Losing a Physician-Patient to Suicide
... and becoming a survivor of suicide loss.
Posted Oct 07, 2020
It is about eight o’clock in the morning as I’m in my car driving to the hospital where I work. Lots of traffic, as usual. Light turns amber. Rather than speeding up and trying to cross the intersection, I actually slow down and come to a stop just as the light turns red. There’s a Starbucks at the corner to my right. I see Dr. Z, sitting outside, enjoying the morning sun with his coffee and a cigarette. He’s alone. He can’t see me; we’re at right angles to each other. Dark glasses hide his eyes. He’s not on his cellphone or reading the morning paper or a book. He’s quite still, looking straight ahead. As I gaze at him, I wonder what’s going through his mind. I draw a parallel with the way he sits and waits for me in my waiting room, minus the coffee and cigarette, plus or minus the dark glasses. My fixation on him is jarred by the driver behind me honking his horn. The light has turned green. I continue on my journey, but Dr. Z remains in my mind’s eye.
Less than three weeks later, he will kill himself.
Dr. Z was in his forties when he first came to see me in the 1990s. It was his family doctor who, privy to the issues that Dr. Z was sharing with him, convinced him that he might benefit from seeing a psychiatrist. “I don’t like myself, one bit, and despite my accomplishments, I feel like a failure” was how he started his first visit. He was always a good student and functioned well in his first career as a teacher. He was an older, non-traditional applicant to medical school, and was a recent graduate and second-year resident in physical and rehabilitative medicine when I met him. He recalled thinking that he might be developing a depression even before starting medical school, but, like so many medical students and doctors, he pushed himself harder and harder and just carried on. Six weeks or so before I saw him, he felt much worse. His energy was zapped, he never slept more than three hours at a shot, he was losing weight, and for the first time in his life he found himself churning about ways that he might kill himself.
Dr. Z was straightforward with me about how much he was drinking to try to deal with his insomnia, but he was insightful enough to know that at the end of the day alcohol was making him feel worse. Being a physician with knowledge of what defines the illness of depression, he rattled off a list of the symptoms and signs, which clinched the diagnosis. He agreed to start taking an antidepressant and, at my suggestion and admonition, to scale back his daily drinking, ideally stopping completely in the short term. So far so good: His sleep improved almost immediately and within two weeks his mood began to lift. After another six to eight weeks, he told me that he felt about 75 percent improved. He was pleased and so was I. He admitted to “an occasional” glass of wine, but no more than this, and no hard liquor, which he had been drinking earlier.
Dr. Z told me in our first visit that he was struggling with his sexual orientation, and had been for years. “I wonder if I’m gay…I’m attracted to other guys but I’ve never done anything about it.” On the advice of his family doctor, he had just begun psychotherapy with a gay-affirming therapist. He was a bit wary and ambivalent: “What if I find out that I really am gay? That scares the shit out of me. But I guess I could get my head around that as long as I don’t have to get intimate with anyone. I suppose I could lead a celibate life. That’s okay, isn’t it?” I didn’t answer his question directly, but said: “Sounds like your question is about not having to rock the boat on how you’ve been leading your life, on your own, alone.” He agreed, but responded with something both existential and familiar: “There’s so much pressure to be coupled in our society, and it seems to get worse as I get older.” He had more to say and I just listened.
He continued to see his therapist on a regular basis and enrolled in a “coming out” group for gay men. He was no longer seeing me that often, as he was stable on his medication. As the months wore on, he missed a visit, then returned several weeks later, not in good shape. He had gone off his medication and was drinking again. He didn’t look well, he had a tremor, he cried repeatedly during the visit, and many of his depressive symptoms had returned. When I asked about suicidal thinking, he admitted that he had felt drawn to and tempted to steal potassium chloride (a commonly known means of suicide among doctors) from the hospital. I put him on medical leave. We repeated the drill: Stop drinking, go back on the medication. I met with him briefly every few days, but this time he couldn’t stop the alcohol. I got him assessed quickly by an addiction medicine specialist who recommended immediate admission to residential treatment. He reluctantly agreed.
But the night before he was to leave, he attempted suicide. And it was serious. While sitting in his car in a closed garage with the engine running, he downed two bottles of wine and swallowed his remaining antidepressant pills, though only a few because I was careful to prescribe him no more than two-week allotments. Fortunately, a passerby walking his dog and feeling suspicious, investigated and called 911. He was taken to a local ER but after 24 hours of tests and awaiting clearance, he ran away. He was found at home. I spoke to him, and he agreed to go to treatment. Two months later, he returned and looked the best I had ever seen him. I was now just one of his doctors, his psychiatrist. He signed a five-year contract for monitoring by addiction medicine, AA, The Caduceus Group, and an individual therapist.
This is an excerpt from my newly released book Becoming a Doctors’ Doctor: A Memoir. Here is the link to Part II of this series: https://www.psychologytoday.com/au/blog/physician-heal-thyself/202010/wh...