From darkness to healing: a urologist’s journey through suicidal ideation [PODCAST]

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In this poignant podcast episode, we welcome guest William Lynes, a urologist and survivor of physician burnout, who shares his personal journey through multiple suicide attempts. Join us as we delve into the four stages of suicidal ideation and the complex evolution of thoughts that lead to such drastic measures. William sheds light on the importance of acknowledging, accepting, anticipating, and ultimately taking action in the realm of suicidal behavior. While emphasizing that these stages do not condone suicide, we explore the significance of early intervention and effective support systems to help individuals in distress. Gain insights into the inner workings of the mind and the critical need for mental health awareness in medical professionals. Join us as we tackle this sensitive topic and foster a deeper understanding of suicidal ideation and prevention.

William Lynes is a urologist.

He shares his story and discusses his KevinMD article, “The 4 stages of suicidal ideation: a physician’s experience with burnout and self-compassion.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back William Lynes. He’s a urologist, and his latest KevinMD article is titled “The 4 stages of suicidal ideation: a physician’s experience with burnout and self-compassion.” William, welcome to the show.

William Lynes: Thank you, Kevin. Thank you for inviting me back here today.

Kevin Pho: So you’ve been on the show multiple times. Your most recent article really tells your story, so let’s jump right into that. Tell me, how did your article come together?

William Lynes: Well, I’m a physician, a urologist, as you said, but I’m also a survivor of multiple suicide attempts. I practiced urology for 16 years, and in 1998, I had the unfortunate experience of contracting sepsis after an out-of-country visit. I was really sick and was admitted to, actually, the ICU where I practiced urology. I was in the intensive care unit for six weeks on a ventilator, had a tracheostomy, had all the manifestations of sepsis, and lost 40 pounds. The tracheostomy, I think I mentioned. I recovered somehow from that and went back to my practice, but about a year later, I had a snowboarding accident and was in the intensive care unit again, this time with facial fractures and a tracheostomy, and lost 40 pounds. I recovered again, and I went back to work.

But, you know, Kevin, when I went back to work after these medical events, I wasn’t the same. I had problems with depression and anxiety, and I began what I call a downward spiral into darkness. It was a combination of these events, severe physician burnout, and then I found out that I was also bipolar, with bipolar affective mood disorder. It culminated in suicidal behavior, thoughts, and ideation, and then attempts at suicide on several occasions. I retired in 2003.

Now, in regards to my article, I can actually remember the beginning of my suicidal ideation, which maybe I should define. It’s basically a series of intrusive thoughts and preoccupation with death and dying. I believe that it’s not just a single step, but rather a series of steps, and I can remember the first step that I took. I was actually in the throes of this mental illness, and I was walking my dog in our meadow by our house.

I think we can agree that we are all born with certain self-preservation mechanisms and thought patterns, and one of them, I believe, is an aversion to suicide, really. So often you hear people say, “I don’t understand why that person would have committed suicide,” and I was the same. But at this point that I’m describing, I can remember actually feeling that, and then one moment later thinking in my mind, “Well, suicide really is not that bad.” I believe that was sort of an irreversible first step in the evolution of my thoughts.

In writing this essay, I came up with four concrete steps that I went through, and I think they are common for suicidal patients. They include acknowledgment, which is the one that I described, where basically you accept the fact that suicide is something that you understand. Then it’s acceptance, where in addition to that, you accept the fact that in your own life it would possibly be something that you would understand. Then anticipation is the third step, which is where you anticipate that in your life, if things do not improve, mental illness risk-wise, you would accept committing suicide. And then, of course, the one that people really talk about is action, the last step, which is where you actually plan out and carry out a suicide attempt.

So these, I think, put in context really what suicidal ideation is. It’s a series of steps and an evolution in thinking. It’s not an all-or-none phenomenon.

Kevin Pho: Now, during what you say was this downward spiral, did anyone step in? Did anyone notice this spiral, or did you notice it yourself during that time? And did you seek help during that time?

William Lynes: Well, right after I went back to work after septic shock, I started seeing a psychiatrist, who is actually still my psychiatrist to this day, and that’s been since 1998. He diagnosed me as having bipolar affective mood disorder and began treatment for that. As far as the medical profession goes, I have a very close colleague who I talked to, and he tried to help me. But I was really recalcitrant to therapy. I was very embarrassed about my behavior. I didn’t talk to people, and I was sort of the school of “just work harder, and things will get better.”

Kevin Pho: And just to be clear, this downward spiral happened after your two major medical events that you described earlier?

William Lynes: Yeah. I was flying along well, really, until those happened. Those are big events, and they have profound changes that you actually don’t realize, taking care of many people in that situation. But yeah, after I went back to work, I started having a lot of trouble doing the things that were required of a practicing urologist.

Kevin Pho: Tell me about that coexistence between some of these mental health issues and going back to work. In terms of the medical profession, were they supportive or not? Do you think that it could have been compatible at all?

William Lynes: Well, I think in my own case, I didn’t have a lot of support, but I blame myself for a lot of that, in that I didn’t really seek out a lot of help other than my psychiatrist. There were not many people who inhibited me.

I did have an experience that you may be interested in, which sort of precipitated my first suicide attempt. I was planning on going back to work after septic shock, and I had to see my rehab doctor, who was writing my off-work orders. I told him that I didn’t want to go back to work for another month, and immediately there was just a reaction on his face. I could tell he was not happy, and he reluctantly agreed to that plan. At that time, we had paper charts, and I hand-carried the chart to my next appointment. He had written in the chart, “Dr. Lynes must go back to work next month without fail.”

That profoundly affected me, and it really told me that, at least in his case, and probably in other people’s cases, people didn’t really understand the degree to which I was suffering. So I don’t have any other profound stories of rejection, but certainly, in the back of my mind, I felt rejected, and I felt embarrassed about myself.

Kevin Pho: As you reflect on this journey, is there anything that you would have done differently?

William Lynes: Well, I attempted suicide three times, and finally, with the third suicide attempt in 2003, I realized that in order to save my life, I would have to stop practicing medicine. In my own case, and I’m not advocating this for physician burnout and suicidal physicians in general, in my own case, the answer was to retire, and perhaps I could have done that sooner.

After my retirement, I was really what I call a medical hermit. I was so embarrassed and so distraught about my behavior. I really stayed away from the medical profession. I didn’t go to meetings, I didn’t talk to colleagues, and so forth. I had trouble even going to medical appointments.

The thing that I’m getting to that I should have done sooner is that in 2017, I wrote an essay where I sort of came out about my experience. It’s called “The last day,” and it’s published in the Annals of Internal Medicine. In that essay, I chronicled my last day of medical practice and my last suicide attempt. Amazingly, coming out and speaking about my mental health issues and suicide has been tremendously cathartic, actually. I’ve had a tremendous amount of relief, feeling better about myself. So that’s another thing that I wish I had done sooner, which is to talk to the medical profession about my problems.

Kevin Pho: What was the reaction to your essay when you shared your story in the Annals of Internal Medicine?

William Lynes: There’s been nothing but positive about it. It was a very popular article, well-read. I had many emails. I advertised it on Twitter and so forth, and there was lots of activity concerning it, even to this day, which would be six years later. Just the other day, a person mentioned that they read “The last day” and were moved by it. That’s really been my experience. I write about physician burnout and suicide, but I also speak about it, and when I do, I get nothing but positive feedback, emails, generally from other physicians who are suffering who ask what they can do. So it’s been nothing but positive.

Kevin Pho: And let me ask, how are you doing now?

William Lynes: I’m doing very well, thank you. Thank you for asking. Something about not having to practice medicine anymore took a lot of relief off of my back, and then, like I said, becoming public about my problems has helped. I have a stable psychopharmacology-type regimen. I’ve had over 30 electroconvulsive treatments in the past. I haven’t had one in probably 10 years. So yeah, I’m doing well, thank you.

Kevin Pho: So you mentioned that you had to stop medicine in order to get better. What was it about practicing medicine that prevented you from healing?

William Lynes: I think it’s a lot of things. It’s a mixture of my own personality and the profession. My personality was one of total commitment, long hours, taking everything very seriously. The profession itself demands that. We had a small urology department of four urologists, and we did help each other to some extent, but I didn’t have residents, I didn’t have interns or medical students to support me. It was basically that I did every surgery, I saw every patient, and I took every call.

So it was sort of a combination of my personality, and, as I mentioned, I have bipolar affective mood disorder, which probably is a contributing factor, and then the profession being such a demanding one, such an important one, such a noble profession, and I took that very seriously. The combination of that, in my own case, was life-threatening and required me to retire.

Kevin Pho: Whenever we hear of a physician attempting to commit suicide, a lot of us ask, “Is there anything that we could have done? Is there anything we should have noticed?” So tell us what kind of signs and symptoms we should be looking out for that make us concerned that, “Hey, this physician needs some help.”

William Lynes: Well, I think there are some pretty obvious ones. I mean, physicians are, you know, people who come to work every day, so people who are calling in sick a lot, who are missing appointments, who are missing meetings, of course. And every physician in this situation is different. I didn’t do any of those things, but things that can be a warning sign are patient complaints and lawsuits. These are some of the signs of mental health issues in a practicing physician’s life.

Kevin Pho: Any symptoms that physicians themselves should be on the lookout for that make them think, “Hey, I may need some more help”?

William Lynes: I think the big thing is not finding joy in your practice. I was a very happy practicing physician. I’m very proud of my practice. I was very active in the community and in my church, and for me, the signs, in terms of signaling to myself, were difficulty in doing those things and not having joy, not having enjoyment with the things that I generally did. I’ve had trouble sleeping all my life, but I had a lot of trouble sleeping. Night call became rigorous, demanding, not enjoyable at all anymore. Long surgeries became things that I had anxiety associated with. So in my own case, those are some of the signs that I came across.

Kevin Pho: We’re talking to William Lynes. He’s a urologist, and his KevinMD article is titled “The 4 stages of suicidal ideation: a physician’s experience with burnout and self-compassion.” William, tell us some of your take-home messages that you want to leave with the KevinMD audience.

William Lynes: Well, specific to this essay I wrote, I think that we should think of suicidal ideation, which, again, is intrusive thoughts and preoccupation with death and dying in the suicidal patient, sort of in a different manner. I think we tend to concentrate on acting out, on action. But really, if you think about it, it makes sense that it’s an evolution, because we begin with self-preservation feelings about suicide, which are ones of aversion, and you have to evolve past that to a point where you accept it, you acknowledge it in your own life, and then you anticipate committing suicide in the future, followed by action. So I think these steps are identifiable, and perhaps in mental health therapy, that would help with early recognition of suicidal ideation and allow earlier intervention and hopefully more successful intervention.

Kevin Pho: William, thank you so much for sharing, and thank you for coming on the show and sharing your time and insight.

William Lynes: Thank you, Kevin.

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