Physicians have one of the highest rates of suicide of any profession: nearly twice the rate of the general population. 400 physicians commit suicide each year in the United States. The stress of being a doctor is constant and unrelenting. The majority of us are perfectionists with a strong work ethic: your classic Type A personality. Maybe we set ourselves up for failure and then cannot accept when it inevitably occurs. Failure is a part of medicine because it is a part of life.

I was 12 years old in 1987 when the first physician I knew committed suicide. My father was the seventh physician to join a large group practice in 1971. I was raised attending summertime backyard picnics at other physicians’ homes and remember most of their families and children. It was a close-knit community of medical providers back then; something that may have prevented more tragic events like this from occurring.

He was an excellent internal medicine physician, revered by many in our county. His wife was beautiful, kind, and could sew the best Halloween costumes in town. I still have a picture of the Snow White costume I borrowed one year; it was as beautifully made as my wedding gown. He had two darling daughters, one my age and another two years older than me. They had horses out in front of their house. I remember being in awe of them.

There was more camaraderie between physicians then there is today. This doctor had a great sense of humor from stories I have been told. He had a nurse wheel him down to my dad’s clinic (the bottom floor of the medical building where a community health clinic resides now) in a wheelchair. He was pretending he passed out and gave his colleagues quite a scare.

I do not know why he committed suicide. It was a gunshot to the head at that same building where they had played jokes on each other. He asked another physician to meet there to talk minutes before completing this final act. The physician arrived to find his friend and colleague dead.  As what happened to his friend dawned on him, he went to throw up, and then dialed 911.

It has been nearly 30 years since this heartbreaking event unfolded, yet it occurs every single day to other physicians in the United States, and we do not think twice about it. These struggling doctors are mothers, fathers, sons, daughters, husbands, wives, colleagues, and friends. I have known other medical providers that have committed suicide, even one of my medical school classmates.

At one time, all of these people had applied to medical school and the day they were accepted was likely amongst the best of their lives. What happened to those bright eyed and bushy tailed medical students they once were when their journey began? How did they reach the point they felt suicide was the only way out of their disillusionment?

The business and administrative responsibilities of running a practice are vast, let alone the overwhelming stress and fear of making a mistake and inadvertently, someone dies at our hands. We carry this burden with us on a daily basis. If we cannot cope with the uncertainty of medicine, it can manifest as depression, anxiety, alcoholism, or suicide.

Finding balance is the only answer to surviving many decades in this grueling profession; it is different for each physician. For some of us, it is picking up our children from school every day and discussing their day on the drive home. Making sure I meet the needs of my children to the best of my ability helps keep me grounded while I acknowledge and accept unhappy or unsatisfied patients in my own office. Stepping back to look at the big picture, I always ask myself if whatever is happening will matter in five years. If the answer is no, I refuse to take it personally and try to let it go.

I have thought so often of this family over the last three decades and wonder where his wife and daughters are today. I am certain they have started families of their own, and I hope they have found balance and peace where their father could not. Here is what I have learned about avoiding burnout and trying to find true balance: Life is extraordinarily precious; do the very best where you can and do not waste a moment on anything outside of your control. Words I live by.

Niran S. Al-Agba is a pediatrician.  

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