent care can be especially hard to find, especially in rural areas. Most importantly, these services should be available independent of insurance status or an individual’s ability to pay.

At the moment, we know very little about the physiology and pathophysiology of depression and mental illness. Significant research lays ahead of us. The effort to understand, treat, and ultimately conquer mental illness deserves the same priority we give efforts to combat terror, drugs, cancer, cardiovascular disease, and infectious diseases.

But families and the loved ones of victims need to know that they are not alone. We are here, and we are many, but we have been silent for too long. It is time to speak up.

There will only ever be one Stinker Cat. And he is missed beyond all words (Figure 1).

Figure 1.

June 20, 2020, Remembrance Gardens, Austin, Texas.