Speaking Out On Suicide

I learned about it on a friend’s Facebook post. A 25-year-old man, a medical intern at New York Presbyterian Hospital’s Cornell campus where I just graduated from medical school, had been lost to suicide. He jumped from Helmsley Tower, a building I walked by regularly on my way to the hospital that stood only a few short blocks from my old apartment. Immediately upon hearing the news, I ran through a mental rolodex my classmates – who went into medicine? Of these, who stayed at Cornell? Were any of them 25? My mind moved through the algorithm and came up empty, but I couldn’t be sure until a name was released. And, while I was feeling a small degree of relief, I knew others were running the exact same algorithm with a sinking feeling in their stomach, the foreboding sense of knowing but willing yourself not to really know. Even more tragically, a family somewhere would be receiving a phone call. “I am sorry to inform you. . .”
This tragedy is compounded by the fact that it is not unique. The week before, a 26-year-old NYU med school grad who was an intern at Columbia returned to the dorm he had lived in as a medical student, went to the roof, set down his keys and student ID, and stepped off the edge. While these may have drawn more attention because of the dramatic nature of their deaths, physicians at all levels of training suicide every year at alarming rates. Studies have shown that male physicians have about a 1.5 fold increased risk of suicide and the rate for women is over two times higher than our non-MD counterparts–and some studies have put the numbers significantly higher(2). The totals are startling. Each year, over 250 physicians in the United States take their life(3). That’s the equivalent of an entire large medical school class(3). Every year. And, for each who completes suicide, there are almost certainly countless more contemplating that abyss.
I wonder about the struggles of these two young men. Just a few short months ago, they walked proudly across the stage to accept hard-earned diplomas and a few weeks later had that little surge that comes with the first time you can look a patient in the eyes and say, “Hi, my name is Dr. X, and I’m going to be your doctor while you’re here in the hospital.” Why does a young, successful individual wake up in the morning and decide to end his or her life? For those of us who have never been in that position, we can only guess. Dr. Samuel Shem, author of the classic The House of God, offers one hypothesis. If you haven’t read it, The House of God is a novel describing the psychological effects of intern year on a group of young doctors, with tragic consequences. In an interview with The Boston Globe in 2013, he noted, “All of my writing is about one thing: the danger of isolation and the healing power of good, mutual connection. If you get isolated, as in The House of God, you can go crazy. You can commit suicide. It happens in medicine. To put it very simply, during internship, each of us got isolated. We not only got isolated from each other, we got isolated from our authentic experience of the system itself. You start to think: I’m crazy for thinking this is crazy”(4).
Some things have certainly improved since Dr. Shem penned his novel back in 1978. My residency program, for example, has a Wellness Committee, although their main task seems to be sending out cheerful illustrated emails advising us of the many things we can do around the city when not in the hospital. And, thanks to resident work hour rules as interns, we are now in the hospital somewhat less. Ironically, the resident work hour rules also stem from tragedy at the same hospital where the Cornell intern spent his last days. Will this latest death, not a patient this time but a doctor, be able to spark another change?
But what sort of change? This is not a problem with a simple fix. It’s not shorter hours or a committee that reminds us regularly to care for ourselves. Writing on the topic nearly a decade ago for the New England Journal of Medicine, Dr. Eva Schernhammer noted that “we must care not only for our patients but also for ourselves”(5). Yes, our patients are important – they are, after all, why we do what we do – and good training does require long hours and hard work. We don’t need to give that up. Efforts are made in medical school to help us maintain our empathy for our patients, but we need to also work cultivate empathy for each other and ourselves. We need to make an effort to cut through the isolation that the long hours and at least vaguely pull-yourself-up-by-the-bootstraps culture that comes with being a physician can engender.
If you are feeling hopeless, please seek help. Whether it’s talking to your residency director, trusted mentor, friend or family member, reach out. Likewise, if you are concerned about one of your colleagues, please speak up. There is no guaranteed way to prevent someone determined to suicide. These young men certainly had many who cared deeply about them. Even the most seasoned psychiatrists struggle to identify acute suicide risk in high risk patients(6) and implement means to prevent it. We can only hope that by raising the awareness and acceptance of mental health issues amongst physicians regardless of their level of training, those currently struggling may be encouraged to get help. Silence only leads to more suffering. As a community of physicians, we need to strive to be a community.
Warning signs for suicide include the following(1):
– Talking about wanting to kill themselves
– Feeling hopeless
– Having a plan and taking steps towards suicide
– Feeling trapped
– Feeling like they are a burden
– Feeling humiliated
– Losing interest in things they once enjoyed
– Insomnia
– Becoming isolated
– Acting irritable or showing rage
Over half of those who attempt suicide tell someone about their plans. If you are concerned about your colleague, please talk to them about it and inform your residency director or other trusted advisor.
Megan Riddle, MD PhD, is a psychiatry resident at the University of Washington. She is a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program.
References
1. American Foundation for Suicide Prevention (2014): Risk Factors and Warning Signs.
2. Schernhammer ES, Colditz GA (2004): Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). The American journal of psychiatry. 161:2295-2302.
3. Andrew L (2012): Physician Suicide. Medscape.
4. Koven S (2013): 35 years later, author revisits ‘The House of God’. The Boston Globe.
5. Schernhammer E (2005): Taking their own lives — the high rate of physician suicide. The New England journal of medicine. 352:2473-2476.
6. Large M, Sharma S, Cannon E, Ryan C, Nielssen O (2011): Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. The Australian and New Zealand journal of psychiatry. 45:619-628.