The Cup: Suicidal Ideation Among Physicians

Originally published by our sister publication Gastroenterology & Endoscopy News

The National Suicide Prevention Lifeline can be reached by dialing 988. For more information, visit 988lifeline.org

“I heard the news today, oh boy.” That’s the Beatles worm I have been unable to get out of my head. Two medical interns in New York City died by suicide a few years ago. First one and then another. Thirty Julys ago, my intern did the same thing.

It was an early Saturday morning and we were on call. He didn’t show up for morning rounds. There was no texting back then. I paged him overhead. I beeped him incessantly. For some reason, I was worried right away. He was all alone in this city. His family lived in California. They were immigrants from Bosnia.

He was brilliant, but who could tell underneath his garbled English skills. I liked him. He had a sheepish smile and he sure knew his medicine. I remember the first time I took him to the cafeteria and he gathered some bread to take back to his call room, as if there might be a line around the block the following morning due to a shortage. I gently informed him that he was welcome to take whatever he wanted back to his room but it probably wasn’t necessary. After a few days, he believed me and the hoarding ceased.

He didn’t make many friends, but I just figured it was early. Fresh out of medical school and right into his internship year. No transition. No contemplation. No celebration. The gun goes off, and you’re supposed to be off and running. However, is that really the case? Are we really off and running? Actually, we are often stumbling. A new set of buildings filled with critically ill patients. Too many patients, if you ask an intern. These interns who sally forth with not enough sleep. Not enough knowledge. Not enough experience. Oh sure, there are laws to govern the amount of hours they can work, but, let’s face it, an hour working at Dollar General is not the same as an hour at Mass General. The responsibilities for a Lenox Hill Hospital intern are quite different than one at “The Tonight Show.” Getting the diagnosis is a bit more compelling than getting the joke.

Aside from the intellectual pressures, imagine the road they have taken. My boys in college noticed that their friends who were not pre-med sure have a lot more free time. My nephew who was a chief resident in Manhattan sure noticed that his paycheck wasn’t exactly enough to live regally. His wife is an accountant, and she has certainly realized that their debt may take a few decades to break even.

Maybe all of these pressures hit my intern that morning in July. Maybe that epiphany mixed with loneliness led to his decision. Maybe that’s why I heard the beeper faintly emanating behind the elevator door. Maybe that’s why I had to pronounce him at the bottom of the shaft.

When I heard the news, oh boy. I sat down and wrote a scathing, angry essay. I sent it to my boys and each one told me it was “dark.” I sent it in to JAMA and it was summarily rejected. I really wrote it to just vent a little bit.

As the days passed, I refocused. I love being a doctor. I wouldn’t trade my job for anything else. I love the people, the patients, my colleagues, the nurses, the techs, the transporters, the housekeepers, the security team. I love seeing them in the hospital, but I especially love when I run into them at the mall or the grocery store or the beach. The outside world is the great equalizer. When the ID badge comes off, we are all the same. Whether we are drooling at Cinnabon or checking the milk expiration date or shivering at the water line, we are all the same. No matter how big or small my paycheck may be, it is worthless without the human interaction.

And that’s why when I heard the news that day, oh boy. It is over 30 years ago but I think about him often. I remember placing his belongings in a cardboard box. I can still see his coffee cup on his call room desk. He received it from the local blood bank for donating. The inscription “Give Life” was cruelly ironic. I remember pausing and wondering whether I should hide it from his family. I put it in the box because I wanted them to know what a good heart he had.

And what is life? It is a series of relationships. To give of yourself is to give life. We need to think about our lives and give others guidance to make theirs better. We need to let others know why we failed and how we succeeded. Life is a competition that I don’t want to win. I want everyone else to win. I want my children to be more successful than me. And how is success defined? Not by the standard bank account but by banking goodwill. You can only be successful by doing good deeds and nurturing long relationships. And a doctor doesn’t want to be healthier than his patient. The doctor is always rooting for the patient.

The coffee cup was right. Give life. And how can we accomplish this goal? Perhaps we need to initiate a week of orientation for these freshmen. We need a week of team building. Maybe we shouldn’t tell our little startup enterprises to “Just Start!” I suggest that every internship program in our nation treats our new colleagues like freshmen in college. Let’s delay July 1 a week. Let’s transition our startups from school to bedside with a week of insight, collegiality and respect. Let’s treat them to a week of ball games and museums and outings and hikes, zoos and parks and cotton candy, and maybe a conference or two. Not merely a week of orientation. Let’s make it a week of celebration. They earned it. Let’s nurture our colleagues every day. Let’s give life!