“I don’t know if I can keep doing this”

“I can’t see a way out.”

“I feel stuck – trapped.”

What is it like?  That feeling of being exhausted, stuck, not feeling like there is a way out.  I think of it as running a marathon where you can’t stop. You are tired, it’s 90 degrees and humid, and you are miserably hot. You keep pushing towards the finish line so you can rest and celebrate.  But the line keeps moving, and you must keep going: You can’t stop.   The is no off-ramp.

I don’t know this feeling myself, but many people have been there, and some have taken permanent ways off their course.

Personal experience

My first experience with suicide was in the summer after I graduated from high school.  My long-time boyfriend died by suicide while I was away at my college orientation. This was before cell phones.  No one could reach me, so I returned home with my two high school friends dropping me off at home, where my parents were waiting to tell me the news.

His death by suicide was not expected.  He chose to end his life after what I could only imagine he felt was a life-altering event.  I was not there to help, to know, to talk with him.  On a night out with friends while I was away, he got an underage DUI.  What was he thinking when he decided to end his life?  That he screwed up. That he could not pursue a career path in law enforcement now.  That his girlfriend would leave him for making this mistake.  That there was no way out.  That he was trapped.  That he couldn’t imagine a future.

My next experience with suicide was just over 10 years later.  I was a chief resident sitting at my desk when I got a call that my elderly grandfather had shot himself.  I remember starting to cry and telling my co-chief what happened.  He had a history of depression treated with medication and had medical issues that were very frustrating to him. He also had life circumstances that I felt trapped him after my grandmother had to be admitted to a skilled nursing home. He had no close friends, and I can only imagine how he felt stuck in his situation without a way out.

Physician experience

I am writing this in reflection before the third annual National Physician Suicide Awareness Day on September 17, 2021.  We talk about physician suicide, but not enough.  Not enough to prevent the more than one physician death by suicide daily.

Over the last year, I continued to see reports of physicians dying by suicide.  A med school and residency mate died last year by suicide. I had not known he had struggled with depression behind the face of an outgoing, funny, friendly physician. It was a shock to his patients and me when he ended his life.  After his death, his wife shared his long-term challenge of depression to bring awareness to this struggle and the possible consequences.

In early 2020 I met a gregarious physician in a group coaching course. As we both learned skills to help our business, we became friendly.   I was saddened when she announced her younger sister, a radiologist with a family including small children, had died by suicide after a long weekend on call.  My acquaintance had just spoken with her sister and made plans, so it was a shock. She was convinced her sister was tired, exhausted, overwhelmed, and couldn’t see her way past this to return hope for the future.

On a Women in White Coats podcast interview, Dr. Lorena Breen’s brother-in-law, J. Corey Feist, implied she died by suicide after feeling overwhelmed at the loss of life she was seeing as well as the loss of the life she had built for herself. She didn’t see a way out.  I am aware of other physicians who died by suicide after thinking their mental health needs would prevent them from continuing their careers due to medical board stipulations.  Recently, three residents in one program died by suicide or in a suspicious way over the course of a year.

Unfortunately, I could go on and on.  I know you could too.  The Physicians Foundation 2021 Physician Survey reported that 55 percent of physicians know of a physician who has either considered, attempted, or died by suicide in their career.  20 percent know of a physician who has either considered, attempted, or died by suicide during the COVID-19 pandemic.

Why

I see a common thread in all these deaths whether they were physicians or non-physicians: They felt trapped with no way forward.   I imagine they were tired of being in this space.  They must have felt this was the only way out.

“I don’t know if I can keep doing it” was a phrase I heard mentioned by three different physicians over the 24 hours before I wrote this.

What leads to a person completing an act to end their life?  I suspect they feel they do not have a choice. They can’t see a way out of this overwhelm, this fatigue, and this feeling of being stuck.

Options

What if they did have choice?

What if they could see a different way?

How could we help them?

What if a person asked them the right question at the right time?

What if they knew beyond a doubt that they had someone that they could talk to?

What if they heard repeatedly that there was support?

Would this make a difference?

What if they believed: “I am not alone” and “I have options”?

The theme of the 2021 National Physician Suicide Awareness Day is “One of Us.” This day was created to commemorate physicians who were lost to suicide and to raise awareness.  The goal is to lower the stigma of conversations about this topic to lead to no physician deaths by suicide.  The organizers want to amplify the thought “I’m not alone” by using the taglines “Shine a Light” and “Speak its Name.”

For American College of Physician members, The I.M. Emotional Support Hub has links to a multitude of resources that can be used for all levels of distress, including a crisis hotline and a real-time peer support service. You can call the Physician Support Line at 1-888-409-0141 or seek resources at their site. The National Suicide Prevention Lifeline is at 1-800-273-8255. Take a moment to review the options here for yourself and to use for others.

Remember, you are not alone. You have options to take an off-ramp from the torturous road I described earlier that does not include suicide.

Join in with breaking the silence around physician death by suicide.  Post your thoughts on September 17, 2021.

Share this with other physicians.

Marion McCrary is an internal medicine physician and can be reached at Marion McCrary Wellness.

Image credit: Shutterstock.com