I’m disturbed by all suicides. This is such a problem in our society now. Something is so very, very wrong. But what I want to write about tonight is the alarming rate of medical student, resident, and physician suicide that seems like an epidemic now.
I know medical school is stressful. It has been since whenever it originated. I know you have to be very intelligent, driven and more often than not, they are perfectionists. You have to have a great drive, intelligence and accomplishments to even come close to being accepted by a medical school. Of course they have to be, look at what they will be doing. But something is not going so right in medical schools when many doctors depression starts there.
I feel I know some of the reasons for physician suicide. Being a doctor is not what it once was. They often don’t have respect, are subject to high malpractice rates, are always under the threat of being sued, they feel they have to hide any depression therefore they don’t seek help, having to see too many patients, insurance calling the shots on many things. And I don’t see anything getting any better at all with our so called healthcare reform. As a matter of fact, I see it worsening.
I know I do a lot of writing about medical student and physician depression and suicide, but it’s because it hits me right into my heart because my daughter was a medical student when she took her life. While I don’t pretend to even know whether the stress of med school had anything to do with it, I can’t help but wonder if things could have been easier for her to seek help without threat of losing everything she put into it.
I wanted to post a couple of articles of physician suicide that have happened within weeks of each other. Then I want to post a blog post from Pamela Wible MD who is trying to move mountains in helping with this problem. She has her own practice that is MD and patient friendly and has started doing things differently than what has been traditionally done. She has retreats for doctors who are burned out and depressed. She holds seminars on how to form a better practice so an MD can feel human again instead of feeling like a machine. She’s been on multiple TV programs, TED talks, and newspapers online, and has her own blog and much more. I know there is more to come from her. Much more.
My daughter Kaitlyn’s picture is on her wall beside her desk….all the way in Oregon. Thank you Pamela for all you do.
Here is Dr. Wible’s blog post:
Physician Suicide Letters
I asked why physicians were dying by suicide. Here’s what they told me:
“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” I wish I could change back but I realize that I will never be the same again and it isn’t in a good way. We had two suicides and one murder—skull crushed with a bat—and one serving life in prison for murder during a delusional episode after not sleeping for almost a month. Yes I went to a hard-core school (old school kind of place). PTSD isn’t benign; it truly affects you to the core—it changes your brain.” ~ Doctor in Philadelphia
“I’m in my first year of practice outside of residency and I can’t begin to tell you how often I think of death. Not because I hate my life—I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help, leaving me with no resources to help. My boss is a douche—unethical and dangerous. I want to build a relationship and do what’s right for my patients—but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession.” ~ Michelle
“I didn’t realize that so many others in the field suffered as I do. I have tried to get help many times but it’s hard because I don’t think that anyone takes me seriously and I don’t think I can be completely honest with anyone without major repercussions. I don’t have any friends to socialize with and all my relationships have failed. I come from a background where I was the first to get a higher education so they think that I should be elated to just have MD behind my name and tell me to suck it up. I don’t want to possibly lose my license because honestly I love taking care of patients and sometimes that is the only time I get a few moments of happiness. But things have just been so bad for me that I have resorted to just doing locums [fill-in work] so I can isolate myself because sometimes I can’t stop the tears. I have tried a few times and the last time probably would have worked but at the time I was lying there looking at the dog I had then who was curled beside me nudging me to get up. Somehow I drove to the ER although severely hypotensive where I was hospitalized and they chalked it up to the fact that I had not really been eating or drinking for weeks. I no longer have that fur companion so I find myself alone and thinking about an escape a lot.” ~ Dee
“My attending took great pleasure in bullying the students, and I saw real pathology among fellow students who felt like they couldn’t ‘take it’ anymore, and complained of ‘PTSD.’ I am not currently practicing medicine (for reasons quite possibly stemming from the fact that I never could find adequate mental health care).” ~ Anonymous
“I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.” ~ John
“I am in my final year of medical school and have had several classmates attempt suicide over the course of my degree. I love medicine and I love people, that’s why I chose this profession. Sometimes when awake studying at 3 am, or watching an autopsy, or witnessing highly emotional scenes at the hospital, I feel incredibly alone. Sort of like I’m not a part of humanity! It deeply saddens me that classmates and colleagues feel they are unable to seek help for their problems, and I hope there is more research in this in the future.” ~ Julie
“I thank you for the website and the many comments by people. I qualified in the UK and things here appear to be the same. I have several colleagues who have committed suicide over the years, and I feel lucky to have survived myself, for all the reasons you describe. I am particularly taken by the PTSD image. Yes indeed I was traumatized in medical school and it continues to happen, but we get accustomed to it, to the point of becoming an abused class.” ~ Christian
For every doctor who dies by suicide, friends, family, and patients are left to wonder why.
“I am still in a state of shock hearing that my brilliant, loving, compassionate, successful, well-respected, honest, hard-working physician committed suicide this past week. Pressure from the changing medical community/insurance/had forced him to close his 30-year practice and he went home and shot himself in the head. The letters keep coming in of how many people loved him, were healed by him, and admire him. What a tragic end to a successful career. Everyone is asking why. He was the best of the best, surgeon and specialist, nice home, nice family and now he is gone. Totally tragic.” ~ Diana
If you are moved by these letters, please watch and share my TEDx talk on physician suicide. Read more letters here.
Thank you for caring.
Here is the link to Pamela’s blog post so you can read the responses and get an even better idea of how doctors and med students are feeling.
There are many words, phrases and thoughts that fill my mind many times a day pertaining to my daughter Kaitlyn’s suicide. One of these words is something that many people that have lost loved ones to suicide dislike very much and that word is “waste.” I think that when people that have lost loved ones to suicide hear the word “waste” associated with the suicide of their child, sibling, parent, grandparent, or friend, that it somehow means that their life was a waste, that somehow it is demeaning to their loved one.
I’m not writing this to tell others how to feel and if that word insults the memory of their loved one, then I respect it and understand it. We all have words that just make us cringe and conjures up all kinds of horrible feelings. But this is about how I feel and why I feel the way I do.
I very much think that the ending of my daughter’s life was a waste. I think the fact that she ended her own life made it even more so. That does not mean that I think her life up until that point was a waste, quite the contrary. And it certainly does not mean that I think Kaitlyn made a rational decision to end her life. I do believe, at that time, that she thought it was rational, but the fact is, depression distorts your thinking, very much so.
It also does not mean that I am angry at Kaitlyn for doing what she did. I don’t like what she did. It has almost completely ruined my life and I am struggling to salvage it as best I can. It has forever changed my life and the life of her father, sister, other family members and friends. But I cannot be angry at my daughter for having a disease that impaired her rational thought. I can’t even be angry that she never told anyone or sought help, which can also be caused by that very disease.
So in saying all that and driving home those facts, I do, with all my heart, think the loss of my daughter was the biggest waste of a human life that I can possibly imagine. This is not saying that I think any other person that has taken their own life was not a waste, but I’m only talking about my daughter here this time.
It staggers my mind on a continuous basis the fact that someone so talented that never gave up on one thing in her entire life, gave up the ultimate, most important thing of all….her life.
She was not a dysfunctional person with the horrors of drug addiction and abuse, a wrecked home and social life, job problems or anything like that. She was an extremely intelligent and gifted young woman. With each passing year her talents increased and she was always adding to her list of talents because she improved herself learning more things all the time.
She was young, oh so young at 23. Right in the time that most of us think is the prime of our lives. She was right in the middle of achieving her dreams and was starting her 3rd year of medical school. She had some good, close friends. She was in the best physical shape she had ever been in her life as she went to the gym and ran regularly along with eating very healthily. She had her own apartment. She had her own car that was paid for. She had her cat Gatito. She had gifts enumerable which included a gift for math, science, all subjects really, writing, poetry and art. She taught herself to cook wonderful meals. She had the best taste in décor and it showed in her apartment
She was very, very well loved by us her parents, as well as her sister and other family members. She had emotional support when she needed it. Her friends loved her. She was kind, sweet, had common sense, was cultured, dignified, had integrity, honesty, ambition, drive and stood up for what she believed in without question.
Her life was not perfect. She was in medical school, and though she was doing well, it is one of the most demanding courses of study there is. She would have owed a massive debt in medical school loans once she would have graduated starting at residency and residents do not make that much. Around 45,000 a year or so, depending on where it is. She would have paid on this debt for a huge part of her life. But she knew all this going in and did not seem to ever fret about it.
She lived in a town where she went to medical school where she felt isolated and alone. She was an introvert, which is not a problem, but a personality type, but it makes it harder to find people of your same interests. I’m an introvert too and though I want friends, it’s harder to actually make them. But she did have friends.
I know that Kaitlyn never believed in things just because millions of people may believe in that thing and have for thousands of years. She was always questioning things, because that is usually what bright minds do. They never take things at face value.
But Kaitlyn never voiced her loneliness or worry about her loan or the stresses of medical school to me. I did know she was not happy in the town she lived in. I was told by her boyfriend at the time that she was lonely.
Maybe the things I just mentioned were more powerful than what I thought. Or maybe none of that had to do with the reason she chose to end her life. Maybe it was depression that caused her to think that with all she had going for her, it was still not worth the pain that she lived in with her severe depression.
So, I do think her death was a waste. Not her life, but what could have been. If she had lived and gotten help for her depression, there is great chance that she could have continued to live on, and have been happy. She could have finished med school even though all of what I have learned since her death about med school, internship, residency and actually practicing medicine, would really make me wish she would do something else. I would have accepted any decision she would have wanted to make whether stay in med school or quit and go for something else. We would have helped her with her loans by whatever means we could. We are not well off financially, but we would have helped her any way that we could have found if it meant refinancing our house. But we didn’t know that was what she wanted and still don’t know. We will never know.
I think it’s a waste that her young life ended. She had not even gotten married yet, had not even had a child. The reality of that was brought home full force to me as I cleaned out her apartment and threw the birth control pills I knew she took away. What a stab in the heart. There will be no babies, I will never have a grandchild by her. I will never have a son-in-law by her. She will never go to a big city with culture and practice medicine like she always wanted.
She will never draw another picture, write another poem or prose, never enter her dietary intake on the online site for that purpose, never run another marathon, never cook another meal for a friend or for us, never go to another restaurant, or play, or opera or symphony. She will never get into her Black Honda Civic with the dent in it from running into something in the parking lot at med school that she was scared to tell us about. She will never text you again Neal or put funny posts on your facebook page, never run with you. She will never get in touch with all her old friends from her past. Christopher, she will never exercise with you at the gym. She will never again use that gym card that still hangs on her keychain. She will never graduate medical school.
She will never be that doctor as she described to me once saying, “Momma, I want to be the best of the specialty I got into and I want to be sought out from all over the country because of my expertise.” And she could have. Kaitlyn always reached her goals and she had the mind and drive to do it. The patients that would have greatly benefited from her care and kindness will never know her.
She will never again call me on the phone, or message me or skype with me telling me of about her life, or in the future telling me of the wonderful and exciting things she would do, new things she had learned at the wonderful city she would settle, wherever it would have ultimately been.
She’ll never come home again to visit from that distant place she would have lived to let me and her father hug her again, telling her how much we love and adore her and how proud we are to have her as our daughter.
All of this and so much more will never, ever happen. And I don’t know any other way of putting it other than saying it is a waste. A waste of so much potential, so much love and sweetness, such a wonderful and loving daughter.
And that lets you know how very powerful and dangerous depression is or any other mood disorder. Someone with that much going for her, such a bright future ahead did not think her life worth living anymore because she was in such despair and perpetual sadness. What a statement that makes, a very sad statement and a statement that makes anyone know that has any sense at all that depression is a not weakness but a disease that affects your mind. There was nothing ever weak about my daughter. Depression caused her to think the only sensible thing to do was to no longer exist.
This all brings to mind a link a friend sent to me yesterday of an article a man wrote (who is supposed to be some well-known person that I have never heard of before). He wrote in this article that the fact that Robin Williams killed himself, that the man that wrote this article lost all respect for him because Robin Williams had children. How could he end his life having children that he knew he would cause such pain? He went on to say many things like this and also said that anyone he ever knew that killed themselves he lost respect for and that to him they no longer counted. They were nothing in his life anymore and their memory forever tarnished because these people chose to take their own life. It was a decision that person made. He does not understand, or want to understand that the mental disease affected that person’s mind. I won’t even give the article any justification by putting a link to this ignorant article. I wonder if he had lost a child to suicide, and really honestly knew what depression did to someone’s thought processes, if he would think the same way. I would be willing to bet that he would not feel this way. He would go out of his way to try to understand depression and I doubt he would cancel out his child’s life just because that child had a disease that made them not want to live, killed himself and by doing all that hurt him. Does he not even wonder how much the people that killed themselves hurt? I don’t think so. People have the right to voice their own opinion, but I have the right to say that their opinion is wrong and only perpetuates the misunderstanding and stigma of mental illness.
Sometimes I think that many people think that if they admit that suicide is caused by a disease that makes someone no longer want to live, that we somehow mean that suicide is ok, that it is acceptable, that by saying this it gives people free rein to kill themselves willy nilly without fear of what it does to their family and loved ones. It’s like we are giving it a stamp of approval. Well that is very far from the truth. What we are doing when we learn and gain correct information about depression and suicide are weapons to fight against it, to help put programs in place for its study and ways to treat mental illness….not an “Ok just kill yourself, it’s ok.” Suicide is NOT ok. It takes away a life and so much of what could have been. It ruins families and lives in so many ways. But that does not mean we should vilify the person that did it. We should shed tears about what horrible disease made them do it and continue to find ways to treat it.
Yes, I think my daughter’s suicide was a waste of a great life. When anyone takes their own life it is a waste. But the life she lived was not a waste, and I will never vilify my daughter or let her life be defined by what she did. Yes, I write about it a lot, very much in fact. But she was so much more than a suicide statistic. But the fact that she did kill herself is a fact I cannot erase. But I will never erase her memory and the wonderful person she was.
I wanted to post this latest review of my book by Dr Ralph Caruana who once taught at Wake med where Kaitlyn went to med school. He makes many good points, especially about med students.
An American Tragedy, August 20, 2014
By Ralph Caruana, M.D. – My Bright Shining Star: A Mother’s True Story of Brilliance, Love and Suicide (Paperback)
This is a beautifully written book about the ultimate family tragedy: the suicide of a young person, who was loved, full of promise and seemingly without any dark clouds hovering over her. I approached this story from many angles: as a parent, as a medical educator and as a former resident and faculty member at the medical school Kaitlyn attended. Sad to say this is by no means the first time that I have heard such a story and in fact I have watched this scenario unfold several times during my long career in academic medicine at three medical schools. Medical trainees are at much higher risk for depression and its sequelae than are other similarly aged demographic groups but this is not a book about the stresses of medical training or a call for educational reform. This is a book about experiencing loss, understanding loss and trying to work through loss.
Kaitlyn’s life history did not put up any red flags suggesting that she could be suffering from depression. Her mother and father are highly sensitive, involved parents who had maintained excellent communication channels with their daughter. They had enough education and life experiences to be aware that depression exists in young people and that it can be a very serious matter. Kaitlyn never communicated to them or anyone else that she was suffering from depression yet the note she left behind makes it clear that depression prompted her actions. Kaitlyn’s high achievement, high energy, loving family relationships and buoyant personality did not suggest to anyone that she was “at risk”.
This book chronicles a family’s experience of living through a devastating loss. The grief, the sense of emptiness and the endless search for answers that never materialize are eloquently put before the reader. Besides telling her story Rhonda Elkins issues a call for awareness and action that could better identify depression in the young and provide the opportunity for effective, early treatment. This book is essential reading for parents, educators and those in the caring professions who work with adolescents and young adults.
When Kaitlyn was 15, she applied to the North Carolina School of Science and Math. It is a boarding school in the NC school system in Durham for the mathematically and scientifically gifted. Room, Board, Food, books…..all free and anyone that graduated from there got a free scholarship to any university they were accepted into in the NC university system. She wanted this so much, but I could not bear the thought of her living away from home 3 hours away from me at 16 to 18 years of age. But I was willing to do it…for her. She was accepted at this highly competitive to get into school (they only accept about 300 a year out of thousands of applicants). But alas, Kaitlyn wanted to come home after 2 weeks even though she was doing well academically….she was just so very lonely. So I went and got her myself and she picked back up at her regular high school just where she left off.
If you want to know somewhat about the kind of child/teenager/and young woman my daughter was, please read this letter of recommendation that someone wrote for her for her application to that school. It speaks volumes about Kaitlyn’s personality and intellect.
There has been a phrase that has bothered me since Kaitlyn’s death when I hear some people talking about mental illness. But since Robin Williams’ suicide, I have heard it so much that I’m sick to death of it and it, quite frankly, upsets me. And what really makes it worse is that you hear so many mental health professionals even using it, not to mention all the news media people and personal friends of his. The phrase I am referring to is “inner demons” when someone is referring to the mental problems and pain or substance abuse that people go through. Example, “Oh he fought his inner demons so hard.” And many more such phrases.
I know that these people (most of them at least) do not literally mean that people with mental illness have a demon in them which is why they are suffering. But I can’t help that the phrase takes my mind back to the days of dark ages when people actually DID think people with mental illness had a demon in them. So it makes me cringe when I hear this phrase. My daughter Kaitlyn certainly did not have demons in her but did suffer an illness that led to her suicide. So I hate that phrase.
Soon after Kaitlyn’s suicide I learned very quickly that the phrase “Committed suicide” was an intolerable phrase to some as it sounds as if they committed some crime because the word commit or committed is often followed by a horrible offense. It actually means “to carry into action deliberately.” The word commit did not offend me as it did others but I soon realized its negative connotations and have since quit using that word in association with suicide and I can see why it is offensive. Once in a while I might accidentally use that word, but it is always an accident.
Another word that I dislike very much when some people discuss bipolar disorder and other forms of mental illness is “madness.” I think it a horribly harsh word and it reminds me of times when people were thrown into mental wards forever deemed “mad.” No distinct diagnoses then….just mad. Have we not come any farther than that? Even Kay Redfield Jamison who suffers from bipolar disorder herself, is a professor at Johns Hopkins Medical School and whose books are very informing on the subject often uses the word “madness” when referring to the disease. Maybe it’s because when she was diagnosed many years ago that word was often used for mental illness. But I don’t like it at all. But who am I to argue with Ms. Jamison who I very much admire….but still.
The name of the mental illness bipolar disorder has been changed in the not so distant past from the previous name of Manic Depression for one reason being (not the only reason) that the word “manic” often conquers up in people’s minds the word “maniac” and so on, which is not used much today thank goodness. So why can’t we abolish these other horrible terms such as “inner demons” and “madness” which are so out of date and causes many people to see mental illness as some kind of condition in which they are filled with demons and not the mental illness that it is.
I know my reflections and statements here might make me sound a little too sensitive about these words and phrases. But for me, I don’t think it sensitive at all. In order to change people’s views about mental illness, we, along with many, many other things, need to change our vocabulary. I think it’s important.
I think when I go see my psychologist this week if I told her I had “inner demons” and I’m a “maniac” and that is what my problem is, I think she would have a lot to say about that.
Inner demons!! My gosh it makes me think of the movie The Exorcist and mental illness should not be associated with words and phrases like that.
Below: Not a nice vision to me. This is what I think of when I hear “inner demons” discussed when people talk of inner struggles that many people have.
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