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We welcome William Lynes, a urologist, who shares his powerful and personal story. William opens up about his battle with burnout, mental illness, and multiple suicide attempts. From his successful career to the devastating medical events that changed everything, he reveals the shame he experienced within the medical community. We discuss the broader implications of this stigma and the importance of open dialogue.

William Lynes is a urologist.

He discusses his KevinMD article, “From physician to survivor: My inspiring journey through burnout, mental illness, and triumph.”

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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 KevinMD article today is titled “From physician to survivor: My inspiring journey through burnout, mental illness, and triumph.” William, welcome to the show.

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

Kevin Pho: So William’s been on multiple times. For those interested in hearing more about his story, go to KevinMD.com/podcast. In the upper right-hand corner there’s a search bar; search for William’s name and hear his story. So let’s get straight into your most recent KevinMD article. Tell us how this came together.

William Lynes: Well, I’m a physician, a urologist, but I’m also a mental health survivor of physician burnout and suicide. I practiced urology from 1987 to 2003. At about the midpoint of that practice, I had two catastrophic medical-surgical problems, one being a septic shock episode and the other being a snowboarding accident with facial fractures. When I went back to work, I didn’t feel good. I had a real problem with depression. I found out that I had bipolar affective mood disorder, and because of that and physician burnout, I really started a downward spiral and ended up with suicidal ideation and three attempted suicides.

Now, the theme of what I’m talking about today is really the shame that I felt associated with my mental illness during my practice, and I have pulled out what I call three episodes of shame to talk about. There were many times that I felt very shameful about my behavior, but these are sort of the real situations.

The first was that I had septic shock in 1998, and I was out of work for 10 months. When I was about ready to go back to work, I had to go to the physician who was writing my off-work orders. He wanted me to return to work, let’s say, in May of 1999, and I told him I wasn’t ready. I remember a real change in his demeanor. He was disgusted with me; it was obvious, and I felt really bad about that. But what really made me feel bad is that I hand-carried my chart, because we had paper charts at that time, to my next appointment, and he had written in the medical record, “Dr. Lynes must return to work without excuses.” This was, I thought, my friend. He was a fellow partner in Kaiser Permanente, and he had been taking care of me along with so many other physicians. I was just really destroyed. I was so upset, I was so hurt, and so that is my first, what I call, milestone of shame, and I remember it to this day.

The second was my first suicide attempt. I have three of them. The first was around the time of that gentleman’s comments, and it really had something to do with it, but it was just an overdose that I took, and I hid it. Nobody really knew about it. I went back to work, but a year, a year and a half later, after doing so poorly and feeling so bad about myself, I began thinking about suicide, and I made a very serious suicide attempt. I went to a hotel and proceeded to take a massive overdose, and when they found me, I was comatose, so I had to be intubated because of respiratory failure. My family was called in, and they were told that I wasn’t going to survive. I obviously did survive. I ended up in a locked psychiatric unit, I had to begin having electroconvulsive therapy, and really, my story at that point was out of the bag. Everybody knew that I was suicidal and had attempted suicide.

For some reason, and you might say it’s a crazy reason, but you have to realize I was only 49 at the time, I had three boys that I was raising, and I loved medicine, I thought that if I went back to work, I could have a successful urological practice. So I had to go in front of the hospital wellness committee and plead my case. I remember it as just a very, very uncomfortable, shameful period of time, several hours that we met with them, and I remember that I really felt that I was begging and cajoling them into letting me practice medicine. So that is my second milestone of shame, something that I’ll always remember. It was very, very meaningful to me.

My third milestone of shame: I went back to work after the second suicide attempt, and I had the same mental issues, with depression, anxiety, and difficulty with long surgeries. Call bothered me tremendously, and I decided to end my life again. This time was again a very serious attempt. I went to my office on a weekend planning to commit suicide, and I can remember just briefly going into my office that morning. It was cold inside, and I remember looking at my reflection in my medical school diploma and thinking how disgusted I was with my behavior and my intentions. I proceeded to lacerate my wrist, and I fell into a deep sleep. I lost maybe four units of blood on the floor of my office.

When I woke up, though, I knew that I wasn’t going to die, and so I had to call the hospital operator. Again, this is a hospital where I had practiced urology for 16 years, and I had to call them, tell them the situation, and then be admitted to the hospital. In my illness, I imagined that everybody in the hospital knew and was judging me, from the cafeteria cook to the hospital operator, and of course my physician colleagues, and it was again extremely shameful. It ended up that I decided that in order to save my life, I would have to quit and retire from medicine, and I’ve been retired since.

So these are three major points in my urologic practice, and my practice of medicine, where because of my mental illness and physician burnout I felt tremendous shame. We talk about it, but shame is endemic in mental illness, and it’s really counterproductive to getting back and being well.

Kevin Pho: So let’s get back to that first episode. A physician whom you thought was your friend, a colleague, said that you had to go back to work without excuses, and that really exacerbated that shame. Why do you think that physician reacted that way?

William Lynes: I don’t think he understood the depth of the problems that I was having. He had been integral in the clinical treatment of my septic shock for quite a while. What happened is that I went out of the country, and when I came back, I was sick. I ended up going to the ICU with the septic shock and was on a ventilator for four weeks, in the ICU for six weeks, with a 40-pound weight loss, a tracheostomy, the whole bit. He was involved in a certain piece of that treatment, and he did not appreciate the depth of mental anguish that something like that does to you.

I’m really big on the reality of so-called ICU psychosis, and I don’t think that treating physicians really understand the depth of the problems that it causes you. So I think his problem was he just didn’t appreciate it. He thought that I was really faking, I guess, and just needed to get back to work, that maybe I was just trying to get out of work.

Kevin Pho: So you mentioned that shame is a hallmark of a lot of mental illnesses. Now that you’ve been on that side, what are some things that the medical institution can do better to reduce the shame that is often associated with it?

William Lynes: I think it’s a real problem. It’s sort of inherent in mental illness. I wrote an essay for you called “The invisibility of mental illness,” which basically says that there aren’t any measurable signs of mental illness; there are only symptoms. And so the patient always thinks that the person they’re being treated by doesn’t really understand or believe that they have these problems. So I think it’s inherent in mental illness, and it’s a real problem.

I think people understand you better than you think. I wrote an article in 2017 called “The last day” that was published in the Annals of Internal Medicine. It was the first time that I really came out to the medical community about my mental illness and suicidality, and what I’ve found is that, without exception, people accept me. They’re proud of me, they thank me, and they tell me about their own struggles and problems. So in terms of what the medical profession needs to do, I think it needs to be more open and reflective about its problems, and the physician who is in that situation needs to open up, because it is cathartic. It is therapeutic to tell your colleagues that you’re having problems.

Kevin Pho: Now, how did you overcome these episodes of shame?

William Lynes: It’s been a long time since I retired, but when I retired, I was destroyed. I became a medical hermit, I’d call myself. I withdrew from the medical profession. I didn’t practice medicine, but I could have gone to meetings, and I could have interacted with my colleagues, and I absolutely did not. I was afraid to go to my own medical appointments.

I coped with it because a fellow physician said, “You should write something and have it published,” and in 2017, like I said, I did that. Since then, I’ve been totally open and have spoken to people and told them that I’m a suicide attempt survivor, that I have mental illness and bipolar disease, and that I have a history of physician burnout. It’s just been like night and day in terms of relief. My self-image is repaired to some extent. I feel like I’m a physician again. So that’s what I did, but it took a long time. It took me, I think, 16 years of being shameful and hiding, and then all of a sudden I came out, and it’s been a relief.

Kevin Pho: Now, for those physicians today who may be going through mental illness or behavioral health issues, even today there’s going to be some facet of shame that may be involved. What pieces of advice can you share with these physicians who may not know where to turn?

William Lynes: Well, first of all, they’re not alone. Our profession has a real problem. Everybody knows the number of 400 suicides, physician suicides, per year, and that sounds like a lot. It’s a Boeing 747, or it’s two medical school classes. But if you think about it, for every one completed suicide, the literature says that we have somewhere between 20 and 100 attempted suicides. So if we take the number 50 and multiply 50 times 400, we come up with a number of 20,000 suicide attempts per year in the United States. There are only about 800,000 physicians in the United States, and that amounts to 2.5 percent. So 2.5 percent of all physicians in the United States attempt suicide every year.

So the first thing I would say is that you are not alone. And in terms of things that you can do, I think reaching out to others is so key: understanding that you’re not alone, and then, when you open up, you’re met with acceptance. I think that’s the basic plan that I would propose to individuals like this.

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: I think that, again, as I just chronicled, the medical profession has a real problem with physician burnout, mental illness, and suicidal behavior. I think that the root cause of it is a deterioration of the physician-patient relationship, and I think that there are many examples of that everywhere. Until we repair that relationship, we’re going to continue to have a really sick profession. Shame, which is what we were talking about, is part of mental illness. I don’t really know how to make it go away, except for the shameful person to realize that they’re not alone.

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

William Lynes: Thank you, Kevin.