Melissa Smith doesn’t remember much about Oct. 17, 2016.
The 26-year-old called out from her job as a licensed practical nurse in a senior-citizen facility that morning. Her recently estranged husband picked up their two daughters.
Around 6 p.m., her mother, Laurie Lehman, noticed a text message.
“Just wanted to tell all of you I love you,” Smith wrote.
Lehman, 45, didn’t realize her daughter’s father and five adult siblings had gotten the same message.
About an hour later, Smith tapped out a Facebook message to a neighbor in her Maytown, Pa., townhouse complex, 100 miles west of Philadelphia.
“Call 911,” Smith wrote. “My door is unlocked, but don’t come in.”
Responding to the call, Susquehanna Regional Police Officer Mike Kimes was climbing the stairs in Smith’s home when he saw a flare in the darkened bedroom ahead and heard an unmistakable sound:
Smith had put a gun to the area just above her eyes and fired.
The hollow-point bullet broke apart on impact, sending fragments of metal and bone into her brain’s frontal lobes. The bulk of the bullet zigged to the right, clipping her pituitary gland. Another large fragment kept tearing through her brain until it finally stopped, wedging in her neck.
The force of the blast shattered parts of her right eye socket and cracked her skull.
The bullet could have killed her in so many ways – if it had taken a different, even more destructive course; if infection had set in; if her care had been less speedy or less capable; if she had different luck.
Smith and Lehman are telling her story to encourage others suffering from depression and anxiety to seek help so they will not surrender to despair. Nearly as important, they say, is to bear witness to the role faith has played in Smith’s recovery.
“I feel blessed to be alive,” Smith said.
For Smith, the dark thoughts began when she was a preteen.
She remembers feeling worthless, “like I didn’t matter. Not good enough.”
Growing up on a farm in York County, Smith had friends and her big family to support her. When she was younger, her mother had their pastor come over to talk about the feelings she was having. But Smith always resisted sharing what was going on inside.
Smith got pregnant in her senior year of high school, giving birth a few months after graduation. She married her boyfriend shortly after.
“I had postpartum [depression] with my first pretty bad. I don’t know how long that lingered,” Smith said. “I felt alone.”
Her husband traveled a lot for work. Smith was used to a full house, but instead, it was just her and the baby much of the time.
When their first child was about 1, she took “a lot” of prescription-strength naproxen pills that her doctor had given her for back pain. She can’t remember how many. She doesn’t think she was trying to kill herself.
“I just wanted the pain to go away and to sleep,” Smith said.
When her husband, out of town for work, called to say goodnight, she told him about the pills. He called Lehman, who took her daughter to a hospital. Smith spent a couple of weeks in treatment at an inpatient mental-health facility.
For the next several years, her depression waxed and waned.
She went back to school and became a licensed practical nurse. She had another daughter. Sometimes, they even felt like a family. Those were the good times.
“But then I would get down,” Smith said.
For about five of those years, she took medication for depression and anxiety, but after a while, she thought it didn’t help. She stopped taking it two years ago.
She kept her bad feelings mostly to herself, and began hanging out with people she thought were her friends.
Smith drifted away from her family and faith. Her marriage began to crumble. Then, last spring, she moved into her own townhouse.
Lehman disapproved of her daughter’s actions. She told her that couples should work out their differences together.
“You love me, but you don’t like me,” Lehman remembers her daughter telling her.
Eleven days before her suicide attempt, Smith filed for divorce.
Smith says she can’t remember planning her suicide attempt. But when the police released Smith’s phone to her family, they saw the signs – messages about death alternated with passages from Scripture. The worst were the photos of her gun, set among flowers.
“It was a dark world for her,” Lehman said.
Signs of life
Witnesses have pieced together what happened after Smith pulled the trigger: Kimes, who held her broken head in his hands, imploring her to stay alive. The Lancaster Medical Center staff who stabilized her and controlled the pressure on her brain. Her family members and their pastor who prayed for her. One of her sisters who sang “Amazing Grace” at her bedside. Then the flight to Penn Presbyterian in Philadelphia, where a team of doctors painstakingly worked to give her back her life.
“She’s made a remarkable recovery physically,” said James Schuster, director of neurotrauma at Penn.
When Smith first arrived at Penn Presbyterian, her prognosis was unclear.
A team worked to further control pressure on her brain, which could have been life-threatening. An endocrinologist handled the pituitary gland injury, which was affecting the balance of electrolytes and water in her blood.
Doctors knew more extensive and detailed surgery was needed, but first they were looking for signs from Smith.
“The damage of the bullet was pretty significant,” said Phuong Nguyen, Penn’s director of adult craniofacial surgery. “All of us were watching and waiting to see if she had any brain function.”
She began to show them – wiggling toes on command, giving thumbs up.
“Miraculously, she started demonstrating purposeful movement and enough brain function that we all said, ‘Let’s go for it,’ ” said Nguyen.
Eight days after Smith shot herself, the team went into surgery.
Schuster removed a portion of the front of her skull so he could clear out dead brain tissue and bullet and bone fragments. Dura, the covering that protects the brain, was repaired to prevent leakage of cerebrospinal fluid, which helps cushion the brain and prevents serious infection. The base of her skull had to be rebuilt to separate her brain from her sinuses. Metal plates, screws, and grafts of her own bones were used to put her skull back together.
When Smith arrived at Penn, her right eye socket had been shattered, her eyeball bulging out of her head like that of a B-movie villain. To reconstruct the eye socket, Nguyen used moldable titanium mesh and some of Smith’s own inner skull to lessen the likelihood of infection.
Two additional surgeries were needed – including one to treat an infection that threatened her brain.
“Who did this?”
“Sorry” was the first word Smith blurted out when her feeding and breathing tubes were removed three days after the surgery.
Exactly what was in Smith’s mind when she said that word, she doesn’t now remember, but about a week after the tubes came out, Lehman asked her daughter if she wanted to see herself. Smith had just been told her injury was from a shooting.
When she looked into the bathroom mirror in her hospital room, Smith asked, “Who did this?”
“I said, ‘You did,’ ” Lehman recalled. “And she just shook her head no.”
Her mother told her what had happened. Smith started to cry.
“I said, ‘What are you thinking?’ She said, ‘That my girls could have been without their mom.’ ”
During Smith’s hospital stay, as the doctors and nurses tended to her body, her family sought to bolster her spirit with their prayers. They played soothing hymns at her bedside. Verses of faith adorned her room, such as the Genesis story of how God brings good from evil to those who trust in him.
Words from Matthew came to have special meaning. The morning Smith’s parents drove to Penn to be with her after the shooting, Lehman, standing on her porch, saw the sun bursting through the trees in a way she had never seen before. To her, it was a sign. She took a photo and made a poster for her daughter’s room: “The people living in Darkness have seen a great light, on those living in the land of the shadow of death a LIGHT has DAWNED!”
When Smith’s bandages were removed, the pattern of the stitches resembled the sunburst.
Smith still has substantial scars, physical and emotional.
She lost the sight in her right eye and hearing in her right ear. She also lost her senses of smell and taste, most likely from damage to her olfactory nerves. Her emotions are muted, and she has headaches every day.
Despite her doctors’ best efforts, she will never look quite the same. That bothers her.
In May, Smith had an additional reconstructive surgery; Nguyen took fat from her abdomen to fill out some of the contours of her face. She has at least one more surgery planned to further increase her facial symmetry and reduce the sunburst-like scar on her forehead.
The bullet fragment in her neck, detectable by a light touch, serves as a constant reminder of the day she tried to end her life.
Throughout her treatment, Nguyen has been impressed by Smith’s spirit, her strength.
“I’ve now had perhaps half a dozen patients who had suicide attempts and survived,” Nguyen said. “The common theme, regardless of race, age, creed, social status, is they are very happy to have survived.”
Imagining a future
Another common thread — those who recover don’t do it alone.
“They have a superlative network of unconditional love,” Nguyen said. “Sometimes that’s not recognized until unfortunate events transpire.”
That can also be true of loved ones. Lehman said it was hard for her to get past the guilt she felt over how she had reacted to some of her daughter’s choices.
Lehman’s advice to other parents: Guide your children, but make sure they know they are loved.
“There’s a light at the end of the tunnel, and it’s not a freight train,” Lehman said. “God created each person for a reason. You are not here by mistake. He has big plans for your life. Don’t give up. Look up.”
Smith says she is doing that. Prayer has become part of her recovery. She is grateful to be here, and she is facing her depression.
She now takes antidepressant medication and sees a therapist weekly. Every other week, she meets with a traumatic brain injury specialist who is helping her learn to cope with how her brain now works. In conversation, Smith is thoughtful and clear. But her short-term memory plays tricks on her. Something she thinks happened days before may have taken place that day.
Smith does allow herself to imagine the future, to dream.
She is trying to arrange vocational therapy to help her go back to work. She looks forward to when she can drive again – she will be able to despite her vision and cognitive compromises – and being as independent as she was before. She currently lives in an apartment attached to her family’s farmhouse.
For now, Smith is focusing on reestablishing the routines of life – cooking, cleaning. She spends time with her family and goes out with friends. She helps out in her family’s feed store, though she requires more rest than she did before.
And she has her girls, ages 5 and 8. Their father has legal custody, but she sees them a few times each week. Going to their T-ball and softball games is a joy. Smith hopes to establish shared custody in time.
She would also like to go back to college to become a registered nurse. Her hope – “my passion” — is to work with people with dementia and Alzheimer’s.
In April, six months after she put a gun to her head, Smith’s friends and family threw a surprise 27th birthday party to celebrate her life.
She says she doesn’t feel depressed, “which is the first time I can say that in years.”
For others who find themselves in the same dark place as she was, her advice is tell somebody, get help.
“People care about you,” Smith said. “Even when you feel like they don’t, they do. You matter.”
How to get help
Every 13 minutes, someone in the United States takes their own life.
Suicides in the U.S. rose 24 percent from 1999 to 2014, according to the most recent figures available from the Centers for Disease Control and Prevention (CDC). It is the 10th leading cause of death.
Males take their lives at almost four times the rate of females and represent nearly 78 percent of suicides. Women are more likely than men to have suicidal thoughts. Men are more likely to use firearms, while women are more likely to use poisoning. In 2015, the most recent year for which data were available, nearly 44,200 people killed themselves.
Depression is common among people who consider suicide. So are feelings of anxiety, irritability, loss of interest, humiliation, and rage.
About 16 million people age 18 or older experience a major depressive episode in a given year, nearly 7 percent of all U.S. adults, according to the Anxiety and Depression Association of America. The lifetime risk for major depression is about 17 percent. A recent study published in Transitional Psychiatry found that by the age of 17, more than 36 percent of girls and almost 14 percent of boys are or have been depressed.
But depression and anxiety are treatable, and suicide can be prevented.
Signs to look out for are isolation from family and friends, withdrawing from favorite activities, sleeping too much or too little, saying goodbyes, and giving away prized possessions.
Resources for help:
National Suicide Prevention Hotline: 1-800-273-TALK (8255)
City of Philadelphia Department of Behavioral Health and Intellectual Disability Services hotline: 215-686-4420
New Jersey Hopeline: 1-855-NJ-HOPELINE (654-6735)