I attended a very early morning lecture on Friday, March 22, 2019, at the Cummings School of Medicine at the University of Calgary. The lecture was entitled “When a Colleague Dies: Growing Through Tragedy.” The lecture was presented by Dr. Michael F Myers, a psychiatrist from New York.
The lecture focused more specifically on the death of physicians by suicide. The numbers that were reported in the United States are a staggering 300-400 physician deaths per year! Or one per day.
Of those, 85-95% were living with psychiatric illness. Of the remaining, not much is known about the reasons. Dr. Myers hypothesized their deaths may be related to humiliation, resulting from negative media attention or living with a secret.
Statistics in Canada are unknown due to the lack of research.
Dr. Myers said Doctors “know how to kill themselves.” They know all about toxicology, and they have witnessed far too many botched suicide attempts in their emergency rooms. He said of those who revealed their suicide plans to him, the plans were quite elaborate. He also said he felt quite honoured that these physicians felt safe enough to disclose their plans to him without fear of reprisal.
Dr. Meyers was successful in treating many of his patients, and said “Despite our efforts, some people won’t let us in.”
What are the underlying conditions that would lead a physician to die by suicide?
Some of this stems from a belief that “medical training and medical work grants doctors immunity from maladies or tragedies that affect their patients.”
Physicians, particularly emergency room physicians, do not have time to process the death of one patient before having to move on to another. This contributes to a feeling of detachment and the behavior of “business as usual.” The system these physicians work within contributes to this behavior as does their own internal demand to be perfectionists.
For those who remain after a death by suicide, the stages of grief play out as they do for all humans, however they are compounded by more questions and undue self-blame through the bargaining stage.
Suicide is so stigmatized and there is very little support for those who remain to have discussions about it, especially within the medical community.
Dr. Myers admitted to his own struggle with depression, and successful treatment. Doctors are human too.
Asking for support is a sign of strength.
Although this lecture was focused on physicians, I believe the same is true for emergency room and ICU nurses as well. Or for anyone who has developed a relationship with a patient in long term care.
No two journeys through grief are the same
As humans, we could do a whole lot better at holding space for each other through the journey of grief, whether we have had a personal experience of it or not.
It is important to allow and make room for “meaning making.” This is a psychological process of making sense of our loss and is an important step towards healing and integration. It takes time, and the amount of time it takes is an individual journey and should not have set rules for what that journey is supposed to look like or be like.
All too often we place expectations on ourselves or each other to just “get over it.” Our expectations of Doctors to be immune to the experience of grief is added pressure on them to be super human. Doctors are just like us.
The nature of our relationship with the person that died, will determine the amount of time it takes to heal. Some may never “get over” it.
How to help someone on their journey through grief
I have always taken the approach of “leaning in” to conversations with people when they share their death stories with me. More often than not, there is something unresolved or unfinished that may be contributing to their inability to move forward in a healthy way.
Often, they have experienced trauma from bearing witness to a medicalized death of someone they love in a hospital setting. Or are still feel the sting of being upsold at a funeral home during their most vulnerable time or feel the experience did not truly honour the person they love. Or they are still trying to resolve some angst or estrangement from other family members that is likely deeply rooted within old family dynamics.
Here are some suggestions for how to help:
- Grief is messy. Be prepared to dive in with an open heart, and open ears to hear.
- When you ask someone how they are doing, make space for the answer to come and learn to feel uncomfortable with the silence. Sometimes it is hard to put words to emotions. Don’t rush them for an answer. This will help them to feel safe and understand that you truly want to know the answer and that you have the time to truly listen. Refrain from talking about yourself unless you ask first if it may be helpful for you to share your own experiences
- Offer your time and assistance. Show up for them. As humans we have become uncomfortable around death and emotions. Far too often I have felt the hollowness of the words “my condolences” and “call me if you need anything,” whenever my grief journey was fresh. I never called or asked for help. I was never sure if the offer was sincere. Grief does not allow for logical thinking.
- Check in often and don’t become a stranger. Often the busyness of life creates long periods of time and distance. Grief used to be a community experience. We are not built to withstand grief in isolation. Ask “What can I do that would be helpful right now?” They may not say, but if you have an idea, follow through on it. Keep it simple and consistent. This will show your intent and commitment and eventually they may open up to talk about their feelings, which is an important step towards healing.
- If you become reminded of your own feelings of grief, be present with them, and take the time you need to integrate them. You can communicate with the person you are supporting that your own feelings have resurfaced. You can choose to go through them together, or take some space and find the support you need, but let them know that you need a time out and that you will be back to check in on them.
- Watch for signs of deep despair that may lead to suicidal thoughts. If you suspect this is happening, do your best to encourage the person to seek professional help. You can reach out to local resources in your community to ask questions on how to identify the signs. This will build your confidence in taking appropriate action if needed.
The importance of empathy and compassion for someone who is going through the very personal experience of grief, cannot be underestimated. With the right resources we can be more effective at supporting our friends and the people we love through the journey of grief.
Books that Dr. Myers recommends:
No Time to Say Goodbye: Surviving the Suicide of a Loved One – Carla Fine
Why Physicians Die by Suicide; Lessons Learned from Their Families and Others Who Cared – Dr. Michael Myers
Gratitude – Oliver Sacks
Applied Suicide Intervention Skills Training (ASIST) – Anyone can learn the skills to help save a life from suicide. Roxanne says, “This is an excellent program. I learned a lot about how to safely intervene.”
The Lifeline Canada Foundation The guides, toolkits and resources throughout this site represent a compilation of suicide prevention resources from various sources across the Globe