The Fallen
by Dr. Blair P. Grubb
They found him dead, lying on his bed, with an empty pill bottle by his side. I shook my head in disbelief. He had been a promising young intern. Intelligent, hard working, a perfectionist. Always the first to arrive and the last to leave. Everybody liked him. His future looked very promising. But then things started to unravel. He began to show up late and his patient notes were incomplete and frequently illegible. He began to look unkempt and disheveled. I was the Chief Resident of the program at that time and I took him aside to find out the reason for his precipitous decline. “My wife,” he said. “She doesn’t understand what it takes to be a doctor. The time, the study, the commitment.” I nodded in acknowledgment to his words, as virtually every physician must at some point deal with similar issues. “I’ll be fine,” he said, “I just need to get some sleep”. I arranged for him to have some time off and made an appointment for him to see one of the hospital’s psychological crisis counselors for guidance. At first he seemed to improve but then worsened when his wife left him. She left a note saying that she “did not want to be married to medicine”. He was devastated. He became even more withdrawn, aloof, and depressed. When he didn’t show up for work one morning the other interns became concerned and drove to his apartment. After they literally kicked the door open they found him. Dead. He left no note.
Although life as a physician can be very rewarding it can also be immensely stressful. Doctors now have the highest suicide rate of any profession in the United States. At least 400 physicians commit suicide each year, a number so great that it requires roughly two medical school classes of students just to replace the ones who died. Every day we lose at least one additional doctor to suicide. Often these deaths are covered up or hidden. The real numbers may be much higher. According to the American Society for Suicide Prevention the rate of suicide among male physicians is 1.41 times higher than among men in the general population. For women, the risk is 2.27 times greater. The stress on physicians begins early. Medical school fosters a culture of perfectionism. That, along with long hours, lack of sleep and stress, all play a role in physician suicide. While medical students begin medical training with normal mental-health profiles throughout the course of medical school they undergo a significant decline in their mental and emotional quality of life. A 2016 study that included data for more than 10,000 medical students revealed that more than 27 percent of them experience depressive symptoms and more than 11 percent reported having suicidal thoughts. Of the 954 students who screened positive for depression, just 15 percent sought psychiatric treatment. Residency is often a time of even greater stress due to the long hours, tremendous workload, the stress of caring for the ill and the pressure to perform well on standardized exams. Studies have shown that burnout and depression are common occurrences among residents. The aforementioned resident’s death was covered up by the hospital administration. The house staff were forbidden to speak of it or give out any information regarding it. When patients and nurses asked what became of him they were told that the resident “no longer worked at the hospital”. I was appalled by the institution’s behavior. A sense of melancholy descended upon the residency program. It was still present when I completed my year as Chief Resident and left to begin a fellowship program at a different hospital.
Despite the passage of more than 30 years since I was Chief Resident, little has really changed. Indeed if anything the problem is worsening. However there is a growing feeling within the medical community that something must be done. In a moving editorial written after the death of a medical student by suicide, Dr. David Muller stated that medical education must commit itself to a “genuine shift in the way we define performance and achievement. We must minimize the importance of MCAT scores and grade point averages in admissions, pull out of school ranking systems that are neither valid nor holistic, stop pretending that high scores on standardized exams can be equated with clinical or scientific excellence, and take the bold steps to relieve the pressure that we know is contributing at least to distress, if not mental illness among our students” (and residents). We need to promote counseling programs that are “safe havens” for medical trainees that are feeling distressed by the overwhelming requirements of a medical education. And we must act quickly, for everyday more lives are lost. How many more of our colleagues need to fall before we take notice? I shake my head and wonder. I have just received word that yesterday that one of our residents was found dead, lying on his bed with an empty pill bottle by his side...
Dr. Blair P. Grubb is a professor of medicine and pediatrics at the UTCOMLS. He is the author of The Calling and The Fainting Phenomenon: Understanding Why People Faint and What Can Be Done About It.
