Living ‘in a really dark place’
Ketchum was transitioning from combat soldier to civilian, and it was uncertain terrain, marked by redemptive periods of sobriety and desperate times of guilt, shame and drugs. The cycle repeated over and over.
He received a medical discharge from the Army National Guard in July 2013.
“I didn’t decide to leave the military. The military told me I had to leave,” he explained to a classroom of students during a talk that was videotaped. “I was medically and mentally unfit.”
He said his comfort zone “for so long was being behind a rifle or being in a big armored vehicle. Being home, walking down the street, going shopping, staying at my house — that was well outside my comfort zone,” he said. “I missed the battlefield more and more, and that consumed my mind.”
The same year of his discharge, Ketchum met Kristine Nichols. She thought he was funny and unassuming, and on the first date remarkably candid about struggling with addiction, living with nightmares, being afflicted with PTSD and coping with a body that, at age 31, felt broken and painful.
“I’m a social worker,” she said. “I know those things don’t mean someone’s a bad person.”
He used his GI bill to pay for studies at a community college but couldn’t relax during lectures and would forget when to be in class. He tried construction but missed too much work. In September 2014, he was stopped for driving under the influence, and the next month, he overdosed on heroin and Xanax in an apparent suicide attempt, according to his medical files. Through it all, Nichols supported him but warned that their relationship depended on his choosing to live drug-free.
Ketchum entered a VA detoxification center and stayed there for weeks. Word arrived that a Marine buddy had shot himself to death in his home outside Charleston, W.Va. Ketchum began to fill out journals about his life choices and what happened on Oct. 14, 2007. “The event has caused me to see myself as a failure, remain on guard or hypervigilant, powerless or not in control and distant from many people who I care about deeply,” he wrote.
He emerged from treatment, as before, focused and optimistic. “I feel like I’m in a much better place,” Ketchum told a VA therapist. He joined Alcoholics Anonymous, loved Nichols and was seeing Layla six hours a week, hoping to persuade a judge to allow more time with his daughter.
But depression returned, along with heroin, in January 2015. By early February, Nichols found him overdosed once again and performed CPR, calling paramedics. The incident frightened Ketchum deeply. He was admitted to a private hospital.
He moved into Nichols’ home in Bettendorf, Iowa, in 2015. Ketchum entered a long period of staying away from heroin, although he still used marijuana, which he said calmed him and helped with chronic pain. Through therapy,
Ketchum explored feelings of mistrust and a sense of being “defective” — feelings that tended to leave him “stuck” emotionally, according to his medical files. “It was hard for him to ever see the positive in himself,” Nichols recalled.
Ketchum avoided heroin and made plans for the future. His dream was to attend a woodworking trade school in St. Louis and become a craftsman, and he drew up a three-year plan. The crux of that future was more time with Layla, and, in preparation, he and Nichols repainted a room in her house in pink and purple in September 2015 and bought bunk beds.
By January 2016, Ketchum felt better about himself. He earned $3,100 a month in disability from the VA and $1,200 from Social Security, $600 of which went to child support for Layla.
“He expressed optimism for his future with his girlfriend, his role as a father, his physical health goals and starting his woodworking career,” Ketchum’s VA substance abuse counselor, Darrel Kirby, wrote in his notes. He tapered off using the detoxification drug suboxone.
By February, he had gone almost a year without using heroin, and in March, he graduated from intensive outpatient therapy for substance abuse. He got his driver’s license back and reached out to Army buddies for a dress uniform to wear to an upcoming child-custody court hearing.
A routine drug test by the VA on April 12 showed Ketchum free of drugs.
Something happened later that month. There was an episode with his family back in Wisconsin. Ketchum wanted to visit his stepfather, who had undergone open-heart surgery, but was told visitors were not a good idea. Then Ketchum learned one other family member was there so that his mother could go back to work. He felt rejected. Ketchum also thought increasingly that he was becoming a burden to his girlfriend, therapist Kirby wrote in his notes.
During April and May, Ketchum began missing group and individual therapy sessions. On the night of June 14, he called the VA suicide hotline and said he was thinking about ending his life. He showed up for counseling the next day complaining about a deep depression.
A VA case manager called Ketchum on June 24 to check in. The veteran admitted he was having severe heroin cravings and was severely depressed. “Patient stated he is in a really dark place right now,” the case manager wrote.
Psychiatrist Miller followed up with a phone call and arranged to have suboxone delivered to Ketchum.
Nichols contacted the VA several days later, urging that someone be appointed to handle Ketchum’s personal finances. He was spending thousands of dollars, and she was sure it was on drugs. He kept promising her he would stop, but Nichols caught sight of his left arm while he was driving and saw needle marks. During that Fourth of July holiday, she told him to move out. Nichols didn’t see it as a breakup, but she hoped to use her demand to finally force him to get help. They spoke or texted every day, and he promised her he wouldn’t do anything to harm himself.
In fact, the Tuesday after that long weekend, Ketchum began drafting a suicide note. “Today is the day, I give up and bring all this suffering to an end,” he wrote.
He didn’t act, however. He was to meet with Miller on Thursday, July 7. If he could be hospitalized, Ketchum felt this would deliver him from cravings and despair as it had before.
When Miller and Ketchum sat down that morning, the veteran confessed about using heroin since early June and asked to be admitted. The psychiatrist disagreed about hospitalization. According to his notes, Miller said it was more appropriate to treat Ketchum on an outpatient basis. Ketchum told him “he can’t do it outpatient,” Miller noted.
The psychiatrist brought up the issue of someone overseeing Ketchum’s personal finances. That ended the session.
“My thoughts about it don’t matter,” Ketchum snapped. “They are going to do what they want to do. They won’t let me come in the hospital to get help, but they’ll take my money.”
He got up, thanked Miller for his time and walked out.
Clearly concerned about how the session ended so abruptly, the psychiatrist followed Ketchum to the parking lot, then called Ketchum within a half-hour, leaving a voice mail. The doctor repeated that no hospitalization was necessary, then seemed to soften on that: “I think we can do it on an outpatient basis. If not, we can talk about what other options we can pursue.”
By the time Ketchum saw Miller, he’d already filled three pages with thoughts about ending his life. That night, he texted his mother in Wisconsin about his bitterness toward the VA: “The blood is on their hands now.”
His mother felt that his daughter and girlfriend gave him much to live for, so Kittoe assured him by text that help was out there and she would call him the next day.
Around 1 a.m. Friday, July 8, Ketchum came by Nichols’ home in Bettendorf, telling her by text that he wanted to get something to eat. She had gone to bed early.
“I remember him standing in the doorway of the bedroom, and that’s about all I remember,” she recalled. “I’m pretty sure he said, ‘I love you.’ ” Then he left. A little after 2 a.m., Ketchum filed an angry rant about the VA on a Facebook site frequented by veterans. “Not only did I get a NO, but three reasons of no based (on) me not being ‘f----- up enough,’ ” he wrote. “They gave up on me, so why shouldn’t I give up on myself ?”
Sometime that morning, in an upstairs bedroom of his home in Davenport, Ketchum gathered photos of himself and Layla. He sat down on the floor with his back against the wall and put the pictures near him. He drew close a fleece blanket embroidered with images of his girlfriend and daughter, a Christmas gift from Nichols. He reached for a .45-caliber pistol.
The 911 call arrived shortly before noon, July 8.
“My boyfriend shot himself,” Nichols said. “He’s already dead.”
Later that day, Ketchum’s cellphone rang with another call from his psychiatrist.
“Hey, Brandon, it’s Dr. Miller. I wanted to check in on how you’re doing.”
The VA declined to allow an interview with Miller for this story. Harold Kudler, chief consultant for mental health services for the VA, defended the psychiatrist’s actions. He said Miller conducted a full and fair assessment of Ketchum, balancing signs of suicide risk and mitigating factors and reached a reasoned conclusion.
“Everybody would like to run this tape backward and make it end differently,” Kudler said. “But this man did an assessment. He reviewed the chart very carefully. He knew the patient, and the patient knew him. They had a strong relationship. He made the best judgment he could make.”
The VA Inspector General’s Office is reviewing the case.
The agency’s analysis of veteran suicides showed that veterans seeking mental treatment from the department have a lower suicide risk than those who do not. The VA reported that its crisis line, 800-273-8255 (press 1), has saved tens of thousands of lives.
The most difficult period for any veteran, according to those who study the problem, is making the transition from a war zone to a peaceful homefront.
“He struggled with finding himself in the civilian world and having purpose,” Nichols said. “They have this important job, and they come back here, and they don’t feel like any job is ever going to be as important as that.”
“Everybody would like to run this tape backward and make it end differently.” Harold Kudler, chief consultant for mental health services for the VA