Why this matters
What if we could reimagine athlete mental health treatment to catch up to the enormous resources we pour into sports performance?
Mikaela Brewer is a multi-disciplinary published author and qualitative researcher. She has played basketball for Team Canada and Stanford University where she studied human biology (brain, behavior, and mental health), creative writing, and science communication. Mikaela writes and speaks about her experiences as both a suicide attempt and multi-suicide loss survivor, exploring how these painful events intersected with her career as a student-athlete navigating a complicated mental healthcare landscape. She is currently working on a second novel and designing a PhD project that will braid suicide prevention with poetry, language, and storytelling.
I need to tell you a story, which, as you know, I don’t often do. While surveying the multiverse the other day, I was struck by two worlds – yours, and another remarkably similar to yours: Earth #988. There is one difference. Not quite an opposite. You seem to have what the other desperately needs.
You have a working physical healthcare system. Earth #988 has a working mental healthcare system. What is fascinating is that Earth #988’s physical healthcare system is a mirror of your mental healthcare system. Imagine.
This is a painful window to look through. But it is a privilege to learn from pain without living it.
I have told Earth #988 your story. Now, you must hear theirs.
A young woman opened a letter, softened by the rain or perhaps tears. It was only a few lines of smeared, desperate writing, unlike anything she’d received.
When I was a little girl, my grandpa told me that if something was printed in the newspaper, it must be true. I’m older now, and I hear his words more clearly. But my best friend died. And there was nothing I could do about it. Please tell me the truth. Is hope real? Is there such a thing as miracles? Is there something out there to believe in?
The woman’s fingers trembled around the damp page and the depth of the questions. She felt her gut respond: no. But the address was from campus, not more than a few miles up the road. Her throat felt dry. She had heard the girl’s name before in the paper. Elvira was an athlete.
The woman was a former athlete herself. When she retired a few years ago, she channeled her competitiveness into writing. She fought to publish all that no one seemed to see or hear while she was an athlete. Rage caught fire inside her. But no matter how brightly her rage flickered, her words didn’t seem to lead to change.
The world feels different to her now, years later. She used to watch the leaves turn like traffic lights outside her office window: green, yellow, and red. Then they crisped into copper, caramel, wood, and golden brown as if taking the world’s color with them. Everything appeared aged and faded. The earth’s soil sought reclamation.
The woman’s thumbs fit into the grooves in the paper, caved in from where it had been dampened. Damp. The room’s carpet smelled damp too – musty, even – and had begun to curl away from the wall. The dehumidifier was full. Again. She didn’t know the last time it had been emptied. A small pile of leaves collected beneath her desk, brought in from hours pacing unraked sidewalks. Her fire was smothered to white ash as the leaves pitter-pattered against the desk’s legs, knocking softly, like bits of discarded paraffin paper.
We’ll return to this woman soon.
Those few miles up the road, just days before, Elvira was driving to her teammate’s dorm. Two young college skiers, much like many young athletes: relentlessly hard-working, fearless, faultless, stout, and imperishable. They don’t know how – or if it’s OK – to be anything else. This is what makes them vulnerable in both your world and theirs.
Elvira thumped the wood door with the meat of her fist. Fragile with age, the door rattled in its rusted hinges. Elvira figured Ottie’s nap alarm hadn’t gone off, but thought that the noise of the cardboard-thin door would wake her. She kicked the door with her boot to make sure Ottie could hear her. They were already late for practice.
“Dude. The car is running outside. I’ve been waiting for 15 minutes!” Elvira put her ear to the door. She could usually hear a pin drop through it, but there was no sound. Not a stir, stretch, sigh, “f*** off,” or deep breath. She thought maybe Ottie had left, but her car was outside. The snow had fallen for a steady four hours, cleanly coating the windshield in a white duvet. The unfashionable lateness wasn’t unusual. The silence was. Ottie, almost always, met Elvira with something to say.
Elvira’s voice had fallen hardly above a whisper. She shook the knob, but the door didn't budge against the steel frame. Starting to panic, she took a few steps back and kicked the door once. Twice. Down.
Ottie looked so calm. So still. Motionless on the thin, navy dorm mattress. Her eyes were hardly open in a gentle, haunting gaze. Elvira’s eyes followed the peel of the sheets, clothes, and strewn mattress pads, soaked together by the salty sweat which created a shaded halo around Ottie’s body. The room was so cold that Elvira could see soft layers of heat lifting into the air.
Ottie was among the most talented skiers in the country. Elvira was close behind. Best friends since their freshman year three years prior, they were riding the crest of success until about six months ago. Ottie fell during practice, shredding her ACL among other ligaments and tendons in her knee.
Read More: When We Were Patched
Nobody at the university knew how to help her. Her coaches and trainers had only a rudimentary knowledge of anatomy and physiology. She had access to limited funding for specialists, and the healthcare center was miles up the road. Elvira found her at the point where Ottie’s pain had worsened until she couldn’t survive its plateau and the injury killed her. Aside from knowing that something shifted when Ottie fell, Elvira hadn’t suspected that anything was dangerously wrong.
Elvira saw then that Ottie was as intentional with what she shared as with what she withheld.
Elvira crossed the canyon of crappy carpet between the doorway and Ottie. Her eyes fell on the squished wet pillow beneath the lofted bed, and the painful arc of Ottie’s neck without it. She stumbled and caught herself on the edge of the nightstand, nausea and dizziness swirling her focus. Her fingers crunched into Ottie’s phone. It was still recording. A red line indicated that the sound in the room had fallen flat seven minutes ago. Elvira’s fingers shook over the “stop recording” button. She let it run, turning her gaze to the bed.
“Ottie? You’re OK. You’re OK.” Elvira touched her cheek – still burning. She fumbled around Ottie’s desk for something reflective. Compact mirror. She held it beneath Ottie’s nose and checked for a pulse. A series of silences stared back through the unfogged glass.
“You’re OK. You’re OK. You’re OK. You’re OK. You’re OK.” Elvira fell to the floor with the words. Her eyes slowly traced the small box of a room, her body nearly convulsing.
She reached up for Ottie’s phone. The recording was only three minutes long. Three minutes. Ten minutes since Ottie must have known her body was decaying toward death. Elvira screamed through her teeth as she stopped the recording and pressed play.
The word itself didn’t have enough air. Elvira shook her head and forced her teeth together, hard enough to propel pain through her jaw, temples, and skull.
“My ACL tore six months ago.” Ottie paused to take the deepest shallow breath she could. “And now I’m going to die.”
As Elvira started listening to the recording, her concept of time slowed to the speed of experience rather than memory. Ottie’s voice became visceral: Her words and memories seemed to breathe, mixing with fragments of Elvira’s memory. Elvira listened to Ottie’s strained voice through the recording, as if it were walking around the room, filling in what she didn’t have the energy to say.
Elvira had spent hundreds of hours in this room, and yet it began to feel unfamiliar in the midst of Ottie’s pain-streaked voice. The room seemed to switch wavelength and frequency, unnerving Elvira as her own good memories flickered to life between fragments of Ottie’s hurt.
Elvira remembered the cheap, laminate checkerboard flooring beneath the carpet, which they’d peeled back to play makeshift chess. The lumpy faux-leather loveseat hoarding empty water bottles and VHS tapes. The slanted roof of Polaroids and the smell of age in the paisley wallpaper. The blinds bleached from never having been opened, just above two lit candles and a lamp – at midday.
Ottie mentioned none of this. Instead, she relived moments of pain that Elvira couldn’t remember (or, she now realized, neglected to notice). Ottie was tough and strong and unshakeable, and Elvira’s body bubbled to a soft boil realizing that when she thought of Ottie as intentional and unfailingly thoughtful, she only saw half of her.
Ottie’s words fell out of the recording like splintered wood chips. Ottie didn’t mention her best friend, which stung Elvira. Deep-seated regret formed in the pit of Elvira’s stomach, and she didn’t know what to do with it. She felt this regret as anguish before it sedimented as shame. And the reality was that Ottie felt more real and whole to Elvira now than ever before.
When Ottie started the recording just minutes before, she felt she had nothing to lose in fully opening herself – in becoming more human and more than what she could usually bear to present to the world. More, especially, than what that same world had allowed space for her to present.
Ottie’s raw voice fizzed like static through the recording. It was a scratchy, angry fuzz.
As I mentioned early in this story, Ottie, is about to experience everything in reverse – a physical health crisis the same way you might experience a mental health crisis in your world:
“I remember the pop. And the fall. Crashing into the snow. It isn’t soft when it’s packed down into ski slopes.”
You see, in your world, a mental health crisis is often referred to first responders when people call 911. People in these crises are met with handcuffs, police, sirens, and involuntary 72-hour hospital stays. Something similar will unfold here, in the presence of a severe injury – a crisis mistreated because it is misunderstood.
Elvira saw the panic all over again. Nobody knew what to do. She felt nauseated thinking of Ottie’s face when they called 911 and the succeeding horror when they handcuffed her. In a mental health crisis, there were city-operated minivans teeming with psychologists, counselors, clinical social workers, therapists, peer specialists, and psychiatrists. Elvira remembered the day the minivans launched as pilot programs a year ago – the day it was made clear that the police were not equipped to handle mental health crises. Why, then, would they know what to do with broken bodies?
“The guy cop looked down at me with his furrowed brow and his hands and arms open. He told the radio he couldn’t see anything that he knew how to handle, as his fear squeezed out of his flak jacket.
“We understand so little that we give fear a piggyback. Fear for our safety. We don’t realize that fear is heavier to carry than faith.”
Though her knee was in ruins, Ottie was offered support for any mental health need she could have had. But the presence of one type of care does not eliminate the need for others.
Elvira remembered the dull room – barer than the babies being born in the hospital wing next door. The top half was a lighter shade of beige paint than the lower half, separated by only a thin strip of uneven baseboard ridge.
“The walls were padded, but the room was an aggressively uncomfortable cage. No equipment. Just a bed. And cops. What came first? The lifeless stares or the lifeless room? Watch, watch, watch – all they did was watch me. Not breathe life back in. Let it seep out. Because they just had to monitor. Because someone might be liable? Because I could die for the next 72 hours.
“Your risk doesn’t dissipate as fast as it builds. Go punch memory foam. It won’t explode back out. It needs a minute to expand again. The lead-up to an injury can be shorter than the time needed to recover.
“Then the steady stream of self-care recommendations. Bake, read, meditate, sunlight, exercise, eat something green, and drink water. Walk. Your next appointment is in 3 weeks. But it might get canceled if there isn’t enough space.
“I can be pissed all I want. It makes me feel stronger to speak this way. But anger masks while having its own mask; there is always something beneath it. My mental health team saw me every day. They feel safe. They look like me. They guide me. They are incredible. I know where I need to go and who does what. But my leg was still rotting beneath my line of vision. I needed care for it that I didn’t have and didn’t know how to find.”
In your world, it is often assumed that 90% of suicide-related deaths are due to mental illness. Suicidal people, who have been in crisis, are then treated for a presumed mental illness, such as depression. Imagine if the same were assumed for physical illness. What if every physical injury was treated with the assumption that there is an underlying flu?
Elvira remembered the physical illness support training at the beginning of the year: Know the signs, start a conversation, evaluate danger, and get help.
“Help became believing that I didn’t need it. My limp was ready to hide before I begged it to. Waited for a water break to stand solely on my good leg. I had to practice, because nobody seemed to be able to identify what was wrong.
“‘How can I help?’ Coach asked. I didn’t know what I needed. And if I did know what kind of help I needed, Coach couldn’t give it. It wasn’t his job, but it became his burden. At first, there wasn’t much swelling. Nothing to see. And Coach, of course, didn’t know bones or muscle or blood or tendons or ligaments or how they built knees. I didn’t know or meet anyone in the athletic department who did.
“‘We have resources,’ they said. Because help means treatment. Which was code for ‘we assume you have an illness.’ I must be sick. Ibuprofen or Advil. Because, they told me, 90% of deaths related to our physical health are precipitated by some sort of physical illness.
“‘Maybe the mental health professionals could help?’ Coach said. ‘They’re great. But they’re for my mind.’ I always replied.”
There was a long pause in the recording.
Elvira could hear Ottie’s labored breathing and troubled swallows. She heard the gasp that gulps down a round of tears. Ottie took a deep breath to soften her voice.
“The snow was perfect you know – almost creamy, like cartoon mashed potatoes. If I close my eyes, I can still feel my body lurching unevenly off the peak of that mountain. You’re never there for long. It is the instant when you can feel the moment before you and ahead of you at the same time. The crest is a crisp tipping point built by the faces of the mountain.
“There are few pathways and trails up or down. They are forged each time and left unpaved. It isn’t always a slow, continuous glide to the tip either. A path uphill could be fast if taken with the momentum of another hill before it. It could be a slow hike with stops and starts. There are many correct combinations. But the tipping point is the tipping point. It is the edge. And once you make the transition from below to above, you fall. And you fall fast. No rest. No moderation. No gradient. No coasting through the peak. There’s nothing to coast through. There’s nowhere but down.
“I was falling when I stumbled through those hospital doors, and I was falling faster when I walked out. I never had surgery. They just let me go with a few meds to dull the pain. And a check-in appointment three weeks later. We all know that an appointment every three weeks for mental health is often too late.
“Nobody seemed to realize that you have to stop falling before you can climb again. It takes more effort and more awareness to halt a fall than a climb, because your body, at that point, remembers both the ache of a long climb and the fear during a fall. I needed someone to see, understand, and believe that I needed to pause. Needed rest. Even if they didn’t know what I needed. Rest isn’t earned. It’s given.
“But ‘if I pause, my body is weak,’ I told myself. And my weakness must be handled on my own. Even if I wanted to accept help, there is no scheduling, screening, insurance, or specialists. Sports medicine people didn’t exist here. Different people told me different things. So the speed gathered until I couldn’t resist the downward cascade alone.
“So, now I’ve been stopped on this bed – forcefully and out of my control – and met with an equal and opposite force: death. Nobody willingly gave up on me.
“My mind hasn’t faltered. If anything, it almost feels healthier. My mental well-being was perennially sharpened by my robust mental health care team. That is why I share clear reflections with you now, as death squeezes its fingers around my body.
“There was a gaping hole in my care. And when there’s no clear system, the whole cannot be greater than its parts.”
For a moment, Elvira didn’t realize that she was numb with cold. Her fingers stopped the sizzling hiss at the end of the recording. She called 911, not knowing what else to do.
The air whistled through the wood-paneled church. Everything was small and brown, including the perfectly triangulated entrance and the cross mounted above it. The benches and their cushions had been replaced, along with new bibles, songs, and scripture that smelled like a new car. The contrast was mildly uncomfortable.
And when it was that time, Elvira stood from her seat at the back of the church, shaking from both anger and cold. Her wet boots scuffed past full rows of people until she reached three narrow half-steps and summoned all of her strength to climb to the pulpit.
Ottie’s words echoed: “When there’s no clear system, the whole cannot be greater than its parts.”
She let the crumpled pages of speech between her thumbs and forefingers drift to the floor. She breathed deeply into her shoulders and jaw. Closing her eyes, she said to herself, “As much as I’m one part of this, it isn’t my fault.” She took another deep breath and began with a gentle assertiveness.
“You know, risk scares us. We’re scared right now because we’re in a rickety church, and there is a risk that the snow may find its way in and soak us. What if this is unsafe? What if it makes us sick? Maybe we could ask: What if we can accumulate protection? What if we’re safer when everyone around us is too?
“We cannot stop death by knowing, precisely, who will become injured or who will die.
“And I know I can only say these things now that she’s gone. I can say that I caught myself in the mirror that day – as if I now had permission to come clean. Ottie, I have two stories to tell, or rather, yours to tell and mine to confront. I looked at my reflection with contempt. Everything in it was yours or a reflection of yours. The selfish thoughts build up in my memory now like lactic acid. And I can’t apologize to you. But perhaps it is better to stare at them within me – in this mirror. An apology would never make me work for the type of love I felt and needed from you then and now. Our stories are knit into a map. And I realize now that I’m staring at a window into you, not a mirror, and it is you who must tell your story. And we must listen.
“We labeled Ottie as ‘at risk’ before building safeguards to reduce the probability of injuries in the first place. We have no safeguards to reduce the probability of death in an unpreventable injury like hers. She was told to change or try so many things. But nothing around her changed. To care for anything, we can’t change procedure before skill. We can’t make administrative changes without changes in practice.”
Elvira pulled Ottie’s phone from her pocket and placed it on the altar. “You need to hear her voice. Not mine.”
Elvira clambered down the steps and out the back door of the church, nearly crashing into another woman. They both stepped back a few feet and paused. The eye contact wasn’t awkward. It was knowing, tired, and timid. The woman pulled a crumpled piece of paper from her coat pocket and pressed it into Elvira’s palms. The woman held Elvira’s hands, closed over the paper in a clasp, for a moment.
“Anger isn’t bad, sweetheart, but it can’t go it alone.” And she walked away.
Elvira stood stunned and confused as she watched the woman leave. Elvira opened the letter, her hands still shaking.
Choose to believe in hope while having the hope to believe. Believe because you believe in your friend.
I am so sorry that you lost your friend. I can imagine your grief, and despite your grandfather’s encouraging words, I may not be able to comfort you. But if he is right – that what is printed in a newspaper must be true – then I hope I can offer some solace by continuing to fight our fight, as boldly as I can in the columns of the newspaper that I work for. I don’t believe that I, alone, have the authority to say what is or isn’t so. But people, together, do.
There is a difference between the quietude of wisdom, the muzzle of trauma, and the mask of fragile ignorance. Each of these is better known (and confused) as silence. Growth comes from our ability to transition between these types of silences.
We’re comforted by each of these silences alone – until we realize that silences are also gradients. And that to understand this, we need to look closer, with more care, effort, and love than we ever have before.
You asked me before if hope is real. There is nothing more real. And thank goodness it lives and breathes.
I had nearly lost hope before your letter found me. I silenced myself. But the other day, I noticed that traffic lights plagiarized the change of the leaves. Green to yellow to red. Fascinating. Perhaps that’s where hope is: where the laws, rules, and structures meant to govern our moments are also the largest banks of hope. Because traffic lights can somehow draw inspiration from leaves that change year round. We live the faults in these systems, as you know. It is daunting that they are inevitable. But there is always an equal and opposite force. And here, it is change, if we choose to believe we have a hand in it.
And here, I leave you. For now, with a few thoughts.
Within the billions of stories I’ve witnessed, I’ve recognized one consistent thing: there is infinite hope in knowing that a piece of you and your story exists somewhere out there, in the heart of a stranger to whom you may never speak. Perhaps this person lives next door. Perhaps they live in another country, embedded in another culture. Perhaps they live in another universe.
Because the roots of our stories are shared, a sort of “what if?” surfaces: What if hope is held in another body when mine can’t hold it?
You know that no two stories are ever the same. Though powerful in its lessons, the events of this story are not generalizable across experiences. I hope you may see which puzzle piece you are in similar stories, but do not fall so easily into evoking blame and shame—upon yourself or others. I have shown each of you this story for a reason. Please let that reason guide you to stand for – rather than against – one another.
Because I have also seen that it would do us all good to hold another’s story in our hearts and minds, as if it were our own. You have held this one. How will you carry it?
This story is inspired by Dr. Craig Bryan’s incredible research, 'Rethinking Suicide: Why Prevention Fails, and How We Can Do Better,' transposed with Francis Pharcellus Church’s famous editorial in the New York Sun, “Is There a Santa Claus,” written in reply to eight-year-old Virginia O’Hanlon’s 1897 letter to the editor.
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