A physician hung himself. That could have been me. [PODCAST]

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“We eventually got the news that Dr. Rathburn had hung himself from one of those beautiful trees that the wind made dance. How sad. It adds to my own grief. Who had found him? How did he look? Babies born with a nuchal cord have the cord wrapped around their neck. That’s the closest I have seen to a hanging. I once delivered a baby who had it wrapped around three times, and by the time he was born, his little face looked bloated and bruised, tongue swollen and sticking out, and he had petechiae (small dots of microscopic veins that burst) on his face. I wonder if he looked similar. Did he have petechiae? How would even do that? I wish I knew. I wish I had said goodbye. I wish the image of him shuffling by me would leave my head. Would every warm and beautiful summer afternoon with the tree limbs dancing remind me of him; of this place; of this horrible feeling? That was something to look forward to. At least I was thinking of a future. That had not been possible just a few short weeks ago. When it’s dark, it is bleak, like black silence and extraordinary effort to move and operate the body. The pain of my empty feeling heart and just holding my head on my neck seemed unbearable at times. Right, I am here, and I am feeling better. At least the empty blackness is gone most of the time. I light another cigarette. It’s better than crying.

Dr. Rathburn, you haunt me still. I was so close. It could have been me.”

Robyn Alley-Hay is an obstetrician-gynecologist and physician coach. She can be reached at her self-titled site, Dr. Robyn Alley-Hay.

She shares her story and discusses her KevinMD article, “A physician hung himself. That could have been me.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Robyn Alley-Hay. She’s an obstetrician-gynecologist and a physician coach, and she wrote the KevinMD article “A physician hung himself. That could have been me.” Robyn, welcome back to the show.

Robyn Alley-Hay: Thank you, Kevin. What a great topic to talk about: physician suicide.

Kevin Pho: So we’ll get into your article in a little bit, but for those who didn’t listen to your first podcast, can you just briefly share your story and journey to where you are today?

Robyn Alley-Hay: I was a busy practicing obstetrician-gynecologist. I went through my own depression and burnout, really tanked there, came back, and now I use my medical degree to do a nonprofit in the Himalayas, and then I’m also a physician coach.

Kevin Pho: Now, you mentioned that you were a busy obstetrician-gynecologist, and that is one of the busiest specialties that I know. What were some of the signs that you were experiencing that made you realize that you were burned out and considering transitioning or retiring out of clinical medicine?

Robyn Alley-Hay: Well, the first time I really tanked as far as depression, I came back from that. I actually was hospitalized. I checked myself into a physicians in crisis program called Menninger, and I came back. I think I just kind of lost the heart of my practice. I was doing locums for several years, got tired of travel, and really needed to find something that fulfilled me. So I retired, and now the nonprofit work just really lights me up, and taking care of and being with physicians as a physician coach as well.

Kevin Pho: Now, in your practice as a physician coach, I’m sure you see a lot of physicians who are burned out. When you’re talking to them, what are some of the stories that you hear? What are some of the symptoms that they describe that make you realize that they may need to transition or retire out of clinical medicine as well?

Robyn Alley-Hay: Well, I think with somebody who’s burned out, you don’t start with, “You may need to transition out.” I think you need to find out what will light that person up. You start with the basics, ABC. What is going to take care of your well-being? What do you need right now? And then look at, OK, what are your options? I think there are a lot of options that physicians don’t necessarily give themselves a chance to look at, and stay in clinical medicine with those options. But for the rare few, I think it’s just that the heart goes out of you. Your soul goes out of you as far as practicing. Every day becomes a chore, and life becomes unmanageable.

Kevin Pho: Now, you mentioned that there were some options that physicians don’t often think about. What are some examples of those options you’re talking about?

Robyn Alley-Hay: Well, I think there are other careers that you can have in research, or be an entrepreneur, or coaching’s a good one. There’s being a speaker, being an author, just really kind of expanding your definition of who you are, both up. Maybe you want to be more in administration. Maybe you want to do public health, so that would be a lateral change. So I think there are all directions that a physician can go in that they just don’t think about. So that’s part of what we explore as a physician coach.

Kevin Pho: And among your clients that you suggest these options to, how often do they make that transition out of clinical medicine to some of the other things that you just talked about?

Robyn Alley-Hay: I think mostly what I’ve seen in my practice is people may change jobs. They’re in a position that doesn’t really respect them, and they’re not feeling fulfilled, and so they make a lateral change to another job that suits them better and suits their family better. I see that more than I see people. It’s really rare that people want to leave medicine. They didn’t start out wanting to leave medicine. It’s just that the daily grind, or whatever their circumstances are, may be getting to them.

Kevin Pho: Now, what are some of the specific things in the system that you’re seeing that get to these physicians that come to you?

Robyn Alley-Hay: Oh, most of it is a time factor: the administrative burden, seeing the patients every 15 minutes or every 10 minutes, being thought of as a number and a producer that way, being employed. I see them as being a lot less happy.

Kevin Pho: All right, so let’s transition into the KevinMD article that you wrote. This was back in January. It’s titled “A physician hung himself. That could have been me.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Robyn Alley-Hay: Sure. Well, the story is about me. I had checked myself in, because I was suicidal, to a professionals in crisis program, and there was a fellow doctor there who was profoundly depressed, and he was getting ECT. I don’t know his whole medical history, but he was profoundly depressed and resistant to treatment, and he ended up hanging himself. So there was an impact: It could have been me. I can remember thinking that it could have been me. Thank goodness it wasn’t, and I got the help that I needed. But isn’t that sad? I mean, how many patients did he take care of over his lifetime? He was probably in his 60s. How many children did he have at home? I mean, the whole, so I wrote that story.

Kevin Pho: When you were in this unit and you saw that story of that unfortunate physician who did commit suicide, paint us a picture. What exactly was going through your mind when you heard about that?

Robyn Alley-Hay: Well, I mean, I was dealing with my own stuff, and I think some of it was probably just gratitude that I had gotten the help that I needed before it was too late for help or intervention.

Kevin Pho: What are some of the lessons that you’ve learned that you could share with other physicians or health care professionals who may be in similar positions? Because suicide in health care, depression in health care, those are actually very, very common, and one of the goals of this podcast and my blog is to really destigmatize that. So what are some lessons that you could share from your own experience?

Robyn Alley-Hay: Well, I think the first one is to remember you’re not alone, that this is something that, like you said, way too often, depression comes up with physicians. So you’re not alone. So the first thing, a tip, would be just to connect with somebody else. We all run around looking like we have it together, but if we actually stop and talk to each other, there are a lot of similar feelings. So that would be my number one tip.

And the other is, don’t treat yourself. I treated myself for years. It worked sometimes, and it didn’t work other times, but definitely the more responsible thing to do is to get the help, and there are physicians who see other physicians. I know there’s a lot of stigma. I wouldn’t be talking this openly, I don’t think, if I was still practicing. I wouldn’t be as brave to come out and say all these things about how my life went and didn’t go. But there are kind of like networks, underground networks. If you need it, just reach out to somebody. Reach out to me, reach out to you, reach out to somebody.

Kevin Pho: You said that you had tried to treat yourself for depression. What did you do?

Robyn Alley-Hay: Oh, I just started taking, it was back in the day when you had samples, I was on Prozac for a while, and then Effexor for a while. I was in a smaller town, and so I really didn’t want anybody to know my own personal business. It felt like this is my personal business, right, when actually it’s not. It was my personal business, but I think as physicians, we know we treat our families and we treat ourselves way too much. Some of it’s like you don’t have time, and a lot of it is we’re not given the opportunity to be human. I think we’re held up in a superhuman kind of way in a lot of instances.

Kevin Pho: Now, if we’re an early physician, or a medical student for that matter, what are some of the signs that you have to be on the lookout for that may point to the fact that you do need to seek a little bit more help?

Robyn Alley-Hay: I think, first of all, you need to make sure that you’re sleeping OK, that you’re given enough time to sleep, you’re given enough time to eliminate, enough time to eat. When those things are off, that’s when we kind of get behind the eight ball. I do think it is like the joy of it just goes out of you. It becomes so much effort just to get up and get out of bed and report for duty. That’s a real sign that you’re in that zone of “something needs to change.”

Kevin Pho: We’re talking to Robyn Alley-Hay. She’s an obstetrician-gynecologist and a physician coach. She wrote the KevinMD article “A physician hung himself. That could have been me.” Robyn, I want to ask about the responsibility of medical institutions, hospitals, and medical schools when it comes to suicide among the medical profession. A lot of times when we have these stories, it’s often suppressed. I’ve heard so many times where hospitals really try to suppress that information from the public, and they just don’t want the public to know some of the struggles and mental health issues that medical professionals face. So I was wondering, first off, if you were aware that there was a lot of suppression of physician suicide, and second, why do you think that is?

Robyn Alley-Hay: I’m aware of it. I think I’m more aware of it now that I’m on the healthy side. When I was ill, I was just too into my own trying-to-survive kind of story. I think I’m more aware of it now thanks to some leaders that are really making things public. I think there’s a lot of stigma that goes with mental illness, and that stigma is what drives hospitals not wanting anybody to know about either their residents or their docs or their medical students, because it would damage their relationship with their patients, who are their payers. So I think that’s the main thing that I can think of with that.

Kevin Pho: Now, you’ve bravely shared your story on KevinMD, not only on my site but of course on this podcast as well. Did you find that helpful, sharing your story and being open about your mental health issues in the past?

Robyn Alley-Hay: Well, I tell you, this has been 20 years. It’s been 20 years later that I’m willing to talk about it, and it’s been since I retired from my active practice that I’m willing to talk about it. And yes, writing about it and sharing the story has certainly been empowering for me, and I appreciate anybody who’s read my story.

Kevin Pho: I just want to ask you what kind of take-home messages you have for the KevinMD audience.

Robyn Alley-Hay: I just can’t say it enough: You’re not alone. Reach out to someone. You are not alone.

Kevin Pho: And how can people reach you?

Robyn Alley-Hay: At dralley-hay.com. I’m sure through the KevinMD article there’ll be a link.

Kevin Pho: Wonderful. Well, thank you again for sharing your story and time and insight, and thanks again for being on the show.

Robyn Alley-Hay: Oh, thank you, Kevin.

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