Doctor Suicide: An “Almost” Story

⚠️ TRIGGER WARNING: Suicidal ideation, doctor suicide, disordered eating ⚠️

I’ve been debating a lot about whether to write this.. debating whether I even want to think about it. 

It can be so hard delving back into the dark times. 

For those that don’t know, back in 2016 when I was a new Foundation Year 2 doctor (UK equivalent of “residency” in the USA) I began to suffer a lot with my mental health.

A large part of the reason for this was working in an unsupportive work environment in a specialty where I had little to no experience. I had done about 2 weeks in this specialty as a medical student. I was given some great (if brief) lectures on how to manage the most common conditions I would encounter. I was also given a book on the specialty that I carried around whilst on call.

I will never forget leafing through that book in the darkness of the on call room, praying that nothing serious would happen. 

I hasten to add that the individual surgeons themselves were actually lovely, supportive even, it’s just that the set up wasn’t designed for someone at my level of experience.

After 4:30 pm there was no senior on site. I was required to manage complex patients, several times in life threatening situations, without any local senior support.

The closest registrar lived an hour away and whilst I could call them for advice, I waited (more than once) for up to an hour for them to arrive, once whilst managing a person haemorrhaging post tonsillectomy. There was blood everywhere. 

One time the registrar didn’t bother to pick up the phone and I had to call in the consultant at 4am because a man was haemorrhaging from the back of his nose and I didn’t know how to posterior pack. 

Another time a consultant refused to come in and I had to beg the consultant I knew was on site to stop his elective list to stem the bleeding from an intensive care patient’s tracheostomy. 

Another time I was first on the scene to Resus attending a patient who, it later turned out, had voluntarily removed their tracheostomy tube, because they were sick and tired of living with throat cancer, and wanted to die. I didn’t know how to replace a tracheostomy tube. 

The list goes on. 

The resulting effect on my mental health? 

At first, immense stress. Vomiting every single morning before work, and thinking it had to do with my stomach. A visit to the GP where I asked if it had something to do with my hormonal contraception. Then, palpitations and shortness of breath every morning. 

Finally? NUMBNESS. The inability to feel anything at all. At least, no more stress. “Maybe I’m adapting”, I thought to myself. Describing my stress levels to a colleague on one occasion as “a graph, where the line goes up and up and then suddenly, it levels off.” 

Burnout, except I didn’t know it. Neither did they. 

More vomiting. Days off work. Then weeks. Then making it into work, being asked about my absence, breaking down in tears. The consultant, gently taking me by the hand all the way to the Occupational Health (OH) centre. Them not knowing how to help me. The consultant, aghast at this. The admin at OH recommending I see my GP. Heading home on the bus and crying all the way. 

Seeing the GP again and getting signed off work, initially for a month. Lying in bed for days at first, then a whole week. Eating 2 pizzas and an entire tub of ice cream a day. 

Hating myself. 

The thoughts begin…

“I am the only one that feels this way. Everyone else is coping so well.” 

“This is what I’m supposed to do, but I can’t do it. I’ll never be able to do anything.” 

“If I’m not a doctor, then what am I?”  

Thinking my identity as a doctor was the be all and end all. 

So much shame. 

“I’ve let everyone down. I can’t tell anyone.” 

Then.. 

“What is the point?” 

“Wouldn’t it be nice.. just to not be here any more?” 

Wanting to just disappear off the planet once and for all. 

Not realising…

Not realising there were other options. Not realising that I was more than my job, that I had other identities still, that I could even create new ones. 

Not realising that others, SO MANY OTHERS, have felt this way before. 

That whilst I might have some personality trait or some gene that made me more prone to being anxious, the SYSTEM was what made it emerge. 

That it wasn’t my fault that the job was this hard, had always been hard, was only getting harder as more people needed to be in hospital, as more people left the profession. 

Calls from the educational department lead, which were more maternal and comforting and supportive than they had any right to be, because they had lost someone to suicide before. (Thank you, I will always be grateful.) 

Going back to work, into a job even worse than the last. Staying till 7pm or 9pm most days, when I was only meant to be there till 5pm. No, I was not the only one, we all did it. 

Being the most senior person on the ward dealing with very ill patients, breaking bad news, staying late to manage Spontaneous Bacterial Peritonitis. 

Winter pressures. No beds. Outliers everywhere. Consultants rota’d onto clinics as well as the morning ward round. Registrars in endoscopy. Calling every morning before I single-handedly led the (first) ward round of the day, to ask the other wards if they had any of our patients. Being told no, then being called back anyway at 4:30pm by the nurse.

“Doctor.. why hasn’t anyone come to see your patient today on this ward?” 

“What patient…..?” 

Being signed off for another 2 months…

Finally being told by a friend, hey, have you heard of Practitioner Health? (An NHS mental health service for doctors and dentists in the UK). No one had told me about it. 

Taking a whole month to self-refer. 50% because I felt I was beyond help. 50% because I couldn’t find the right button, or email, or way to do it. (Why can’t I do this…?) 

Ticking the questionnaire in the waiting area, the one we gave to patients. Knowing what it meant. 

Diagnosis: Severe anxiety and depression. 

Getting CBT. 

Crying during the session where my poor therapist tried to show me I had intrinsic worth.. Worth?? Choking with tears AFTER every single session in the bathroom cubicle for 40 mins at a time, then collecting myself and making the trip home. 

Days spent at home. 

My brother visiting me, me not wanting to open the door, but eventually agreeing. Telling family. My dad stopping work to come and look after me, my mum having to keep working to look after us all. (I love you all.) 

Obsessively bullet journalling. 

Learning how to look after myself again. Again? No.. for the first time. (Why don’t we get taught this at school?) 

Daily checklists: Go outside. Exercise for 30 mins. Make a healthy meal. Go to bed on time. Meditate. 

Doing some of those things. 

Being asked by the therapist to keep a positive thoughts diary to retrain my brain to look for the positives. The first and only thought, on so many days, “It is sunny.” 

Then later, “I am still here.” “I am alive.” 

I get asked what specialties I want to do when I phase back into work.

Paediatrics. ITU. 

One day, just like that, I am back at work.

The consultants know who I am. Educational department lead – again – making sure I’m being looked after. 

I learn new things. 

I love paediatrics. 

I move on to ITU. It’s scary, but I’m so well supported. I learn more things. I put VERY BIG lines in people under ultrasound guidance. I see lots of death, and hear lots of bad news. I observe some of the best communication skills medical practice has to offer. 

I start nights again, having been signed off them for so long. I manage the High Dependency Unit along with the fantastic nurses. I’m the only doctor – the registrar is busy with outliers, but I’m not scared. I help a man have a “good death” (comfortable, supported). His last wish is to stand up. I can’t fulfil it because he is too weak and there is not enough time. I call his family 6 times, leaving messages. His family make it there just in time. After he is gone and I have confirmed he is gone, they are scared. I ask if they want me to stay with them. I stay with them and we watch over him together. 

He is gone, he is gone.

They are gone.

Patients are gone. Doctors are gone. 

Somehow I am still here.  

I stay here. I think and think.

And one day I share my story. 

I try to build something so others will read this story, and know that they are not alone. 

So that they will know that they can get better. 

So that they will know there is help out there, that there is hope, that there is light. 

That there are countries to visit, and waterfalls to jump off, and other identities to step into, and to flourish, to flourish so much, to hug their friends, to hug their family, to find love. To be happy again. 

I break my memory and my heart open each time so that people can hear this message. 

“Doctor, human… Please, stay.” 

[If you this sounds like you please click HERE to access the BMA wellbeing support services directory for doctors and medical students in the UK.

If you feel unsafe:

UK: please click HERE for a list of mental health & suicide helplines including text message support

USA: please click HERE]