One of the most difficult roles in my job is to lose anyone.

When you lose a student in particular to suicide.

It saddens everyone because we're all wondering what could we have done?

What could have I done to assist the soul?

In search for an answer In the state of Indiana, Unfortunately, one in seven children have contemplated suicide in the last six months.

That's a chilling statistic.

Friends, family, those you worship with, those you play sports with, they're all included in that seven.

I see these things unfolding in my state and it's hard to know how to improve it.

Literally, the suicide rate has increased in my career and our treatments have gotten better.

The problem is more severe and more drastic than probably most people are aware of.

In the behavioral hospice, there are system and process challenges that are not enabling us to be as successful as we need to be.

I've had the opportunity to review medical records.

It has surprised me.

I guess I would say is an understatement that many people are not given a thorough assessment to begin with and then are not even given therapy in many settings.

We do have an enormous problem with access and there's no question about that.

But what we don't talk about enough is this idea that we also have a maybe bigger problem with quality.

You can't yell loud enough about this issue.

I helped lead a group of over 1300 physicians and advanced practice providers.

The U.S.

Surgeon General recently came out and said children's mental health is the biggest public health crisis facing us.

And I think our frontline pediatricians would tell you, that's for sure.

If you had told me 12 years ago when I took office that I would spend as much time convening and helping people discuss solutions to mental health, I wouldn’t have believed it.

In my case, really good friends and a daughter die by suicide, and they've been very open about it.

They reached out to me after the funeral and okay, what can we do?

What does a Mayor do?

I can tell you that there have been students in my office over and over again seeking counseling from me; I’m not a counselor.

I'm a mentor.

I'm a president.

With the pandemic, we saw chaos.

We saw people were disorganized.

We saw sadness.

We saw frustration.

We saw anger.

But most importantly, we saw death.

This mental health crisis, to me, is no different.

We need to build a system that's going to be responsive to the needs of community members.

The urgency of us being able to recognize the need is real.

Everyone wants to do better.

The question is what's the roadmap to do better?

We know that we can't just attempt things that we think will work.

What's the evidence that's going to help us move the needle?

How many suicides are attributed to mental illnesses that have treatments associated with them?

And I don't know that we really know the answer to that.

But if we're not going to deliver the right treatment at the right time for those disorders, it's hard to imagine a very significant change in the suicide rate.

Hi.

Hi.

Hey Claire.

Well, our oldest is Claire.

She is 24 years old.

Hi, Phoebe.

Hey, Phoebe.

We also had a son, Tate, and he was 19 years old when he passed.

I guess.

I mean, it is sunny.

It's warm, too.

Mm.

Bye.

Love you.

Have a good day.

Love you.

Okay.

Bye Bye.

I heard him walk in.

He's very friendly, and he seemed to attract friends very easily.

Mm hmm.

Guys like some fruit.

I'll take some fruit and a great family.

Love and enjoy.

He would always be, like, the loudest one in the dugout, like cheering everyone on instant energy, instant jokes.

So we just.

We've really fed off each other well, and we got to know each other well.

And so we were, you know, best friends for for forever, really.

So it was your fifth or sixth grade?

I struggled pretty bad with anxiety at that time.

And Tate was one of my guys who would help me through it and is a gifted encourager.

He also had a way of just like melding humor and supporting you, and he was our emotional kid.

He would get up in the middle of the night and climb in the bed and cuddle between the two of us.

Yeah, the term I understand now is highly sensitive person.

What I understand is that you just your feelings are big, you know, your highs are highs and lows are lows.

One of the earliest times I noticed it was when he played sports and he was very competitive.

He wanted to win.

And if things didn't go his way, he got very upset.

And I remember one time I think he was eight years old, he was the last batter and he struck out and he came back and it was very hard to console him.

He was a perfectionist and had very high standards for himself and was very hard on himself, even as a toddler.

I am the oldest of three.

I love animals and I am 14 years old going into freshman year.

Math is definitely my favorite subject.

My first struggles, I remember with mental health are when I was, I would say five.

I would have I was having like panic attacks, like separation anxiety, but I didn't know what that was.

I didn't understand why I was, like, shaking and couldn't breathe and couldn't go to sleep.

I would just kind of, you know, have intrusive thoughts of like, you're not doing good enough at this.

Somehow people are going to figure out that I'm actually not very smart.

After high school, he graduated.

He finally decided on Purdue.

He was eager to meet people.

He got involved with the Purdue Gold Rush.

But during COVID, it was not really effective.

I just don't think there were a lot of options We had a really strong community in high school, a lot of support from family and friends.

But his wells were kind of running dry.

Like, he really liked music.

He really liked sports in high school.

He just wasn't getting as much out of that in college as he was in high school.

During COVID, I developed kind of a depression state, especially with like not being around people.

Even really simple things like brushing my teeth or taking the shower were so, so hard.

Tate headed back to campus after the holiday break.

We dropped him off and a few days later he called home to talk to his sister.

Claire was still home.

She came downstairs and said, I'm going to Purdue.

Tate's upset he's had a breakup and I'm going to go check on him.

She ended up bringing him home.

He had expressed thoughts of suicide.

It was scary and we didn't recognize him.

He would just walk around sort of with this expressionless face and it would kind of become catatonic and just not respond to you.

We'd never seen anything like this coming from Tate before.

This is my cuddly kid and that's just not him.

Anxiety and depression kind of go hand-in-hand.

So an anxiety kind of spikes.

You know, sometimes you shut down.

Okay.

This was February 14th of 2022.

I've had a lot of panic attacks today.

Not really sure why.

I'm just in this constant loop of why and hating myself.

I feel like I should be talking to more people because it's getting really hard.

Tonight, I really fought the urge to cut myself, and I just honestly don't even know anymore.

It's like I'm trying to figure out who I am.

Also trying to fit in.

We decided with him that going back to school was not the best choice.

So we pulled him out of Purdue.

We knew we needed to keep a close eye on him.

And so after about a week, we all looked at each other and said, Hey, we can't continue this.

We need help because we were monitoring him 24/7 They stayed in the hospital for about four days while he was seeing a counselor.

Actually, we met with the counselor before Tate would go in there and we'd talk to him about how it was going and what was going on.

I kind of felt like I had the pieces in place.

We were going with the counselor, and so I just felt like if there was a concern, he would let us know.

When a parent or anyone seeks mental health care.

It's a very, very difficult decision often, and they don't know what they're looking for.

It's not as may be easy to do as a, you know, like a dentist.

I know that my dentist is going to work on my teeth.

So therefore, if a dentist doesn't work on my teeth, probably that's not where I want to be going.

Mental health is a little bit more amorphous.

We don't really know What am I looking for?

What does it mean when our kids are in crisis like that We want relief for them and we may not know exactly what that is.

So we're trusting that a mental health provider is going to be able to say, hey, I think we have some concerns here.

If there's something going on, I'm going to tell them.

There would be times where like, if I just got into an argument and my parents or my siblings and I was already in a pretty dark place, you know, just kind of be like, would it be easier for them if I wasn’t here?

Would it make our lives easier?

Thoughts of like, you know, like, even just like making plans on how I could, um, uh, you know, and my life.

I think my biggest fear as a parent would be for any of my children to feel like they're not enough and take any action related to them feeling like they're not enough.

I don't think anyone really sat down and explained to us about suicideology or depression or the standard of care or standard of care.

In fact, Take did not have a safety plan that evidently is standard practice.

It just makes it really difficult to know how to parent.

I think if you ask most people what's the treatment for mental health disorders?

Go get therapy.

Go talk to a therapist.

And I think there is increasing awareness that therapy is good for people and we should all promote therapy.

The problem is most people aren't aware that there's like 65 plus types of therapy And you really want a therapist who knows how to deliver the type that matches up with the disorder that you have.

Within the next month, he had another crisis and left the house without letting us know.

We didn't know where he was and he didn't sound like he was himself.

And we were scared.

So we called the police and they were able to track him down.

And that was the start of his second hospitalization.

You rely upon the system to provide you with clinicians that have that have the skills to do that.

Just like when you get on an airplane, you want to make sure the pilot really knows what they're doing right.

Your life is in their hands.

And so you'd like to think there is a system in place to monitor that.

And I think the bad news is there isn't.

To get better, you really need to be working to identify that the type of disorder that you have is, in fact aligned with the intervention that you're being given.

And that is hard for people who aren't trained in mental.

I mean, what how could we ask that of people like, I don't know how to tell and to tell if my airline pilot has taken the right courses, how would I know?

I felt like he was trying to do things for himself as much as he could, but he also felt like the resources we had for him just we're not working and we didn't know where to go in it.

I never really acted on any of my suicidal thoughts, self-harm thoughts.

I did a few times, but that was definitely really hard.

For one, I didn't want to make anyone upset.

And I also just kind of thought like, you know, if I bring it up, then, well, I was kind of scared that they were going to like put me in more intensive therapy or something like that.

And I was like, you know, I have it under control.

I mean, it wasn't under control.

No matter who comes to see me, I ask some some important questions.

Most everybody has had a thought in their life.

What if I wasn't here?

What would life be like for other people if I wasn't here anymore?

That's really scary because then people are like, Am I suicidal?

Is there something wrong with me?

And I will talk about it on a scale.

I like the I like the end points.

I like people to be able to say like it's not all or none.

So on that scale, one is we've all had those thoughts.

What would I feel like ten is I've done something or I'm going to do something to take my life.

Right now I work with people on what's the highest you've ever been and when do we need to be engaging somebody else?

He was very open, I think, with a lot of us.

I would talk to him a lot, but it felt very like I'm just reminding him of this pain that he can't control.

I knew he was obviously struggling and he would be open and honest with me, but I don't know.

I sometimes felt like I maybe took the approach, just like, how can I get his mind off things?

I found that my role was often like the encourager or the Let's go have a good time together.

I had hoped that the counseling and the therapy was was helping a lot with that, and I'm sure in bouts it did.

But I don't know.

In August of 2021, Tate was getting ready to get back to school at Purdue.

We're all having a great weekend at the lake, and he got some information that was really upsetting to him and kind of had another crisis.

Took all of us to keep him safe until we could get back home the next morning.

And that's when the psychiatrist suggested that he needed to be seen at a facility because she thought he was suicidal.

And he got very upset and he didn't want to go.

And they brought out the ambulance with the firefighters to take him there, you know, against his will.

So then they had the transport him via, a police car.

They decided that he didn't need to be admitted as an inpatient and then they could just follow up with his outpatient counselor or if we wanted to get a new one, she gave us a couple of names.

We're kind of left with not a lot of resources or information, not a lot of explanations.

Tate was really angry because he felt like people didn't understand him.

What we need to do for our kids is to say, as you are growing up, you are going to have these huge, intense emotions.

This may be their first experience, might be their first heartbreak, their first flunk test, their first car accident.

So having somebody come along and say, regardless of what it is, even if you haven't had depression, what level of suicidal thinking have you ever had?

And what do we do with that if it ever increases?

Dialectical behavior therapy was developed around 30 years ago by a psychologist who was working with suicidal younger women who self-harmed, and the therapy model that was used at the time was cognitive behavioral therapy.

And what she and her colleagues found was it didn't seem to be that effective with this population.

She developed dialectical behavior therapy.

There have been a number of research based studies that indicate DBT is very effective for individuals who have impulse control issues, who have a hard time regulating emotions, individuals who have a history of depression, individuals who don't have a good ability to communicate their thoughts and feelings.

I really don't think my son ever had DBT.

I think it might have been a good option for Tate, and I'm really sorry he didn't have access to it.

It's hard to monitor psychotherapy, and that's not because they aren't good at monitoring.

It's because things like psychotherapy are abstract and hard to quantify, hard to measure.

And so I don't think it's that people don't care about it.

It's just that it's really hard to assess and quantify and measure and regulate.

Standard of care is hard to measure because that's what I do sitting with you and nobody's checking that.

And nobody can really check that because it can't be in the room.

How are things going in general?

Pretty good Big issue when you came open was your family was in quiet disarray.

Everybody was hurting.

Everybody was struggling.

How does it feel today?

I mean, I mean, it's not like I cry every day.

Yeah.

And I'm going to be honest about what I see the effectiveness of treatment being and why I'm the saying, what I'm saying for us to do.

I don't need to fill out two pages of paperwork here.

It has been managed very well through administration in your supervision time that they feel like you're not measuring up.

They are talking to you about how that's not happening, what you need to do, making a plan with you to make things better.

And so I have not seen those kinds of folks stay ineffective in Mill Hills Center for a long time.

They tend to give process to either leave or they improve.

It's really hard to hear from someone else that comes in and says, Hey, what you're doing isn't as good as what you should be doing, and you need to learn to do it differently.

At its core, it's saying the care that you provide every day of your life isn't as good as it should be.

It may be that individual providers are absolutely fantastic and are doing a wonderful job providing care, but the problem is when it's one offs, there's no way to systematically understand if that's true.

We actually are taught to monitor ourselves and also talk to colleagues, and we expect everyone who is practicing to adhere to that code of ethics.

I will say as an employer of mental health providers, it's really important that we have the highest possible skill level, that we have strong clinical supervision, that we have good accountability, and we also evaluate our outcomes and other areas of medicine, surgery, internal medicine, cancer.

There's a very organized effort nationally and internationally to track exactly how patients are doing.

That effort just is sort of missing altogether from the behavioral health psychiatric space patient safety especially is embedded from the second we get into residency.

Things like time outs and time out procedures to make sure we have the correct patient, make sure we're the correct site and make sure we have the correct, you know, extremity.

We're constantly told by our mentors about it you want things to be done the correct way, the safest way, and you need some sort of checks and balances to make sure that's being done properly.

I really do feel that every single aspect of medicine should have some sort of protocol in place and should be held accountable for maintaining the high standards.

I do think we have great processes in place to ensure quality and safety in medicine.

Time out.

This is John Smith.

We have entire teams dedicated to quality and safety that just review the outcome metrics, review any potential concerns and discuss the anticipated risks.

The reason I have these evidence based standards of care is to ensure that across the care delivery system that your son or daughter, mom, father, brother, sister is getting the same level of care.

No matter where you go.

In mental health, one, I don't know if we know what we don't know.

There's I think so much out there that is untreated and unrecognized.

I think we have significant opportunities there to improve our delivery of care.

I think people want to do the right thing as as a whole.

But the field just doesn't even have the metrics and the data sets to compare.

It's just not part of the culture of the delivery of behavioral health care to be monitoring quality and safety in the way that it is part of the culture.

On the medical pediatric side.

Health care has learned several best practices and lessons from other industries, and the racing industry in particular has made huge strides toward the safety of its drivers and its teams by focusing on continuous quality improvement through manufacturing and other means.

Are there lessons there that we can learn from and adopt to help us mitigate this mental health crisis in our youth?

Engineering Company Our concentration is not specifically on the performance of the car, but on safety aspect of the car.

I think safety maybe wasn't, you know, obviously the primary focus years and years ago, watching old race events makes me feel like we all had a huge false sense of security.

So basically, when I was saying the middle of the 50, 60s, the drivers themself, they started to figure it out, okay, we're going to lose friends here every race, so we better do something to protect ourselves.

And so I think the expectation was, is that maybe it should be a little bit safer that there was a some motivation there.

And with motivation came rule changes from this series that they'd hope would result in fewer injuries.

That is sort of required by their customers.

I think motor sports is known for being quite fast to respond.

I think many industries will consider that To be a risk in itself is to respond to quickly and create problems where you didn't have problems before.

But I think that there is some value in having an open mind and moving quickly.

In Indiana, we are known for being the best at racecar driving in the world, and we're really proud of that.

And I think it's encouraging that we could be really good at something else.

And what I'd like to see is us be really good at patient quality and safety in the mental health space.

Tate went back to Perdue in the fall.

He was doing well in school.

He joined a couple of clubs.

He was engaging with friends.

He was going to football games and we thought, that's our Tate and he's back.

And, you know, that semester when he was back, you kind of started to see a little bit more of the Tate that we remembered and then the real Tate that we knew.

But that was actually I think he was very good at putting a cover and putting a mask on it in that time, which for me made it made it a lot harder.

His primary care doctor did warn us that when people who are considering suicide, that they're going to be more apt to act out on it when they're feeling better.

Shortly before he passed, I had that moment where I was really worried about him because he was seeming to be doing so much better.

When we started, Jaclyn was maybe in third grade.

Dr. Thorne, I think, made Jaclyn feel so comfortable if she was having some type of scary thought.

I think she felt comfortable to share it, even knowing that it would be, you know, communicated to us.

I ended up talking to Dr. Thorne about everything that was going on.

She kind of, first of all, validated my feelings and made sure I understood that it was okay to feel like that.

We kind of got out of order, too.

I've come to therapy a lot more to talk through those kinds of things.

And it's I mean, definitely helped.

But I now know how to cope with those thoughts whenever I have any thoughts like reoccurring, like suicidal or self-harm, I just kind of think about that.

I'm going to get through it.

I think that I mean, therapy, if I didn't have it, it would be very, very bad place right now still.

I had therapy as a resource to talk through it and now know how to cope with it.

I got lucky right before Thanksgiving was the Purdue University Dance Marathon right up Tate’s alley, and they were doing this.

Yeah.

And it just felt really good to see him smiling and having fun.

It was just really good to have him home.

Our Thanksgiving was Thursday, so we had our family over at our house.

So we had Thanksgiving together.

Then Friday.

And that's the time when we start creating our Christmas lists.

And so he told me what he wanted.

So I went ahead and ordered that for him.

We went out, we got takeout that night for dinner, Thai food.

He opened a gift from his sister.

That was early.

It was a gift to go see his favorite.

One of his favorite music groups play a band in called Lawrence in Philadelphia.

And he opened it.

He was a little reserved about it, but my thought was, Oh, he's worried that his sister's spending that much money on him.

And she, I think, picked up on that, too.

Looking back now, I'm wondering if he wasn't starting to spiral down and we just didn't see it.

Then we decorated the tree.

And as tradition, Tate would put the star on top of the tree, which he did, and he stepped back.

It were all sitting around and he stood there and he said, you know, it's sort of funny.

Last year at this time, I was happier.

And we all sort of just sat there and I don't know why we are a hugging family.

And normally we would just go up there and hug him and we just all sat there and I don't know if anybody said anything.

Nobody did.

Yeah, we all wonder why we didn't.

And I don't know if it would have made a difference, but I think that was that one bit of reaching out that we just didn't hear.

My gut was telling me that there was something wrong and I wanted to go down and check on him, but my, hey just gave him space.

You're supposed to just be a counselor.

This is his deal.

Made me think I should just stay put.

So we all went to bed and we woke up and all of us were awake, ‘sept Tate.

That's when Angie and Claire found him.

And he was gone.

That was.

That was the last of it.

As a father, you look for the things that you want to see your son go through.

I know with my dad, experience going to ball games, I can think back to the day of my wedding, my dad fixing my tie before marrying Angie.

I remember one of the things that made me really sad was not getting sorry [Unintelligible] Just the opportunity to play catch again or hit tennis balls out on the court.

You just wanna be with your baby.

I just wanted to hold him.

You just want to hold him as long as you can.

He was a great kid.

He was successful.

He was well supported.

He was loved.

And he still struggled.

My biggest struggle has been with guilt and, you know, shame that I wasn't able to help him.

And I wasn't able to get him the help that he needed.

I think as a parent, we want to fix things.

If our child is hurt in some way, we want to just take over.

I don't necessarily have to solve it as a parent, but I do need to know what to do.

We need to help people figure out what to do.

I've learned a lot about myself, and I think about Tate and about suicideology.

And I recognize now that I think Tate may have had some unidentified medical conditions that weren't being treated.

I feel like a lot of the things that I've benefited from would have helped him immensely, and I wasn't aware of it at the time, nor did I recognize that it was something that might have helped him or I would have sought it out.

pull pull pull pull pull pull hard, pull hard Oh.

ow, my eye Hit you in the noggin didn’t it?

All right.

I'm not sure who really manages mental health.

There's a lot of broken parts of our mental health system.

We have to realize that we're at a point where we need to do something different.

If in five years, we are sitting at same place we are today, we have not taken advantage of a very important moment.

Overwhelmingly, many leaders have this kind of 30,000 foot view of a problem.

And when we have that view, I think we have a broad understanding, but not necessarily an intimate one.

You know, there are things we see every day that we just ignore because we're able to people in crisis no longer can wait.

We need to be attentive immediately to this issue.

Families want this.

Families need it.

Families deserve it.

In my experience, clinicians are starving for access to high quality training and supervision.

The problem is it costs them money and time.

Mental health is always one of those things.

People say, Yes, we need to put more money into that.

And then when you get done, when you have a new building, you have more administrators, but you just don't have more people on the ground doing the work.

And that's where they need to spend the money.

More people on the ground doing the work, the people on the ground doing the work, being high quality people who are getting paid a salary commensurate with their skill level and the risk that they take every single day.

Somebody in this building is making a decision on someone's life.

This crisis is so much bigger than what Riley could impact alone, or what IU health could impact alone, or any number of other entities and health care systems and providers across the state could do alone.

It's going to take all of us.

We need everyone at the table to help us move this forward.

What does a Mayor do?

you start calling people.

You start calling people who are really smart in this space and you think you know what you need until you really start talking to experts.

You're like, Oh, we don't need that.

We need this instead.

And then you go down this path for a while, okay?

You don't really need that.

Maybe we need to be right here.

And those are hard meetings in their emotional They are draining.

But I think we're a stronger community because of people pulling together to do that.

There might be some other aspects of some of these others that we pull into a bit.

See what you're trying to do already.

You're trying to do everything.

We can't do everything well.

So our youth are different.

They are dealing with different challenges and we have to be much more responsive to that.

And so I think what our work has centered on is really how do we change that?

One of the best ways we can start to implement small changes is with the students we're training.

We all need to be doing a better job preparing our future practitioners and providers for caring for individuals with mental health disorders.

I think we're on to something pretty special here, and I appreciate everybody's leadership.

It's our collective responsibility to develop initiatives to address the growing pediatric behavioral health crisis in Indiana.

We've brought together over 200 stakeholders across the state who are engaging in developing a statewide strategic plan to mitigate this crisis.

This includes clinicians, educators, families, state and community leaders, leaders of corporations.

Our vision is to create a future where Indiana youth can receive the right care, the right time, right place for their mental health and substance use Disorder needs.

We're going to use evidence based interventions.

We're going to use professionals who have dedicated their lives, making sure that the quality of care that they provide is going to improve the care of the kids that we serve.

I want the same care for every kid in Indiana that I would expect for my three children.

We're going to need everybody in the boat.

We're going to need health care.

We're going to need the schools.

We're going to need our public health system.

We're going to need businesses.

We're going to need legislators.

This is one thing that hopefully we can come together on and say, let's just do the right thing for children.

I think the ultimate solution to this problem lies in large scale changes to how our national, state, even international systems monitor and fund this work.

I think for all of us, the end goal is about allowing people to live their best lives, to be as functional as and as successful as possible in all domains.

Building great citizens.

Building great communities.

Building stronger families.

Having people not walking around feeling stigmatized.

People having dignity and autonomy to live a fulfilled life.

This is why this is so important to me.

We know that we have to create awareness and make sure that everyone in the state knows how important it is to focus our efforts.

On improving child health.

This is to give them hope that we are together going to make a difference.

I play this all the time.

Makes me feel better.

That's what we do this for.

There is always hope for everybody who walks in the door.

The kids are the future of society, the future of community.

I mean society, with no kids has no future.

I think by doing helps me a lot.

And this is given me a do and I'm grateful for it.

We don't want others to go through what we had to go through.

I'm 100% sure that this doesn't have to happen again to anybody.

I'm hopeful.

I'm always hopeful because you don't have an option to not be.

♪ I'm not going to make this easy.

♪ ♪ Here comes a goodbye ♪ ♪ ‘cause every time I go, I'm scared ♪ ♪ it's going to be the last time.

♪ ♪ Take a bath in all the sorrow and enjoy this side, ♪ ♪ ‘cause every time I go I’m scared it's gonna be the last time.

♪ We need our Indiana homes to be better resourced and informed on what they can do for their children collectively.

We can push for something better.

♪ So I know when I really need to ♪ ♪ I can close my eyes ‘cause every time I go, I'm scared ♪ ♪ It's going to be the last time.

♪ ♪ You promise me each time ♪ ♪ you leave, you haven't seen the last of me.

♪ ♪ It's just I never had enough of you.

♪ ♪ Feed me any line, ♪ ♪ Just tell me this won't be the last time.

♪ ♪ So just let me know when you land ♪ ♪ only then I'll be fine.

♪ ♪ ‘Cause every time you go, I'm scared it’s gonna be the last time.

♪ ♪ You promise me each time you leave, you haven’t seen the last of me ♪ ♪ It's just I never had enough of you.

♪ ♪ Feed me any line, just tell me this won’t be the last time ♪ ♪ Just tell me this won’t be the last time.

♪ ♪ And one day we're gonna look back and laugh at how much we cried ♪ ♪ ‘Cause every time we laughed, we thought that it would be the last time ♪