Dart Center for Journalism and Trauma

Some people are listening.

In California, mental health advocates are working to get legislation to mandate depression screening for pregnant women so that a support plan is in place when the baby is born. In Illinois, where four women committed suicide in summer 2001, a governor's task force is developing guidelines for identifying and treating postpartum mood disorders.

U.S. Sen. Richard Durbin, D-Ill., has introduced the Melanie Stokes Bill, named for a Chicago woman who jumped from a 12-story hotel window, that would provide for more research on, and better services for, postpartum depression and psychosis.

In the meantime, those who cared for Carol are left with "what-ifs." Carol saw at least a half-dozen people who tried to help her in the last weeks of her life, from a "spiritual therapist" to a psychiatrist. None seemed able to shake her delusion that her family would be better off without her.

At the time, each thought the right things were getting done. Gallegos, who cared for her the longest, is still tormented by how her death might have been prevented. "It was so fast-moving," she said. "It literally felt like trying to stop a charging bull."

Abby Myers, the nurse-practitioner who saw Carol for the first time the day she died, said early intervention is critical in treating depression. Myers, who heads Depression After Delivery, a postpartum support group, said lack of awareness about postpartum depression contributed to Carol's death. "We need to educate all different kinds of providers about this," she said.

And parents as well.

Myers said Washington should copy New York's law mandating that women be informed in the maternity ward before they are discharged about what signs to look for and how to get help.

Gallegos has her regrets. "What I do wish is maybe if we had all talked more — all of us, and Thomas — that maybe then we could have caught this."

If there's a lesson, it's that denial can be deadly.

"As health care providers we have to deal with our own sense of belief that it couldn't happen," she said. "The part we all missed, we thought no matter how difficult it was, she would never leave her son."

Thomas believes his wife didn't really want to kill herself, that she was not in her right mind.

Almost to himself, he said: "I forgive her."

When Alexander looks at her picture and asks for her, he tells him she's watching them. He isn't sure yet what he'll tell him in the future.

But he doesn't flinch recounting details of her death to others, and he will tell them again and again if it will make a difference. He wants people to understand how desperate she was.

"I'm like Sisyphus," he said. "I will push that huge ball up the hill over and over to prevent it from happening one more time."