Sobering Sadness

I have been circling around writing this post for the past week or so, afraid I will not give it what it deserves.

I was deeply saddened last week to learn that one of my GP-Surgeon colleagues took her own life. This news was so devastating. She was 37 years old. She was a few years ahead of me in the same residency program so I knew her through alumni events and conferences, then last year we were in the same lap salpingectomy course. We spent a couple of nights catching up, telling rural doc war stories over $18 cocktails in our hotel lobby.

I found out the news while at a dinner party with friends. From the confines of a bright pink toddler's bedroom I called my co-resident and we tried to wrap our heads around so many questions. Why did she feel this was her only option, did her colleagues see any signs, did her family and loved ones know what was going on? Was any of this work related? How could this have been prevented? Where did we go wrong? How had 'the system' failed?

My co-resident, A.B knew her well as they have been locuming in some of the same places over the past year. She had recently had dinner with her and so A.B was trying to retrace every word and gesture and nuance from that night. She was left holding guilt and regret for not knowing V was so close to unravelling, and not realizing the desperate situation she was in.

I have to admit, this whole situation has caused me to take a hard look at my decision to leave my rural surgery job last year. I don't have to go through mental gymnastics to see how the sleep deprivation, stress of the job, interpersonal conflict at work, having to make high stakes decisions, clinical unpredictability, and isolation could take down even someone whose mental health was robust. We have to be perfect. Our paperwork must be pristine, we cannot make any mistakes, our sleep and personal lives are not protected, and we have to be nice 100% of the time. Every medical advisory counsel meeting was a parade of other departments admonishing the physicians for not filling out the forms right or for calling techs in during the night, or having the resident make requisitions when only the attendings should, or ordering too many liver enzymes, or forgetting to put an impression on our radiographs. We take this quietly most of the time because we are sitting there in our rumpled scrubs, our socks damp from being worn for 14hrs in rubber boots and we've just lost the desire to defend anything or attempt to justify why we order those enzymes.

I have gone through bouts of depression in my life, thankfully not last year. Even so, I visited some dark places in my mind. I often feel ashamed for leaving that role behind because I fabricate in my mind the judgements that others must be assigning me: that I wasn't tough enough, brave enough. I built this image of myself - the hard core ER nurse working in the arctic who would then become a hard core rural GP-surgeon. I could go to the rural conferences and snub my nose like everyone else at those city docs who have it so easy and who would never survive a day in my job. And yet, the image I created of myself wasn't actually me. I tell myself that it would have probably gotten easier and I probably would have started enjoying it. I probably would have laughed at the fact that I would wake up with a heart rate of 130 some mornings because I was so stressed out about being on call.

I was at a conference last year and a board member of our medical association, who worked with me as a resident, came up to me while we were milling around at an appetizer social. He asked my how it was going and I just started crying. Not the gulping, ugly crying. The tears streaming into furtive dabs with a tiny drink napkin before dripping off chin kind of crying. I was mortified. He was mortified. I attempted to regain my composure as fast as I could. He reassured me that the first year of practice is hard for everyone and told me about some challenging cases he'd recently dealt with and then moved on to a different conversation. I felt embarrassed and angry with myself. I thought about that interaction for weeks afterward. He didn't get in touch. He didn't check in or pass on any information about physician support. It was just another conversation in a long history of similar conversations that didn't seem to ring alarm bells to anyone.

But now, after all this with V, I see that maybe it wouldn't have gotten better. Maybe it would have gotten much, much worse.

V's death brought the statistics around physician suicide, particularly female physician suicide, into painful focus. We do not talk about these realities and about the people behind these numbers. We do not admit to needing help, we do not reach out to those that might need it.

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Late entry.

I wrote the beginning of this post several months ago. I think I was scared to make it public. Or maybe I was just wanting to marinate on it a little longer. Either way, I think there continues to be more and more evidence that we need to be vocal about the fact that people are afraid to ask for help. That feeling weak and on top of that feeling guilty about feeling weak does not spurn one into wanting to reach out. It makes one want to curl into a ball at the far end of a cave with the hope that everything will just go away if you pretend it isn't there. But this is not the way to improve ourselves or this broken system.

For those who are struggling: please, please know that it is quite possible that no one knows you are hurting or if they do, do not know how to approach you about it. Know that there is increasing awareness about mental health as well as support for those who need it. If you fear being judged, recognize that those casting judgement are probably hurting too and not addressing it in a healthy way. Know that sometimes things get better and sometimes it takes a major life shake up like a relocation and retraining to get to a place that will work for you. We've only got one precious life. No career or degree of recognition or fear of embarrassment is worth sacrificing that precious life for.

Courage.