I was very saddened to learn this past week of another physician who died by suicide. This, the untimely death of a young and brilliant mother of two, is a horrifying tragedy. I do not write this to pretend I know anything about this recent tragedy. I write this as a sort of case report on myself. I was an at risk physician at one point. I’ll start where the problems most obviously began. For me, that was progressing through a highly competitive residency in a surgery subspecialty. As I entered the final leg of my residency training, I became one of the few seniors in a very small program. I was on call at least every 1 in 3 days for my final years. There were scheduled cases, conferences, supervising juniors, rounding, research, labs, and significant administrative work. I found myself with less and less personal time. I fell out of touch with family and friends. I was disappearing. Burnout is described as being insidious, and it definitely was for me. I also believe that is a reason why the physician and also the people around him or her are not alerted to new changes. The loss of control over my life and schedule was becoming increasingly frustrating. I was a multifaceted person at one time. Now, I was only really a surgeon. I felt alone. I talked to a few physician friends who felt similarly. After a while the talk gets old. I didn’t want to burden others or seem ungrateful for what I had. I engaged in a lot of negative self-talk. I lost the sense of magic as some surgeries turned routine and much of my week was spent doing mundane things. I had no idea how to prove myself any more or form new goals. It seemed a sure thing that I would graduate from residency and move on to a private practice career. Now, my amazing career was turning into a street race to build a business and make money. I lost interest. I felt mired in a high-level form of mediocrity. The picture of the depressed doctor is one of someone with low energy, failing at their job, not engaged with patients, crying in their car, and not confident. I am here to refute that classic picture. I harbored four of the symptoms of classic depression which eventually included suicidality. But, I had energy, socialized, and cracked jokes. My performance on my yearly evaluation actually improved over the years, and I was confident in my surgical judgment. I was nice to patients. I was unemotional about it but felt drained and empty. It is difficult to describe in words the tunnel of thought one gets into that is so dark. It is hard to explain why simple logic that would normally appeal to such a logical, practical person does not work when your burnout turns to suicidal thoughts. I cannot fully explain why your brain begins to demand the peace that only death can bring. For several months, I drove home everyday from work and contemplated suicide. I had a very specific plan of action for my suicide that would have guaranteed a fatal outcome. This plan was a pleasant fantasy. An opportunity came up for me to see important friends and family all in one visit and I took it. I envisioned this visit as being a goodbye. The visit did give me pause. Shortly after this trip, I was sitting in our resident office with a junior resident who I had known for years. He suddenly asked if I was truly alright. Looking at how serious he looked, I could tell he also had some intuition about me apart from mere observations. I had trust in this friendship and in this resident to keep our discussion in confidence. I answered him as honestly as I felt I could at the time. I described my situation as a ‘funk’ and admitted that I was desperately unhappy. I admitted that I might be depressed. He listened. He did not try to talk me out of my reasoning. I explained my paranoia of seeking professional care. Very soon I would be submitting an application for a state medical license and hospital credentials. I was not convinced that I was classically depressed and did not want a diagnosis of depression to follow me. I admitted my interest in starting an anti-depressant medication. Irresponsibly or not, he offered to prescribe it for me, and I accepted. I did take Zoloft for several months. It worked. My mood was brighter, and I was talking more like my old self. I did stop planning my suicide. We discussed my improvement, and he left the conversation open for the future. I am an ongoing work in progress. I weaned myself off the Zoloft and have done well. My family is my joy. I have identified aspects of practice that I need to eliminate or include for my well being. Income is not my focus. I spend more time with my kids. I do some teaching. I schedule time to exercise. Diversifying my activity to find ways of being productive both in medicine and outside of medicine keeps my struggle with worthlessness at bay. I’d like to raise awareness of how a suicidal person does not always fit our cookie-cutter image. I hope this story encourages others to reach out to a troubled colleague. It helped in my case. My final message would be that there are still large barriers to receiving mental health care for physicians. I will still only write about this anonymously. Even today, I would still opt out of seeking conventional mental health services even if I needed them. We should welcome physicians into treatment without threatening their careers. Resources that preserve anonymity should be available in all residency programs. Untreated mental anguish is now more the rule than the exception. And, it results in about 400 of us dying by our hand every year. Source
