Thanks for gathering today in this anonymous detached space. Since it’s unlikely that we’ll ever publicly convene in a circle on metal folding chairs, I’m reaching out through this letter. You can peruse this in private and perhaps see a piece of yourself here.

As a non-practicing physician who speaks openly about my decades of suicidal ideations, I know there’s a thirst for connection on this topic. Colleagues pull me aside to whisper that they, too, have felt “that way.” See this letter as my way of firing a flare into the dark cavernous topic of physician suicide in order to faintly shed light and, above all, signal that you are not alone.

First off, I believe suicidal thoughts are natural human reactions to intense stressors. For some, suicide presents itself as a straightforward rational remedy for unrelenting psychological torment. There is no shame in considering death.

For others, however, suicide is never a genuine threat. Those blessed humans are constitutionally incapable of considering suicide, no matter the degree of stress. In a recent meeting about physician suicide, a tone-deaf internist extolled the benefits of a silent “namaste” when meeting each patient. Well-meaning but condescending comments like that only suppress meaningful discussion. Facebook memes and kindergarten platitudes are no match for the vicious fury, self-loathing, and anguish of suicide.

Out of respect for the dead, speak with great care and listen without ego. Lives depend on it.

Like many, I chose medicine for a handful of external factors. As the firstborn of an immigrant family, my female gender was an open disappointment. The passing of my mother and the entrance of a stepmother and half-brother further unsettled my place in the family. To cope, I played the role of caregiver and connected with my parents through external achievements.

Although the details may differ, I’m sure many others come to medical school severed from their emotions and uncertain of why they are alive. If you’re smart enough to get in, medicine is a great place to hide a broken person. Eternal usefulness erects a solid facade of belonging.

Of course, my shadow motives eventually led to resentment. A lifetime career commitment needs to engage both my heart and mind. Medicine, however, only stimulated my intellect, and the hospital was a mismatch to my disposition. I tried for years to settle into that logical but neutered life, only to have my thoughts perpetually drift back to suicide.

We witness the similar demise of lifetime personal commitments all the time. Professionally satisfied physicians who are unequally yoked in their marriages bray, overspend, cheat, drink and on occasion, drive alone into the woods. Two years ago, one sat in his car, pondering if life had to “go on like this.” The financial dependence of four mouths compelled him to drive home that night, but he’s still figuratively in the woods.

That friend was in imminent danger, which brings me to another point. Though laced with death, suicidal ideations do not all convey the same meaning. In my case, they are varied and nuanced, corresponding to distinct moods and circumstances. Some ideations flare like a patch of plaque psoriasis. Not actively life-threatening, they instead serve as a barometer of my stress level. My body can reliably get my attention this way, and I still occasionally have these whispers.

Another type is a “desire for control” ideation. Although loud and painful, those lack a sincere craving for physical death at their core. They carry a wish for escape. As a performative people pleaser with limited conflict resolution skills, intense helplessness used to generate these ideations. Along those lines, one classmate carried a lethal dose of opioids in her backpack throughout fourth year. Their mere presence gave her comfort.

Then, of course, there are the flat-out, active ideations. Our medical expertise makes these especially troublesome. Other people mask their cries for help with a mix of pills and alcohol or superficial slashes to a wrist. Not us. We are functional and effective people. By and large, we’re found dead.

This is why I find the credentialing query of “Have you ever considered taking your own life?” inappropriate and offensive. The binary question implies that a “yes” response is indicative of moral deviance or deficiency. That claim is based on the outdated notion that people “commit suicide” as a criminal act against God. No. We now respectfully say that people “die by suicide.”

For my Gen X peers in distress, I want to add a bit of social context. Daniel Goleman’s seminal book Emotional Intelligence wasn’t published until 1995. Growing up, no one noticed if a parent tossed out smacks and contemptuous put-downs. Fast forward, and we met a few attendings who were also bullies. In residency, one took pride in his ability to make male residents cry. “Negative self-talk” doesn’t even come close to describing how many of us see ourselves after all that scrutiny and scorn.

To us, the new millennial mantra, “Always be kind,” can feel like whiplash. Turning the emotional corner involves a reckoning with all those years when we were unabashedly unkind. Furthermore, we wonder and grieve who we might have become if we had lived in a kinder world. It’s a lot for an employed adult to process, not to mention the strain of RVUs, parenthood, COVID wars, hospital administration, sexual decline, electronic medical records, personal diagnoses, malpractice, online physician reviews, and on and on. No wonder some of us believe it’s too late to change course, that only failure lies ahead.

Unlike others, you and I are still alive. As someone who suffered greatly, I assure you that inner peace is attainable, no matter how long you have secretly wished for death. The path to peace is granular and personal, and in that sense, you will be alone. But on a higher plane, I sense you, I see you, and your pain matters to me.

Identifying details have been altered to protect the privacy of individuals.

Eliza Shin is an actor and former radiologist. 

Image credit: Shutterstock.com