‘The world was too much for her’ SU­SAN CLAIR­MONT

She just turned out into the sky and jumped

The Hamilton Spectator - - FRONT PAGE - Su­san Clair­mont’s com­men­tary ap­pears reg­u­larly in The Spec­ta­tor. sclair­mont@thes­pec.com 905-526-3539 | @su­san­clair­mont

SHE SLIPS OFF HER BLACK high tops and leaves them side by side on the pedes­trian bridge. She drops her beige sweater in a heap.

In the dis­tance, where High­way 403 be­gins its long curve down the moun­tain into West Hamil­ton, a trans­port truck comes into view. It will take nearly 30 sec­onds to wend its way to the bridge.

As it nears, she quickly and with­out hes­i­ta­tion climbs over the rail­ing onto a nar­row ledge. Fac­ing the sky and traf­fic below, she jumps.

Ni­cole Jea­nine Pate­naude, 20, was men­tally ill.

THIS IS HER STORY.

Carolyn and Don Pate­naude had four daugh­ters in four years: Jeanette, Emily, Ni­cole and Re­bekah.

By the time the girls were all out of di­a­pers, the cou­ple had sep­a­rated and Carol was rais­ing them alone. It was ex­haust­ing but she did it with love and good hu­mour in a small East Hamil­ton bun­ga­low that dou­bled as a home day­care.

It was the baby, Re­bekah, who was the fo­cus of much of Carol’s at­ten­tion in the early years. She is un­able to walk be­cause of cere­bral palsy. For a time her mom wor­ried she would be un­able to talk.

“Now we’re look­ing for the mute but­ton,” Carol teases.

She was put in re­straints. Ni­cole said the straps around her made her feel safe.

Re­bekah, 19, will soon en­ter para­le­gal stud­ies at Mo­hawk Col­lege. She wants to be a hu­man rights lawyer.

When Carol was com­ing to terms with the re­al­ity that Re­bekah needed a wheel­chair, Ni­cole — seem­ingly the pic­ture of health — was lit­er­ally climb­ing the drapes.

“The cur­tain rod was bent,” re­calls Carol, 48.

“Ni­cole was very en­er­getic. Happy-go-lucky. Ad­ven­tur­ous. She was a char­ac­ter.”

On her first day of kinder­garten, she was fear­less. “Could she even shed a tear?” Carol says, re­mem­ber­ing her own emo­tional mo­ment watch­ing her daugh­ter head ea­gerly into St. Eu­gene School.

A nat­u­ral ath­lete, Ni­cole played T-ball. Jim Roberts coached all the Pate­naude girls. (Re­bekah’s CP didn’t stop her.)

“Ni­cole was al­ways smil­ing,” Roberts re­calls. “Full of en­ergy. Talk­a­tive. She was the fastest run­ner I’ve ever seen at that age. She had a com­pet­i­tive air about her. She wanted to do well.”

She was easy to coach, says Roberts. No trou­ble at all.

By the time she hit Cathe­dral High School, Ni­cole had friends and good grades. She did wrestling, vol­ley­ball, base­ball and cross-coun­try run­ning.

“Her es­cape was cy­cling,” Carol says. “If she was in a bad mood or needed to get out.”

Ni­cole was a Girl Guide leader. Her Guid­ing name was “Cup­cake,” a nod to her sweet tooth.

THE PATENAUDES

are a bois­ter­ous, lov­ing, fam­ily.

They fin­ish each other’s sen­tences, make jokes and use pet names. One minute they bicker, the next they are hug­ging.

The girls call Carol “Won­der Woman.” She pro­vided ev­ery op­por­tu­nity and ad­dressed ev­ery need.

Like all the girls, Ni­cole saw a fam­ily ther­a­pist. Carol was con­cerned about the im­pact of the di­vorce on the girls’ men­tal health, so for years they went to a coun­sel­lor.

Carol and the girls had this thing called a “Ni­cole Sand­wich.” It in­volved pil­ing onto Re­bekah’s lap in her wheel­chair, stack­ing them­selves youngest to old­est. The sand­wich was in­vented af­ter Ni­cole’s di­ag­no­sis of men­tal ill­ness to sur­round her with love and sup­port.

ON HER 16TH BIRTH­DAY,

March 6, 2013, Ni­cole left on a school trip to Europe.

Carol saved to en­sure each daugh­ter could go on such an ad­ven­ture. Jean­nette had done it, and now Emily and Ni­cole were go­ing dur­ing March break, al­though they were on sep­a­rate trips.

Ni­cole’s class was tour­ing France and Ger­many for 10 days and she was ex­cited, al­though ner­vous about trav­el­ling with­out her fam­ily for the first time.

A few days in, Carol missed a call from Ni­cole. She tried ring­ing Ni­cole later that night, but had been given the wrong phone num­ber.

“I guess she waited up for me to call all night,” says Carol.

Things weren’t go­ing well on the trip. Teach­ers told Carol that Ni­cole was act­ing up. She wasn’t par­tic­i­pat­ing in ac­tiv­i­ties, didn’t want to go on the bus, wasn’t eat­ing. She pushed a teacher.

The be­hav­iour was com­pletely out of char­ac­ter for Ni­cole. Carol got up ev­ery night to phone Europe and con­sole her daugh­ter who, she hoped, was just ex­pe­ri­enc­ing acute home­sick­ness. “I knew she wasn’t her­self.” Ni­cole com­plained her legs weren’t work­ing. Given Re­bekah’s CP, Carol asked the teach­ers to take Ni­cole to a hos­pi­tal to be sure she was OK. They told her it wasn’t nec­es­sary and she ought not to worry.

Mean­while, ac­cord­ing to Carol, the teach­ers took two other stu­dents to the hos­pi­tal be­cause of stom­ach aches.

CAROL, RE­BEKAH,

Jean­nette and her boyfriend Tyler Rayn­ham (now her hus­band), met Ni­cole when she re­turned to Cathe­dral af­ter the trip.

“She comes off the bus, her head is down, she won’t even look at us,” says Carol.

In the car, Ni­cole curled into a fe­tal po­si­tion, shak­ing and silent. She was of­fered home­made cook­ies but didn’t re­spond.

“Ni­cole, talk to me, honey,” said Carol. “What’s wrong?” “I don’t know,” Ni­cole whis­pered. “Do you want to go to the hos­pi­tal?” “Yes.” At McMaster Chil­dren’s Hos­pi­tal she was ex­am­ined and sent home. Jet lag, maybe?

Ni­cole curled on her bed, co­cooned in a blan­ket, shak­ing. She nei­ther ate nor spoke.

Carol de­cided to take Ni­cole back to hos­pi­tal, but couldn’t rouse her. She called 911.

The scene that un­folded still up­sets Re­bekah.

Her thin, five-foot-five sis­ter kicked and punched paramedics and bat­tered po­lice.

Ni­cole was hand­cuffed and loaded into the am­bu­lance.

“She was scream­ing ‘I don’t want to go,’” re­mem­bers Re­bekah.

Emily came back from Europe ea­ger to ex­change travel stories with Ni­cole. In­stead, she learned her sis­ter was hav­ing a breakdown.

“I didn’t know how to process it,” she says. “I ex­pected we’d talk about the Eif­fel Tower.”

NI­COLE WAS AD­MIT­TED

to the chil­dren’s men­tal health ward at Mac. She stayed six weeks, the first of many hos­pi­tal­iza­tions.

While there, Ni­cole hid in the closet and un­der the bed. She kicked, bit and punched staff. She pulled taps from the bath­room walls. She cut her­self with any­thing she could find. Once, she used a de­odor­ant lid.

She was put in re­straints. Ni­cole said the straps around her arms, legs and chest made her feel safe.

Some­times, amid the chaos, the old Ni­cole sur­faced. “I’m sorry,” she said. Then she was gone.

DOC­TORS WARNED

they were go­ing to send Ni­cole home, and Carol begged them not to.

Ni­cole didn’t want to go home. She said so re­peat­edly.

Carol didn’t know if she could han­dle her daugh­ter. Her vi­o­lent out­bursts were hard for trained staff to man­age. How would she do it?

What about the day­care kids? It wouldn’t be safe to have Ni­cole around them. The day­care was the fam­ily’s only source of in­come.

Most of all, the fam­ily knew Ni­cole wasn’t well.

“Pro­fes­sion­als think they know what’s best, but they don’t lis­ten to the fam­i­lies,” says Jean­nette. “Yet it’s the fam­ily who knows them and must care for them.”

One day Carol heard a car out­side the house. Ni­cole got out of a cab. The hos­pi­tal had sent her home.

C AROL DE­SCRIBES

Ni­cole’s men­tal ill­ness as “a con­coc­tion.”

It is Border­line Per­son­al­ity Dis­or­der com­bined with Im­pulse Con­trol Dis­or­der and a dash of anx­i­ety and de­pres­sion. Maybe.

Many of Carol’s ques­tions re­main unan­swered. That school trip, was it a trig­ger? Did the fam­ily miss signs of men­tal ill­ness be­fore that?

“Un­til then, I only no­ticed nor­mal, teenaged prob­lems,” she says.

NI­COLE WASN’T

home long be­fore she was read­mit­ted to hos­pi­tal. And re­leased. And read­mit­ted. Lots of med­i­ca­tions were tried. The fam­ily runs through some of the more mem­o­rable episodes in Ni­cole’s saga.

There was the time Carol took Ni­cole out of Mac for some fresh air and Ni­cole climbed a tree on cam­pus and wouldn’t come down. Fire­fight­ers were called.

Or when she grabbed her so­cial worker in a head­lock at the hos­pi­tal and threat­ened to smash her head in with a fire ex­tin­guisher. Se­cu­rity guards tack­led her, po­lice were called and she was charged.

Like many des­per­ate fam­i­lies, Carol hoped the crim­i­nal jus­tice sys­tem might help Ni­cole get treat­ment. She was locked up at Syl Apps, a youth de­ten­tion fa­cil­ity in Oakville.

“Syl Apps is ab­so­lutely amaz­ing,” says Carol, with gen­uine ap­pre­ci­a­tion for what it did for Ni­cole. “She was thriv­ing at Syl Apps.”

Ni­cole at­tended school there and learned to cope with her ill­ness.

Ev­ery week the fam­ily made the trek by bus (they don’t have a car) to visit Ni­cole. They gave her a blan­ket that says “I Love You” on it with a big heart. It was meant to “hug” her even when they couldn’t.

“She loved it there,” says Re­bekah. “She was hap­pi­est there.”

Ki­nark, the agency that op­er­ates Syl Apps, de­clined to com­ment for this story.

On Ni­cole’s 18th birth­day, she was dis­charged from Syl Apps.

She was an adult by law, says Jean­nette, but she did not have the men­tal­ity of an adult.

NI­COLE MOVED

into Charl­ton Hall, a home for trou­bled girls. But she as­saulted a staff mem­ber, so she didn’t stay long.

Next came a se­ries of group homes, in­ter­spersed with hos­pi­tal stays, which were now at the West 5th Cam­pus of St. Joseph’s Hos­pi­tal in Hamil­ton, the city’s adult men­tal health unit.

“All the group homes have re­ally tried to help Ni­cole,” says Carol. “They tried and they were com­pas­sion­ate, not only with Ni­cole but with our fam­ily.”

The hos­pi­tal, how­ever, cut the fam­ily out of the loop. Now that Ni­cole was an adult, her mom was no longer her le­gal guardian. Carol was not told when her daugh­ter was ad­mit­ted to hos­pi­tal.

“MOMMY, I WANT

to be nor­mal again,” Ni­cole said.

Her goal was to have an apart­ment and a boyfriend.

She got a job de­liv­er­ing fly­ers, but af­ter a few weeks she was back in hos­pi­tal and lost her route.

Con­tact with her fam­ily be­came spo­radic. They often didn’t know what was go­ing on in her life, though they let it be known they loved her and missed her.

“She didn’t want us to be dis­ap­pointed in her,” said Carol. “But I told her, ‘I love you and I’m heart­bro­ken be­cause you’re in pain.’”

Ni­cole got a tat­too on her right fore­arm. A blue and pur­ple but­ter­fly with the words, ‘Stay Strong.’

In an un­dated poem she wrote, Ni­cole likens her­self to a but­ter­fly:

Be­cause ev­ery­body has their strug­gles, Ev­ery­body has their trou­bles. I am win­ning be­cause ev­ery day, ev­ery mo­ment is a new be­gin­ning. I am soaring over what­ever is in my way. I am like a but­ter­fly fly­ing away.

Though Ni­cole may not have thought of it, her tat­too also evokes the phi­los­o­phy of The But­ter­fly Ef­fect. It’s the idea that one small event — or maybe one per­son — can change things in a way that can­not be pre­dicted.

IN AU­GUST 2015, Ni­cole was re­ferred to lawyer Court­ney Ha­mara at Sul­li­van Festeryga LLP.

She had a youth record and now adult charges re­lat­ing to an as­sault on staff while at West 5th.

She en­tered into a peace bond, but, when in cri­sis, wound up as­sault­ing an­other worker and be­ing charged with a new as­sault as well as breach­ing her bond.

“She was al­ways very re­morse­ful,” says Ha­mara. “She did worry about what the con­se­quences would be.”

Ha­mara says Ni­cole could have ben­e­fited from a des­ig­nated Men­tal Heath Court, had there been one in Hamil­ton. An MHC is about treat­ing low-vi­o­lence of­fend­ers. “I re­ally liked Ni­cole,” says Ha­mara. “She was very sweet.”

FROM JAN­UARY to Novem­ber 2016, Ni­cole lived at Elm Villa, the res­i­den­tial care fa­cil­ity where she would meet her boyfriend, Justin Hind.

Tanya Han­ni­gan runs the home and has fond me­mories of Ni­cole.

“I just al­ways en­joyed talk­ing to her. She was fas­ci­nat­ing. Wise … She had am­bi­tion.”

Han­ni­gan hoped Ni­cole would have a ca­reer help­ing oth­ers one day. But there would be moun­tains to climb.

“Ni­cole had ma­jor strug­gles … She was a soul cry­ing out for help. The com­bi­na­tion of her dif­fer­ent ill­nesses added up. She was strug­gling with a dark­ness in­side her.”

THANKS­GIV­ING was the last time the whole fam­ily was to­gether.

Dec. 11, Ni­cole phoned her brotherin-law, Tyler, to say she loved her fam­ily but wouldn’t be join­ing them for Christ­mas. She was spar­ing them the burden of her com­pany.

Around the same time, Ni­cole was ad­mit­ted to the West 5th Cam­pus. She re­mained a pa­tient there for the rest of her life.

The Scrab­ble game the Patenaudes bought Ni­cole for Christ­mas is still at her mother’s house, un­opened.

EV­ERY YEAR, on each daugh­ter’s birth­day, Carol has their photo taken at a por­trait stu­dio.

There are gaps in Ni­cole’s. No photo at 16, be­cause she was away and then in hos­pi­tal. Also in hos­pi­tal at 18.

On her 20th birth­day, March 6 of this year, Ni­cole called her mom and sis­ters from the hos­pi­tal to say she was sorry and she loves them.

DR. PETER COOK is chief psy­chi­a­trist at St. Joe’s. Peter Biel­ing is head of men­tal health and ad­dic­tion ser­vices.

They over­see the staff who cared for Ni­cole dur­ing her fi­nal five months in hos­pi­tal. With Carol’s per­mis­sion, they agreed to speak about Ni­cole’s care and her sui­cide.

Ni­cole’s men­tal ill­ness was “com­pli­cated and pro­found,” says Biel­ing. She grew up in­side in­sti­tu­tions. The goal for her care team was to get her well enough to live in the com­mu­nity.

“It ap­peared to be go­ing well,” says Biel­ing. The team helped her se­cure an apart­ment on May 1 and was work­ing up to dis­charg­ing her. No date had been set yet.

“So many agen­cies were wrap­ping around her and get­ting her ready,” says Biel­ing. NI­COLE TRIED many times to kill her­self.

She used her bra to hang her­self from the closet and from a bed­post. She bought a knife and stabbed her­self in the neck. She over­dosed on al­lergy medicine.

Her fam­ily wasn’t in­formed by the hos­pi­tal about her adult sui­cide at­tempts.

“She wakes up in the hos­pi­tal af­ter over­dos­ing with no­body there for her,” Carol says an­grily. “You’re go­ing to let a men­tally ill young lady, who al­most died, wake up by her­self with no sup­port?”

That le­gal is­sue is one of the thorni­est that Cook and Biel­ing must navi- gate: the rights of pa­tients vs. the rights of their fam­i­lies. In the end, adult pa­tients win.

“We were ob­li­gated to pro­tect the pri­vacy of Ni­cole,” says Cook. “She was an adult.”

While in­volv­ing the fam­ily is a part of treat­ment wher­ever pos­si­ble, if a pa­tient does not want their fam­ily in­volved, the hos­pi­tal must re­spect that wish, says Cook.

Con­fi­den­tial­ity be­tween pa­tient and doc­tor is “sacro­sanct,” says Biel­ing. Ni­cole did not want to share her med­i­cal in­for­ma­tion with her fam­ily.

From her po­ems, jour­nals and con­ver­sa­tions with her fam­ily, it ap­pears Ni­cole’s de­ci­sion to shut them out wasn’t be­cause she didn’t love them. In­deed, it seems to have been be­cause she loved them so much. She con­sid­ered her­self a burden.

“I know that I’m hard to love,” she posted on Face­book.

On May 11, Ni­cole was on a pass from St. Joe’s. She dropped by Elm Villa, her for­mer lodg­ing home, for a half-hour visit with Han­ni­gan.

Ni­cole had marks on her arms and neck, and Han­ni­gan was con­cerned. She knew Ni­cole had a his­tory of self-harm­ing — cut­ting, head bang­ing and stran­gu­la­tion. That pain was a way of di­vert­ing the pain from in­side her head.

Han­ni­gan re­calls Ni­cole’s fi­nal words: “I’m young. I can do any­thing.”

A selfie on Ni­cole’s phone, taken May 12, is a close-up of her neck. Long red marks are vis­i­ble across her throat.

NI­COLE MET Justin Hind when they both lived at Elm Villa.

“She seemed very nice,” Hind, 23, re­mem­bers. “I was afraid to talk to her.”

But Ni­cole made it easy. She was out­go­ing and fun and they had much in com­mon, in­clud­ing their strug­gles with men­tal ill­ness.

“She made me get out of the house and do stuff. We’d go for hikes.” Ni­cole was Hind’s first girl­friend. “I told her ev­ery day that I loved her,” he says. “I texted her ev­ery morn­ing so she knew she had some­one who cared about her.”

When Ni­cole was in hos­pi­tal, Justin vis­ited twice a week. He saw she cut her wrists and neck. Some­times she talked about sui­cide.

“I told her never to do it. And to call me if she was think­ing about it.”

TUES­DAY, MAY 16, is the last day of Ni­cole’s life.

At 9 a.m. she sends a text to Hind: “Love you lots. Sorry I couldn’t get

back to you sooner. Had a bad week. Hope­fully I’ll be bet­ter soon.”

Hind texts and calls her through­out the day, but never hears back.

Ni­cole gets a “ther­a­peu­tic pass” from West 5th.

Dif­fer­ent lev­els of passes al­low in­creased free­doms.

Level 1 means the pa­tient must re­main on the se­cure in-pa­tient unit. Level 4 grants vis­its to the com­mu­nity. Ni­cole had Level 4 passes be­fore with suc­cess, ac­cord­ing to Cook and Biel­ing.

Ni­cole starts her day out by go­ing to her bank and pay­ing her phone bill. At 9:29 she checks out a book at the li­brary.

At 10:30 she meets with a mem­ber of her care team at Forti­nos on Main Street West.

“How are you feel­ing? What is your mood like?” are likely ques­tions, says Cook. Ni­cole would be asked about her plans for the day.

Part of that con­ver­sa­tion is a risk as­sess­ment, says Cook. Is the pa­tient a risk to them­selves? To oth­ers? Are they vul­ner­a­ble to harm from oth­ers?

Cook and Biel­ing say they were un­aware of the red marks on Ni­cole’s neck. They say it was not un­usual for her to self-harm, so per­haps the care team mem­ber sees the marks but does not con­sider them a sui­cide at­tempt.

An­other pos­si­bil­ity is the big sweater Ni­cole has with her. It is a turtle­neck. Yet it is a warm day.

Ni­cole goes to the apart­ment she has taken in West Hamil­ton. A week ear­lier, on an­other pass, she went there with Hind and played board games. It was a happy day.

This time at the apart­ment, Ni­cole writes a sui­cide note: “For ev­ery­one who tried to help, thank you.”

She records a video on her phone. It is time stamped at 11:29 a.m.

Those good­byes will be found by po­lice.

The mys­tery of what Ni­cole does for the next four and a half hours haunts her mother, re­duc­ing her to tears when she thinks of that deep, dark gap in time.

Was Ni­cole tee­ter­ing on the brink of a de­ci­sion? Was her pain un­bear­able?

Ni­cole leaves her phone and iden­ti­fi­ca­tion in her apart­ment, car­ry­ing only the apart­ment key.

She makes her way to the wide, smooth pedes­trian bridge that is a 15-minute walk away and part of the Hamil­ton-Brant­ford Rail Trail.

At about 4 p.m. Ni­cole stops on the bridge above the down-bound lanes of Hwy. 403, takes off her shoes and drops her sweater. Po­lice will tell Carol and her three re­main­ing daugh­ters that shed­ding cloth­ing is a com­mon thing for jumpers.

Po­lice will de­scribe Ni­cole’s sweater as “neatly folded,” and that trou­bles the Patenaudes. Did some­one else fold her sweater? Was some­one with her?

Even­tu­ally, when they see a pic­ture taken by Hamil­ton Spec­ta­tor pho­to­jour­nal­ist Barry Gray — he shot it be­fore po­lice ar­rived at the scene — they see the sweater is not folded, but rather crum­pled in a heap. It is a re­lief to them. “That,” they say, “is so Ni­cole.” Two passersby see Ni­cole climb over the rail­ing. They call 911 and later tell OPP de­tec­tives the young woman was gone in a heart­beat. She didn’t linger on the ledge. She just turned out into the sky and jumped.

Carol and the girls be­lieve Ni­cole waited for a trans­port truck.

“The world was too much for her,” says Carol.

THE OPP CLOSED the 403 in both di­rec­tions for hours.

Mo­torists near the pedes­trian bridge got out of their cars and sat on guardrails, wait­ing.

The of­fi­cial word from po­lice was that a pedes­trian was struck by a truck. Noth­ing about sui­cide.

Traf­fic backed up for miles. It took driv­ers two and half hours to crawl from the Ford plant in Oakville to down­town Hamil­ton.

Jean­nette, 22, was on a bus, com­ing home from York Univer­sity. It was her next-to-last day be­fore fin­ish­ing her teach­ing de­gree.

She won­dered what was caus­ing the traf­fic jam.

NI­COLE WAS IDEN­TI­FIED by her tat­too. Po­lice ran it through the Cana­dian Po­lice In­for­ma­tion Cen­tre (CPIC) data­bank and came up with five peo­ple with sim­i­lar but­ter­flies on their fore­arm.

At 10:30 p.m., just as she was pre­par­ing for bed, Re­bekah an­swered the phone. A po­lice of­fi­cer said it was about Ni­cole and they were on their way over. When they ar­rived they said a woman, who may be Ni­cole, had been struck by a truck.

It was the next day, when fin­ger­prints con­firmed Ni­cole’s iden­tity, that her fam­ily learned she had jumped. And that it was sui­cide.

Carol and the girls did not see her body at the fu­neral home. It was too bro­ken. She was in a body bag, her old I Love You blan­ket wrapped around it.

Ev­ery­one took turns hug­ging what was left of Ni­cole.

Af­ter her body was placed in a cas­ket, ready for cre­ma­tion, Carol, Jean­nette, Emily and Re­bekah said their fi­nal good­bye.

“We Ni­cole Sand­wiched the cas­ket,” says Emily.

THIS WAS NOT the first time sui­cide touched Tyler’s life. When he was 10, his older brother died by sui­cide. He was 23.

THE BUT­TER­FLY had an ef­fect. Carol, the girls and Tyler want the truck driver to know they think of him.

They know there was noth­ing he could do. In fact, they are grate­ful.

They know he saw her face as she fell from the sky. They can only imag­ine how this af­fects him.

“We re­ally hurt for him,” says Emily, 21.

It is a mir­a­cle to them that the driver was able to stop with­out caus­ing an ac­ci­dent.

The truck didn’t kill Ni­cole, says her fam­ily. Her ill­ness did.

Ni­cole could not have imag­ined the way her death re­ver­ber­ated through the world.

Her old base­ball coach, now with fam­ily mem­bers of his own cop­ing with men­tal ill­ness, was dev­as­tated to hear the fleet-footed girl with the big smile had killed her­self.

“I was in shock,” Roberts says. “It took me a cou­ple of days to come around.”

Han­ni­gan, the lodg­ing home op­er­a­tor, re­plays their fi­nal con­ver­sa­tion, look­ing for clues.

The lawyer, Ha­mara, had to ap­pear in court af­ter Ni­cole’s death to of­fi­cially close her case. It was very emo­tional for her.

Ni­cole’s death is “very dif­fi­cult for the staff ” at St. Joe’s, says Dr. Cook. They were very fond of her.

Hind, Ni­cole’s boyfriend, was crushed.

“It was the first time I cried in a very long time,” he says.

And, 15 km away from where Ni­cole jumped, a 10-year-old girl in Wa­ter­down named Jas­min Hanif was fa­tally struck by a car. Po­lice say her death was caused, in­di­rectly, by traf­fic di­verted off the high­way closed for Ni­cole’s death in­ves­ti­ga­tion and rerouted through Jas­min’s neigh­bour­hood.

“I don’t blame Ni­cole,” says Sha­keel Hanif, Jas­min’s fa­ther. “I blame the sys­tem. More re­sources need to be put into men­tal health care.”

Hanif sup­ports the Pate­naude fam­ily’s de­ci­sion to tell Ni­cole’s story.

“The story is the smartest and most ben­e­fi­cial thing to do for the public right now,” he says.

THE PATENAUDES want you to know Ni­cole was deeply loved and deeply trou­bled. They want you to know some­thing about her be­yond the fact she is the one who jumped off the bridge.

They see no shame in men­tal ill­ness or sui­cide. They be­lieve talk­ing about it is the only way to break down stigma, ed­u­cate and let other fam­i­lies know they are not alone.

Carol is dis­ap­pointed the OPP didn’t ask if they could tell the public that Ni­cole’s death was a sui­cide. In­stead, the news re­lease sim­ply said a woman was struck by a ve­hi­cle. (Even when di­rectly asked if Ni­cole’s death was sui­cide, the OPP would not con­firm and did not seek di­rec­tion from Carol.)

Po­lice have closed their in­ves­ti­ga­tion of Ni­cole’s death but the coro­ner’s case is on­go­ing. St. Joe’s is re­view­ing its work to de­ter­mine if any­thing could have been done dif­fer­ently.

How can a doc­tor or nurse or so­cial worker know a pa­tient’s sui­cide is im­mi­nent?

“That’s the Holy Grail ques­tion,” says Biel­ing.

LAST YEAR, three peo­ple died by sui­cide while in-pa­tients at West 5th Cam­pus.

The hos­pi­tal saw al­most 24,000 unique men­tal health pa­tients last year.

The clus­ter of sui­cides led the hos­pi­tal to or­der both an in­ter­nal and out­side re­view, which is be­ing con­ducted by a for­mer chief coro­ner for On­tario and the re­tired head of psy­chi­a­try from a ma­jor hos­pi­tal. It was ex­pected to wrap up in Fe­bru­ary, but the hos­pi­tal is still wait­ing.

Mean­while Ni­cole took her own life. And on June 25 an­other pa­tient died by sui­cide at West 5th, St. Joe’s has con­firmed.

Carol would also like to see a Coro­ner’s In­quest called into the sui­cides of West 5th pa­tients. That, she be­lieves, may be her best chance of get­ting an­swers and pre­vent­ing sim­i­lar deaths. THE VIDEO is one minute and two sec­onds long.

Ni­cole shot it with her phone, likely in the apart­ment she never got to live in. Her face fills the frame. Her dark hair is short and tou­sled. Her dark eyes are big and pen­e­trat­ing un­der thick brows. They peer straight into the cam­era. On her neck are an­gry, red marks. Her voice is barely a whis­per. At times, her words are in­audi­ble. It is as though she doesn’t have the strength to speak them aloud.

It is hard to imag­ine any­one could pos­si­bly look sad­der than Ni­cole in this mo­ment. This is a woman in agony.

“Hi. If you’re watch­ing this, it means I killed my­self. I have been think­ing of sui­cide a lot, a lot lately. I want to get out of this world. I have tried three times in three days … I want to get out of this world. In all fair­ness to ev­ery­one … My fam­ily will al­ways be num­ber one. I’m sorry for … pain to ev­ery­one. I’m sorry it’s over. I think it needs to hap­pen. I left this for my loved ones — fam­ily and friends. I’m sorry it has to end this way.”

Ni­cole got a tat­too. A blue and pur­ple but­ter­fly with the words ‘Stay Strong.’

BARRY GRAY, THE HAMIL­TON SPEC­TA­TOR

On May 16, Ni­cole Pate­naude left her sweater and shoes on this over­pass be­fore climb­ing the rail­ing and jump­ing into the on­com­ing traf­fic below.

Carol Pate­naude holds a photo of Ni­cole from when she was two years old. "Ni­cole was very en­er­getic. Happy-go-lucky. Ad­ven­tur­ous."

Age six

Age four

Age three

Age two

Age seven

Ni­cole at age one

Age five

SOURCE: OF­FICE OF THE CHIEF CORO­NER AND ON­TARIO FOREN­SIC PATHOL­OGY SER­VICE

* Pre­lim­i­nary fig­ures, sub­ject to change once the sta­tis­ti­cal year has been com­pleted. Ap­plies to all ta­bles.

Mom Carolyn with daugh­ters Ni­cole, Emily, Re­bekah and Jean­nette — “a bois­ter­ous, lov­ing fam­ily.”

Age 14

Age 12

Age 11

Age 10

Ni­cole at age eight

Age 13

Age nine

Tyler watches as sis­ters Re­bekah, Emily, Jean­nette and mom Carolyn make a “sand­wich,” which they used to do with Ni­cole ev­ery time they got to­gether. They are wear­ing match­ing “Team Ni­cole” T-shirts with an im­age of her but­ter­fly tat­too and the words, “Stay Strong.”

Age 20

Age 16

Age 18

Ni­cole at age 15

Age 19

Age 17

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