Tuesday, January 18, 2011

Go Not Gently Into The Night

Go Not Gently Into The Night

Just read an article about a survey that shows surgeons at high risk for suicide. This does not surprise me much. It is a lonely and demanding profession.
Lonely because often nurses and support personnel either fear you (or fear their image of a surgeon) or are just looking for a chance to take you down. With the current “snitch” laws which allow for anonymous reporting of almost any behavior, just walking through the hospital can be grounds for being reported, if you are not sufficiently, “friendly,” or, “engaged.” Never mind that you are intensely focused on that pt. in 301 who is not doing too well.
Lonely because it is a competitive business, and your colleagues are often waiting for you to make a mistake. And lonely because when you do make that mistake, and the pt. suffers, so do you, with little, if any support.
Lonely because even mentioning what you do puts most people off;. I suppose it is like being a priest, no one wants to let their guard down. And if you do mention what you do, the price of every service doubles.

Not much need to say anything about the demanding aspects of this life. Patients’ lives in your hands daily, and the buck stops with you!

I do not know if my personal experiences with suicide are abnormal, though they seem that way to me. I do know they are very painful to think about, and something I have only, after many years, been able to discuss at all.

My first experience with suicide struck like the proverbial bolt out of the blue. I was between my junior and senior years of medical school. I was on the West coast searching for internships; I was more than ready to bid adieu to the East. I received a letter from my parents that the police in Syracuse wanted to talk to me, with a number to call. When I called, they wanted to question me about my best friend, an architect student who lived in the apartment next to me. It seemed that he had hung himself in the bedroom of my apartment; his wife found him the next day. The cops wanted to talk to me because there was no note, no fight with his wife. He just went over to my apartment to practice his guitar, which he liked to do, and for which I gave him keys so he could indulge his passion in the middle of the night without disturbing his wife.

This guy was one of the few people I have ever met that I truly envied. He seemed to have everything. From his Norton racing motorcycle, to a command of classical guitar, to his monstrous tennis serve, there was nothing that he was not extremely good at.Even his method of suicide demonstrated his ability and ingenuity. It is not easy for a 6’4’ man to hang himself in an apartment with 8’ ceilings. He cantilevered a 2x4 using the closet rod so the end of the beam was at 8 feet, and using his knot tying skills constructed a very short noose to do the job.

I was so stunned that I did not talk about it to anyone for 20 years. The first time I spoke publicly about it was at a eulogy for another friend who had blown his head off (with his wife’s gun) because she was having an affair. He staged it to make sure that she would find him when she returned home. This was certainly more understandable, though again, this was a very talented, brilliant, and well traveled person. Of course his act was much more clearly what most suicides are; the ultimate, “fuck you!”

In between there were two more suicides that were at least a little more removed, though painful. It was My wife’s best friend’s husband’s ex-wife (whew, all those possessives!) She responded, after the all-knowing court awarded her the children (after all mothers should always get custody,)* to the voices again; those of God telling her to kill her children before they went to hell. She shot her two kids and herself in the head. The other was a surgeon who, though a partner in the large group I was working with, was no friend of mine; I knew he was nuts, and tried to convince the chief not to hire him. His wife was also cheating on him so he shot them all, the wife, the three kids, and himself.

The most poignant suicide was a friend, who was also Dr. Kevorkian’s first patient, Janet Adkins. Janet was a wonderful lady, in her mid 40’s with rapidly progressing Alzheimer’s disease. She was with it just enough to realize how bad she was getting, and knew that her life would not be worth living without a brain that worked. Of course, this made headlines around the world, and resulted in an hour long television show (Town Hall, Portland, Or.) where her husband and I took on the religious zealots and the medical do-gooders who would, if given the chance, have denied her this opportunity, and forced her continued existence; not a life, just an existence, to satisfy their own inner turmoils.

I have no moral, nor conclusion to this story. I will say that, barring a terminal illness, I could not do this to people who admire or love me. It is just too painful, even after all these years.

* At my divorce, in 1981 the judge told my lawyer, "I don't care what the law says, as far as I am concerned the mother should always get custody." It was at this trial that I first became aware that court recorders skipped those passages that reflected badly on the judge. At least they used to, might be harder these days with all the recording devices available.
PS 01/18/11

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