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Join us for a thought-provoking podcast episode with guest William Lynes, a urologist, as we delve into the depths of a poignant message that left a lasting impact. Explore the story of Mr. G, a patient who tragically took his own life, prompting William to reflect on his interactions with him. Discover how Mr. G’s struggle with painful recurrent renal colic sheds light on the emotional anguish and insecurity often associated with severe medical conditions. William candidly shares his personal journey, including his own battles with despair, and offers profound insights into understanding and addressing the hidden pain that may lead to such devastating outcomes. Don’t miss this eye-opening discussion on mental health, empathy, and the potential for making a difference in someone’s life.

William Lynes is a urologist.

He discusses his KevinMD article, “The tragic story of Mr. G: a painful journey towards understanding suicide.”

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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. His KevinMD article is titled “The tragic story of Mr. G: a painful journey towards understanding suicide.” William, welcome back to the show.

William Lynes: Hey, thanks, Kevin. Thank you for inviting me.

Kevin Pho: So William’s been on multiple times. To hear his story and background, just go to KevinMD.com/podcast. In the upper right-hand corner, there’s a search bar. Search for William’s name to hear his prior episode. So today, let’s talk about your article. Let’s go straight into it. Tell me about the story.

William Lynes: Well, I had a very memorable message left for me one morning when I came into my office, my urology clinic. It was a message taken by my nurse, just sitting on my desk, and it was a phone message from the wife of a patient of mine. We’ll call him Mr. G. It was a single-sentence question in which she asked, “Doctor, why did my husband commit suicide last night?”

Well, needless to say, I was startled, and I reflected quickly on Mr. G. I had been treating him urologically for the last few months prior to this, and it had only recently come to my attention that his condition was recurrent flank pain from renal colic. He was intermittently passing kidney stones. I was anticipating a very uncomfortable phone call, so I went on and reviewed the chart and tried to have as much information as possible.

Mr. G, it turns out, was in his 60s. He spoke with an Italian accent. He had great difficulty expressing himself, which I always thought went beyond the language barrier. He understood my words, and I understood his words. It wasn’t a language problem; it was something else. He seemed to be burdened by obsessions. He talked in circles. He asked the same questions over and over again, and he gave us such a disjointed history that it really took me several months to figure out, first, that he was complaining of intermittent pain, and then, as it turned out, that it was from kidney stones.

When I finally realized what his problem was, I was relieved, actually, because while there would possibly be future episodes of pain, I felt very comfortable with a fairly common condition, and I thought that I could treat him well. However, the fact that he committed suicide, and he ended up shooting himself, suggested to me that while I felt comfortable with his diagnosis and treatment, Mr. G did not.

In general, about suicide, I firmly believe that people who commit suicide are suffering from unendurable pain. It’s generally emotional pain. In this case it seemed to be physical pain, but it’s generally emotional pain, and the emotional pain is really similar to renal colic. I mean, it’s very, very severe, and that brings them to that point. They have a feeling of unendurable suffering with no solutions, foreseeing a future plagued by this intolerable pain, and they commit suicide.

I failed to grasp the emotional anguish that the condition had inflicted on Mr. G. He must have had tremendous, tremendous emotional insecurity stemming from a sort of unpredictable disease process of periodically passing stones. And I think that, in retrospect, I failed to communicate the treatability, the commonality, of the condition to him. This insecurity, this emotional anguish, is a common backdrop to suicide.

My own life at the time was different than it is now. I hadn’t reached the point of my own emotional anguish, desperation, and hopelessness that caused me to eventually attempt suicide multiple times. I like to think that had I seen Mr. G now, I would have been able to comfort him and help him better.

Kevin Pho: Tell us what your interactions were like with Mr. G. What was it like in the exam room when you saw him?

William Lynes: It was confusing. I was a specialist, a urologist, and so I would get consults, and the person who referred him to me suspected that he had a urologic problem. But it actually took me several months to figure out, “Oh, it’s recurrent pain that he is having.” So he gave a disjointed history, as I said, and talked sort of in circles, and I remember being really frustrated in dealing with him. And then, naively, I was relieved when I figured out, “Oh, he has renal colic.”

Kevin Pho: And how long had you been treating him?

William Lynes: I believe for about two months.

Kevin Pho: So you walked into the office one day, and you received this startling message from the nurse. Tell me your initial reaction, and what did you do next?

William Lynes: I was startled. I sort of think the nurse should have talked to me before I walked into my office, but that’s another subject, I guess. But it was, “Oh my gosh, what is this woman talking about?” And so it was one of being startled.

Kevin Pho: And did you eventually have a conversation with Mrs. G?

William Lynes: I did. I called her. Like I said, I reviewed his history and so forth and tried to prepare myself as much as possible. But I talked to her, and as I recall from the conversation, first she was angry, not really at me, but at him, for committing suicide. I think that’s a very common reaction of family members in situations like this. She seemed to confirm the fact that the primary reason for his suicide was not understanding the unpredictable nature of his condition. She really didn’t have a lot of specifics about what was wrong with him, but she knew that his clinical condition was responsible for his actions.

Kevin Pho: Now, how did this episode change you as a physician? What did you do differently in the exam room as a result of this episode?

William Lynes: I’m not sure I did a lot at that time. This was in the late ’90s. Very soon I would be in the middle of my own mental health breakdown. What happened to me is I had a couple of medical catastrophes occur. When I went back to work, I had severe problems with depression and anxiety, and I marched down this downward spiral, I call it, into suicidal behavior. So very, very soon after Mr. G, I was having great difficulty practicing. Eventually, after my last suicide attempt, I decided that in order to save my life, I would have to retire. And I’m retired. I didn’t mention that, but I’m retired now.

Kevin Pho: Now, as you reflect on this tragic story, is there anything that you wish you would have done differently?

William Lynes: I wish I would have had a little bit more sensitivity for the man. I really am haunted by him. Knowing what I know now about suicide and mental illness, I’ve always thought that I could have helped him with his insecurities about the urologic problem that he was having.

Kevin Pho: What specific things regarding suicide do you know now that you wish you knew back then?

William Lynes: That it’s not an answer. That it tears up your family. There’s always the possibility that you’re a failed attempt. I didn’t mention it, but he shot himself. So those are sort of the things that I would have talked about. I’m a Christian, and I really believe that the answer for suicidal people is found in the Bible and with Christ. I wasn’t really witnessing to people at that time, but I would have brought that into the exam room, and hopefully I would have made a difference.

Kevin Pho: Now, for the clinicians listening to this story on this podcast, tell them what kind of signs they should be looking out for. What kind of questions should they be asking to prevent an occurrence like this for other clinicians?

William Lynes: Well, of course, being a urologist is a little different than being a primary care physician or, certainly, a psychiatrist. But I mean, there are signs of suicidal behavior or ideation. We talked just recently about my four steps in suicidal ideation. But there are things like life becoming disrupted, sleep being a problem, not making deadlines, and having difficulty going to work. These are all signs of the deep despair and mental illness which may end in suicidal behavior.

Kevin Pho: You mentioned that for those who contemplate suicide, scripture may be an answer. Talk more about that.

William Lynes: One scripture is James 1:12, and Jesus said that blessed is the man who perseveres under trial, because having stood the test, that person will receive the crown of life. I believe that you can be saved through belief in Jesus Christ, and it sort of puts life’s tribulations and problems in perspective when you know what your eternal resting place and life will be like.

Kevin Pho: We’re talking to William Lynes. He’s a urologist. He’s telling his story in his KevinMD article, “The tragic story of Mr. G: a painful journey towards understanding suicide.” William, if today you were still practicing and you met someone like Mr. G, the same clinical scenario, how would you approach him?

William Lynes: I think I’d be more understanding. I think I would spend more time with him. I think that I would appreciate the insecurity that he felt. I’ve dealt with a lot of kidney stone patients in the past. I’ve been retired for a long time, but it’s not a new diagnosis. It’s periodic episodes of severe, unrelenting pain. It can happen while you’re driving home from work. It can happen while you’re sleeping in the middle of the night. It can totally destroy your life by the unpredictable nature of it.

As a urologist, I looked at it surgically, in terms of, “Well, yeah, we can do a ureteroscopy. We can do lithotripsy.” But Mr. G, in retrospect, really brought home different clinical psychological manifestations of this disease process, which I appreciate much more now.

Kevin Pho: And my final question, William, tell us some of your take-home messages that you want to leave with the KevinMD audience.

William Lynes: People who commit suicide have unendurable pain. It’s generally emotional, but it’s pain, as bad as renal colic is. It is associated with emotional anguish, and then a decision to end your life. Mr. G taught me some humility and a type of understanding of the disease process of renal colic that I never really appreciated before.

Kevin Pho: William, thank you again for coming back on the show and sharing your story, time, and insight.

William Lynes: Kevin, thank you very much. Thank you for all you do, and definitely thank you for inviting me.