A friend on Facebook recently forwarded a news article and a link to a physician blog about the media response to a physician’s suicide. (http://www.idealmedicalcare.org/blog/doctors-death-an-inconvenience-for-patients/) A lot of the concern centered on the lack of compassion for the physician who took his own life and the seemingly self-centered comments of several ‘patients’ at the hospital. Lost in the coverage was any exploration of the problem of physician suicide or suicide in general.
Any one who works in trauma or emergency medicine is acutely aware of both sides of this issue. We are the first line of treatment for these patients and must deal with the immediate repercussions on the families and loved ones left behind. Our profession also has a higher than average rate of suicide among the doctors, nurses, and other providers who work in this environment.
Many of the comments regarding this particular incident focused on the lack of help for residents who are struggling with the demands of training. It doesn’t get much better after one leaves the nest of the residency and goes into practice. Doctors are expected to remain cool and objective, to be able to deal with adversity and come through unscathed and secure in their daily lives. We all know it’s BS, but we all tacitly buy into the myth because it preserves our standing as ‘professionals’. Displays of emotion, except under tightly circumscribed control, are seen as weakness and as ‘unprofessional’. So we cover up pain and uncertainty, limit our responses to well rehearsed bromides, and box up our regrets like toxic waste to be buried or locked away never to be seen again.
This is not limited to medical workers. Police, firefighters, soldiers; anyone who must deal with stress or chaos and continue to do a job knows what I am talking about. Expectations for physicians in this regard are high, but I would argue that they are even higher for first responders such as police officers or firefighters. And guess what? All of those jobs carry a higher risk of suicide.
I must admit to some ambivalence about suicide and patients who attempt it. I have myself circled that pit of despair but was able to pull back. As the child of a suicide, I have seen the devastation that the act brings to a family left behind. Part of me wants to blame suicidal patients for their own self-centered actions. But I know, both emotionally and intellectually, that it is unfair to do so. Another part of me coldly acknowledges that the ultimate freedom we possess in having free will is the freedom to decide to die. There are times when it makes sense to end ones life. It can even be a noble act. Most often, though, it is an act of despair, done impulsively. The individual just wants to end their pain, right now, and has no other thought.
Solutions? I have none. This is not a plea for understanding or a call for action. The problem is too complex for such simplistic responses and the needs of each suicide are so individual that all-encompassing solutions are unrealistic. Calls for better ‘balance’ between work and life are sensible, but for many of us the line between work and what is really a WAY of life is indistinct and variable. We need the sense of purpose and commitment that comes from a life in service in order to find meaning and fulfillment. I am often unhappy with my profession, but I would be even unhappier working in a job that was simply a means of paying for the things I really enjoyed doing rather than getting paid to do something that I love. The price for that is high, but to me is still worth it.