This past weekend marked International Survivors of Suicide Loss Day, or Survivors Day for short. On this day, individuals and families affected by suicide loss gather locally for support, comfort and healing amongst the only other people that can truly understand the grief in their hearts.

Suicide remains one of the most highly stigmatized social issues in our country, a horrifying reality given the depth and breadth of scientific research that supports suicidality as a major public health concern. Just this year the suicide rate in the United States rose to its highest level in 30 years across almost every age group, and yet some medical (and dare I say mental health) professionals still struggle to legitimately address the issue.

Providers still ask people if they have thoughts of “hurting themselves,” but all this does is minimize the real thoughts they have about killing themselves. Providers avoid asking people how they want to kill themselves for fear that it may give them ideas, as if all it takes for someone to hang or shoot themselves is for another person to mention it.

But mention it we must, and mention it I did when I worked on a suicide and crisis hotline. Today I share some tales from my time at the hotline in honor of Survivors Day and on a continual pursuit to destigmatize suicide.

The crisis and suicide hotline I worked on only hired licensed clinicians, unlike many volunteer-run hotlines still in operation today. The crisis work we did was stressful, urgent and often scary, yet there was something terribly peaceful about the bond among us clinicians. After tough calls we had no choice but to share in a laugh or a cry or a hug. We were united by imminent threat, working side by side in trenches where the outcome was quite literally life or death.

My time at the suicide hotline was brief, about six months. The headsets we wore all day were uncomfortable and though I enjoyed coloring, reading and online shopping between calls, I had difficulty feeling chained to my desk all day. In addition to functioning as the statewide crisis and suicide line, we answered crisis calls for a variety of local mental health centers and the national Lifeline affiliate. Our headsets automatically picked up incoming calls when it was our turn in the rotation, signaling in our ear which line the call came in on.

In the brief moment after a call alert but before the caller’s voice came through, my heartbeat increased and my palms sweat. I never knew just what I’d hear when the call began. The simplest calls came from individuals in search of substance abuse/mental health resources or worried family members seeking advice on how to address concerning thoughts or behaviors.

Many callers hang up immediately, yet it is hard to say when this is out of fear versus pathology. At least several times per shift I received prank calls from teenage boys attempting to order pizza or feigning suicidal thoughts only to give themselves away with fits of laughter. I got a twisted sense of satisfaction from calling these boys back to scare them shitless. The joke was on them when I explained that suicide hotlines, though anonymous, still have caller ID.

Of course I cannot forget about the sexually deviant callers, men too cheap to pay $1.99 per minute for the soothing embrace of a warm female voice. I often identified these callers by their grunting and heavy breathing. I did not get paid enough to put up with that shit.

And then there were the real calls. A woman in her living room recliner after swallowing an entire bottle of pills. A man with a rope headed into a forest. An elderly fella living in his car holding a knife to his wrist. A mother in her car, parked and idling in a closed garage. A teenage girl walking across a bridge. A young man with a needle so full of heroin it would certainly kill him. A man with a loaded gun and intent to kill both his cheating wife and himself.

As a clinician on a suicide hotline you have but a minute to build rapport with someone who used all of their courage and strength to simply dial the number. You must find a way to convey empathy without body language and facial expressions. You must assess for safety and risk with limited information from the caller.

And at the end of the day you go home with the knowledge that the world is full of incredibly lonely people, that so many of our fellow humans suffer constantly and greatly. You go home without knowing whether the paramedics made it in time, whether the follow-up call will be answered, whether you were the last person to speak with someone who then killed themselves.

And yet, at the end of the day you also go home with the knowledge that the world is full of incredibly resilient people, that so many of our fellow humans somehow survive and maintain hope. You go home knowing that you were there, that you listened, that you sat calmly in a scary space with someone at the most needed time.

Those who choose to kill themselves live in a universe of suffering so profound, so deep, so inescapably obscure that we cannot begin to comprehend their anguish and pain. We cannot judge their determination that self-inflicted death is a peaceful escape, a final end to their unfathomable agony.

We can, however, remind our fellow humans that they are not alone. We can talk to each other openly and honestly about depression, mental illness, substance abuse, suicide, trauma and painful life circumstances. We can sit in the shadows of their sorrow, the depths of their darkness and the tortures of their souls while casting aside our own fears and anxieties.

I am forever changed from exposure to the brutal, visceral humanities, the horrendous sorrows and the inspiring triumphs that I heard on my end of a suicide hotline.