Piecing Together The Puzzle To Understand Suicide

Suicidal thoughts siphon through a sieve
Of should I
Could I
And how
My burden may be lifted
Confusion take a crown
King now of the realm
Give me a royal death
To give me an average again life
Leaving guilt where once I stood
Can I not win
In this, the sins of depression?

—Jean Robey MD

We tackle depression and anxiety for ourselves, our loved ones, and our patients daily. Depression is an array of emotions and never the origin or the only end emotion. Looking around the emotion may help us see the room and hallways and human house better. Maybe then we can seek to minimize it and address its’ fateful child, suicide.

I belong to a large and wonderful group of female physicians online. As we seek to understand our calling, our custodial patients and families, our own families, our own pain and losses, and our purposes and possibilities professionally and personally, sharing to solve each others’ heartache and confusion with hopes of surviving long enough to save society, one physician stepped up to speak on suicide.

She spoke of her own suicide attempt. She shared this deeply personal experience so as to comfort the cries of guilt she saw; guilt of fellow physicians and loved ones that they missed signs and opportunities to change minds, to save lives. What she wrote accomplished that, but for me I found something else extraordinary. 

We are taught that suicidal people often seem better before they attempt suicide. We are taught because perhaps the medicine gives them just enough lift to act or that resolution to act feels like solution. To read an account of this from a physician who survived the pain of depression adds true color and dimension to what we are taught.

I found in her words a wealth of details that together answer a mysterious confusion around suicide and dares to understand physician suicide better. She weaves a perfect storyline over time that explains the non linear and dismantling thoughts of depression, as she grappled with conflicting desires to end her life without bringing pain to her loved ones. Depression and suicide IS that powerful and elusive, yet surviving it all, this doctor, also a mother, wife, friend, colleague, and community member tells us pieces to a puzzle. She was not herself. She cannot fully recall or relate to that former person but can enough to take us through the major twists of her depression and suicidal thoughts. That is already a huge gift of insight.

As we look to answer why physicians fall into depression and why they succeed to commit suicide, let us enter the stories we are gifted by brave survivors to help us understand something we hardly can fathom as just observers. Thank you to this physician for taking the time to use her pain to provide hope of clarity. She has granted me permission to include her post and my foreword. Our hopes are to provide it to a wider audience for consideration, understand, problem solving, comfort, and hope. Please share.

“I have seen a few posts lately talking about the anguish of losing a patient to suicide. I want to share my story in the hopes that it can ease even a tiny bit of your pain. I have shared bits and pieces with family/friends but never in its entirety.

(trigger warning, and long post ahead)

I have a history of depression/anxiety, first saw psych and treated with an SSRI in college. I did ok, was on and off of it for a few years. Had some dark times but always came out of it.

Went to med school, started residency, got married, had a baby (planned and wanted pregnancy. Uneventful pregnancy and SVD). A few months after my daughter was born I knew I wasn't doing well - overwhelming anxiety and started having real trouble sleeping. I went to my PCP who immediately put me back on SSRI (had been off since prior to becoming pregnant) and sent me to psych with focus in post partum mood disorders.

I was compliant - I took the meds, went to my appointments.

I didn't get better.

We increased the dose, changed the meds.

I got worse.

I still had insight and began having alarming suicidal ideation. I told my psychiatrist (knowing that I wouldn't be going home that night) that I was having thoughts of standing on the train tracks. I was admitted to hospital directly from her office. It was scary but it was the right thing. I stayed for a few days and they adjusted my meds. I was discharged with plans to continue seeing that psychiatrist and set up with a therapist.

Many of my memories from that time period are gone. Shortly after my discharge, I decided I was going to kill myself. I was 100% convinced that my family would be better off without me. I debated if it would just be easier to divorce my husband so that he could find a new partner and raise our daughter without me in the picture but I decided that it would be too hard and painful for my family.

I didn't tell anyone.

I secretly researched methods that would be least traumatic for my loved ones. I wondered if I could make it look like an accident. I debated about where, when...and once this decision was made, my depression lifted. I no longer had to worry about how I was going to be a mother to my child. Or how I would be a doctor.

I began eating again (after having lost a bunch of weight.) My family and friends were ecstatic that I was 'back.' I suppose I was, but I was on my way somewhere else.

I wrote letters to my husband including lists of what to feed our then 6 month old, and details about her upcoming doctors appointments. I wrote cards to my siblings and parents. Pages and pages of letters.

I went out and bought toys that I thought my baby would like, and left them in my car to be found, so that people would know that I loved her.

I continued to see my therapist and psychiatrist. I think I even saw one of them the day before my attempt. I finally settled on a day that was shortly before my parents were going on vacation, so that they wouldn't have to find out that I was dead while out of the country.

I won't go into details but briefly - the day came, and things didn't go as planned. I was re-admitted to psych, and spent a long time pretty much on lockdown. My friends (who didn't know about the attempt) were shocked because I 'looked so good' and 'seemed so much better.' My sister told me that she was scared that she would be worried for the rest of my life that I was lying when I said I was ok. Can't say I blame her.

Time passed. I got better.

I'm lucky that I didn't die, and somehow I still have my family and my marriage. I don't know if I had psychosis, or psychotic depression.

Nobody knew I was planning to die. This was intentional. I really, really wanted to die. If I had died, I am confident that my doctors (and family/friends) would have said - 'but I just saw her and she seemed great!'

I'm so lucky that I came out on the other side. My meds were changed and it took time but things got better. I still have my family, my marriage, my life. I have a job. I can't believe that the story above is about 'me.'

If anyone is still reading - thank you for listening. I really hope that I've given some insight into the mind of a severely depressed (or briefly psychotic?) mind... it's not your fault.”


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