I called my sister every day during the rest of the August and September before she died on October 6. She often wouldn’t pick up the phone but when she did our conversations focused on her fear and loneliness. She feared running out of money and hoped to sell her farm to gain some cash and reduce her expenses. However, in recent years she hadn’t kept up the huge old house and barn so that getting it ready for market was overwhelming. She fantasized of being rescued by a man who could solve all her problems with money and know-how and whose presence would make her feel secure. I tried to help her with practical matters, encouraging her to get financial advice and look at options for living more simply.

None of what I suggested appealed to her. It was obvious she didn’t think I understood what she was feeling. I didn’t, I see that now. In fact, I resented her unwillingness to take practical steps and her disparagement of my input. Our conversations often left me frustrated. It wasn’t like other situations I’d been in where the suicidal person I was involved with was my psychotherapy client who would usually at least respect my advice. This was my big sister and she’d never really taken me that seriously.

In the meantime, Carlton said her live-in boyfriend was helping her “get rid of stuff” at the house to stage it for sale. At first I thought this sounded like a good idea, but the more she talked about giving away expensive clothes, furnishings, jewelry and art, the more suspect I became. I asked her if she felt suicidal and she denied it. I asked her if she had a gun and she laughed and said no, certainly not. When I inquired about medications she might have on hand she got irritated with me. She said she was actually feeling so much better and that she and her boyfriend had plans to go to San Miguel for the winter. Even with all the "reassurance" I decided to go home as soon as I could after I finished teaching a week long DBT intensive training in San Diego. I dreaded making the trip to Louisville, another big trip in already busy fall season.

I was in the airport on my way to San Diego when heard from our other sister. “Carlton finally got rid of her horses,” she said, sounding pleased with this development. “Now maybe she’ll be ready to move into town.” My reaction was cold chills. I knew that selling her horses was probably not a good sign at all. But I didn’t want to believe what was now right in front of my eyes.

On the third morning of the intensive training I was deeply asleep in my hotel room when my phone rang. It was my other sister and she was sobbing. Carlton had just been admitted to the hospital after a suicide attempt. She’d taken a lot of pills and cut her wrists severely but was found by her boyfriend. We tried to make a plan for what to do when she got out of the hospital. We hoped they’d keep her in-patient for at least a few days.

That day I was scheduled to teach a module on suicide risk assessment and management. It felt surreal to be reviewing all the material I knew so well while my own sister was in the hospital. All day was as if I was sleepwalking, but my heart was racing, I was sweating and my head ached. At lunch I tried to reach Carlton at the hospital but she was sleeping. The next day my other sister called again to say that Carlton was already out of the hospital. They'd let her out because she denied being suicidal and they took her at her word. The psychiatrist had seen Carlton for a total of ten minutes. He suggested that her family try to find Carlton a new therapist.

During every spare moment of the next few days I focused on trying to find the best therapist for Carlton, someone with experience dealing with suicidal people. As someone who’d worked with many suicidal people I knew that expert help was crucial. With help from a colleague I found a psychologist at the University of Louisville and set up an appointment with him for my sister, who promised to go. Somehow I made it through the rest of the intensive and came home, exhausted and scared. I promptly came down with a bad chest cold.

I continued my daily calls to Carlton but she was harder to get hold of than ever. She was back in full avoidance mode, assuring she was much better and would never ever try to harm herself again. She told me not to be in a rush to visit. “I’m so busy getting the house ready,” she said cheerfully. When I asked about her horses she gushed about what a great new home they had with an acquaintance in Indiana. “He has a hundred acres of pasture,” she claimed, “It’s like heaven for them. “ Finally, she told me she’d found a “spiritual” therapist and told me to cancel the appointment with the psychologist at U of L. “I’m coming as soon as I get over this cold,” I said, angry and hopeless and very afraid. The was the last conversation we ever had.