Remembering Ricky: Losing a Friend to Suicide

Andrew N. Wilner, MD

Disclosures

February 20, 2019

When my good friend Ricky* stopped replying to emails, I didn't think much of it. He had retired in his 40s, traveled a lot, and didn't live by a strict schedule.

I met Ricky more than 25 years ago at a scuba club meeting when I lived in North Carolina. He taught me to water ski, crewed on my sailboat, and we shared scuba diving stories. He was one of my few good friends.

Once I moved away, we stayed in touch but rarely saw each other. For a while, Ricky lived on a tiny sailboat in Florida, played guitar, and sang in clubs. Ricky had been married once, and it didn't end well. He wasn't interested in trying again and lived the life of a carefree bachelor. Every now and then he'd call me about a promising romantic relationship or one that had fizzled. Mostly, he lived alone.

Ricky occasionally asked for medical advice as he slowly accumulated a variety of ailments. He had a painful peripheral neuropathy that went unexplained but was probably secondary to alcohol. (Ricky could put away a six-pack in an afternoon without any hint of intoxication.) He had arthritis in his knees and couldn't play tennis the way he used to. He often lamented the inexorable deterioration of physical prowess that accompanies increasing age. I referred him to neurology colleagues in his town, which I felt was sufficient care on my part.

After a few weeks went by without any word, his brother sent an email notifying his friends that Ricky had taken his own life with a gunshot wound to the head.

Of course, I was shocked. I didn't realize Ricky was in so much pain, either physical or psychological. Based on posts from his friends and family to his funeral website, no one did. I didn't even know he owned a gun.

Suicide is the tenth most common cause of death in the United States and is increasing in frequency.[1] Suicide attempts in the US have also increased, from 0.62% of adults in 2004-2005 to 0.79% in 2012-2013.[1] According to the Centers for Disease Control and Prevention (CDC), intentional self-harm (suicide) accounted for 40,600 deaths in 2012, more than the number of motor vehicle accident deaths.

Risk factors for suicidality vary according to the particular study but include anxiety, antisocial and borderline personality disorders, depression, education limited to high school, lifetime violent disorder, non-Hispanic white and black race, substance use, and young age.[1] Chronic pain doubles the suicide risk, and isolation is another risk factor.[2]

According to the CDC, 54% of people who died by suicide did not have a mental health disorder. Further, "People (suicides) without known mental health conditions were more likely to be male and die by firearm."[1] According to the American Foundation for Suicide Prevention, white males accounted for 7 of 10 suicides in 2016l; and further, the rate of suicide is highest in middle-age white men in particular.

During my reading, I also learned that physicians have the highest suicide rate of any profession, with one completed suicide every day.[3,4] That's twice the suicide rate of the general public. I don't have any intention of joining my friend, but I don't like being in a high-risk group!

I thought that Ricky was just a regular guy. But based on the above studies, the fact that he was white, male, in chronic pain, lived a somewhat isolated existence, and probably had depression and alcohol dependence increased his risk for suicide.

I should have made a bigger effort to stay in touch. Maybe I would have sensed the severity of his distress. Because Ricky had never owned a gun, I wonder whether easy access to firearms in this country played a role in his sudden demise.

I miss sharing stories with Ricky. His death was premature and probably avoidable. Surely we can do better for our friends and ourselves.

*His real name. Ricky was a stickler for honesty.

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