Fifteen years after being voted “The Couple Most Likely to Succeed” at our college, my life-partner John bought the self-deliverance book, Final Exit, that we both planned to use. We were the last people who would think of ending our lives, but that’s where the constant physical and emotional torture of chronic pain takes most of us.

I haven’t yet talked to the woman (or man) with high-impact pain who doesn’t think about suicide. It can be a fantasy – a coping mechanism – to help us survive. Or it can be our ultimate painkiller. Pain, and everything that accompanies it, often takes us beyond the boundary of human endurance.

I’ve planned my suicide countless times over the past 33 years. I don’t know how I’d survive without that option. It’s seemingly a contradiction, a paradox – but it makes perfect sense in the senseless, agonizing world of chronic pain. To survive the impossible, we must have a way out.

For me and probably most people with high-impact pain and fatigue, the desire for suicide comes not due to our physical suffering, but because of our ever-mounting losses. Our families and friends run for the hills, many of us lose the chance to have our own families, our doctors label us crazy or worse, society calls us malingerers and drug seekers, we lose our careers and dreams, and, in turn, our identities.

I’ve known a number of women in pain who have chosen suicide. I never judge them, but am always devastated to hear the news and wish they’d made the choice to push on – because they had something extraordinary to offer the world. I also know women who’ve been right up to the edge and haven’t, as yet, taken their lives.

One of my closest “sisters” moved up to the mountains two years ago, literally walking away from healthcare, family and friends – all who had failed and/or abandoned her. I was the only sister Carrie stayed in touch with, and I love her deeply. Before the holidays, Carrie told me she was considering taking her life again (she’d made an attempt with pills a decade prior.) Recently she cut off communication with me and I’m fearful I’ve lost her. Sadly, as a pain advocate, this experience is far from unique.

The horror of a chronic pain life can only be understood by those who live it. The despair decade after decade pulls us down into a hopeless abyss, an experience our life-long caregivers join us on in shared-isolation and suffering. Surviving is the difficult and seemingly more unnatural choice. I think it’s normal to think about taking our lives. When the hope of regaining well-being is long gone, we have to find control. For me, the fantasy of suicide oddly provides comfort and is sometimes how I get myself out of bed.

In order to survive – and this is the hardest part – we must accept that our pain is most likely not going to go away and our lives are forever altered. We must re-invent ourselves, finding deep purpose and meaning. We must also realize new expectations. John and I no longer seek a happy life. We seek a purposeful life that provides satisfaction and contentedness.

Bottom line, life is always the best choice. We with pain have “the strongest souls forged by the hottest fires.” We have wisdom and courage most people can’t imagine. Pain has gifted us extraordinary qualities the world desperately needs.

John and I still have our copy of Final Exit. It’s tucked away deep in a box somewhere collecting dust. A memento to remind us of a choice we didn’t make.