By Janis Bultman

Published in The Massachusetts Review, Summer 2025

I’m in the call room at the Suicide Prevention Center (SPC) when the phone rings. I hate it when the phone rings. I’ve never had a three-hour shift when it didn’t ring, but sometimes there are long stretches of silence. I pray for those long stretches of silence.

Sometimes I’ll arrive for my shift and Cam, the twenty-six-year-old Call Room Supervisor (CRS) will say, “It’s been quiet today,” and I’ll say, “Good,” which I absolutely intend to mean something positive because I’m here to prevent suicide, and when it’s quiet, it could very well mean a period of time has passed when no one in the length and breadth of the country is suicidal and in need of our services. Though probably not. It’s far more likely the suicidal are feeling disinclined to talk. A lot of people kill themselves every year. Over a million. Globally, there’s one suicide every ten seconds. Eighty percent don’t tell anyone first. Really, it would be better if the phone rang more than it does.

The phone rings, and I do what I always do, I jump and slam my laptop shut on my Expert Level Sudoku. I check the call monitor on my computer to see if a name has popped up. Sometimes, I’ll recognize the name—or Cam will. We have regular callers, some of whom have actual contracts negotiated with care and concern that specify how often the regular caller can call and how long he, she, or they can talk. This was a revelation to me, but I recognize and applaud its efficacy. In general, I enjoy talking with the regular callers, especially Maureen, who has a British accent and always starts off with “Hello luv.” If a name pops up and we recognize it, we know exactly what to do and say and what boundaries to maintain because there’s a history, and we can call it up on our screens with a few quick keystrokes.

The call monitor says U.S. Cellular. No name. Just a number. I do what I do in any event. I pick up the phone and say, “Lifeway, this is Robin,” in as kind and soothing a voice as I can muster. Meanwhile, my heartbeat revs, and my brain starts flipping through all the information and scenarios we’ve learned, discussed, and practiced during our sixty-hour training. Cam says the cognitive dissonance will abate with time and practice. I look forward to that.

The caller says, “Hi Robin. This is Mary McSweeney, I’m calling from Rincon Hills, and I’m not doing so well.”

It’s unusual for a caller to give a first and last name, let alone tell us where she is, but I don’t have time to muse on that. I type in her name to see if she’s called before. Nothing. “Hi Mary. What’s going on?” I ask.

This might seem like a casual, tossed-off question, but it’s not. It’s what we call an Open-Ended Question (OEQ), designed to offer the caller an array of options in the discussion department. The best OEQ’s begin with “what” or “how” but never “why” because no matter how carefully you choose your words, “why” questions are always judgmental, and we avoid judgment at all costs. For example, if I said,” “Why aren’t you doing so well, Mary?” it would sound like an accusation, as if I thought Mary had failed to keep herself in the pink. At the SPC, we are all about Unconditional Positive Regard (UPR). You will find no judgment here, even if you’re Hitler, and you’re calling because the Allies are at your door, and you’re really nervous about what might happen next. We will say, “What’s going on, Hitler?” at which point he can begin to relate his predicament, and we can provide an empathetic ear and minimal encouragers (MEs) such as “wow,” “uh huh,” and “gosh,” to keep him talking and alive.

This was an actual example provided in training. I was as appalled as I’m sure you are right now.

“So many things,” Mary says. “My husband left me for another woman. I’m manic-depressive. My doctor switched me to a new medication, and it’s not working. My teenage daughter called me a bitch and a loser and ran away from home. I have no idea where she is. Maybe with her deadbeat boyfriend and his deadbeat family. Who knows? I don’t have the energy to find out. And of course, my husband tells me it’s my fault. So, on top of everything I’m a terrible parent. That’s not all. I got laid off, and I’m fifty-five. Where am I going to find another job at fifty-five? Even if I had the energy to look. Which I don’t. “

While she talks, I utter MEs—wow, uh huh, gosh—and scribble notes. When Mary pauses, I hold a beat in case there’s more, but when she stays silent, I say, “Mary, it sounds as if you’re feeling absolutely crushed because there are so many awful things happening in your life.”

This is what we call an Empathy Stem (ES): You’re feeling fill-in-the-blank because fill-in-the-blank. For example: You’re feeling exhausted because your insomnia won’t let you sleep. Or: You’re feeling angry because your mother won’t let you go to the dance. (I don’t mean to sound flippant here. We get a lot of teens, and minor as it sounds to older folks, it’s not at all minor to them.) If we’ve got it right, the caller will say something like “Exactly!” which is a feel-good moment for everyone. If we’ve got it wrong, the caller will offer a correction, which is equally useful. Now we know exactly what the caller is feeling. Empathy is the key to achieving UPR. However, as you may have noticed, ESs can sound stilted and formulaic, which makes certain callers suspicious. “Why are you talking to me like that?” they demand. I’ve used them on my grown-up daughter, and she’ll say, “Mom, are you practicing your skills on me?” The proper response on such occasions is to be genuine. To my daughter, I always say, “You caught me!” To the suspicious caller, I might say, “I’m using something called an empathy stem to try to express my understanding and empathy.” That might sound stilted too, but if it’s heartfelt and honest, I’ve given it my all. We can do no more than that.

“Worse than crushed,” says Mary.

At this point, someone who hasn’t been through the training might blurt out something like I’m so sorry, but we never, ever, ever say I’m sorry. I’m sorry is sympathy, not empathy, and we eschew sympathy, basically because it isn’t empathy, which is way better.

Instead, I say, “That’s awful.” Then I fumble for an OEQ that will elicit more of Mary’s story. Quickly, I scan my notes and see she’s made several references to her husband. “What’s going on with your husband?” I ask.

It’s too quick, too abrupt. “What do you mean?” she asks.

I try another ES: “It sounds as if you’re feeling worse than crushed because, among so many other things, your husband is misbehaving.”

“Exactly,” she says. “Bingo. You hit the nail right on the head, Robin.”

Dancing girl emojis. Confetti. Figuratively speaking, I mean.

“He moved out a month ago. He got an apartment on the east side. I thought he was living alone but come to find out he’s living with this floozy he met on Match. How is it that he’s on Match? What a stupid, cold-blooded way to meet people. Are you familiar with Match?”

As it happens, I’m not especially familiar with Match, but I’m intimate with eHarmony. It’s how I met my second husband. It’s also how I came to find out my first husband was not a very nice fellow, which I suspected anyway. There’s this thing you do when you’re approaching thirty and you want to have babies. You meet a guy and he’s decent enough and you project, project, project—all the things you want him to be. You convince yourself you share all the same values, even though you’re a Christian Democrat and he’s an atheist Republican Jew and based on that alone, odds are you don’t. And yet you enter denial—because hormones. You get married. You stick it out for eighteen years. You have two daughters. They’re twelve and sixteen. You have another fight. You want to make up. You walk into your shared bedroom, which is huge because he’s a derivatives trader and makes a shit ton of money. He’s sitting in his favorite overstuffed armchair in the bay window overlooking your park-like front acreage with his laptop in his lap.  He has ample time to minimize the screen, but he lets you traipse all the way across the outsize bedroom and lean over to give him a kiss, from which position you see he’s on eHarmony filling out some sort of questionnaire.

You recoil. “You fucking asshole,” you say.

“I’m exploring my options,” he says.

But I digress.

At this point, I have the option of offering genuineness—sharing a little bit of my own history—which lets the caller know you have a common bond. This advantage, however, pales in comparison with the disadvantage of pulling the spotlight off the caller. After all, it’s not about me. To reduce the impact of such a disadvantage, we’ve been cautioned to limit genuineness to one succinct sentence. My instinct is that at this juncture genuineness wouldn’t work toward my advantage, so I eschew it. “Not really,” I say to Mary.

“It’s just too much. It really hurts, and I can’t get it to stop hurting. I don’t see any reason to continue.” She begins to sob.

This is what we call an “invitation.” Mary has just expressed suicidal ideation. So, I ask point blank and exactly as trained, “Mary, are you considering suicide?”

Some people worry that asking a suicidal person if she’s considering suicide will cement the idea in her mind and cause her to do it. Studies show the opposite is true. Knowing that doesn’t make the question any easier to ask. It’s always a tough one, although it gets easier with every ask—or so I’m told.

“Yes.”

“Do you have a plan?”

“I’m going to do it in my car.”

“Where are you now?”

“In my car. In Clear Lake. I’m going to do it. Robin? I’m going to do it right now. I’m going to kill myself. I’ve got pills. I’ve got vodka. I’ve got a gun.”

Oh no.

The call room at the SPC is long and narrow with four computer stations equipped with phones and headsets, two on each side. There is a window to the hallway, but no window to the outside world, so we are a planet onto ourselves. We often work with the overhead fluorescents turned off, so the only light is from our computer screens, as is the case on this particular afternoon. We find this ambience soothing and thus more conducive to performing our task than the hum of the overhead fluorescents—although it makes reading the call monitor slightly more challenging. Today, it’s just Cam and me, working back-to-back. Generally, Cam as CRS does not take calls, so he can be available to supervise and intercede if necessary. He is always there, and he has been doing this job for years. He is twenty-six years old and cool as a cucumber. He’s seen everything. He has all the answers. I swivel to get his reaction. His chair is empty. I jump up and scan the hallway outside the call center. No Cam in sight. It is all on me.

“Mary, I’m glad you called. I’m really concerned about you. You sound really distressed. Would you like to go to the hospital?”

“Yes, but my body’s not broken, only my head.”

“That’s okay. The hospital cares about broken heads too. Is anyone with you?”

“Yes. My sister and her kids.”

This isn’t what I’d pictured, but it’s also encouraging. “Where is your sister? Can I speak with her?”

“Sure.”

A muffled exchange commences. I hear an adult female voice, but I can’t make out the words, thanks to the unidirectional attributes of the modern cellphone. The voice’s tone is quizzical, not alarmed. That’s reassuring.

“Mary?”

Where is Cam? If emergency services have to be dispatched, Cam has to do it while I stay on the phone with Mary. The fact that children are present is an additional complication to which I am especially sensitive. At one point in in my nasty, high-conflict divorce from my horrible ex, I described him on the phone to my lawyer in an especially unsavory way. We were in the car on our way to a dance competition. My daughter and her best friend were chattering in the backseat, and my lawyer heard them. “What’s that?” she demanded. “Is that your daughter? Why are you talking like that in front of your daughter?” It was judgment of the highest order, which we eschew, but I deserved it. Not in front of the children. Never, ever, ever.

Cam pushes open the call room door, and I gesture frantically for him to listen in. With preternatural calm, he picks up the phone and plants it against his ear. He nods and I launch into summary. Summary has the double advantage of letting the client know you’ve been listening and apprising the CRS of the situation. “Mary, you’re feeling suicidal. You’d like to go to the hospital, and you’d like us to call emergency services. You’re in your car in Clear Lake, you’ve got vodka, pills, and a gun, and your sister and her daughters are with you.”

“It’s all right,” Mary says. “I’m feeling better now. We’re going to do some shopping. Can I call you back later?”

I’m speechless. Cam lifts an eyebrow and makes a spinning motion with his forefinger, his way of indicating it’s okay to wrap things up. Thus prompted, I managed to stammer, “Yes, of course. Call us anytime. Don’t hesitate. We’re here for you twenty-four seven.”

Mary hangs up even before I can get it all out.

“How was that?” asks Cam, which may sound cold, but we debrief after every call, and this is the OEQ with which he initiates every debriefing.

“Whoa,” I say.

“Nicely put. Perhaps you’re feeling frustrated because the caller may have misled you.”

“Good one,” I say. “I see what you’re doing. That rolled right off your tongue.”

He grins. “I’ve had lots of practice. What’s the risk?”

“Well, clearly not imminent. She said she wanted to go to the hospital, but her sister was with her, and she wasn’t the least bit concerned, and now they’re going shopping.”

“She might have been yanking your chain. I really wish people wouldn’t do that. What a waste of resources.”

This was another revelation. Some people think it’s hilarious to prank the National Suicide Lifeway—usually, though not always, teenage boys. It takes all kinds to make a world.

Still and all, we manage to do some good. Studies show UPR, MEs, and all the other things we learn during our sixty hours of training effectively disrupt a suicidal trajectory, which is why very few of our contacts progress to getting the CRS involved to call emergency services.

“If that wasn’t real, she’s a creative genius. She really had me going.”

“It sounds like that was a tough one. Do you want to take a break?

“Nah, I’m okay,” I say as he knew I would.

“Why don’t you write it up,” he suggests.

Unconditional positive regard. Easier said than done, for sure. But doable, especially with practice—or so I’m told.