As Kalanithi describes the height of his training, nearly reaching the end, he brings briefly into view a different perspective on death, mentioning the suicide of his friend and colleague “Jeff.” Kalanithi writes,
“I wished I could have told Jeff what I had come to understand about life, and our chosen way of life […] Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. […] But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel […] We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
A dark and difficult topic suicide among healthcare professionals is widely gaining press. Kalanithi merely grazes over the struggle, the isolation and the sense of responsibility that healthcare professionals often take on as they daily delve into the difficult and complex challenges of our patients.
While this is a broad, deep and important topic, I wish to highlight just a few pieces of what other, more eloquent writers have brought to the conversation.
In his blog, Dr. Levi, and ENT surgeon highlights the buckets into which we lump and understand how despair can creep into a career with high demands: loss of control, loss of support and loss of meaning. I hope you have a chance to read the letter he posts from the wife of Australian GI doc who ended his own life. I think the honest and transparency which which she writes, brings home how silent and sinister distress can appear.
Along the long list of reflections I found this upcoming documentary “Do No Harm” particularly poignant summary of the scope and character of the darkness that some physicians struggle with:
The Foundation for Suicide Prevention has great information on suicide prevention in healthcare workers, specifically highlighting suicide in residency as part of their toolkit; its a great place to read more and understand the supports available if you or someone you know are struggling with depression or thoughts of suicide.