My medical school tenure was bookended by news of loss. In the early days, when I spent my time in a lecture hall, I listened to somber faculty announce that a resident had died by suicide. I remember sitting near the back of the room because I had come in late, and while the administration’s platitudes droned on uncomfortably, I remember feeling something dark inside of me. This was a common fate in my profession. Even then, before I could truly understand the pressures and the losses, I felt a connection. This was one of our own and I felt sick at the closeness of it.
Now, as a fourth-year, weeks away from completing my doctorate, news broke that a physician had recently taken his own life. The same emotions, tempered in the crucible of my clinical years, rushed back out of me. It was raw—a sadness disproportionate to my nearness to the event. This was not the first person I had known to die in this manner, and likely will not be the last.
In each case my first reaction was to find some explanation. Was it a patient that had a bad outcome? An impending criminal charge? Anything that would brush away the uncomfortable reality that my friends and I were just as vulnerable to the symptoms of depression that weighed heavily on the members of my profession.
I think that both as physicians and as people, we crave clarity. Actions necessitate a purpose, and lives call out to be organized behind a maxim. Doctors and patients alike are drawn to it and repelled by it. As humans, we seek to derive some grand narrative from the scraps we pick up—a diagnosis that lends context to a life, an arc that demonstrates a more forceful trajectory. Yet despite our constant scavenging for meaning, none may be evident.
Sometimes tragedy fits into the mold of a known pathology that can be combatted, but more often, actions are nothing more than the undulations of a fragmented unconscious, emblematic of no general superstructure. In the light of both these events, this lack of clarity is uncomfortable and the distance that can be generated inside the familiar confines of the doctor-patient relationship is not present to lend any relief. In my short experience in medicine, I have been privy to more life-altering events than few others of my age outside healthcare. Within the well-defined boundaries of hospital and clinic walls, I’ve grown up quickly. Yet when tragedy reaches me outside of these known contexts, I find myself broadsided—isolated from my normal defenses. I’ve seen a lot of death but am rarely reminded so acutely of my own mortality.
Maybe as a result of this discomfort, the topic of physician mental health and suicide is not often discussed openly. The reality is that doctors take their own lives at rates significantly higher than the general population, and the fact that I have had experience with two such events during the course of my training highlights its disturbing regularity. I have been fortunate in my training to have encountered some incredible attendings, mentors, and colleagues who strive to bring mental health to the fore, where it belongs. As I begin my psychiatry residency, I hope to follow their example. In the aftermath of events like this, care needs to be extended to the multitude of second victims, and as we move forward as a profession we need to continue to have meaningful conversations about physician wellness.