Support and treatment successfully help most people who have had suicidal thoughts. For resources or help, call the Suicide and Crisis Text Line at 988 or go online to 988lifeline.org/talk-to-someone-now.
Real Change has purposefully excluded specific details about the suicide in this story to reduce the risk of contagion.
About an hour outside of Seattle, an old, one-lane metal bridge sits high above a river canyon. With its commanding view of the canyon, which seems to stretch into infinity, it is as much a destination as a thoroughfare. Hikers and offroaders on their way home from the many trails on its south side stop on their way home for photos or just to have a look over the side.
Built in 1921 to connect a long-since-abandoned coal-mining town — previously only accessible by horse or rail — to the outside world, the bridge boasts a rare three-hinged arch. Arch bridges are particularly well suited to steep, rocky canyons, like the one it spans. Staring down from the deck, the roaring river it crosses looks like a tiny stream.
On Jan. 6, 2021, Nathan Lerner, a 30-year-old man struggling with homelessness and heroin addiction, jumped off it. That January was noted for unusually heavy rain, causing the river to run high and fast. His body was never found.
That should never have happened, said his mother, Miriam Lerner. She spent nearly the next two years trying to piece together what happened to Nathan, who had been discharged from an area hospital earlier that night.
Miriam and her husband, Kenny, knew Nathan had gone to the hospital and began to suspect the worst when they didn’t hear from him for days afterward. However, if he’d overdosed, first responders would at least have found his ID, she surmised. Desperate for information about her son, she came up with the idea of calling abandoned car hotlines.
While hikers heading to the dirt road underneath the bridge frequently park on the road nearby, Pierce County Sheriff’s Office deputies tend to know what it means when a car is left there too long — especially, as in Nathan’s case, when that car is sitting open with the keys in the ignition. Her hunch about abandoned cars, said Miriam, proved to be a very accurate one.
She left a message with the license plate number at the King County Sheriff’s Office (KCSO). They called back quickly and told her they knew where the car was — it had ended up in a tow lot in Enumclaw. After a bit of back and forth about where the car had been towed from, Miriam was able to look up the exact location.
“I said, ‘It looks to me like all that’s up there is a bridge?’” she recalled. “He said, ‘Yeah.’ I said, ‘Wait a minute,’ and I looked at Google Images, and I said, ‘That’s a really high bridge, isn’t it?’ And he said, ‘Yes, ma’am, it is.’ Then I realized — poor guy, I feel so bad for him. He had to hear me figure it out. He had to hear me realize it.”
The KCSO has strict policies about how to inform family members of death, but there isn’t really any guidance about what to do when an abandoned car tells someone everything they need to know.
“He said, ‘Yeah, other people have done the same thing, ma’am.’ That’s how I found out,” Miriam said.
How did Nathan become one of those people? For anyone who has seen the effects of America’s opioid epidemic up close, it’s an all-too-familiar story.
Nathan first encountered heroin in Colorado while working at a ski resort in his early 20s. He was always a bit of a stoner, Miriam said, and she suspects he thought he was smoking hash the first time he tried it. In a 2018 blog post Nathan wrote during his time at the Elmira Correctional Facility outside of Ithaca, New York, later published on his mother’s Medium account, he said that a friend introduced him to it as opium and continued to lie about what they were smoking to sell him more.
Either way, he got hooked. He eventually moved back home but was stealing from the family to support his habit. This got Nathan 19 months in prison, including a six-month stint in solitary. He wrote in the same blog post that solitary was “TERRIBLE punishment. It doesn’t help anyone and it isn’t meant to. It is meant to mentally, spiritually, and physically BREAK YOU.”
After his release, he relapsed and soon incurred a misdemeanor charge for stealing to support his habit. Rather than face reimprisonment, he decided to abscond. Despite being the ones who initially involved the criminal justice system, his family had seen what prison was like for Nathan. He left for Alaska with their blessing. Being away from the carceral system did wonders for Nathan’s recovery, Miriam said. Always an outdoorsy person, he got a job as a kayak tour guide, got clean and was doing great.
“He absolutely found himself. He had friends, he was happy, he was in great shape. He wasn’t using. He said to me after about three weeks, ‘This is what they should do with people like me! Being outside, exercise, [...] a job where I can earn money, good people, doing something great in nature,’” she said.
The coronavirus pandemic destroyed all that. Other guides quit, leading to extreme overwork and stress. He went through a bad breakup. Ultimately, he relapsed. Faced with the prospect of another sunless winter in Alaska, dealing with his depression and fighting addiction, Nathan begged his parents to help him relocate to Seattle. Getting him and his dog down here was no easy feat; the dog couldn’t fly and he couldn’t, as a felon, enter Canada. However, his parents found a ferry route from Whittier to Bellingham, and he landed in the Seattle area, staying on-and-off with a family friend in Bonney Lake.
That’s how he ended up in the ER of MultiCare Auburn Medical Center. He called his parents, telling them he had an infection and was in terrible pain. This wasn’t the first time he’d had health issues related to his heroin use. In his blog post, Nathan wrote, “For the past few years I have been constantly shuffled in and out of hospitals, the separate occasions in the ER a blur, its entrance turned into a revolving door.” Miriam and Kenny urged him to get it treated immediately.
In the same blog post, he reflected that hospitals were, for him, “a much needed rest from the chaos of my everyday life, a chance to charge the batteries.”
This time, tragically, that wasn’t the case.
While every victim of the opioid epidemic has a unique and often poignant story, Nathan’s is even more so in that it highlights an especially pernicious issue for unhoused and addicted individuals: medical equity.
Instead of being admitted to the hospital, Nathan was discharged with an antibiotic prescription and a referral to treatment. MultiCare Auburn Medical Center maintains a social worker in the ER department at all hours, but Nathan did not meet with them. While he passed the standard suicide screening, one can imagine that when he left the hospital, with the last dose of Dilaudid, a powerful pain killer he’d been given, wearing off — alone, in pain and ashamed of his relapse — things started to look a little darker.
It’s also worth noting here that, according to National Health Care for the Homeless Council’s 2014 “Suicide and Homelessness” fact sheet, Nathan had several high risk factors for suicide among people experiencing homelessness, including ongoing depression, drug use and past trauma. While association with depression and mental health crises are similar for homeless individuals who commit suicide and the general population, a drug problem changes things drastically. According to that same fact sheet, within the general population, 16 percent of deaths by suicide occur among people with substance use disorders. Among homeless individuals, this number jumps to 34 percent. Homelessness itself is also a risk factor. One 2012 study found people experiencing homelessness to be 10 times more likely to die by suicide than the general population.
When he entered the hospital, Nathan self-identified as homeless and having a substance use disorder. This, Miriam argues, should have gotten him more care, not less.
While Miriam was hesitant to say it was an instance of homeless dumping — the practice of releasing homeless individuals to the street instead of treating them, especially when that treatment could be difficult or expensive — she did express frustration with the treatment Nathan received.
“They released him too early,” she said. Shortly after Nathan’s death, when she was able to speak with a higher-up in the hospital’s ER department, she said his response only confirmed that for her. “When I talked to the doctor about it […] he was like, ‘If you keep them too long, it wears off and then they need another dose.’”
He probably did need one, she said, but what he really needed was more time.
“Look, we could have flown out that night and saved him that night or that week. Maybe the day after we left, he would have done the same thing. Or maybe he would have hung out for a month. But he would not have died that day. He would not have died that day if they’d done their jobs and kept him,” she said.
While her initial inquiries into his death were motivated by a simple desire to piece together what happened to her son, this research soon became a nearly two-year campaign, led by Miriam and Kenny, to change the way hospitals approach care for people facing issues similar to Nathan’s.
Miriam called the hospital doggedly to access Nathan’s medical records, eventually discovering that the hospital had actually tried to readmit him, calling him an hour after his release to ask him to come back. She discovered that several of his biometrics were outside of normal range, in some cases dangerously so. She also forwarded all this to the Washington Medical Commission (WMC), which had rejected her initial request for an investigation. The second time around, they agreed to investigate, ultimately finding that there was “cause for corrective action.”
Despite the fact that the WMC did find the attending physician had made the wrong call, it’s nearly impossible to hold the hospital responsible via the legal system for Nathan’s death, because the death didn’t occur while he was in its care. But that wasn’t what the family wanted anyway, said Miriam. They just wanted an apology — specifically from the head of the hospital — and a little bit of systemic change.
Ultimately, Miriam and Kenny got both of those things.
On Aug. 11, 2022, the Lerners returned to Seattle with the intent of protesting outside MultiCare’s Auburn facility until their concerns were heard. When they drove down that day, Auburn MultiCare’s chief medical officer, Dr. Arun Mathews, decided almost immediately to meet with them.
“From a general mindset, I had a pretty conservative mindset,” he said, noting that staff had been followed and harassed over their provision of COVID-related care, so he has been extra cautious about on-site protests. However, with regard to the Lerners, he said, “When it actually occurred, and our security officer shared that it was two individuals and it was [Nathan’s] parents — oh my goodness, that completely changed things around.”
In that meeting, Mathews apologized for Nathan’s death and outlined specific changes to the hospital’s policy on monitoring people who receive any medication that affects their mental faculties or ability to drive/operate machinery or who have a condition that affects their mental state. Such patients will only be released to a responsible adult who can be accountable for their safety. To accommodate patients who can’t arrange for a responsible adult to be present, the hospital will monitor them for an extra hour after receiving medication and release them only if they still meet the necessary criteria for discharge after the hour is up.
“We consider that is kind of a pretty big process of learning from this whole experience. I shared with Miriam that that is Nathan’s legacy for us,” he said.
MultiCare’s Auburn hospital serves a significant number of patients experiencing homelessness, substance use disorder or both, Mathews said. For that population, these changes could be lifesaving. They also come alongside increased efforts from MultiCare to provide care that better meets the specific needs of unhoused or addicted individuals.
While MultiCare does staff a social worker in its emergency department 24/7, there are gaps, Mathews said. Getting coverage, especially in the age of COVID, is no simple matter, and social workers are in especially short supply nowadays. That said, he sees it as a goal for all hospitals that treat unhoused individuals or people experiencing homelessness to set up meetings with a social worker as part of the standard ER care routine.
“I think that’s a best practice, quite frankly,” he said. He also noted that MultiCare has stepped up its investments in behavioral health facilities and is currently producing research internally on health care disparities related to homelessness or addiction.
“There is a very earnest interest in understanding how we can better serve our communities in this regard,” he said.
For Nathan’s family, those changes in policy and philosophy aren’t necessarily worth their son’s life — nothing is — but they do give his life worth.
“That’s the only meaning I have out of it,” she said. “I miss him, and I don’t accept it completely. They didn’t find his body; his body will probably never be found. It got washed out to sea or something. All I’ll have will be that this whole battle changed something. [...] At least I have that, and it will help people.”
Read more of the Aug. 31-Sept. 6, 2022 issue.