Recently a physician I know died suddenly, at home. He was young, certainly young enough for his death to be surprising. Shortly after this news filtered to me via the grapevine, a brief email from hospital administration arrived in my inbox. It was light on details, vaguely written, asked for thoughts and prayers. You know, the standard stuff.
Nothing is absolute in life, but in my heart I knew what happened. I didn’t know the exact details, but it just smelled like suicide to me. The most interesting skill medical school gave me was not the gift of healing or a nearly limitless ability to make a living (although that was a cool byproduct). It gave me this weird medical intuition and ability to read a situation like this. It is not perfect, but I’m right more times than not about these things.
Life Went On
Time passed. There was a funeral, which I was unable to attend due to work. I probably wouldn’t have gone anyways, as I did not know him all that well and knew none of his friends or family. In spite of working with him for a decade or more, our paths just didn’t cross often. We had a few superficial conversations in the doctors’ lounge from time to time and a radiology consultation here and there, but that was about it.
I had not seen him for months, and remember being a bit surprised when I saw him about a week or so before his death, at lunch in the doctors’ lounge. I hadn’t seen him for so long, I had wondered if he quit and was working somewhere else. I’m kind of oblivious to these things, but physician turnover is not uncommon.
The encounter was brief, but I remember feeling that something was a bit off. Maybe it was a look in his eyes or a brief expression, but he looked…different. Then again maybe this is just my mind trying to attach meaning to something and make sense of things in retrospect.
A few weeks went by and the event slipped from my mind. I heard nothing further, and I’m not the gossipy type. My brain was distracted by my return to full time work and soul-crushing back pain that had been plaguing me.
A couple of weeks later I ran in to a good friend of mine, a nurse practitioner who knew him much better than I did. I had not seen her in a while, and after a hug and several minutes of light conversation her face changed. She of course did know many of the details. I was right about the cause of death. As I greatly respect people’s privacy, I will leave the details out of the story. They don’t matter anyways; suicide is suicide. Gun, razor, pills, car, rope; the outcome is the same.
As we talked, she told me she was reminded of the article I wrote over a year ago about my classmate and good friend who died of suicide. We had a long and deep discussion on physician suicide, among other things. She wanted to do something…anything. Maybe we should give a talk; maybe have a suicide prevention seminar/week/retreat/campaign/whatever.
What would I say? All I really know about physician suicide is my personal experience of having people I love and respect die by suicide. To the best of my knowledge I’ve never actually prevented or stopped someone from killing themselves. I’m not an expert or guru. I’m just a guy typing crap into my computer, trying to get the thoughts out of my head so someone else can use them.
I paused and took a slow drink of the beer I was holding. In my heart I knew what really needed to be done. Having awareness campaigns or putting some HR sanctioned corporate article in the monthly hospital newsletter is a well-intentioned, but ultimately meaningless, gesture. Fuck that. Nobody reads those, and if they do it is gone from their mind in five minutes. When is that last time a newsletter drove you to action? That’s what I thought.
I could give a talk and make a fancy PowerPoint presentation, but I have my doubts anyone who actually needed to hear it would come. As painful as it is, what we really need to hear is the truth. We need to talk openly about the topic and have an outlet for people on the edge. We need to hear a message that reaches inside our chest and squeezes our heart; something that makes us hurt a little and makes us choke back the tears. We need that emotional jolt of anger, sadness, regret or whatever.
What would be really helpful would be a letter from the family detailing the awful truth and asking for those who need it to seek help. There should be a memorial in the main conference room or doctors lounge with a phone number beneath it for providers to call when they reach the end of the rope and life seems hopeless. We need more life rafts in this turbulent ocean of our dysfunctional medical-industrial complex.
A Way Out
One of my good friends was heading off to residency and she wisely asked me to have coffee with her. She asked me my opinion on many things medical and I offered advice. At the end of the conversation I looked her in the eye and told her that I was her escape valve. If she ever got into a dark place she couldn’t figure out how to unwind from, she was to call me, any time, day or night, and we would figure it out. I made her promise to call me if things got really bad. This seemed a bit silly, as she is a much stronger and put together human than I am, and I was thinking perhaps I would be the one calling her someday begging her to help me off the ledge, but I have been surprised before, and I have learned to not be surprised at being surprised.
Every physician every person should have a lifeline, one person they can call to bounce their problems off no matter what. One person who will not judge them and can talk them off the ledge and get them the help they need. We should teach this to all medical students and residents. Darkness hits hard and fast and you need an emergency plan. Your parachute must be on and ripcord ready before you fall out of the plane. You will often not be able to figure it out while you are plummeting towards the ground at terminal velocity.
We need to give people a way out that doesn’t end in death.
No Good Answers
I don’t know why he did it, but my guess is he saw no other option; no way out. It’s hard to quantify what society lost. He was a fantastic, experienced, highly specialized, respected and loved physician. He will be replaced of course, but not easily. A decade of medical school, residency and fellowship training is gone in a few seconds. The cost to his family is impossible to measure and I will not try and describe what his wife and children lost with my pithy platitudes. My heart is saddened, and I’ll leave it at that.
Viktor Frankl writes:
If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death, human life cannot be complete.
His suffering ultimately led to his death. It was a direct cause, but if it ends here there is no meaning to his suffering. In order for there to be meaning we must not sweep this away and pretend it didn’t happen, or be too ashamed to stand up and speak the truth. Through the truth, and the pain of sharing it we will find meaning. We have to find meaning. Maybe not by me, but someday his story must be told. We owe him that much.
For those of you who reached out to me and commented on my last post: Thank you. I appreciate the support and all of the kind words and encouragement.