COMMENTARY

When the Physician Suicide Is Your Friend

Melissa Walton-Shirley, MD

Disclosures

July 28, 2017

I ran into a friend and colleague in the dictation room. We exchanged pleasantries, talked about the kids, caught up on our respective practices. On that particular day, our conversation went deeper than the usual chitchat.

 "I miss Joe and I feel guilty," I said as I kept typing. I knew it was a risky conversation because it conjures a sadness that I try to avoid at all costs.

"Me too," he said. "I can't believe he's gone."

"I know it's weird, but I haven't been able to delete his text messages," I admitted as I pulled out my iPhone and stared at Joe's name. There were perhaps 20 texts on my phone that day and no matter how many or how few, the bottom of the screen is reserved for Joe.

"I can't delete mine either," my friend replied with the sense of relief one might expect after a long reveal in a confessional. 

He opened up further. "How would you feel if you had advised him to get the hell out of here, go anywhere? And that's exactly what he did. He got the hell out forever. I've felt guilty ever since," my friend lamented.

Missing Signs

Why did we not see it coming? For Pete's sake, I got honors in psychiatry. When I read his messages now, I think how stupid I was not to know.

My thoughts drift back to a surprise visit Joe made to my office 2 weeks before. We talked about the drama and medical politics we were dealing with. He was being pushed daily by a nonphysician entity to do more. Being berated regularly had really bothered him. I thought our conversation was a great whining catharsis. It seemed benign.

But there is a statement that rings in my ears until this day. Did it push him over the ledge? Sometimes I think of him with his legs figuratively dangling over the side, staring down into the deep dark abyss of depression. I said, "This stupid political crap is never going to end. Nothing is going to change with the current infrastructure . . . nothing."  

 I meant it, but I would have never ever said that if I had known.

A Good Doctor, a Great Friend

Joe was a beautiful human. He had a wonderful family that he loved fiercely. He was among the best of his profession. I never met a patient who didn't love him. I never met a nurse or an employee who did not worship him. Since his death, scores of patients have told me that they thought of him more as a friend than a physician. He was bigger than life. He still is.

I smile when I think of his quirky side. He wore scrubs everywhere, even at the local movie theater, often with a big red and white leather jacket. He thought he was fat when he wasn't. He would always start a conversation with his geographic location: "Hey MWS. I was just lying here in bed with Anna [his wife] thinking about you," to which I would reply, "That's really weird, Joe."

"You know what I mean," he would say without missing a beat before he launched into a conversation about the latest issues at work. He would call me from the bathtub (that bathtub), announcing his location with the sound of water splashing.

One particular night around 9 PM, he called to check on me because he knew I was taking a lot of heat at work for standing up publicly and advocating for patients. "I'm worried," he said. "Don't worry," I replied. "I'll be okay."

I hate myself for that too, for not asking more about how he was doing.

Fatigue and Health Problems

Joe started having issues with fatigue and severe muscle spasms that progressed over time. He had been to several physicians, and no one could really give him a diagnosis. From my estimation, things started going wrong when America fell in love with the Atkins diet. I had to jump off at 5 weeks because it gave me severe muscle cramps, which remitted as soon as I grabbed some carbs. Joe's spasms didn't quit but he stayed on the diet for months even after I told him he should stop. He saw a neurologist and tried various treatments. At one point he was told he had a mitochondrial disease. When I heard he was in a hospital in another town in critical care, I immediately called.

"What the heck?" I asked, or actually yelled, when he finally answered the phone.

 "The rumors of my demise are greatly exaggerated," he said and then laughed, but I could tell he was genuinely touched that I had called.

Four days before it happened, he texted me out of the blue. "I'm in a bad old place, trying to get back. It's a bit uphill . . . .Regardless . . . I'll see you soon."

"Glad to help always. Feel better," I replied

I texted a "smiley face," pre-emoji, the kind with a colon and a single parentheses. : )

He replied with a similar smiley face but with lots of parentheses, lots of smiles. :)))

Four days later, on a beautiful cool October morning, with Halloween pumpkins adorning local porches, Joe crawled into his bathtub, grabbed his handgun, and ended his pain forever. The stress of balancing a high-powered job against the rigors of an unending mysterious illness fueled by the continued berating by the nonphysician entity created the perfect millstone. In desperation, he did the unthinkable and the unimaginable, choosing the clichéd permanent solution to what the rest of us assumed was a temporary problem.

But no one should judge until they have walked a mile in his scrubs.

Those who loved him were angry for a while. When I entered the church for the funeral service, I saw one of the people whom Joe had complained about the most, and it was all I could do not to go over to his seat and choke him. I blamed myself for not being more aware. What if I had called to check on him at precisely that moment?

Those who had seen him in his last days regretted not taking time to have a real discussion. One physician friend had gone over to his house for a chat. He said there were no signs, but looking back they were flashing all around us. Joe's wife Anna had been proactive. She knew Joe's father had committed suicide and his brother had made multiple attempts, but Joe denied suicidal ideation, saying he would never do that to his children. Besides, he was making plans to take a leave of absence, and all good students of psychiatry know that making plans for the future is a reassuring sign. He told me in our last text that he would see me soon. He was smart, and he knew how to throw us all off track.

Removing the Stigma

It would honor Joe's memory if his suicide would serve to help anyone else who finds themselves in the depths of despair. I read that every year, we lose the equivalent of a medical school class of students to suicide.[1] In America, a "doctor a day" ends his or her life,[2]  and so I reached out to his wife, Anna, and asked her permission to tell his story. She encouraged me to reveal anything that might help anyone who is suffering.

We discussed the fact that physicians feel trapped. We feel we can't seek psychiatric help for fear of having to disclose it on our next job application. We can't be perceived as less than 100% capable. We can't take medications in case it will affect our performance. We find it difficult to admit that we aren't the perfect person that our patients expect us to be. We belong to the only profession on the planet where we are accused of thinking we are God and then sued when we are not.

Often, we don't think anything will work when, in fact, medication, therapy, and respites can help. A 2015 trial published in JAMA psychiatry looking at cognitive therapy produced a 60% reduction in suicidal ideation in medical interns.[3]

Stories like Joe's should prompt legislation that prevents discrimination against healthcare providers who seek psychiatric help and are considered stable. We should be encouraged to take time off if we feel burned out. Only disruptive behavior or behaviors that endanger patient care should be reportable to a medical board, not the fact that a physician recognized they were in trouble and sought treatment. There should be a physician/medical-student suicide hotline with a guarantee of confidentiality. We need more conversation on the topic, but too much conversation and too little action will prove lethal for many.

Joe's texts are still sitting on my phone, and I doubt I will delete them any time soon. Perhaps his last words will serve as a reminder that I should advocate for those who are too confused or too sick to cry for help. I think I will keep them on my phone until meaningful legislation and help for struggling physicians is consistently implemented across our nation. Perhaps only then will I feel that Joe can rest in peace.

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