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.
The Truth
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.
Reflection
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.
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Here’s something we should all be telling each other. Success isn’t a porsche or a vacation home. Success is having 2 hours/day when you aren’t on call, you aren’t caring for kids or parents and you can read or exercise, or play candy crush or look at your navel. The current strategy for men in medicine is to work your ass off for 30 years and then (if you haven’t had your first MI yet)still be in debt and have unrealistic expectations hammered into you by administration and very often your own family.
What about only buying a house that is $25,000. If shit gets bad at work and your monthly expenses are only $4,000, you can quit and wait tables to support your family. If your monthly expenses are $15,000, being a physician is the only thing you can do. OH, an by the way, you signed a no-compete at this job which means you have to uproot your family if you want to leave. You also have to incur the transaction costs of a house, moving expenses, etc. (news flash–the next job will be exactly the same as your last job)
I can’t speak for your friend, but the financial stress of being a doctor is real. Med school can cost $300,000. When someone “marries a doctor”, they ain’t doing it at the VFW. The doctor’s wife doens’t want a used dodge minivan, she wants a nice car. Financial obligations = stress. Solution: dramatically reduce financial obligations.
I don’t think I am over simplifying this. Pay off your student loan debt. Buy a small house. Say no to the porsche and country club. Eat rice and beans instead of take out three times/week. ONLY THEN can you say no to your partners, or the hospital. Not before.
b
I agree that being financially secure can help to reduce stress and may help to reduce suicide amongst physicians. But I don’t agree that all doctors’ wives want nice cars. I know lots of doctors’ wives (and husbands, because this is the 21st century) who are perfectly happy with practical cars and reasonable homes. You just have to pick the right one!
Why do you only mention men in medicine ? Is it easier on women in medicine – who are often breadwinners , with a less appreciative or supportive partner ( because society makes men feel less maaculine so they are more resentful than supportive ), with child care duties …… and patients who expect more compassion and time … because after all you are a woman !! And added society pressure to still look well groomed ( manicure , pedicure , hair , make up …) . Your reply was good other than the focus on medical men .
Thoughtful post. I know someone who will probably commit suicide soon. He has ALS. His wife is supportive of his decision. I would probably do the same thing. Unless someone reaches out it is hard to help.
I attended my mother’s funeral in August. During and after the ceremony and hearing family and friends share stories I began to wonder “Why don’t we say all these nice things about people when they’re around to hear them?” I mean, get past the common mention of that and really -think- about it. I have friends and know people that I think are fantastic, and do fantastic things, and are awesome. And yet no one, including myself, really every tell them that. Can you imagine if we often told people those things? Imagine having semi-planned events where we just celebrate how awesome Frank is? How good Maria has been to all of us? They may feel a little more support, a little more love, and little less reason to give up…
The first reaction when someone who *seemed* happy and healthy commits suicide is often surprise. Then, it is questioning why. Sometimes there is a good answer to why, such as Hatton1’s friend with ALS. Often the answer was inside the mind of the now deceased, and will never be truly known. It might be difficult for us to imagine, but we have no clue how much psychological suffering may be happening behind that happy-looking facade.
I had some very dark times in high school and early college. Looking back, I was probably depressed, and the thought of suicide crossed my mind more than once. I never started the planning phase. If I had decided to commit suicide, I think it would have been very difficult to stop me. Over time, life kept moving, things got better, and I slowly came out of it.
I don’t know how to prevent suicide. Humans have always done it, and probably always will. A lack of social connections and lack of a path out of their suffering are certainly big parts of the problem. I think what you do here—telling the story to a wider audience—might help wake some people up who have not been pushed over the edge yet. Thanks, THP.
Thank you for this. As a physician myself who has witnessed both a fellow resident and program director die needlessly from the stresses of the work, I appreciate the caring candor of your post. Too often, we physicians worry about others but forget that our value as humans render us worth being worried about.
Brother, as tears nake their way down my face reading your piece. The reality of being truly real
has being lost in this society, profession, residencyp program, family and board rooms across the hemisphere. We are a hurting civilization.. I dont know what the answer is- all I know is that my world was turned upside down after the suicide of one of graduated residence. I like you went on with my life ignoring the fact that something deep inside has being consuming my inner soul. I dont know what to do how to help- one thing I certainly do now I give my phone # to my collegues amd reaidents and like you I tell them to call me if they are down to the point of no return. Is that helpful, I dont know— All I know is that we are all fragile no matter what you might think of yourself. Thank you..
As a Doctor across the pond in the UK’s NHS, this post hits home. It’s not just in corporate US Hospitals the stress and pain is happening. I have been to the dark places, and managed with colleagues help to make a pathway back.
The key here is ‘colleagues help’. It doesn’t matter who you are, or what job you do – our broken world no longer values real friends. The measure of success is how many ‘friends’ you ave on Facebook, how many ‘likes’ you have on instagram, and how big, brash and expensive your seeminly successful lifestyle is. All driven by the insane economic model of consumption to bolster the nation.
It is an empty path to follow, that inculcates a culture of ‘more’ and never being good enough for others expectations.
Against that background, it would seem impossible for individuals to do or achieve anything to change this. But that is wrong, it is only individuals that can make a difference. 100% agree with the HP that YOU can help somebody, by being a real friend, forget Twitbook and Fritter, emephermal narcotising crap for the multinationals; but speak to people, and listen. This will be more real and fulfilling than any number of likes, and as has been said above, don’t play the Corporate Game of ‘stuff’. So what if a Porsche gets to 60mph in 3s, my Honda gets there in 10s. So what if the latest phone has a gazillion pixels on its phone, if all you are doing is working to pay for it, you aren’t ever going to enjoy it.
Seek friendship, and freedom. These two things will allow you more riches than you can ever buy.
I like Ron’s suggestion as well as giving your number and making that person promise they will call you. And hopefully, they will. We all need that person who can talk us down.
If most people knew just how much they were actually valued, so many fewer would make the decision to end their life. I don’t view Hatton’s friend in the same light. They are facing a disease that they can’t win against and wanting to go before quality of life is no longer there. Although, many great people have lived great lives where quality may have been suspect on the outside. Still, I can’t hold it against someone who wants to spare loved ones the pain of watching a slow, painful death.
At the very least, we can all do our part to make sure those around us know just how much they are valued.
cd :O)
You’re a fine writer. Thanks for sharing this story with such grace. We all need to be more mindful, aware, and *engaging* of those suffering around us.
Sad and seemingly more common story. I have heard that physician suicide is on the rise. I’m sure the reasons and solution are complex.
A good place to start would probably be training i.e. medical school and residency. When I was a medical student over a decade ago we had several talks about physician substance abuse including guest lecturers who had lost their license and ability to practice medicine as a result of drug abuse. I don’t think I’ll ever forget those stories, and I’m very cognizant of alcohol and drug abuse amongst physicians and therefore potentially myself.
I don’t recall receiving any education on physician suicide. Hopefully this will change soon. I know that over the past couple of years I am more acutely aware of my close colleagues mindset as a result of hearing these stories. Like you say, recognition is important.
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