Left Behind: Understanding suicide and its aftermath

The day 33-year-old Jordan Resh died, his twin brother Ian Resh had no inkling anything was wrong. Just as they always had, their morning routine began with two cups of coffee, breakfast, watching television and joking around.

Ian then drove their mother to a doctor’s appointment in Keauhou. A phone call later, Ian screamed so loud he could “hardly hear another sound.” It was “a terrifying scream” of panic, utter disbelief and grief. Though Ian and his mother, in total shock, sped down the highway toward their Kailua-Kona home, everything seemed to stop.

“I couldn’t believe it. I was crying like a baby,” Ian said. “I kept telling myself, ‘This can’t be true. This can’t be happening. Do something. Anything. Get there.’”

The caller was youngest brother, 32-year-old Adam Resh. He found Jordan dead in his bedroom.

An hour or so before, Adam woke up and joined Jordan in the living room for some television. They laughed and talked story. When Jordan went outside to smoke his usual half of a cigarette outside and then returned, only to leave the room again, Adam thought nothing of his actions.

Minutes passed, followed by a sound like that of a table falling over, which seemed to come from a nearby construction site. Adam eventually left the couch to look for Jordan. When Jordan wasn’t in his bedroom, Adam wandered around the house, looking into other rooms and calling out for him … to no response. The unusual red on his bed sheets made him stop and enter his own bedroom.

Turning the corner, Adam said his heart sank when he found Jordan on the ground. Jordan had used Adam’s gun to shoot himself in the head. There was “so much blood everywhere,” and in this shocking aftermath of suicide, Adam tried to make sense of what happened.

“So many things were going through my mind,” he said. “At first, I thought this was some kind of sick joke. Then time seemed to stop and everything moved in slow motion. I had tunnel vision, could feel myself crying, but also felt nothing at all. I felt numb and helpless.”

Confused and crying, Adam yelled Jordan’s name over and over again while cradling him. He desperately tried to help Jordan while waiting for emergency medical personnel, police and his family to arrive.

Exposing a silent epidemic

“Suicide is the single leading cause of injury death in Hawaii, where one life is lost every other day,” said Nancy Sallee, West Hawaii Suicide Prevention Task Force chairwoman and Orchid Isle Psychotherapy therapist. “I know of at least four suicides that occurred in Kona this summer. It’s a serious and growing problem in our state, one that people routinely have an aversion to talking about and is compounded with a lingering stigma. It’s a silent epidemic.”

According to a report from the state Department of Health Injury Prevention and Control Program, “there was an annual average of 170 suicides in Hawaii, with a peak of 200 deaths 2010, in the number of suicides in the state, by far the highest total in a 22-year period for which data was available.”

Sixty percent of victims from 2008-12 were Oahu residents, most of whom had a documented history of mental illness, according to autopsy records. However, Oahu’s fatality rate — 53 suicides per 10,000 residents — was significantly lower than the neighbor islands’ rates, the report stated.

Hawaii County had the highest fatality rate — 85 per 100,000 residents — over the past five years. Islandwide, there were 19 suicides in 2007, 28 in 2008, 36 in 2009, 29 in 2010 and 38 in 2011, the report stated.

Sallee said the number of suicides is likely higher, uncounted in the statistics because those deaths are possibly attributed to a motor vehicle accident, drug overdose, poisoning, falling or other accidental cause. Also, the media typically does not report on suicides as “reporting on this tender and tricky topic can do more harm than good if not careful,” she added. Certain kinds of news coverage has been shown to increase the likelihood of suicide among vulnerable people.

The report also indicates an increasing trend in people being treated in emergency departments for nonfatal, self-inflicted injuries annually. Hawaii Island and Kauai counties had significantly higher rates of such injuries than Honolulu and Maui counties. However, Oahu had the most, with 537 patients, followed by Hawaii Island’s 181, Maui’s 76 and Kauai’s 67. Sixty percent were younger than 35 and residents 15 to 19 years old had the highest rates of hospitalizations, especially emergency department visits.

Overall, the age of suicide victims was widely distributed in Hawaii, although 95 percent were 19 or older. The highest fatality rates were for those 45 to 54 and 85 and older. Men outnumbered women in suicide by three to one.

Forty-nine percent of the victims hanged or suffocated themselves, and 20 percent used a firearm. The most common negative life events for the victims were related to intimate relationship problems, usually a breakup or divorce, or serious illness and medical issues, the report stated.

Experts also ascribe reasons for suicide to pressures at home, school or work, financial worries, domestic violence, alcohol and drug use, severe depression and other mental health issues. According to the Centers for Disease Control and Prevention, warning signs include talking about wanting to die; looking for a way to kill oneself; talking about feeling hopeless or having no purpose; talking about feeling trapped or in unbearable pain; increasing the use of alcohol or drugs; acting anxious, agitated or recklessly; sleeping too little or too much; withdrawing or feeling isolated; showing rage or talking about seeking revenge; and displaying extreme mood swings. The more severe these symptoms are, the higher the risk, Sallee said.

Besides being a public health crisis, Sallee thinks suicide needs to be viewed as a preventable problem, one in which “all of us must see ourselves as part of the solution.” With knowledge and existing tools, such as effective prevention strategies and intervention programs, she stressed there are realistic opportunities for ordinary citizens to save lives.

“Preventing suicide is everybody’s business,” she said. “Most people with suicidal thoughts truly don’t want to die, but see no other alternative out of their dark hole and to escape their pain. But with help, these people can begin to see suicide is a drastic, permanent end to what is most likely a temporary problem. They can make the decision to instead stay alive.”

With reports of actor Robin Williams’ recent suicide, more light has been shined on this dark subject, including “how we’re all vulnerable and affected by suicides and suicide attempts,” Sallee said. “It also helps emphasize the point that suicide can strike at any time and occurs across all ethnic, economic, social and age boundaries,” she added.

Suicide needs to be a regular topic of conversation in the community, and the all-volunteer West Hawaii Suicide Task Force is among those diligently working to bring stakeholders and resources together into an effective force of change. Its motto is “no shame, no blame,” Sallee said.

The three-member task force meets the first Wednesday of the month at 3 p.m. at Orchid Isle Psychotherapy in Mango Court in Kealakekua. More members are welcome. To join, call Sallee at 333-8988.

Another key annual campaign helping prompt a more open public discussion on this issue is National Suicide Awareness Week, which starts Monday. Several events are being held this month through November on Hawaii Island in recognition of this week. Activities center on efforts that promote, support and increase awareness of suicide, as well as suicide prevention, intervention and recovery.

After a suicide

The void is still raw for Adam and Ian, who admit their brother’s suicide May 16 is often beyond their comprehension. Months later, the brothers say they, like so many of their family members and friends, struggle to come to grips that Jordan is no longer at their side.

Ian described Jordan as “the most outgoing, friendliest, totally original guy.” He did auto repair and had a passion for hot rods. Moving to Hawaii Island from Oahu, Jordan planned to have a fresh start.

“He was great with people, always laughing and making people smile,” Ian said. “He had so many friends who loved and cared for him. As a family, he had unconditional love and knew we always had each other’s back. He was brought up well and had a good life.”

Since his death, they’ve searched for a letter, any note, to explain why he’d taken his life. But nothing.

“He’s gone. It’s been hell,” Ian said. “These past three months, I feel like we’re all walking in a trance, zombie-like, not knowing what to do, what to say and how to move forward. Our family is in ruins, emotionally, physically. We’re aching inside. Every day that goes by, I try to be stronger. We miss him.”

As they grieve and go to therapy, Ian has agonized over missed warning signs: sad music Jordan listened to; his remarks about antidepressants not working and wanting to change medication; and his repeated questions about how to load a gun, initially thought to be excitement for an upcoming shooting trip. Ian also said Jordan struggled with alcoholism since age 15, and at times, depression, but always reached out for help and went to rehab several times.

Adam and Ian shared their story with the hope of helping others.

“Suicide rips a hole in your heart,” Ian said. “All your loved ones and those who care about you so much — those left behind — are left with thousands of questions and unbearable sadness while trying to understand why. We think and talk about you constantly. I want those who are thinking about suicide to know there’s always another way out of what they’re going through. Things that you think can’t be better can be and life can be good if you don’t give up and seek help.”

For Adam, life after Jordan has been as “worse as it can get.” He is “haunted” by images of blood and death and suffers from panic attacks.

“They say time heals, but no amount of time will heal this,” Adam said. “I just want others to know there’s always help, even if you’re so down and think this is the only way out. Suicide doesn’t free anything. It makes things much worse. Say something, anything please to get help. One word can change the whole outcome.”