Inside the ACE’s – Part II

So where did we leave off? Well, first, let me refresh your memory of what I introduced in my last post. Hopefully I didn’t depress your whole mood and life. The ACE (adverse childhood experience) score is a guideline, that will hopefully be a standard screening by healthcare and social work providers, to assess risk of physical and mental health consequences that can be a result of chronic exposure to toxic stress.

Trauma at any age obviously has negative effects. But trauma in childhood effects a developing brain and nervous system. Our good fortune, or rotten luck, is “written into our biology,”—wired into synapses and coiled within strands of DNA—where it exerts a stealthy and persistent influence on our bodies and minds, for better or worse, says Nadine Burke-Harris, the former and first surgeon general of California and author of the book “The Deepest Well” written all about her further investigation of the ACE score study done by Kaiser and what do we do with this information.

excerpt from part I

The higher a persons exposure to these stressors, especially before the age of 18, the risk of chronic health problems, increased high risk health behaviors, disease, and death by suicide. So, the goal is to recognize this, hopefully remove the child or yourself from the toxic stress, and begin on reparative therapy. To learn more, and see one of my resources, click here!

I Love You….uh, ok, Thank You?

I am 35 years old, and I’m not sure if my dad has ever told me I love you. My mom did used to say I love you all the time, but she obviously didn’t show it. That must be very confusing for a kid. Still to this day, I have the hardest time saying I love you. I even have a slight hesitation or pit in my stomach when I say it to Travis. Now Kylie, I try to say and show her how much I love her multiple times a day. I also get VERY uncomfortable when people tell me they love me. I know I am supposed to say “I love you too”, but I just can’t. People have called me out on this, and it’s pretty hard to explain.

My therapist explains it that the way I have been bottling up all my pain and stuffing it down and my brain blacking it out, it doesn’t leave much room for love. Feelings are feelings. If you cannot let yourself experience great pain, it’s hard to experience great joy. When I tell her I don’t want to have all these feelings and be sad all the time, she encourages me that when I let myself feel the pain and work through it, I’ll have the capacity to feel a greater joy and love than I have before. So, fingers crossed. 

How, with all this stacked against me, am I fairly normal and decently successful? Well, who am I kidding? Maybe not normal, that is subjective I suppose. On paper, someone with my life of experiences and lack of support and love could easily have fallen off the road to success and be stuck in some destructive and negative life patterns. Just like not everyone that has all the opportunity and support in the world are a major success, not everyone who grew up in hardship end up in the gutter. So what makes the difference?

Resilience and Buffering Forces

Am I the only one who kinda hates when people say, in response to any difficulty, “don’t worry, kids are resilient”? That said, they say it’s true, (whoever they are)🤷🏼‍♀️. There are many factors that build a child’s resilience: positive experiences, community ties, close friends that you feel comfortable talking to about your problems, genetics, and probably the most effective, even one supportive adult inside the home, and/or other supportive adults outside of the home. This can be a loving grandparent, an engaging teacher, other adults that show love and positive examples. 

The genetic part is pretty interesting to me. I have always been fascinated with the human body, which was a huge part of why I became a nurse. Genetics has the power to predispose a kid to be more sensitive or more naturally resilient in the face of adversity. ANDDD studies show that toxic stress can be passed down through the generations, due to a fun component of the human body called epigenetics. While we are all born with a set of genes and DNA, there are components to those genes that can lay somewhat dormant. And with exposures to increased biochemicals, like cortisol, the stress hormone, environmental toxins, stuff like that, those components can get turned on. And then that DNA is passed down to your children, who then are genetically predisposed to being triggered by stressful situation. 

I want to give an example of a buffering force that I had in my life that I think really helped me get where I am today. Aunt Donna. Donna was my dad’s sister and she had no children of her own so I know she thought of me as her child and she really took the charge of sharing in the responsibility of raising me, and thank God for her. My dad and I lived with my Aunt on and off throughout most of my life. I definitely did not appreciate her and all she did for me until she was gone. Aunt Donna died this past fall from Covid. I spoke about her as a buffering force and positive adult in my life in my eulogy at her funeral, so I can only have faith in the afterlife and a power greater than us that she heard me. 

Here is a Letter to Her…

Aunt Donna, thank you for supervising Rebecca (my sister) and me during our visitation with our mom, keeping us safe and making it that we could even have that time with her. Thank you for helping teaching me and my friends to drive, in your pink car. I know you’re out there yelling, “it’s not pink! It’s salmon“… So many of my good girl friends growing up saw you as family and knew you to be so kind and loving to all. Thank you for making sure I had new clothes for school each year. Thank you for always praising my achievements and good grades in school, I know that its very possible if I didn’t receive that positive feedback, doing well in school may not have mattered so much and I would not be where I am today.

Thank you for being “Aunt DD” for Kylie, taking such a large role in her early life, babysitting every other weekend all through the night so I could continue working after she was born. Showing her love and care and encouragement, making her feel like such the special little girl she is. Most importantly, thank you for being my sounding board. You were the number one person that I knew I could always call and be 100% myself with, express my feelings to, no matter how unreasonable they might have seemed. You were always available to me, it was rare that if I called you, you didn’t answer or at least call me back very quickly. I miss that most of all. I would say, that is probably, at the core, the most impactful force you had on me in counteracting all my negative experiences. Having someone to call and confide in gives a sense of safety, and the trusting advice or interventions received was security. There have been so many times these past 6 months, when I felt I had no one to call. No one who would understand in a loving way. I miss you so much, and I know that without you in my life, I would not be the same. Even more than that, I would be worse. I miss you with all my heart, I thank you with all my soul, and I think of you often with my whole mind.

I always observe that my patients in labor are meanest to their moms when they are in the labor room with them, way more than even their significant other. The mom is the one that gets snapped at for offering a drink or trying to rub their back. I know that is because someone can be mean and take out their frustrations on the person they know will love them unconditionally and will understand in the end. I did that to my Aunt Donna. Getting annoyed with her so easy, rolling my eyes at the slightest weird ass thing she said or noise she made. She put me in a bad mood if she got upset with me for seemingly leaving her out of something; but it could be the next day, and if something happened that I needed the only person I could process it with, she would still answer my call.

Two Sisters, Very Different Experiences 

As I mentioned before, I have an older sister, Rebecca; same mother, different fathers. As I grew up with my dad, she grew up with her dad along with her step-mother Susan, and went on to grow up with 6 brothers from her dad and Susan. 

I asked Rebecca to review the ACE (adverse childhood experience) score test and give me her score in preparation to write this post. Her answer is two. 2/10 marked yes on the test. She said that she could relate to a few more and she was on the borderline, but felt that her experiences didn’t cross the line into adverse or abusive. Like I said, I would say my score is 7/10, maybe 8. What a stark difference right? I think there are many factors in both our real life experiences as well as perceptions of those experiences. By my count, just based on our mother, she should at least have 3 to 4. But here is what I am thinking: being that she grew up with her dad and step-mother in the home, and her step-mom was a stay at home, she was surrounding by a mother that was loving and supportive and was not mentally ill or use illicit drugs. Rebecca might not even remember or think about our mother being in jail, because she wasn’t around and she might not have seen her in that time whether she was in jail or not. This example of two sisters show how impactful a supportive adult and family in the household can have on a developing child. 

I used to get so mad when I would hear Rebecca call Susan “mom”. It was mostly jealously, I am pretty sure, that I did not have that. I mentioned in an earlier post how much I wanted siblings growing up and she had that. She had a semblance of a nuclear family, and although I know it was not perfect, it may remove her from a bit of the trauma. Also, when I was much younger, before our mother died, I still had a lot of hope that she would be around more, even hope that her and my dad would reunite and I would have that family unit I craved so deeply. I think a lot of children of divorced parents have that hope. Now, that I am older and can reflect with more wisdom, I should thank Susan. She deserves to be loved like a mother from Rebecca, she raised her and was obviously a positive maternal figure in her life. Just like I thank my Aunt Donna. 

Forgiveness is Choosing to Love

It is the First Skill of Self-Giving Love

That is a quote from Mahatma Gandhi, I am not nearly as eloquent and wise. I hope one day to be. Starting this mental health journey, I could never foresee myself having grace and forgiving my mom or my dad. Shit, starting this blog post I never imagined feeling forgiveness at all. But a funny thing happened this weekend. I suppose I did this extra research for the post, read IG stories from the wise accounts I follow, and started to take my own, and my therapists, Allison’s, advice. She’ll be proud.

I mentioned in part I, that becoming a mom was hard; I could never understand how my mom could be so absent and seemingly care so little about me, when I have such immense love for Kylie. But doing this reading about ACE’s and thinking about my moms own ACE’s and all she must have been battling, I should extend some grace. My therapist says, “little ashley can be mad, she should cry, she is hurt”. But I am big ashley… ew not big. Older-ish ashley, and this ashley can tell the little version that it is not her fault. Her as in not her own, and as in not her moms. It’s no one’s fault. It’s shitty fucking cards that played out. And this ashley can understand being a mom is so hard. Being an adult is hard. Having mental illness in a such a judgmental world is awful. And I wish someone could have helped Ginny before it was too late.

Speaking of Late…

Speaking of too late: my mom died. That was weird to type. Wanna know something even more weird? Well, I am going to tell you anyway. I am not 100% sure how my mom died. That’s weird AF right? That should be a huge red flag waving around that shows you what my life was like. When you’re a freshman in high school, you get home from school, you have a missed call from your semi-estranged sister checking on you, and a voicemail (on the home landline phone fyi) from your dad saying stay home when you get back from school, you think maybe you’re in trouble. You don’t think, I bet my mom died. So, my dad got home from work and just blurted it out. I didn’t ask any questions, I just went up to my room and cried. My Aunt Donna came over and didn’t explain anything, just said it happened the night before in them middle of the night at home and she will find out more.

Then, it was super straight to action mode and a to-do list. I had to find proper clothes to wear to a viewing and a funeral, I was asked did I want to speak, plans were made for my best friend Charity to miss school and come with me to the funeral. Apparently, there’s no time for talking and explanations. I have a few very clear moments, but they read more like quick flashbacks in a dramatize TV episode. Quick clear scenes, but not linear, not very story telling. Apparently, my family wanted to leave me with the ultimate cliffhanger?

Fyi, I never ever planned to write about any of this. Not this. But here we are. That is the point of all this, to get it out. To help. Help me and maybe even help others. Maybe, more like probably, no one will read this far down anyway. But it’s here.

My Aunt Becky, my moms older sister, tried to explain something to me once on a long car ride; I don’t even remember why I was in a car alone with her. She told me, ‘your mom had pneumonia, but she didn’t know it. She took some pain medicine [read opioid] for her knee (which she had had multiple surgeries on, but was “sober right”?), and that kind of medicine can make you super sleepy, and the pneumonia basically made her choke but she couldn’t wake herself up to cough it out’. I suppose, to a freshman, that kind of makes sense. I am telling you, I was already filled with such angst and negative emotions, I might not have even cared to listen to more. What started bothering me is having to tell the story. When people ask, oh I am so sorry, how did your mom die? Some can say a car accident, cancer, maybe even heart attack, or feral hippopotamus (I heard those cute little guys are vicious). I say uhhh… well she had pneumonia… blah blah blah and deal with super awkward stares and questions.

Bob and a Blank Death Certificate

Fast forward about 10 years. I was filling out paperwork for a new patient appointment with my first reproductive endocrinologist (fertility doc) to try and get pregnant with Kylie. And they always ask medical history, allergies, and I get to family history. And I’m like, you know what, I need to know what to write here. I go to my dad’s house. I knew he should have a death certificate copy in this huge filing cabinet where he had a bunch of old paperwork. He had honor roll certificates I got in 5th grade, so bound to have something useful. I found it. It said “Cause of death: unknown”. WTF. Well, I guess that was issued pre-autopsy and he must have needed a copy for social services or something. My dad was like what are you doing, what are you looking for in there? So I explained the dilemma I had dealt with for 10 years. He looked at me like I was crazy. What are you talking about? I said the story my Aunt Becky told me those years ago, and he very quickly replied, “oh no, she must have just said that since you were young, your mom overdosed. Accidentally I am pretty sure”. He said it very casually and matter of fact. Like it was common knowledge.

I am sure anyone who has read this far down is thinking, well duh, even I knew that. But when it’s your mom and you’re young, I guess you don’t connect the same dots. BUT, Bob is not the most reliable on information and obviously not very caring with delivery. So I am not 100% sure. I have always been too much a punk to ask anyone that was reliable. Not wanting to upset my grandmother and then she passed away right before Kylie was born. I suppose I’ve always assumed my sister heard the same story am I did. But, she might actually read this so maybe I will hear something soon. My goal is to ask my Aunt Lisa, my moms other sister, but it just feels so personal, awkward, and random. I don’t want to bring this shit up. So here we are.

Back to Forgiveness

Ok, I feel like that took a turn. Back to my point. Forgiveness. I’ve always heard and read, forgiveness is not for the other person, it’s for yourself. What do they say? Holding resentment is like drinking the poison and expecting the other person to die. This weekend, as I write this, was my younger cousins wedding. My Aunt Lisa’s son, Ethan. Despite my family having a TON of ugly drama over my grandfathers death, won’t even get into, it was a good time. Kylie absolutely loves my Aunt Lisa, we got to see my sister who is now pregnant, and open bar!

I noticed driving up to Virginia, that the highway exit for the cemetery where my mom is buried was not far out of the way. And during the drama about my grandfather, my grandmothers remains were taken and placed with my mom, and instead of Arlington National Cemetery like we all thought, just last week, my grandfathers ashes were interned just a few feet away apparently. So, I asked Travis, on our way back to North Carolina, should be stop and visit? I haven’t been there since moving to NC in late 2014. I never really felt the urge, or wanted to go through the trouble. But something in me said go, the timing lined up.

The memorial park was peaceful. Full of mature trees, overcast weather conditions, fresh flowers looked recently placed for all the loved ones lost. Birds were chirping and very welcoming. I have said before, Kylie is so sweet and sensitive. She is so good for this world. She stood right by me, “are you holding up ok, Mommy? Is there anything you want to say?”. Then she asked if it was ok to look at the other gravesites and name plates. She walked carefully and quietly, reading the names and then even saying, “I don’t want to pronounce it wrong and be disrespectful, I want them to rest peacefully”. Gosh, I am so lucky to have her. But her being so at ease in this setting and caring so much for all the family members that have passed on, and talking about how they are probably missed by their families kind of put things into perspective. Death is not a time to hold on to regret and resentment. What do I want to get from that? What I want is, go back in time, have loving parents who were there for me, raised me, supported me, and had fun with me. That’s not going to happen. So I just admired the scenery, smelled the fresh air, appreciated my sweet daughter and supportive husband, and prayed for my family to be resting peacefully and know that I missed them.

It is quite healing. It feels authentic. I can always tell my therapist, ‘sure, I’ll try. Ok, I understand’. My nursing brain knows that addiction is a disease, knows that mental illness is BARELY getting de-stigmatized and recognized as important in 2022, so pre-2001, imagine what kind of care and understanding my mom received. I already knew that. Knowing and accepting are vastly different. But, I always say that knowledge is power. And learning and studying about the ACE study and risks, and what do we do to mitigate the effects has helped.

Mental Health. Motherhood. Registered Nurse.

I know all this is a lot. I keep telling you guys, I am long winded. This experience has just been such a huge part of my adult life, with major impact on my mental health, me as a mother, but, hopefully, I can use this information as education to help me be a better nurse. So, in line with the goal of this whole blog and website, it checks all the boxes. 

My mental health has taken a beating in response to repeated exposure to adverse childhood experience. And now I recognize that it can have an effect on my physical health as well. I think it already has. I am very interested to read further research and developments as it may relate to my autoimmune disorders, endometriosis, and even infertility. Motherhood still scares the shit out of me. When you don’t have a great example around of a mother, how are you supposed to be a great one? I am working on it, and I plan to break this generational curse for my daughter, giving her great childhood memories. Not let her childhood be something she has to heal from. I will say, she probably won’t grow up to be very funny. No one with a healthy and stable childhood ever grows up to be a comic. Hey, pros and cons amiright? Lastly, I can continue my research on adverse experiences and relation to both physical and mental health, and be a better advocate and educator for my patients. 

ashley, RN

mental mommy nurse