A tube and death, in that order

Hecklers bedamned

May 01, 2025

Before you continue, I caution: this post is about suicidal ideation and themes surrounding it. It also references cancer. Please don’t read if you are triggered by discussions about either. I am safe and well and at risk from neither.

I do, however, think about dying every day.

A lot of you might be surprised to read this statement. Publicly, I present myself in a reasonably cheerful manner. I make a lot of jokes and often play with humour to help soften the tedium of having to market myself on the daily, to anyone who will listen, because the ability to market oneself and one’s books are prized traits in today’s publishing landscape, an expectation and pressure that weighs heavily on many of us authors. To segue, I remain continually surprised that publishers themselves are not doing more in that area to actually promote the literary, book-shaped investments they have secured, but that particular rant is, perhaps, better suited to another post- I will lead however, with my firm opinion that putting the full weight and expectation of book marketing solely on the shoulders of authors without providing assets, support, ideas, a plan, social media engagement, encouragement and ring fencing resources is tantamount to a particular form of abandonment I’ve become increasingly uncomfortable with, the longer I do this- not to mention the ableist nature of these demands on authors who are physically compromised, emotionally strained, or struggle with executive functioning, RSD, social interactions or any of the other qualities many of us neurodiverse folks face when having to promote our own work. In my opinion, offering a space to publish us isn't enough when it comes to industry standards and taking accountability. A huge piece of work needs to be done to support disabled and Neurospicy folk after the book is written, and not doing so with any real level of dedication is tantamount to exclusion. I should clarify here: my current publishers have been amazing on that front. I received a three page marketing plan for Itch!, the first I have ever been sent with such a detailed commitment to promote laid out, and wept a little. I then spoke to the wonderful team at Titan about a launch event for ROOTS, and other things which filled me with life. That, in turn, has energised me to keep pushing and promoting as far as I am humanly able to. I strongly urge all authors to get comfortable asking for sample marketing plans from publishers before handing over massive percentages of royalty revenue. It doesn't have to involve huge amounts of spend, many indies for example can’t afford that. But there should be a clear, goal oriented plan for what a publishers is going to do to ensure your book will actually earn out, and make you some money, else why go with them in the first place? Beyond the distribution, but what good is that if the book doesn’t actually sell? The reluctance to market products that have received a little upfront investment in the form of an advance is such an odd thing to me, a marketer for over ten years (nearly twenty if you count me marketing myself as an author). The received wisdom is usually spend money to make it, at least it was back when I worked as a marketing manager, but that never seems to happen to the vast majority of books put out these days.

Anyway, I digress. This is not a post about book marketing, but ADHD is like that. It takes you on exciting little journeys off the main path, and if you’re lucky you’ll find yourself back where you started having experienced something truly wonderful and enriching, or, you’ll realise you’re completely lost in the woods, which is why my career thus far has been characterised by my ability to write nine books all at once in between bouts of staring at the wall thinking about dying for weeks on end.

Before you all rush to tell me life is worth living etc: relax. I’m not going to do anything silly, I’ve been through this before. Many times. Every day. For as long as I can remember, really. The feelings come in and out like the tide. Like love. Like anything: thoughts are impermanent. Read FULL IMMERSION, it’s all there. My history with intrusive thoughts and thoughts about death have been a constant feature of my life for many years. It becomes a bit like wearing a very heavy jacket you can never take off. Just an extra, weightier part of my day to day.

It’s important to say, at this juncture, that ideation and intent, at least in my spaghetti brain, are two very different things. I think the best descriptions I have ever seen or heard of someone else feeling a similar way is Joe Tracini’s incredible posts on his various channels about this very thing. He is very open and honest about his feelings and struggles and watching him post makes me feel rather less alone (although I do find myself easily triggered if I’m not careful, so I consume in moderation.) Repetitive, intrusive thoughts do not always result in a foregone conclusion, is what I hear, and I believe it now. I know this is simply my brain, being a dick. Like having an audience of hecklers always there in the front rows of my mind, but instead of catcalls and boos and hisses, they shout weird things like ‘There’s a bus! Quick!’ or ‘Have you taken a walk near the bridge today? It would be quiet enough if you went now’ or ‘Look inside the utensils drawer! Now!’

It’s possible to ignore those voices, with training, but it’s not a pleasurable endeavour. They have weight, and impact, those sibilant heckles. I find I do not want to engage with people as much as I used to, because the mental energy I expend in clearing my brain theatre of audio junk tires me out for anything, or anyone else, much.

Except two things happened to me this year (which we are nearly halfway through already, dear christ) that have begun, rather significantly, to rewire my brain, I think for the better, and I am compelled to write about them, because that is how I deal with everything- I write about it, and it makes a lot more sense to me once I have done so.

The first one was the health scare I had back in January.

The doctor’s soft voice on the telephone was so carefully neutral in tone I immediately knew it was not a routine call.

“It’s probably nothing to worry about, and could quite possibly be an imaging issue, but…”

Not bad news, but not good news either. I had been extremely unwell with a chest infection turned into pleurisy for going on six months. I had a cough that would not die, and got scanned as a result. Which led me to the phone call, whereupon a shadow was mentioned.

The lack of definitive information or opinion immediately turned me into a cat in a box. Schroedinger’s as yet unnamed threat, growing inside of me.

There was, apparently, a shadow on my left lung, or more specifically the hilum, which is in the middle, where all the blood vessels, nerves, arteries and lymph nodes gather. The hilum is also known as the root of the lung, which is fun, because I am currently editing an anthology of ancestral horror stories called ROOTS OF MY FEARS, in which I explore the definitions of the word ‘root’, and all its applications. I didn’t imagine for a second when I started writing it that I would be able to add the specific anatomy of my left lung to the rosta of roots-based vocabulary within. I would have liked to make a joke along the lines of ‘I take my job very seriously,’ but I couldn’t make jokes. I couldn’t do anything much, except curl into a ball and wait for the waiting to be over and done with.

I found, to my immense surprise, that I was scared. Which was supremely ironic, and not a little absurd, because, for the past six months or so, on an almost daily basis, my brain had been telling me most emphatically that I want to die. Finding out I might actually have an illness that could facilitate this put me at odds with myself.

Before you roll your eyes at how dramatic I was being: I watched my granddad die slowly and painfully from a type of lung cancer that metastasized. It was nasty, gruelling and dehumanising, especially for a man who was so very proud, and, before the tumour, robust, healthy, and always outdoors digging, building, walking, climbing, sawing, drilling and making things. By the end he was a frail remnant of himself, so I was, of course, working with all of those memories. The placement of the frightening shadow was in a very close spot to where my grandad’s tumour was located, so it is perhaps a little easier to understand why I was so worried. He was a wonderful man, by the way. The only real father figure I had growing up. I miss him a lot. He died at 72.

I remained worried about this as I lay in a giant tube. Then the audience piped up:

Oh well, they said. The onus is off you to actually do anything about dying: nature has taken control, it’s in her hands now. Blessing for everyone, really. How lucky you are!

I found a plastic tube sticking out of my left arm, ready to pump dye into my body. I had to hold my arms above my head for the scan. I listened for instructions as the tube sucked me into it like a withdrawn tongue. The roof of the scanner was about an inch from my nose. Something whirred around. It felt like how I imagine the inside of a washing machine looks to a pile of laundry. Perhaps. A glowing digital smiley face told me to breathe in. Hold my breath. Breathe out. The tongue poked out of the tube again. The dye was injected into me via the cannula. Warmth instantly floods to my groin, replicating the feeling of having wet myself in an eerily convincing way. I know I haven't because I've been warned about this sensation. Still, a hot groin in a spinning tube is a strange thing to explain to anyone who hasn’t experienced it.

I realised, I wasn’t just scared. I was extremely scared. Not because of the scan, but because of what it might show me. The potential. Schrodinger's cancer. I imagined it spreading across my body.

I realised at that moment, how terribly wrong the whispering audience was. I didn’t want to die.

I wanted to live very much.

My brain didn’t like this realisation very much. It started to fight me, rapid fire instructions hurling into my head from every direction. The audience of hecklers became a heated live debate inside my skull. For, and against. Live, or die.

The tube was suddenly far too small. I was second or two away from a panic attack, then the tongue withdrew once more, pulling me out into the radiologist’s friendly presence.

“All done,” he said, cheerfully, as if was another Friday.

Fast forward a week. I receive a text:

Dear XXX,

Your CT chest scan has been reported. Your lungs are clear with no concerning features…

You would think this would quiet the hecklers down, wouldn’t you?

Quite the opposite. They went into a frenzy of persuasion while I sat and thought about mortality and the fact that, even though there was little wrong with me beyond an extremely nasty infection, I felt like I had been given a second lease of life. My brain split into two modes: a constant, passive monologue about death and how appealing it was, and a more sporadic, active declaration of gratitude that I had longer on this earth to figure all my shit out. Confusing? Yes. Exhausting? Definitely.

Fast forward three more months. I am sitting in a warm room in the city centre, opposite a new therapist. This is a trial session. I am now on my third therapist, and I have come to the conclusion that previous incompatibilities have largely hung upon the professional I was trying to bond with not understanding, or viewing my various issues, through the lens of neurodiversity. Eye contact in particular was an issue for my second therapist, who often thought I was not listening or focusing on his messaging because I was staring fixedly into a corner. Anyone who knows me knows that if I trust you, I will gaze deep into your orbital face holes for all eternity. If I don’t, a fleeting glance into the general region of your face is about the best I can do until we’ve known each other a while.

This therapist is different. They are an ADHD specialist, neurodiverse themselves. There is immediate rapport and trust on my part, perhaps because I am looking forward to understanding that all the significant issues I am facing at the moment can, by and large, be rooted in ADHD.

And this is demonstrated to me most specifically when I glance over the form I have to sign before sessions can begin in earnest. There is a clause about needing to inform family or a doctor if a client is at risk of harming themselves. I mention the thoughts I have, every day. I always balk at doing this: I have a huge fear of being whisked away to a padded room, but that’s probably mostly attributed to the sheer amount of gothic fiction I consumed as an impressionable teen.

The therapist, however, doesn’t make that usual face of concern people make whenever I bring this up: rearing back slightly, examining me like a feral weasel about to bite, perhaps. They simply nod, and explain that this is a very common symptom for many of the ADHD clients they see. It’s called passive ideation, they explain. Thoughts that occur without any desire to make a plan or enact them, as a response to overwhelm, commonly. Impulsivity can play a part, as can emotional dysregulation, intrusive thoughts, substance abuse common with ADHD sufferers trying to self medicate, a whole range of factors. Not ‘normal’, by any means, not as dangerous as the active thoughts, but not un-dangerous either, as one can progress to the other, but common, and treatable. There is evidence that ADHD medication can reduce suicidal thoughts by a significant factor, for example.

This simple statement completely undoes me. I have always assumed my brain to be defunct, ungrateful, abnormal, as malignant as the tumour I imagined I had growing in my chest. I never for one second imagined those thoughts, as grim and seemingly aberrant as they are, to be a symptom of a neurodevelopmental condition. I never for one second imagined it could be treatable, or mitigated at all. I simply assumed I had to wear the coat forever, and just deal with the added weight and discomfort. I burst into tears. The therapist remained calm and non-reactive and passed me a tissue. I felt safe, for the first time in a very, very long time.

All of this has given me something of a conundrum to untangle: where I stand on death. What an enormous privilege to be alive, and yet what a colossal shame for my brain to keep thinking about the opposite state as if it is something to be desired. I see friends and peers struggling with horrible health conditions and feel cretinous and inhuman for not being able to accept how lucky I am. But I know, now, that I am not simply being ungrateful or unaccepting. I am struggling with a symptom, a health condition. A highly complex engine that needs careful calibration. Maintenance. Health checks. Ongoing care. I feel hopeful that I am better placed now, to achieve this calibration. I feel hopeful that I can throw cold water on the hecklers, shuck off the hot, heavy jacket, even for a little while. I feel hopeful, which is nice, because feeling the way I have been for so long has been exhausting to say the least. It would be nice to expend that extra mental energy on other things, like writing more books. Forming better relationships. Holding boundaries with people who wish to take advantage. Promote my books. Teach other people how to do the same, instead of constantly gazing out of an open window and gauging the distance to ground level.

I do not want a single person to reach out to me and ask me if I am okay, by the way, after posting this. I am, as I have stated, not in danger. Fielding those types of queries and messages stresses me out. Sharing all this stuff so publicly is my way of communicating, not a cry for help. Think of it as extra, free therapy for me. As I write this, the window to my study is open. I can hear birds chirping. There is a warm breeze, the faint sound of kids playing in the distance. I have not thought about what it would be like to exit that window (thus far), I have simply sat and enjoyed the benefits of it being open. It’s a rather seismic shift: understanding the nature and likely origin of the thoughts reduces their power significantly. I am, therefore, grateful to the two significant events life sought to send my way: the tube, and the new therapist. They are not the only things life has lobbed at me in 2025, but they are two of the better things. I am taking both as a win.

Anyway, here is a quick list of some resources and articles for anyone wanting a little more information or needing some support. Please note, I am not a medical professional and cannot speak to the veracity of the information contained within, but it might arm an interested party with enough interest to seek accredited information, which I continue to look for myself.

With love,

Gemma

https://pmc.ncbi.nlm.nih.gov/articles/PMC7292769/

https://www.theedgetreatment.com/passive-suicidal-ideation-in-adhd-can-adhd-make-you-suicidal/

https://connectionsoc.com/passive-suicidal-ideation-adhd/

https://www.berkshirehealthcare.nhs.uk/media/109514702/suicide-in-adhd-adhd-bekrshire-healthcare.pdf

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03247-6

https://www.embarkbh.com/blog/suicide/passive-suicidal-ideation/

https://www.embraceu.com/2023/09/14/passive-suicidal-ideation-vs-active/

https://www.sandstonecare.com/blog/passive-suicidal-ideation/

Samaritans: Call 116 123 (lines open 24 hours every day)

https://mhanational.org/resources/suicide-prevention/