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We delve into urologist William Lynes’ emotional journey as a physician grappling with burnout and the weight of medical decisions. A distressing note triggers introspection, unraveling the hidden turmoil of a healer. Join us to explore the intersection of duty and personal battles in the world of medicine.

William Lynes is a urologist.

He discusses the KevinMD article, “Quitting medicine: a disgraced survivor of a bloody suicide attempt.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

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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 today’s KevinMD article is titled “Quitting medicine: a disgraced survivor of a bloody suicide attempt.” William, welcome back to the show.

William Lynes: Thanks for having me.

Kevin Pho: So William’s been on many times on The Podcast by KevinMD. Just go to KevinMD.com/podcast. In the upper right-hand corner there’s a search icon; click on that, and you can look up William’s prior episodes to hear his story. But today I want to get right into this KevinMD article. It was published back in 2019, but it really resonated with the audience and got over 18,000 shares. It’s titled “Quitting medicine: a disgraced survivor of a bloody suicide attempt.” William, tell us how this article came together.

William Lynes: Well, let me just say that, besides being a physician, a urologist, I’m also a survivor of multiple suicide attempts, and what we’re talking about today is what I call the note, which is basically a note that a nurse handed me that a patient wanted me to read before an appointment that I had with him.

Just briefly, I started practicing urology in 1987, and I retired after a suicide attempt in 2003. During that 16-year period, about in the middle, in 1998, I had two catastrophic medical illnesses, one being septic shock, with an intensive care unit visit of six weeks on a ventilator with a tracheostomy and so forth. I was very, very sick, and I lost 40 pounds. Then, just right after that, I had a snowboarding accident, with again an intensive care unit visit and a 40-pound weight loss and so forth. Anyway, these two events were very significant in my life, because when I went back to work, I really was never the same. I found out that I had bipolar affective mood disorder, I was suffering from physician burnout and severe depression, anxiety and so on, and I began in 1998 what I call a downward spiral into darkness, which is sort of code for suicidal behavior. My practice culminated in September of 2003, after a suicide attempt.

Now, the patient that we’re talking about, I’m going to call him Mr. Smith. This happened a couple of months before I retired from medicine, so we’re talking about the summer of 2003. He was a longtime patient of mine. I had actually been seeing him since he was 72, 14 years before this event, and he had two urologic problems. He had recurrent low-grade, low-stage transitional cell carcinomas of the bladder, which required transurethral resection on multiple occasions and intravesical chemotherapy, and he did well from that. But I also picked up that he had a localized prostate cancer, which is extremely common at the age of 70. Specifically in regard to the prostate cancer, because of his bladder tumors and because of his age at the time, being 72, we elected to observe the prostate cancer. He lived, however, a long, productive life.

Fast-forward 14 years later, when he was 86 years old. The prostate cancer had progressed, and he had developed widespread bone metastases from castrate-resistant prostate cancer. He also had a problem with local prostate cancer disease in the prostate, and he required me to do a transurethral resection of the prostate on multiple occasions because of recurrent bleeding and urinary obstruction. He was coming to me for a preoperative exam for another one of these transurethral resections, and he handed the nurse a note and said, “I want Dr. Lynes to read this before he sees me.”

So of course I looked at it, and it was interesting. It was a postcard written in very beautiful handwriting. I remember it had a flowery border around the outside. I should say that, as I recall, he was in the journalism field, and he really knew how to write, really knew how to capture my attention, because what he said was, “You are a devious, underhanded character.” The perfectly scrolled writing went on. Then he accused me further, saying, “How could you neglect my disease?” I was shocked, but I read on, and it got worse. The sort of grand finale was really a betrayal to me and wounded me deeply, because after I’d taken care of him for 14 years, he said, “I know you really did not do those operations.”

At the time, I was a couple of months away from a suicide attempt and retirement, and I was not in the mental state that I would have been in at some other time in my career. I don’t want to say I flipped out, but I was really, really upset. I remember telling the nurse that Mr. Smith’s surgery was canceled. I walked across the hallway, talked to one of my colleagues about him and referred Mr. Smith to him so that somebody else could take care of him. So that’s the situation with the note.

Fast-forward a little bit in his care. He had widespread bony metastasis from prostate cancer; I knew that. But it was eventually proven that he had some brain metastases from prostate cancer as well. It’s actually ironic, because the very first peer-reviewed journal article that I wrote as a Stanford urology resident was on brain metastases from prostate. So in retrospect, there was really something wrong with the thinking of this patient. But he wrote a beautiful script to me, and I was able to communicate, and I had a longtime relationship with him. That’s the story behind this article.

Kevin Pho: So you said that you had a 14-year relationship with this patient. Could you have seen any of this coming from your prior interactions with him?

William Lynes: Absolutely not. I had what I thought was a very good relationship with him, and I never had any paranoid type of interactions with him. It’s so clear now that there was something medically wrong with his thinking, but at the time, in my mental illness, I really just sort of took it personally and didn’t really put it all together.

Kevin Pho: So the fact that he had brain metastases that may have disrupted his thought processes, now that you reflect on it and you’ve had the benefit of time, does that change the impact of his note?

William Lynes: It does a little bit. I think that at the time I was really in bad shape, and I didn’t appreciate it at that time. But as I look back, I mean, I forgive him more so, and it all makes sense. Brain metastases from prostate cancer are very, very unusual; that’s why I wrote a paper. Unfortunately, they occur in terminal individuals. Everybody who has them dies. There really isn’t treatment, though people do give radiation therapy for palliative effects. But yes, I forgive him, and I understand better now.

Kevin Pho: What kind of messages can physicians learn from your story? Because I’m sure that sometimes they do get notes from patients who are dissatisfied with their care, and it could be influenced by brain pathology or not. What kind of messages can you share with clinicians who may receive similar notes from patients who might be dissatisfied with their care?

William Lynes: I think that you need to take a step back when you get a note from a patient, or through other channels have some understanding that they are unhappy with their care. Try to look at it from their standpoint. In this case, there was a medically associated reason for his sort of bizarre thought processes, and other people may be in that situation as well. Or it may be that they are unhappy with their medical course and are blaming the physician. But I guess the main thing would be to step back, take a deep breath and try to look at it from the patient’s standpoint.

Kevin Pho: So at that moment, and I know that you had other behavioral issues going on at that time, did you have anyone to talk to about this? Did you have anyone to help you take that step back in terms of processing something like this? Tell us what kind of support systems you had at that time.

William Lynes: Well, I was really sort of unusual in that I had a psychiatrist who I had been seeing since my septic shock days, 1998, so I’d been seeing him for, I don’t know, six or seven years, and he had always been very helpful with me. I’m not sure I talked to him at that time, but I could have. As far as the medical community, not really, and I really blame myself for that, in that I didn’t reach out to people. I have a dear friend who tried to reach out to me, but I sort of rejected his trials of trying to help me. So beyond my psychiatrist, I did not. I think that’s very typical of people in the middle of mental illness and physician burnout, that you feel alone, you feel embarrassed, so embarrassed, and you don’t want to burden; you’re already overburdened.

Kevin Pho: So when you say take a step back whenever a clinician receives a note like this or receives some feedback that the patient is dissatisfied, let’s go into more detail. What exactly do you mean by that? What kind of questions should that clinician ask? What kind of things can he do to proverbially step back?

William Lynes: Well, I think you need to review what’s been going on in the care of the patient. The patient has very specific knowledge of what’s going on, and you may have a sort of cloudy view of what’s been going on. I mean, I knew this patient very well, but I should have stepped back and reviewed what was going on. I think you should physically, actually take a moment of time-out and ask, “What’s going on with the patient? What did I do to cause this, and what can I do to settle the situation?” I think then you need to talk to the patient and try to come to a mutual solution to the situation.

Kevin Pho: We’re talking to William Lynes. He’s a urologist. Today’s KevinMD article is titled “Quitting medicine: a disgraced survivor of a bloody suicide attempt.” William, tell us some of the take-home messages from the story that you want to share with the KevinMD audience.

William Lynes: Well, physician burnout is a very common problem; 400 physicians in the United States commit suicide per year, almost all attributed to physician burnout. You can do some quick calculations. If you say that 50 physicians attempt suicide per completed suicide and multiply 50 times 400, you come up with 20,000, and if you divide that by the number of physicians in the United States, exactly 2.5 percent of all U.S. physicians attempt suicide per year. I think that’s a harrowing statistic, and I think it’s a real problem. We could talk at some time in the future about what my solutions are, but I think that the main cause of the physician burnout suicide problem is the deterioration of the patient-physician relationship.

Kevin Pho: William, once again, thank you so much for sharing your honesty, story and insight, and thanks again for being on the show.

William Lynes: Thank you, Kevin.