Suicide after dismissal.

[CDI]

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Heard a sad story today of a former 3rd yr resident who took his own life after being let go just 3-4 months before graduation. Rumor is he was an IMG, supporting his family back home, and may have lost his Visa status as a result of the dismissal.

Unfortunate that a resident who clearly needed help was thrown to the wind by his own and resorted to such measures. (No idea why he was dismissed so late into residency, so can't speak on that.)

http://www.chicagotribune.com/news/ct-berwyn-body-found-met-0417-20150416-story.html

http://abc7chicago.com/news/police-man-found-dead-near-hospital-in-berwyn/663789/

Thoughts are with the residents of the program.

 

[Doctor Bob]

Why is this such a big deal? Some resident, who had access to the same helping resources we all have, chooses this as the answer to adversity. And I'm supposed to feel bad for him?
Sure, I feel bad for his family. And I feel bad for the other residents (who now have more call to cover, although they incurred this extra work when this guy was dismissed).
But I don't feel bad for him. And I certainly don't blame the program. Any more than I blame any other company who has an employee off themselves.
Some people have bad coping skills, and we can try and try to keep them from making bad choices. But at the end of it, they are the ones with a gun in their hands, a bottle in their hands, or whatever else. And if they feel that's their only option, so be it. It's one less person to have to devote limited resources to.

Here; I'll save you all some time.
You're a bad person; You don't care about people; You're a terrible doctor, You're cold callous and heartless; You're a mean and hateful person;
Just quote whichever sentence you think is most applicable.

<shrug>... life goes on.

Well... except for him.

 

[Jon_azkue]

deleted

 

[hamstergang]

Why is this such a big deal?

Because most people (especially doctors, one would think) don't like it when people die (despite these limited resources you mention) or suffer. And when someone commits suicide, they were certainly suffering before, and their friends and family are certainly suffering after (including the residents who have to do extra call but probably also have an emotional reaction).

Yes, this person had access to resources, but they either weren't used or didn't help. Most decent people would want to know why so we can use that information to help alleviate someone else's suffering in the future.

 

[DeadCactus]

It's 2015 and mental illness still gets treated as something below "real" diseases...

Asthmatics have access to the same air as the rest of us, they just choose not to breath well. 🙄

 

[Doctor Bob]

Asthmatics have access to the same air as the rest of us, they just choose not to breath well. 🙄

Weak analogy. Better to say 'Asthmatics have access to the same albuterol as the rest of us, they just sometimes choose not to use it... or smoke.'

Yes, this person had access to resources, but they either weren't used or didn't help. Most decent people would want to know why so we can use that information to help alleviate someone else's suffering in the future.

If they weren't used then I don't see what the answer is. More signs around saying "call for help"? More mandatory lectures on signs of suicidality? Required weekly meetings with psychiatrists? Daily hugs?
If they didn't help then I don't see what the answer is. Some diseases, both physical and mental, have no cure and end with the same finality. You can take steps to address them, but some conditions are just terminal.

If you're suicidal and you come to me asking for help, yes, I'm going to plug you in with mental health counselors. If I think you're a danger to yourself or others I'll prevent you from leaving until you see a psych professional. And then I'll go about my day, work my shift, laugh at the jokes people make about you at the nurses station (just like I do about the diabetics who are still overeating, the asthmatics who are smoking, the hypertensives who don't take their medications, etc, etc), and not give your story much of a second thought.

It's not like I'm handing out flyers to patients...

 

[Law2Doc]

These stories are sad and I think it's important to realize that being a doctor is not the only road to career satisfaction. You don't always get what you want and need to always have some flexibility to find a plan B. As I've said on other threads, medicine often seems to attract some of the people whose initial interaction with healthcare has been due to help with depression and the like, and often this is the worst path for such a person to be on due to the pressures, sleep deprivation, isolation, and level of competitiveness. Regardless it's always sad when someone opts to "solve their problems" in this way.

 

[hamstergang]

If they weren't used then I don't see what the answer is. More signs around saying "call for help"? More mandatory lectures on signs of suicidality? Required weekly meetings with psychiatrists? Daily hugs?

Perhaps studying this to try to better understand why the resources weren't used, understand the barriers that keep people from seeking help so that we can work on addressing these barriers and presumably consequently reduce suffering.

If they didn't help then I don't see what the answer is. Some diseases, both physical and mental, have no cure and end with the same finality. You can take steps to address them, but some conditions are just terminal.

So we should just give up, then? If a disease/disorder is currently terminal, there's no point to doing further research to try to change that? Are you a real doctor?

If you're suicidal and you come to me asking for help, yes, I'm going to plug you in with mental health counselors. If I think you're a danger to yourself or others I'll prevent you from leaving until you see a psych professional. And then I'll go about my day, work my shift, laugh at the jokes people make about you at the nurses station (just like I do about the diabetics who are still overeating, the asthmatics who are smoking, the hypertensives who don't take their medications, etc, etc), and not give your story much of a second thought.

I'm in psychiatry and see suicidal patients every day. That doesn't keep me from doing my work, laughing about my patients, or going home happy where I continue to live my life. I haven't cried over anyone's suicide. I'm not asking any different of you. What I am suggesting is that this death still matters, and we can still try to learn from it to help us better treat future patients.

 

[Mass Effect]

Because most people (especially doctors, one would think) don't like it when people die (despite these limited resources you mention) or suffer. And when someone commits suicide, they were certainly suffering before, and their friends and family are certainly suffering after (including the residents who have to do extra call but probably also have an emotional reaction).

Yes, this person had access to resources, but they either weren't used or didn't help. Most decent people would want to know why so we can use that information to help alleviate someone else's suffering in the future.

You are correct. Unfortunately, when it comes to mental illness, some people are incredibly callous and arrogant. They don't "get it" so it's easy to blame the patient for his/her own problems. After all, they made a "choice" right? It's disturbing.

 

[Over9000]

This unfortunate incident brings to light two issues that are fairly deep-seated in the medical profession.

1. The stigma of mental illness is horrible for doctors. There is a general fear, and in my opinion it is not an unwarranted one, that any disclosure or seeking of help for mental illness will jeopardize one's career. License boards, whose duty is to protect the public, often ask about prior psych diagnoses on their applications. The current coverage of the recent Germanwings disaster has essentially turned into a vilification of mental illness, not just of the horrible actions of the pilot. There's a whole lot of tangible downside to disclosure.

2. Uncouth unscrupulous garbage residency programs accept any warm body from anywhere in the world provided they can cover call or do other low-skill ancillary duties without any real intention of training said individuals to be proper physicians, often expecting from day one to dismiss these FMG residents once they've outlived their funding. I see it in pathology all of the time - plenty of programs, most of them situated in the state of NY, recruit essentially anyone of any skill level to do the scut. If they graduate, they're marginally more skilled than when they started. I wonder about the doctor in this event. It looks like he was quite advanced in age, probably very far out from training, and probably very rusty. Why even take a candidate like that unless you're just desperate to fill some hole somewhere.

These are topics for discussion that the medical profession would be wise to concentrate on.

 

[Frederica]

Heard a sad story today of a former 3rd yr resident who took his own life after being let go just 3-4 months before graduation. Rumor is he was an IMG, supporting his family back home, and may have lost his Visa status as a result of the dismissal.

Unfortunate that a resident who clearly needed help was thrown to the wind by his own and resorted to such measures. (No idea why he was dismissed so late into residency, so can't speak on that.)

http://www.chicagotribune.com/news/ct-berwyn-body-found-met-0417-20150416-story.html

http://abc7chicago.com/news/police-man-found-dead-near-hospital-in-berwyn/663789/

Thoughts are with the residents of the program.

Neither article posted states anything about the physician being fired from a residency program. Are there any facts noted anywhere about this?

 

[TheShowGoesOn]

Am I the only one who thinks suicide is selfish? - Will delete comment if necessary but it's just my opinion.

Mental illness is nothing to joke about but let's be real, it is the 21st century. This individual has had the opportunity to access plenty of healthcare services and I would assume he/she held some knowledge regarding mental illness- is there still not enough awareness? lack of services? I have known people who were "suicidal" and they had plenty of healthcare services available to them, the onus was on them whether or not they wanted to seek help.

Edit: This also makes me question (and i'd like to hear others opinions on this) whether or not somebody who is suicidal is fit to be a physician in the first place? How can you help patients if you can't help yourself? Just my thoughts on this matter.

 

[VA Hopeful Dr]

Am I the only one who thinks suicide is selfish? - Will delete comment if necessary but it's just my opinion.

Mental illness is nothing to joke about but let's be real, it is the 21st century. This individual has had the opportunity to access plenty of healthcare services and I would assume he/she held some knowledge regarding mental illness- is there still not enough awareness? lack of services? I have known people who were "suicidal" and they had plenty of healthcare services available to them, the onus was on them whether or not they wanted to seek help.

You're assuming a level of rationality and planning that severely depressed people often lack.

 

[TheShowGoesOn]

You're assuming a level of rationality and planning that severely depressed people often lack.

Assumptions can only be made as depression and the factors surrounding it are very much subjective. You make a valid point and I guess nobody can, judge- for lack of a better term. The question stands whether or not a severely depressed individual should be responsible for patients' lives.

 

[Over9000]

Suicide = mental illness?

It could be the terminal result, some would say to all cases, and is thus potentially preventable. There are arguments for "Rational suicide" but I don't really think its applicable here from my understanding of the situation. That's more of a moral call than anything though.

 

[Mass Effect]

Suicide = mental illness?

Yes, at least acutely.

Am I the only one who thinks suicide is selfish? - Will delete comment if necessary but it's just my opinion.

Mental illness is nothing to joke about but let's be real, it is the 21st century. This individual has had the opportunity to access plenty of healthcare services and I would assume he/she held some knowledge regarding mental illness- is there still not enough awareness? lack of services? I have known people who were "suicidal" and they had plenty of healthcare services available to them, the onus was on them whether or not they wanted to seek help

Eating hamburgers is selfish too. Cholesterol is nothing to joke about, but let's be real, it's the 21st Century. You have access to healthy food. Is there not enough awareness about the dangers of hamburgers?

Edit: This also makes me question (and i'd like to hear others opinions on this) whether or not somebody who is suicidal is fit to be a physician in the first place? How can you help patients if you can't help yourself? Just my thoughts on this matter.

Most of the time, you don't know someone is suicidal until they commit suicide. And your point is out of line, unless you want to include people who are overweight, people who eat fast food, people who don't exercise 5 days a week, people who smoke, people who drink, anyone who's ever had a DUI. If you want to include all of the above in your definition of who isn't fit to be a physician, then let's talk. Otherwise, you're hypocritical.

 

[Mass Effect]

I get that. But this was a thread about a guy who may or may not have taken his life after a serious career setback. And yet it seamlessly transitioned into a discussion on mental health care and stigma. I just don't get the connection that everyone else seems to assume exists. Can't someone be sad or irrational without being mentally ill? I'm not a psych guy, but often it seems like that field considers anyone with negative emotions as sick, and I don't really get that perspective. It seems like negative emotions, even ones that interfere with your functioning, are normal and expected parts of being a person.

I think the reason it doesn't make sense to you is that you're likely thinking of mental illness as a chronic thing when, in fact, people can be acutely mentally ill without a psych history. Yes, sadness at obstacles in life is a normal reaction, but suicide is not. For someone to plan out their death, there is some level of illness there.

 

[TheShowGoesOn]

Yes, at least acutely.



Eating hamburgers is selfish too. Cholesterol is nothing to joke about, but let's be real, it's the 21st Century. You have access to healthy food. Is there not enough awareness about the dangers of hamburgers?



Most of the time, you don't know someone is suicidal until they commit suicide. And your point is out of line, unless you want to include people who are overweight, people who eat fast food, people who don't exercise 5 days a week, people who smoke, people who drink, anyone who's ever had a DUI. If you want to include all of the above in your definition of who isn't fit to be a physician, then let's talk. Otherwise, you're hypocritical.

But does not exercising or being overweight directly affect your interactions with patients? I would think somebody who is depressed and has suicidal thoughts is a little more unstable than somebody who eats fast food.

 

[Mass Effect]

But does not exercising or being overweight directly affect your interactions with patients? I would think somebody who is depressed and has suicidal thoughts is a little more unstable than somebody who eats fast food.

You're assuming that someone who is depressed is ALWAYS depressed, 24/7. That isn't the case anymore than someone with COPD is always having a COPD exacerbation. And you don't know that someone is suicidal until they actually commit suicide, unless they tell you. FYI, the reason they don't is because of statements like these.

That just sounds like a moral judgement used as a diagnostic criterion. Not being snarky, but it just doesn't seem to fit with the rest of medicine.

It's not a moral judgment though. Do you consider suicide to be a normal reaction? I certainly don't. It's an abnormal reaction to stress. By definition, pathology and in this case, pathology of the mind. Had this man survived and was seen in the hospital, he most certainly would have been diagnosed (by diagnostic criteria) with a mental illness, possibly something like adjustment disorder, but likely depression.

 

[Mass Effect]

I don't know, I'm not sure. This isn't a topic I think about often. Surgery is much more cut and dried. "Pathological" is defined as an anatomic structure that is different from most others, and produces unpleasant/undesirable symptoms. With suicide, we see an unpleasant/undesirable symptom, and infer an underlying anatomic/chemical structure. It's just weird to me.

And I think that's why surgeons (and others in medicine) don't tend to like psychiatry. Most of psychiatry is like that unfortunately. It's symptomatic diagnosis when it comes to things like depression.

 

[ari202]

I'm certainly not trying to knock psych. I actually considered it at one point. One of the things that killed it for me though, was when I asked a psychiatrist if she had ever given someone a diagnosis of "normal examination" or "no diagnosis" and she said she hadn't. That was tough for me to stomach, so I moved on.

None of us is "normal" though, if you think about it, we all must have a some type of underlying cluster A, B, C traits if we analyze it.

 

[Wordead]

You're assuming that someone who is depressed is ALWAYS depressed, 24/7. That isn't the case anymore than someone with COPD is always having a COPD exacerbation. And you don't know that someone is suicidal until they actually commit suicide, unless they tell you. FYI, the reason they don't is because of statements like these.



It's not a moral judgment though. Do you consider suicide to be a normal reaction? I certainly don't. It's an abnormal reaction to stress. By definition, pathology and in this case, pathology of the mind. Had this man survived and was seen in the hospital, he most certainly would have been diagnosed (by diagnostic criteria) with a mental illness, possibly something like adjustment disorder, but likely depression.

I don't see why suicide couldn't be a normal reaction. I can picture dozens of situations where I'd say suicide would be a good answer to me. It also baffles me when psych people portray things as fact when frankly, its mostly speculation.

 

[FranzLO]

Why is this such a big deal? Some resident, who had access to the same helping resources we all have, chooses this as the answer to adversity. And I'm supposed to feel bad for him?
Sure, I feel bad for his family. And I feel bad for the other residents (who now have more call to cover, although they incurred this extra work when this guy was dismissed).
But I don't feel bad for him. And I certainly don't blame the program. Any more than I blame any other company who has an employee off themselves.
Some people have bad coping skills, and we can try and try to keep them from making bad choices. But at the end of it, they are the ones with a gun in their hands, a bottle in their hands, or whatever else. And if they feel that's their only option, so be it. It's one less person to have to devote limited resources to.

Here; I'll save you all some time.
You're a bad person; You don't care about people; You're a terrible doctor, You're cold callous and heartless; You're a mean and hateful person;
Just quote whichever sentence you think is most applicable.

<shrug>... life goes on.

Well... except for him.

Why did you feel the need to post this?

 

[Mass Effect]

I don't see why suicide couldn't be a normal reaction. I can picture dozens of situations where I'd say suicide would be a good answer to me. It also baffles me when psych people portray things as fact when frankly, its mostly speculation.

We're not talking about a dozen situations. We're talking about this one. What is exactly is speculation passed off as fact? Psychiatry, like every other field, is based on research. Just because you can't see the pathology under your microscope doesn't mean it doesn't exist.

 

[gracie369]

Oh man, letting someone go in April of 3rd year is really cold. I hope they had a good reason.

 

[hamstergang]

One of the things that killed it for me though, was when I asked a psychiatrist if she had ever given someone a diagnosis of "normal examination" or "no diagnosis" and she said she hadn't. That was tough for me to stomach, so I moved on.

I have. It's certainly possible to do, and not doing so is more a function of the particular provider than the field as a whole.

Surgery is much more cut and dried. "Pathological" is defined as an anatomic structure that is different from most others, and produces unpleasant/undesirable symptoms. With suicide, we see an unpleasant/undesirable symptom, and infer an underlying anatomic/chemical structure. It's just weird to me.

I don't see that psychiatry as a field assumes that suicide implies underlying mental illness. It almost always does (because there are also other symptoms/signs of mental illness), but there are certainly reasons for suicide that exist outside of mental illness.

Surgery may be more cut and dried, but not all of medicine is. Personally, I have pain in my shoulder that, via physical exam, localizes pretty well to the biceps tendon. But no imaging has shown any pathology, and no treatment so far (NSAIDs and steroid injections) has worked. There is certainly unpleasant and undesirable symptoms but it's very difficult to show any dysfunction in underlying anatomy or whatnot, but we still assume something is going wrong in there. Additionally, what about hypertension? That's just a reading, but not in itself the 'pathology.' We hardly ever know the underlying issue that leads to the hypertension, but since we know hypertension can lead to other issues in the future, we consider it a pathology.

In psychiatry, as in many parts of medicine, we identify suffering and work out how to alleviate it. Understanding it deeper is nice and certainly something we work on, but we don't always have it and it's not required to be properly classified as medicine.

 

[Wordead]

We're not talking about a dozen situations. We're talking about this one. What is exactly is speculation passed off as fact? Psychiatry, like every other field, is based on research. Just because you can't see the pathology under your microscope doesn't mean it doesn't exist.

Edit: Guy below is right, if there's a family member actually following this thread, this is not the place.

 

[OddNath]

Hello there CDI. Im the son of that doctor you are speaking about. Had not talked to him in 5 years or so. Learnt about his death today after the police contacted an aunt i have in maryland. Found this post after googling trying to find out something about my fathers death. Is your information verified? Do you know someone who knew him, someone i could talk to? Me, and my sister would be very grateful. I cant travel over there, nor do I know anyone in chicago. Just trying to get some closure...

Hey guys, so in the midst of pontificating about hamburgers and that enlightening Rippy the Razor cartoon, there is possibly an immediate family member following this thread?!

I'm actually inclined to believe this is not a troll, let's try to not make this guy's life more frustrating than it already is.

 

[charmiedermie]

Here; I'll save you all some time.
You're a bad person; You don't care about people; You're a terrible doctor, You're cold callous and heartless; You're a mean and hateful person;
Just quote whichever sentence you think is most applicable.

You're being way too easy on yourself especially since the deceased resident's son can read what you posted. What is worse is you got likes for your inhumane post.

 

[charmiedermie]

Yes, at least acutely.

Eating hamburgers is selfish too. Cholesterol is nothing to joke about, but let's be real, it's the 21st Century. You have access to healthy food. Is there not enough awareness about the dangers of hamburgers?



Most of the time, you don't know someone is suicidal until they commit suicide. And your point is out of line, unless you want to include people who are overweight, people who eat fast food, people who don't exercise 5 days a week, people who smoke, people who drink, anyone who's ever had a DUI. If you want to include all of the above in your definition of who isn't fit to be a physician, then let's talk. Otherwise, you're hypocritical.

Was Brittany Maynard mentally ill?

Why did you feel the need to post this?

My guess is it's his defense mechanism if one were to give him the benefit of the doubt. (which I'm not inclined to give him).

 

[Doctor Bob]

Why did you feel the need to post this?

Because if you scan back through previous threads about resident/medstudent/premed suicide, they all turn into boohoo-hugfests where everyone talks about how bad it is that this happened and how the institution or the school or society could have/should have done more.

It is my opinion that in these cases the decedent takes a significant portion of the blame for the outcome.
If we're going to assign blame (which we don't have to do... we can just say <sigh> it happened, and move on), then a lot of it rests with the person who takes the final action.
Sucks, but so it goes.

You're being way too easy on yourself especially since the deceased resident's son can read what you posted. What is worse is you got likes for your inhumane post.

He can. Sure. Welcome to the internet. Is there any evidence that he has? Sorry, I call BS on that post. The resident's son googles for details of his father's death and a short time after the incident gets this thread? Which doesn't mention his name? This thread isn't in the top 10,20,30,40,50 posts on google. It doesn't even turn up there now that the thread has been active for longer. But he happens to search and find it right after I post an unpopular stance? (the first comment in the thread by the way) Then creates an account to post a reply? Then goes back to delete his post? Nuh uh... don't buy it. Doesn't pass the "sniff test".

My guess is it's his defense mechanism if one were to give him the benefit of the doubt. (which I'm not inclined to give him).

Nope. Just my opinion.

Are you a real doctor?

Last I checked.

Plus I took the time (in the past) to verify my physician status with SDN, along with my militaryness, and my facultyness. So I get the cool little badges under my avatar.

And as an aside... why do people do that? "You have posted an opinion contrary to mine! You must not be legitimate!"

I'm in psychiatry and see suicidal patients every day. That doesn't keep me from doing my work, laughing about my patients, or going home happy where I continue to live my life. I haven't cried over anyone's suicide. I'm not asking any different of you. What I am suggesting is that this death still matters, and we can still try to learn from it to help us better treat future patients.

I'm in emergency medicine. I see them every day as well.

Hey guys, so in the midst of pontificating about hamburgers and that enlightening Rippy the Razor cartoon

This is the one mea culpa I'll make in this thread. The rippy the razor cartoon (while I find it funny... and the comic Something Positive has quite a few cartoons in the same vein) got me Mod-Hammered. And perhaps rightfully so. I shouldn't appear to be encouraging people to go out and harm themselves and I shouldn't make light of a serious topic.

 

[DermatoFIGHT]

All you need is hope but when you are smothered in >$300,000 in debt that isn't possible to pay off I can see where those become hopeless and things like this occur.

 

[DermatoFIGHT]

Yes, at least acutely.



Eating hamburgers is selfish too. Cholesterol is nothing to joke about, but let's be real, it's the 21st Century. You have access to healthy food. Is there not enough awareness about the dangers of hamburgers?



Most of the time, you don't know someone is suicidal until they commit suicide. And your point is out of line, unless you want to include people who are overweight, people who eat fast food, people who don't exercise 5 days a week, people who smoke, people who drink, anyone who's ever had a DUI. If you want to include all of the above in your definition of who isn't fit to be a physician, then let's talk. Otherwise, you're hypocritical.

I think they know in retrospect, the signs were all there most of the time but people are too self absorbed and into their Facebook/instagram/iphones to realize what is going on around them. You would be surprised how many people will say "I think I am going to kill myself", "I feel like I should put a bullet in my head", "I think of jumping from a bridge when I drive home" but they 100% mean it. People have a tendency to laugh and ignore those statements. The reality is there is fear with seeking treatment or publicly seeking help. They will drop hints to those in hopes that someone picks up on the situation before it is too late because they are too ill to help themselves. There is a fear to come forward and apathy about it. All it takes is one night alone or another event to hit threshold and that's it. Very troubling disease 🙁

 

[Doctor Bob]

I think they know in retrospect, the signs were all there most of the time but people are too self absorbed and into their Facebook/instagram/iphones to realize what is going on around them. You would be surprised how many people will say "I think I am going to kill myself", "I feel like I should put a bullet in my head", "I think of jumping from a bridge when I drive home" but they 100% mean it. People have a tendency to laugh and ignore those statements. The reality is there is fear with seeking treatment or publicly seeking help. They will drop hints to those in hopes that someone picks up on the situation before it is too late because they are too ill to help themselves. There is a fear to come forward and apathy about it. All it takes is one night alone or another event to hit threshold and that's it. Very troubling disease 🙁

We laugh and ignore the statements because there's response fatigue amongst us as well. We hear "omg I'm gonna kill myself" or some variant all the time. People are flippant in the language they use. We see attention seekers who come into the ED weekly with suicidal ideation. There is so much background noise that it completely drowns out any legitimate message. We just simply can't work up every person who says "ugh, I just want to die"?

If you come in with a chief complaint of SI, you get put in a room and you sit there till the psych people come to see you. But I get a lot of push back from psych people because, as they tell me, they're no better at figuring out who is well and truly serious.

Ask for help? You'll get what the system has in place for you.

Don't even ask for help? It's the same thing I tell the asthmatics who come in over and over and over for exacerbations because they refuse to even try to quit smoking. Why should I care more about your health than you do?

 

[FranzLO]

We laugh and ignore the statements because there's response fatigue amongst us as well. We hear "omg I'm gonna kill myself" or some variant all the time. People are flippant in the language they use. We see attention seekers who come into the ED weekly with suicidal ideation. There is so much background noise that it completely drowns out any legitimate message. We just simply can't work up every person who says "ugh, I just want to die"?

If you come in with a chief complaint of SI, you get put in a room and you sit there till the psych people come to see you. But I get a lot of push back from psych people because, as they tell me, they're no better at figuring out who is well and truly serious.

Ask for help? You'll get what the system has in place for you.

Don't even ask for help? It's the same thing I tell the asthmatics who come in over and over and over for exacerbations because they refuse to even try to quit smoking. Why should I care more about your health than you do?

How do you know they refuse to even try to quit smoking? Are those the exact words they tell you? I am one of the most conservative, anti-hand holding people I know and I want to defend smokers and overweight people when I hear the things you say. You make decent points, but you just sound so stubborn and unwavering. You must have some empathy for people who struggle to help themselves, right? Did you know making major life changes is difficult? It is easy to tell people to change, but it is much harder to actually help them make the change. But then again, you are in EM so you probably aren't involved in that process and I think a lot of people in your profession feel similarly (I apologize if someone in EM reads this who disagrees adamantly with this poster). I don't know if it is desensitization, burnout, bias, but it comes across as such.

Also, saying things like ultimately they are the ones with a "bottle in their hands" is a little strong. Do you believe that addiction is not a disease then? Would it be a disease if a mental health problem caused this man to commit suicide? Just curious since I was confused about what you meant unless you wanted to go into a survival of the fittest rant and more talk about "one less person to have to devote limited resources to."

 

[OddNath]

He can. Sure. Welcome to the internet. Is there any evidence that he has? Sorry, I call BS on that post. The resident's son googles for details of his father's death and a short time after the incident gets this thread? Which doesn't mention his name? This thread isn't in the top 10,20,30,40,50 posts on google. It doesn't even turn up there now that the thread has been active for longer. But he happens to search and find it right after I post an unpopular stance? (the first comment in the thread by the way) Then creates an account to post a reply? Then goes back to delete his post? Nuh uh... don't buy it. Doesn't pass the "sniff test".

LOL do you really think that a family member would just google the name for 5 minutes, not see anything for 50 pages, then just close the computer and give up? In the course of a quick google search (with more general terms), it would be pretty easy to come across studentdoctor, then browse through the residency forum and find this thread. He doesn't even care about or comment on your "unpopular stance"; he just asked for more information.

All I know is that after my brother killed himself, our google searches went far and wide to all sorts of random/horrifying nooks and crannies of the Internet, searching for any clues or answers. But whatever, you're clearly the expert on every imaginable aspect of this topic, so what would I know.

If the son is still reading this thread (and given how unhelpful it's been, I'm not surprised that he deleted his post)- I hope that you are finding answers, or in the absence of that, hopefully, eventually some peace.

 

[Doctor Bob]

How do you know they refuse to even try to quit smoking? Are those the exact words they tell you?

Often times yes.

but you just sound so stubborn and unwavering. You must have some empathy for people who struggle to help themselves, right?

Stubborn and unwavering? Yea.. that pretty well describes me.
And sure, people who try and fail and try and fail and try etc etc... sure I feel bad for them. When I start the smoking cessation process with people I preface it with "it's a lot easier for me to say stop doing this, than it will be for you to actually do it."

(I apologize if someone in EM reads this who disagrees adamantly with this poster)

I dunno.. for some reason the phrasing there makes me sound like Voldemort... "this poster... (he who must not be named)" 🙂

Also, saying things like ultimately they are the ones with a "bottle in their hands" is a little strong. Do you believe that addiction is not a disease then? Would it be a disease if a mental health problem caused this man to commit suicide? Just curious since I was confused about what you meant unless you wanted to go into a survival of the fittest rant and more talk about "one less person to have to devote limited resources to."

I don't see it as too strong of a statement. I can't (and wouldn't) hospitalize a suicidal person for life. At some point they've got to have the inner fortitude to ignore the desire when they are alone. If they can't... then that's where it ends.

LOL

Did you really just "lol"?

do you really think that a family member would just google the name for 5 minutes, not see anything for 50 pages, then just close the computer and give up? In the course of a quick google search (with more general terms), it would be pretty easy to come across studentdoctor, then browse through the residency forum and find this thread. He doesn't even care about or comment on your "unpopular stance"; he just asked for more information.

All I know is that after my brother killed himself, our google searches went far and wide to all sorts of random/horrifying nooks and crannies of the Internet, searching for any clues or answers.

Did you find what you were looking for?

But whatever, you're clearly the expert on every imaginable aspect of this topic, so what would I know.

Nope, I'm just a person with an opinion. I may be wrong. I may be right. But my opinion is mine borne from my experiences, as yours comes from your experiences. Neither is wrong because we aren't debating a topic with a factual basis. We are discussing how we should feel about a topic. Why are my feelings about this topic somehow being portrayed as wrong? If you don't like them, then don't feel that way. But you aren't going to argue and make me feel any different about this topic.

My opinion and feelings come from my experiences of having family members kill themselves as well.

 

[Bbutterfly]

Hey guys, so in the midst of pontificating about hamburgers and that enlightening Rippy the Razor cartoon, there is possibly an immediate family member following this thread?!

I'm actually inclined to believe this is not a troll, let's try to not make this guy's life more frustrating than it already is.

Looks like his son was following the thread, made a post and deleted it

 

[Mad Jack]

I don't see why suicide couldn't be a normal reaction. I can picture dozens of situations where I'd say suicide would be a good answer to me. It also baffles me when psych people portray things as fact when frankly, its mostly speculation.

Most of those that attempt suicide are not of sound mind when they do so. There's been research on it in the past, with people studying those that survived suicide attempts to see how many eventually ended up taking their own lives. The answer is a very, very small minority. There are exceptions, certainly, for those that are in incredible pain, those with persistent illness, etc. But for the vast majority of those that attempt to take their lives or are contemplating doing so, all it takes is some time to distance themselves from the event or trauma that has brought them to the brink in the first place. Most suicides are not well-thought plans to end intractable suffering, but rather split-second decisions taken in a moment of anguish or a deep but transient depression.

http://www.hsph.harvard.edu/means-matter/means-matter/survival/
http://www.newyorker.com/magazine/2003/10/13/jumpers

 

[charmiedermie]

Often times yes.



Stubborn and unwavering? Yea.. that pretty well describes me.
And sure, people who try and fail and try and fail and try etc etc... sure I feel bad for them. When I start the smoking cessation process with people I preface it with "it's a lot easier for me to say stop doing this, than it will be for you to actually do it."



I dunno.. for some reason the phrasing there makes me sound like Voldemort... "this poster... (he who must not be named)" 🙂



I don't see it as too strong of a statement. I can't (and wouldn't) hospitalize a suicidal person for life. At some point they've got to have the inner fortitude to ignore the desire when they are alone. If they can't... then that's where it ends.



Did you really just "lol"?



Did you find what you were looking for?



Nope, I'm just a person with an opinion. I may be wrong. I may be right. But my opinion is mine borne from my experiences, as yours comes from your experiences. Neither is wrong because we aren't debating a topic with a factual basis. We are discussing how we should feel about a topic. Why are my feelings about this topic somehow being portrayed as wrong? If you don't like them, then don't feel that way. But you aren't going to argue and make me feel any different about this topic.

My opinion and feelings come from my experiences of having family members kill themselves as well.

I think you have a right to your feelings. As you are an EM doc, we realize your field has a lot of burnout and compassion fatigue and maybe you see a lot of fake suicidal people. But for everyone else, your feelings toward the deceased was unusually cruel and heartless. At the very least, as a human being, you should feel a tinge of empathy for the deceased, that circumstances were bad enough for a medical resident, which you know the pressures of residency all too well, to take his own life.

Worse part is his son in Maryland had to read what you wrote about his own father.

 

[charmiedermie]

Looks like his son was following the thread, made a post and deleted it

Can u blame him?

 

[charmiedermie]

I think the reason it doesn't make sense to you is that you're likely thinking of mental illness as a chronic thing when, in fact, people can be acutely mentally ill without a psych history. Yes, sadness at obstacles in life is a normal reaction, but suicide is not. For someone to plan out their death, there is some level of illness there.

Do you think Brittany Maynard was mentally ill to commit suicide?

 

[hamstergang]

And as an aside... why do people do that? "You have posted an opinion contrary to mine! You must not be legitimate!"

That's not what happened here. I think it was obvious that I wasn't actually questioning if you were a doctor. But the opinion you posted sounded anti-medicine to me, which is the point I was making. You said "Some diseases, both physical and mental, have no cure and end with the same finality. You can take steps to address them, but some conditions are just terminal." I mean, how does accepting that some conditions are terminal without wanting to find a way to change that fit in with being a doctor?

I'm in emergency medicine. I see them every day as well.

Great, that was really not the point I was trying to make. The rest of what I said there was the important part -- not crying about patients that commit suicide is different than not caring about people committing suicide.

 

[rokshana]

That's not what happened here. I think it was obvious that I wasn't actually questioning if you were a doctor. But the opinion you posted sounded anti-medicine to me, which is the point I was making. You said "Some diseases, both physical and mental, have no cure and end with the same finality. You can take steps to address them, but some conditions are just terminal." I mean, how does accepting that some conditions are terminal without wanting to find a way to change that fit in with being a doctor?.

its called hospice...

 

[inspirationmd]

its called hospice...

This!

But tell try telling that to some of these H/O docs....

 

[Wordead]

Most of those that attempt suicide are not of sound mind when they do so. There's been research on it in the past, with people studying those that survived suicide attempts to see how many eventually ended up taking their own lives. The answer is a very, very small minority. There are exceptions, certainly, for those that are in incredible pain, those with persistent illness, etc. But for the vast majority of those that attempt to take their lives or are contemplating doing so, all it takes is some time to distance themselves from the event or trauma that has brought them to the brink in the first place. Most suicides are not well-thought plans to end intractable suffering, but rather split-second decisions taken in a moment of anguish or a deep but transient depression.

http://www.hsph.harvard.edu/means-matter/means-matter/survival/
http://www.newyorker.com/magazine/2003/10/13/jumpers

See, your read of those results is that "people are not of sound mind", which is an extrapolation of those results based on what you want the results to say, because "mental illness is an undertreated problem in america etc etc etc". You have no basis to say they are not of sound mind from that study. I could just as easily say that those patients are people who use suicide attempts as an attention seeking technique and thats why there are low rates of suicide completion long term and few further attempts when they get that attention. No comment on the new yorker article which is more novella than anything scientific.

I don't want to keep denigrating the field - I do think that there are cases of profound mental illness and some people need treatment, just not to the frequency and extent that people within the field seem to push for. I also dislike when limited research is passed off as fact (which is not limited to psych, but is too common in psych).

 

[Doctor Bob]

I think you have a right to your feelings. As you are an EM doc, we realize your field has a lot of burnout and compassion fatigue and maybe you see a lot of fake suicidal people. But for everyone else, your feelings toward the deceased was unusually cruel and heartless. At the very least, as a human being, you should feel a tinge of empathy for the deceased, that circumstances were bad enough for a medical resident, which you know the pressures of residency all too well, to take his own life.

But I don't. Perhaps some psych person would say there's pathology there, but... I don't care about him. He is a story on the internet to me. If I had to feel bad or a tinge of empathy every time someone killed themselves or had something bad happened to them I would spend all day twinge-ing. But even when it's someone I know peripherally I still don't care that much. When it's someone close to me, sure... then I feel bad when bad things happen to them.
Once they're dead though I don't feel bad for them either. They're dead. Why should I waste time sitting around ruminating about them and making myself feel bad? It doesn't benefit them any and it certainly doesn't benefit me in any way.

Worse part is his son in Maryland had to read what you wrote about his own father.

Perhaps it's the perpetual cynic in me but I still doubt the veracity of that post.

That's not what happened here. I think it was obvious that I wasn't actually questioning if you were a doctor.

Well... if it was obvious I wouldn't have made a snarky retort back.
But hey, we both re-learned something today. The inflection and intonation we have in our heads when we write something online doesn't stay with the words when they go out into the internet.
It is very easy for people to misinterpret what you say when they read your words on the computer screen.

I mean, how does accepting that some conditions are terminal without wanting to find a way to change that fit in with being a doctor?

Sometimes the best way to help a person is to let them die.

But tell try telling that to some of these H/O docs....

Oh goodness yes. I have this argument with heme/onc a few times a week.

 

[hamstergang]

Sometimes the best way to help a person is to let them die.

Of course. But that doesn't in any way contradict the idea that we should be studying disorders that lead to death and see if we can prevent those deaths. If the field of medicine gave up on every terminal disease from the start, how could it have moved forward?

Here, the person is already dead. We can either say, "oh well, nothing else to see here," or "we don't want others to go through this too, so can we learn something useful from his case?"

 

[Doctor Bob]

Of course. But that doesn't in any way contradict the idea that we should be studying disorders that lead to death and see if we can prevent those deaths. If the field of medicine gave up on every terminal disease from the start, how could it have moved forward?

Very true. I will agree with that point.

Here, the person is already dead. We can either say, "oh well, nothing else to see here," or "we don't want others to go through this too, so can we learn something useful from his case?"

I'm staring at the computer screen trying to figure out how to parse out the distinction I'm see in these cases.
But I think there is a fundamental difference in where we are standing to view this issue.

I'll start by saying if a person is not going to be able to returned to a state where they are a contributing member of society then I am less inclined to want to devote a lot of time and effort to help them. It doesn't mean I don't do it (because that's my job) but I don't feel a great burning desire to do it.
I feel this way about both physical and mental ailments. If you're a demented quad who is trached/PEG'd and just lays in bed drooling and accumulating decubitus ulcers, why are we spending so much time and effort to perpetuate your existence. When these people come in and their paperwork lists them as full code I die a little inside.

If you are chronically suicidal and we have to stand between you and a knife every week then at some point we should step out of the way and go off and try to help someone we can actually affect a change on.
If you're acutely suicidal and you're a teenager/early 20's, there are enough hormone changes and poor impulse control, and perhaps a lack of knowledge about resources and alternatives, that I agree we should be devoting time/effort to helping this group.
If you're acutely suicidal, and you're in your 50's, and you're an educated person in the healthcare field... I still wonder what we can do besides make resources available (which we already do), and tell people the signs to watch for (which we already do), and have education during residency (which we already do). We can't be with people every hour of the day, we can't give them constant hugs and reassurance (that's their family's job and their own inner sense of self-worth). So when that acute moment hits, either they have good coping skills and know where to turn, or they disregard all of the safety nets we have in place and choose to end their life regardless. So it goes. Bad stuff happens.

 

[dozitgetchahi]

Pretty shocked by a lot of the comments here.

Some dude gets dumped by his residency program 3-4 months before finishing, kills himself and the predominant reaction is 'who cares'? For shame.

I sincerely hope many of you do not exercise this level of callousness in your day-to-day lives as physicians and physician trainees.