Trigger warning: This article discusses suicidal ideation. Please use your best judgment in reading. I am sharing my journey with caution in hopes that my reflection will help others, and I invite you to continue shall you feel it’s a safe and appropriate time for you to join in this discussion.

I am no stranger to existential crises. The moments where I realize my mortality and have a mild panic about when and how I may die. The moment I wonder: What if I die before I even learn how to live?

I wonder: What if I die when my bed isn’t made, or there are dirty dishes in the sink? What if I die before I tell people where all my accounts are located? What if I die and my dog, Reese, is left alone with no way to alert others that he needs to go potty, eat, be loved? What if I’m not ready?

To ease the anxiety, I make the bed and clean the dishes. I clean my home just in case it’s the last time I see it.

I tell my sibling where my accounts are located and make sure she knows who is listed as a beneficiary.

I fill out an advance health care directive form, and then when I discuss with the chosen family member that will be in charge, the family member indicates he doesn’t want to be the one to make the decision. Whew, good thing I asked. Have you?

Then I think: Why don’t we talk about this more? We talk a lot about other diseases that impact a fraction of the population but ignore the one fate shared by all: death.

Acknowledging this reality and feeling tremendous anticipatory anxiety about the unpredictability of my own death, I started to wonder how it would feel if I could control when I died? The thoughts became dark when mixed with the development of tremendous psychache.

At that time, I was in the Air Force, a dentist, sleep-deprived surgical resident, and struggling with anorexia — roles and conditions highly correlated with increased suicide risk — and by the time I paused to reflect and appreciate my real risk, I felt trapped.

My sleep-deprived, undernourished brain was experiencing such psychache that I just wanted it to end. I wanted it all to end. Or did I?

Thoughts about what it would mean to end my life became pervasive. When stakes became real, I made the split decision to get help. I felt that moment when it could have turned for the worse. I recall that very moment deeply and painfully to this day. If you relate, please seek help stat.

In seeking help, I gained the ability to step back and realize that I had various options in life rather than the two that my brain was perseverating over. I realized how easily sleep deprivation and malnourishment can hijack your brain and contribute to thoughts that no longer feel like your own. I learned the importance of rest and permission to pause when attempts to power through are no longer serving you. I learned that nothing in my career was more important than my life. Nothing.

And in truly accepting that nothing in my career was more important than my life, my brain felt like it could finally breathe. The crushing devastation and sense of feeling trapped were released from my perceived reality, and the factors that were weighing heavily on my brain and causing me to crave the need to escape all of a sudden became less important.

When I stepped back, I could finally see the whole picture. I looked at life from a completely different angle and realized how much I was being blinded by societal pressures to put career before life and I accepted the fact that choosing to save my life meant that I would risk sacrificing my career.

When I first considered prioritizing my life over my career, I paused. Was I worth it? Who would I be without this career? It was not immediately apparent to me what to do. I felt guilty that I was even considering that maybe I could choose a career that actually allowed me to meet my basic needs and be — dare I say it — happy?

My thoughts and emotions became overwhelming as I leaned into the inner turmoil. My psychache became intense, and each day, I contemplated ending it all. However, in reaching those deep, dark thoughts day in and day out, I was forced to choose life with intention — over and over, every single day.

Through staring death in the face and asking myself each morning: What would it mean to die? I learned the precious nature of existence. Rather than learning what it would mean to die, I started to appreciate what it would mean to truly live.

Each moment that I chose life, I appreciated the gift of breath. The gift of a hello. The gift of an authentic connection with another human being trying to make it through this crazy journey we call life.

I appreciated how much I hid my pain, and I wondered how much others do the same? I learned the value and craved the ability to hold space for others and let people know that they have a safe place to go when their world turns dark.

And to this day — each time my own deep dark thoughts threaten my brain to spiral — I replace the question of “What would it mean to die?” with “What would it mean to truly live?”

While I never wish the psychache on anyone that leads them to contemplate death, I have learned to feel gratitude for my experience with suicidal ideation as once I faced the reality of the potential for imminent death, I could no longer just go through the motions.

Now, every morning, I recommit to life and make the most of the opportunity to breathe, exist, connect with others, and appreciate the world from a new, clearer lens. I learned how to start to truly live by staring death in the face. Have you?

Jillian Rigert is an oral medicine specialist and radiation oncology research fellow.

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