Two Years Later… After Suicidal Ideation
Physician Suicide is increasing. Among the major American Professions — physicians commit suicide more than any other professional. The current rate is a little over one doctor each day ending their life. Compared to the general population, doctors are twice as likely to commit suicide.
I could have been one of those statistics. I am writing this not because I particularly want to. In fact, I do not want to write this at all. This subject hurts to write about myself, to admit, to rehash these things I want desperately to believe I have moved completely past. I have tried a few times to compose the words just right and it has been… difficult. Yet, another physician or a physician’s loved one might learn something or gain some insight and be able to help themselves, their friends or a family member struggling with depression and suicidal ideation.
In 2018, I’ve been attempting to launch my second career into advising and advocating for physicians to have excellent disability insurance. Why? Because I lost my career as an anesthesiologist to disability in 2010. I had disability insurance (one good policy, one bad policy). I had saved 20% since I first made any money. I fought the good fight against my group disability insurance carrier only to finally lose in Federal Court a couple months ago. I also educate and coach doctors on the very basics of financial security and literacy that protected my family through our crisis. This is something sadly missing from many young physicians’ training in the 21st century.
A little bit ago, after putting some time and effort into generating leads and new business opportunities, I became sort of bummed out for a few days. It happens, I’m human. Balancing between being the stay-at-home-spouse with the kids out of school for the summer while attempting to build a new career has been daunting… still is daunting! Anyway, I’d become introspective during these few days; thinking maybe I am not doing this selling-insurance thing correctly, pondering what I could do differently or more effectively, reading a lot as well. Then there were the normal human emotional and psychological failings and feelings that accompany ‘trying’ things… like starting a second career. I had been quieter, spent more time reading, thinking, planning and was gearing up to make another month-long effort when my wife started a conversation with me in the late evening, “I do not want to find you dead someday and I am worried.”
What? It dawned on me though, seeing the look on her face in that moment… I thought to myself I might never be free of the label ‘suicidal.’
What. In that moment, looking into her eyes, my thoughts were and still are, simply soul crushing.
When you love someone and you think they might kill themselves, it is piercing on many levels. When you didn’t kill yourself and are being questioned or suspected by that someone who loves you and who got you through the worst moments in your life… well, that is equally piercing.
My wife and I have a great relationship and marriage. She’s a physician like me and we met in anesthesia residency twenty years ago. We can have conversations on many levels and I love that dearly about her. This… this thing that had just occurred between us… I had to fix it.
Part of me was a little overwhelmed by her statement… a little self-doubt erupted inside. “But that is not how I see it,” I said to myself. I mean, imagine you break your leg. You get an operation with a few days in the hospital. The injury heals over a month or two while you do progressive exercises. Then you do a year of rehabilitation… and… you are good to go. People may ask you from time to time, ‘how’s the leg?’ but no one will ever say, looking at you, that they are afraid one day they are just going to find you with a missing leg… that would be ridiculous.
However, if your Will to Live breaks, as mine sadly had, you also get to spend a few days in the hospital. You do progressive exercises over a month or two and then therapy for a year… and, it is somehow very different. No one will dare ask you, ‘how’s your Will to Live, today?’ but maybe when they are looking at you they are pondering… maybe, one day, they’ll do it. We could begin to go into all the reasons there’s such a difference between physical and mental/emotional ailments within ourselves, our society or even our core base human natures… but I will leave that work to much smart psychologists and philosophers.
I am no longer the broken man I was in 2016 that was pushed to suicidal ideation. Yet, these brief few days of personal quiet and thought had provoked this response from the person that knows me best. Maybe this is exactly why we, as a society, do not talk about this subject with one another, as often or as openly as perhaps we all should. Maybe it is equal parts fear from both the sufferer and those that watched the suffering. Maybe they are still watching, waiting and even anticipating that the suffering will return. It was an awful idea to contemplate… and it is a bit soul crushing to feel.
After reassurances and conversation with my best friend and wife, I concluded, what I had not done was taken the time to show her and perhaps myself that my mental/emotional ‘leg’ really was no longer broken, and that it had healed, I mean, that I was healed on the inside. It’s not like I could show her an X-ray of my head and say, ‘see, my Will to Live is all back together now.’ Yet, there was something I could do and am doing right now; I’m talking, through writing, about it in hopes of teaching from my experiences. First and foremost to her, then others and hopefully, myself even.
I am a teacher at heart. I teach so much my kids ask me to stop all the time (which is exactly how I like it and know I am doing enough of it). When I am teaching, I feel the most alive in this world… the most connected to life itself, human life, conscious life and our human race. My wife went on to explain in our conversation that the recent celebrity deaths had brought up memories and feelings within her from that summer in 2016.
So, reflexively… I apologized to her… for what? I’m not exactly sure. Men can be like that; we apologize just to say something in the awkwardness of having a true pure emotion. I had worried her with my quietness. The educator in me decided to figure out how to ‘show’ her what it was like back then compared to now because try, as I believe I had to get her to understand from my point of view… I had failed somewhere and that had led to her statement, “I do not want to find you dead someday and I am worried.”
This part is hard to express. It is hard to even get started. You can’t see it. You are the audience… reading this finished product. I wish the audience could see me starting and stopping to write… failing to complete this exercise ten times, twenty times… fifty times… deleting words, reshaping them, deleting them again… looking in the recycle bin on the computer for something written well. Anger. Disappointment. Feeling the weakness within myself exposed. However, I know well that our human weaknesses are always counterbalanced by our strengths. Determination finally wins in most of us, most of the time, or there would exist no human race. Clearly, determination won for me as you are reading this now.
One day in the future, perhaps from my just being human again; contemplating, thinking, and being quiet it would be my sincere hope that I will not scare her into that brief visage of terror and panic I had witnessed. You see, I really got to see her face this time. I never saw it in 2016, nor heard the fear in her voice… everything was dark and muted in my world in 2016. I never tried to kill myself either… that was what everyone worried about. What happened to me? Well, I just slowly faded to black on the inside.
Hence, let me begin with the picture above. 2016 was a dark place all around me. It was not just the lack of light, but sounds, smells and touches had all faded away. My life was out there on the horizon; I could witness it and the light or sound that did get to me… what was often forced onto me… was deafening and blinding, the touches were all harsh and painful. I’ve heard people do not know what to do when they are with someone who may be suicidal.
I know for myself, in my case, the people trying to touch me, interact with me, get me to talk or to function was about the most painful thing in the world but my kids, whom have no medical or psychological training at all, because they are kids, would just sit near me… often doing nothing at all.
My advice is Presence in the Present. I firmly believe that Your Presence in the Present is the most valuable thing you can give to a severely depressed or suicidal person.
We all want to ‘do’ something or ‘say’ something to help others in need or in pain. This is hard wired into our own personal survival, our parenting instincts and perhaps the survival of our species… to want to care for others. Yet, we forget in these modern times of texting and email that over half of human-to-human communication has nothing to do with speaking at all, or any words exchanged. You’d be surprised how much being truly present in the Present with another makes them, actually forces them to connect to the world, now and in the Present.
Losing my medical career. Losing my ‘control’ over my own life. Losing our savings slowly. Losing all my friends. Losing my place in the world. I had spent decades getting ahead and then just years falling behind. It did take more than five years after my 2010 disability to break me… and break, even shatter I did, most assuredly.
In 2016, my focus and thoughts and feelings mostly turned to the Past… and all of the losses that I felt I had incurred. However, when I was forced to see the Present and look forward, I only saw the fear and uncertainty in my future because my insurance carrier would not tell me how to make any income without further injuring my and my family’s financial health. If all your waking time is spent overwhelmed by your losses in the Past and your dread of the uncertainty in your Future… well, for me, this vice methodically gripped all the life from me in the Present.
In the Spring of 2016, I stopped trusting anything anyone said, so I generally stopped speaking to people. I wouldn’t pick up the phone. Eventually I stopped texting even. I stopped trusting what I read or saw and so I slowly stopped reading or following anything. I never actually had the thought, ‘I’m going to kill myself.’ Instead, I would see images of my family in the future without me… these would appear while I was awake and ‘seeing’ what you normally see… the images were overlaid on my reality. Sometimes they would haunt me as I was waking up or falling asleep. Yes, they freaked me out, too.
I’d lost in the Past. I was terrified of a Future without me doing what I valued most (producing resources for my family) and in the Present I was haunted by images of me removed from this existence… perhaps my mind decided that being gone, not Being anymore, was the final way out… and so I faded day by day away.
My wife knew I was profoundly depressed from all the loss and she knew I was terrified of producing income without the certainty that the income production would not hurt the family further. She had run out of ideas to help me. The simple idea that earning money will make your family resources worse off is dreadful… I sincerely hope no doctor ever has to know that fear and uncertainty. It’s why I teach doctors about disability insurance, financial literacy and income protection because out of all that happened to my family, and me, that ambiguity was the single worse experience.
One day, May 30th, 2016, I was ‘caught’ staring at these images that were not there and my wife knew something was terribly wrong. Also, at that moment, I had no fight left in me to resist going to the emergency department. I spent thirty days in an intensive outpatient treatment. This was followed by a year of weekly therapy. During this time I met others who had attempted suicide and I heard their stories, many of which were far more frightening than my own. I lost my career, my purpose, my hope and my will to live… many of them had these things forcibly taken from them and none of them had my education or background.
The best metaphor I’ve read or heard concerning suicide is that of a person trapped in a burning building whose only means of escaping being burned to death is an open window several stories off the ground. The heat builds and the pain increases everywhere. At some moment the ‘jumping’ alive is better than the ‘burning’ alive… even though both choices end with death. I do not know that I ever felt this horrific metaphoric choice myself. I know I did think the only way to make the images stop would be to destroy my mind, somehow keep my mind asleep forever.
My kids, with no training at all other than what is hard wired by evolution and biology, because they are kids, would just sit near me. I only understand what they did now, in retrospect. The thirty days of intensive inpatient therapy helped greatly, the follow up therapy for a year helped more… but reconnecting with the Present is what began to heal me… began to stitch back together those broken parts of my Will to Live.
While my personal story of approaching and contemplating suicide is my own human-story, I remain a physician, both healer and educator, and I admit my attempting to ‘heal thyself’ did not work so well two years ago. I performed anesthesia for eleven wonderful years and it was awesome. I loved being an anesthesiologist! I have spoken to many doctors in my career, after my career and now about subjects that span the horizon of Life itself. I can feel the pressured disappointment in some of them with the modern healthcare system in America, the madness of their own hospital systems and the learned-helplessness most believe is not truly there inside their own medical groups.
I can imagine and comprehend the profound torment that leads people, even physicians, to feel the only escape is suicide… because I was there myself. I lived in the bureaucratic cement of modern healthcare, I felt the arresting weight of conflict the ‘system’ places between you, the doctor and you, the human, attempting to care for others. I am deeply saddened by the descriptions of working physicians who feel any remaining empathy they have is slowly asphyxiating along with any future they see in their own careers. Some can no longer understand why they even became doctors in the first place. The system can feel hopelessly inflexible and pointlessly adversarial… the doctors are talking about the failures and losses they have endured in their Past(s) and of their fear and hopelessness of their career Future(s).
That’s the point at which things went downhill for me, caught between loss in the Past and fear of the Future. For my wife, that is no longer where I am. I am securely the Present each day. I reach out and teach. I talk with doctors, I write everyday on income protection, financial literacy and a host of other subjects about our future, the future of medicine, about technology and today, about suicide.
I would like to say that Kate Spade’s and Anthony Bourdain’s suicides will help push the message that mental illness should be considered differently in the future by our society. I know that in my own marriage, their deaths forced an uncomfortable conversation to occur between two people whom love each other. Perhaps one day, breaking your own Will to Live and breaking your leg may be both considered injuries that can be successfully healed. However, I’m convinced it will be the one-on-one moments from everyday people with one another that will bring the concept of, Mental Injury, to its place in our amazing modern medical world. The 20th Century saw the most incredible leap of technologies and understandings about the human body. Perhaps the 21st Century will be looked back upon as the time when the most incredible leap of technologies and understandings about the human mind took place.
Talking and writing about this does not trigger suicidal thinking or feelings for me any longer. I do not believe that discussions about suicide trigger suicidal ideation or thinking. In the end, reconnecting with my Present brought me back to Being in this Life.
If you know someone suffering from suicidal thoughts and severe depression… picture the person in the window of that burning building. Attempting to ‘cheer’ them up or offer ‘advice’ only focuses them on jumping out that window because from the sufferer’s point of view, that is their only future, fear. Explaining to them they have a great job, are in fantastic physical shape, have a solid family, a community and did all these great things to get to where they are in life only shows them the flames are burning all those things down to ash around them in their own mind.
It can be tempting to point out to people that better things lay ahead for them, but when they are suicidal… their entire future is jumping out their window that is too high to survive… they cannot see any future past their jump and every potential future you point out is full of terror and horror for them. It can also be tempting to remind people of all they have and all they have accomplished, yet, that suicidal person… their entire past (the one you are bringing up to them) is on fire all around them, their past is literally the fuel for the fire burning them and hurting them.
Where you can make the difference is in between the fire and the jump; in between their past and their haunting future, in their Present. There is tremendous power in being with someone, just being there. We speak too much, in general, and listen too little and technology is making that easier to do… which is perhaps making us worse at being human. Physicians are supposed to know more than regular people and we do know a lot more. But how to be with someone, how to show one’s presence in the Present to another who is suffering… that is a Human skill we all have, but perhaps some of us adults have forgotten.
Everyone, in order to be present for the one you love, the one who is suffering you will need to take care of yourself.
Physicians, in order to care for so many other people who are suffering when they seek your guidance and expertise, you need to take care of yourselves.
I am sorry and have apologized to my wife for the mean things I said in 2016 and for the months of the self-centeredness I exhibited prior to seeking help. I know it was exhausting and painful for her when I was lost and silent. Since beginning to compose this piece, I’ve done more to show her I am healed than I believe I did in the last two years. I’m not just saying or writing the things I believe she may want to hear… or reminding her of all the positive people, events and relationships I have today… the secret to reassuring her and what has been most effective… my being Present in her Presence.
If you are a doctor suffering or the loved one of a doctor suffering, reach out to get help and keep reaching out until you find a way to connect back to the Present. At the current rate of physician suicide, about 400 per year, nearly 1,000,000 patients literally ‘lose’ their doctor every year. As a society we are facing increasing physician burnout, physicians are retiring early or beginning other businesses in order to fade away from modern medical care in America. The physician shortage will continue to worsen over the next two decades and that shortage will strain the system and the doctors even more than today.
Dr. Christopher Yerington
Bio: Retired from clinical anesthesiology by a disability in 2010, Dr. Yerington has turned his love of teaching and service to others to his family, colleagues and community. He speaks and educates medical groups and residency programs about the importance of great disability insurance. Having attended law and business schools, Chris is a perpetual student, currently working on his financial certifications.