This article is an excerpt from the book, We’re Stronger than We Look: Insights and Encouragement for the Caregiver’s Journey. Jill and David Brown lived full and healthy lives until David took a violent fall off his bicycle and into a wheelchair in 2009. Jill now serves as his primary caregiver.

Six tall steps of brick and concrete connect our porch to the front sidewalk. Their steepness explains why we couldn’t build our wheelchair ramp there. To meet slope requirement codes, any ramp going down those front steps would have to end halfway across the street.

One morning, when David and I sat on the front porch having coffee, I got up to go into the house for refills. As I reached for his cup, he said, “Don’t leave me out here alone.” I laughed.

He didn’t. “I don’t feel safe,” he said. “Those steps . . .”

A man we’d met at Craig Hospital popped into my mind. After years as a paraplegic, Jack had accidentally tipped his wheelchair down a flight of stairs and become a quad. His lack of bitterness and warm encouragement of other patients put him high on my list of quiet heroes. But the thought of that crippling plunge always made me feel shivery. Maybe David had been thinking of him too.

“Are you afraid you might fall down the steps?” I asked. “You’re nowhere near them. Just stay where you are.”

“I’m not afraid of falling. I’m afraid I’ll do it on purpose.”

Life stopped. The background noises of traffic went mute. I put down both cups and sat.

We talked. The previous year, scar tissue in David’s neck had decreased his mobility and ramped up his nerve pain. Surgery stopped the downward trend, with a fifty percent chance of getting him back to his version of normal. We’d strongly hoped for that. But it hadn’t happened.

Without that hope, he told me now, the pain seemed unendurable. The idea of suicide had sneaked in . . . and stayed. “I never looked for an opportunity,” he said.

“But the thought keeps getting more intense. I’ve been ashamed to tell you, but I knew I had to. I was afraid sometime when you weren’t out here with me, I’d just roll over to the steps and do it.”

I’d had no idea. I wouldn’t have even thought to ask.

For David, this time on the porch marked a turning point. Being taken seriously, really listened to, drained the power out of those thoughts. He no longer felt alone. He decided he didn’t need professional help—a counselor himself, he could meet with someone on our team for that. But he promised to tell me if any suicidal ideation showed up again. Even the faintest breath of it.

I believe him. But whenever he seems a little off, I check in. It’s scary to do that. I have to brace myself to ask, then stay with it and encourage him to talk about what’s going on.

Lately, more and more of our medical appointments include a short mental-health survey that asks about suicidal thoughts. The VA has done that for a while because of veteran trauma, but now I see it everywhere. I like it. Filling out the form together gives me a natural way to check in.

Five things David wants you to know when you’re feeling hopeless:

1. When I first came home from the hospital and thought I would never have a life again, I hid in sleep. Long naps, two or three times a day. The opposite—having trouble sleeping—can also mean depression. If your person loses their appetite or their usual interests, that’s a heads-up too.
2. Talking about this is vital. Be direct.
3. If they express negative feelings to you, listen. Don’t try to talk them out of those feelings.
4. If they pull in and isolate themselves, ask. Sometimes when my pain is high, I don’t want to be a burden to Jill, so I get quiet. But I’ve learned that my silence is the heaviest burden I can lay on her.
5. Pain and hopelessness aren’t logical. That idea of throwing myself and my wheelchair down the porch steps . . . not smart. Most likely, I would have ended up with a lot more pain and hopelessness. So don’t dismiss what you notice just because it doesn’t make sense.

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