America: 393,000,000 guns & 28,000 psychiatrists →

(Update to 2012 America: 350,000,000 guns & 47,000 psychiatrists)

 

Untreated mental illness + guns = predictable catastrophes.

America in 2018 = 307 mass shootings in 311 days.

This week a veteran with presumed PTSD shoots up Borderline Bar & Grill. On Facebook, shooter explains:

“I hope people call me insane… (laughing emojis).. wouldn’t that just be a big ball of irony? Yeah.. I’m insane, but the only thing you people do after these shootings is ‘hopes and prayers’.. or ‘keep you in my thoughts’… every time… and wonder why these keep happening…”

Is it time for us to do what the shooter seemed to be asking for—help those with insanity—or shall we just hope and pray?

Or fall into our usual anti-gun/pro-gun divide?

Let’s analyze the irony identified by the shooter before the devastating slaughter of 13 Americans.

Let’s go into the uncharted territory of human psychology by asking a new question.

By delving into the mind of a straight shooter before a calamity.

His prophetic post may reveal the answer we’ve been seeking.

Because we the people are responding exactly as he predicted.

Vilifying the shooter as insane.

Offering hopes and prayers.

Is that really the best we can do?

They say insanity is doing the same thing over and over again and expecting a different result.

Yet we keep asking the same post-carnage questions: Where did he get the gun? Did he acquire it legally? What was his motive?

Rather than interrogate the shooter postmortem, let’s analyze the response of the living for clues as to why killings continue just as each homicide-suicide ends.

I’ve got a unique vantage point on mental health in America.

I was once a suicidal physician.

Physicians have the highest suicide rate among all professions. Higher than veterans.

Since 2012, I’ve been running a physician suicide hotline. I’ve spoken to thousands of suicidal physicians and investigated more than 1100 doctor suicides (some homicide-suicides).

If doctors can’t even get proper mental health care, how will patients fare any better?

They won’t. And here’s why.

America in 2018 has 393,000,000 guns and only 28,000 psychiatrists (that’s 14,036 civilian-owned guns per U.S. psychiatrist—up from 7447 guns per U.S. psychiatrist in 2012).

That means we’ve doubled the number of guns per psychiatrist in the last 6 years.

Increasing firearms while decreasing mental health access is not a winning strategy.

So why do we have so many guns and so few psychiatrists?

We have a constitutional right to bear arms.

We have no constitutional right to health care.

America is the most heavily armed nation in the world.
(120 guns per 100 U.S. residents)

Yet America is a world leader in mental illness.

Most Americans will develop at least one mental illness.

More than half begin during childhood.

Nearly half of all Americans have at least one gun at home.

The human brain controls the gun.

People will find a way to end their pain.

A civilized society offers civilized solutions.

A violent society offers violent solutions.

With a gun-to-psychiatrist ratio of 14,036:1, it’s way easier to grab a gun than see a psychiatrist.

It’s also cheaper to buy a gun than see a psychiatrist.

Ammunition costs less than medication.

Bullets are just a few cents each.

So who’s insane? The shooter? Or us?

(I’m not inherently against guns. I’m against untreated mental illness. And I’m against untreated mental illness + guns, pipe bombs, machetes or anything else that can damage life on Earth).

Pamela Wible, M.D., reports on human rights violations in medicine. Dr. Wible attends therapy weekly to maintain her sanity and wishes all Americans enjoyed the same luxury.

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1103 doctor suicides & 13 reasons why →

(Listen in above to a rerecorded keynote—due to a fire alarm during event—or read transcript of Dr. Wible’s presentation below)

Michael Phillips MD: Good morning everybody. I want to introduce the lectureship and remind everybody who Gil was. Gil was originally from Philadelphia and then moved to Oregon where he joined The Gastroenterology Clinic, which at the time was the only GI-specialty clinic in Oregon. He became one of the preeminent gastroenterologists well-loved by patients and staff alike and known for his outstanding humor, his clinical skills, and patients who absolutely adored him. I continue to take care of patients that he took care of 20 to 25 years ago and they still think of him as their gastroenterologist. I’m just kind of standing in. That’s the kind of guy Gil was. Gil really dedicated himself to education. He was Outstanding Teacher of the Year twice—a testimony to who he was. He died unexpectedly at the age of 50 [on a ski trip, not a suicide]. In response to his untimely passing, we established this lectureship 20 years ago. We’re here today to commemorate him and to continue to use his legacy to help facilitate our practice and humanity in taking care of patients.

It’s really with a great pleasure that I get to introduce our speaker today, Dr. Pamela Wible. Pamela is family physician born into a family of physicians. Her parents actually warned her not to become a physician. Shortly into her first year of medical school, she experienced the adverse effects of medical education on her own mental health. It wasn’t until 2012 after losing three colleague physicians to suicide that she began to investigate the mental health crisis among medical students and fellow physicians.

For the past six years, Dr. Wible has reported on doctor suicides and human rights violations in medicine. Her articles have been picked up by major media including The Washington Post and Time Magazine. She’s the author of the bestselling book, Physician Suicide Letters—Answered (free copies available today). Dr. Wible has two TED Talks on doctor suicide. She’s been interviewed on primetime investigative television and featured in a new award-winning film Do No Harm that’s currently being screening at hospitals and medical conferences internationally.

In between treating patients as a solo family physician in Eugene, Oregon, Dr. Pamela Wible continues to run a free doctor suicide hotline that’s been in operation since 2012. Today, she’ll share the results of her investigation into more than 1100 physician suicides and reveal simple truths and solutions to prevent the loss of our healers. Please welcome Dr. Pamela Wible. Thank you.

Pamela Wible, MD: Thank you all so much for being here. I want to thank Providence for hosting this event and taking on this topic of doctor suicide. Though I never met Gil in Oregon, our paths did sort of cross in Philadelphia. Turns out my dad and Gil attended the same high school where Gil was actually the vice president of his graduating class.

There he is. Teacher of the Year at Providence as a young guy before he had the mustache. Gil knew from early on that he was headed for a career in medicine. He declared that right away at Central High.

Unlike Gil, my father assured his classmates as the president of his class that his future occupation would be in the motion pictures.

Like a good Jewish boy he relented to parental pressure and became a doctor. Both Gil and my dad did some of their training at Hahnemann in Philadelphia. Both pursued internal medicine. How odd is it that I’m invited to do this lectureship and my father and Gil have such parallel paths in medicine.

Unlike Gil who died at the height of his career, my father practiced medicine for 62 years and retired at 87. He died four years ago this morning at 91. My dad ignited my interest in medicine. Here I am following him around in the hospital. With physician parents I grew up in the hospital hallways back when they didn’t care if your kids crawled through the morgue with you. I don’t see many physicians’ toddlers wandering the hospital hallways today. Too bad. I had so much fun playing with the paraffin in the pathology department and looking at this huge glass jar with all the bullets and foreign bodies he found in patients (that I thankfully inherited after he died).

Dad’s a pathologist. I think the human drama of running a small neighborhood internal medicine practice was a little bit too much for him, so he chose a more predictable patient population in the morgue. My mom is a psychiatrist so I tagged along as a child at the state hospital. So I spent my time with mom hanging out with the seriously mentally ill and with my dad I got to hang out with dead people. Neither of my parents needed stethoscopes so I inherited all their equipment from med school too. I developed this love for medicine and a fearlessness about mental illness and death because of the unusual experiences I had with my parents—amazing for a blossoming young doctor, but for my siblings morgue visits were horrifying and traumatic.

Unlike my father, I’m much more of a rebel. Since I was warned not to pursue medicine, here I am graduating from medical school and becoming a solo family physician (who still doing house calls and practices medicine the old-fashioned way—which is kind of a rebellious thing to do in 2018!).

I was living the happily-ever-after life of an old-fashioned family doc in the sweet town of Eugene, Oregon until October 28th, 2012 at 3:00 p.m. when my entire life got turned upside-down. I found myself sitting in the second row of a memorial service for our third physician suicide in our small, idyllic little town full of farmer’s markets, organic food, and friendly hippies. Sitting at this memorial service, I started to count on my fingers the number of doctors that I had personally lost to suicide in my life and/or who died under suspicious circumstances that I thought maybe were suicides covered up with the classic euphemisms.

Within a few minutes, I had counted 10. Startling for me in my early 40s—the prime of my career. So I did what I needed to do to get a handle on this epidemic—I gave up knitting and mosaic mural artwork and began tracking doctor suicides as a hobby. I became completely obsessed with why so many doctors were dying by suicide. Two of the doctors on that list of 10 were men that I dated in medical school who died by suicide (not while I was dating them I want to make that clear) but later on when they were married. They died at 39 and 44 leaving wives and young children behind.

Because I am so vocal and such a prolific writer on doctor suicides, I ended up well-known among my peers for my investigation into doctor suicide and soon people began telling me about more and more doctor suicides. Five years later, I ended up with 547 cases submitted to me by physician colleagues and family members. I never went looking for these suicides. They were submitted from people calling me saying, “Hey, I want you to know my neighbor shot himself in the head a year ago. I was in my backyard. I heard the shot, I saw the police come. The family’s not really talking about it, but here’s the backstory and I want you to know what really happened to this cardiologist.”

So I end up with this list—an informal suicide registry where I’m tracking by name, specialty, date, method, and location of suicide, plus any extenuating circumstances. Now I have a very deep understanding of why my peers chose to die. And cases keep coming to me almost daily. Now I have 1103 doctor suicides that I’ve personally investigated by talking to family members, friends, the last boyfriend, and medical school classmates.

With so much content, I’m discovering themes. Here is my blog where I began to share results of my investigations. Full disclosure: Personally I’m so obsessed with this topic because I was a suicidal physician myself in 2004. I thought I was the only one. I had no indication that other doctors were suffering. I felt like the oddball, the sensitive one. Maybe I was too idealistic. I just had no idea physician suicide was such an epidemic.

Professionally, I feel called to be a healer. As a scientist and physician, it is my obligation to research why my peers are dying. So I started blogging about suicide and my blog (that nobody really read up until then) suddenly on December 12, 2012 when I published Why Physicians Commit Suicide ended up with 80 comments right away and now 231 comments. So the public response kind of egged me on to continue talking and writing about it.

Then my blogs started to get picked up by The Washington Post, like this one, What I’ve learned from my tally of 757 doctor suicides. That was how many cases I had on my registry as of January 13th this year. Here’s a screenshot of the top of my blog a month ago back when I had just over 1000 cases and reported on my latest data at my keynote at this orthopedic surgery conference. I was the only female physician speaker during this four-day orthopedic surgery symposium. I consider that a huge accomplishment. All the orthopedists only got 10 minutes to deliver their content and they gave me an hour on doctor suicide! There’s an indication that we’re making progress as a profession addressing doctor suicide.

So here’s a wall in my house covered with physicians and medical students who have died by suicide. Again, I’m taking this very personally and I’m in touch with many of their family members.

Now a bit about the scope of the doctor suicide crisis. We’ve known about the high rates of doctor suicide since 1858 when first reported in the UK. Now, 160 years later, the root causes of these suicides remain unaddressed. That’s because we don’t really understand the root causes of a taboo topic—hidden for more than a century. Because as a culture we’re scared to say suicide out loud in and we’re definitely scared to say doctor suicide out loud.

Doctor suicide is a triple taboo. Death is not a topic anyone wants to discuss over dinner. Suicide is death suddenly in your face. Now doctor suicide—the people that are supposed to be helping us are dying by suicide too. This strikes terror in the hearts of patients and makes doctors feel vulnerable. It’s just a scary topic for most people so I’m taking this on because lives on the line that can be saved today by the way we behave with each other and our willingness to tell the truth about physician suicide.

Physician suicide is a public health crisis. More than one million Americans lose their doctors to suicide each year—just in the United States. Researchers say we lose 400 physicians per year to suicide (they believe this is an underestimate), yet 400 is the size of an entire medical school. The average medical school has 126 students in each class, and so that’s an entire medical school equivalent of physicians per year. Due to all the secrecy and underreporting—even death certificates that are completed as accidents when they are self-inflicted—doctor suicides are often well hidden. A physician in family medicine has a patient panel of 2,300 patients. The average emergency medicine doctor probably sees even more per year. Simple math on 400+ times 2,300+ and you’ve got a million patients who’ve lost their doctors to suicide (and that’s not including student doctors).

Here’s some raw data on more than 1100 cases I’ve received. Of 1103 suicides. 969 are physicians and 134 are medical students on the registry and 920 of these happened in the U.S. while 183 are international. People are contacting me from all around the world. Last week I was on a Skype call with a doctor form Israel telling me about the head of the department who died by suicide, as usual “happiest” guy and totally unexpected. When looking at raw registry numbers per specialty (and not accounting for size of specialty), surgeons are in the lead, then anesthesiologists, family medicine, internal medicine, emergency medicine, psych, ob/gyn, pediatrics, and radiology. However when evaluating these numbers based on active physicians per specialty we can see the real impact of suicide per specialty below:

These are numbers based on active physicians in the largest specialties. Now we start to see some really interesting trends. Anesthesiologists are really off the charts. Of the largest specialties, general internal medicine has the lowest number of suicides according to my 1100+ cases. Anesthesiologists actually have 2.3 times the rate of suicide of all surgeons (general surgeons plus all surgical subspecialties). Anesthesiologists have 5.5 times the rate of suicide of general internal medicine doctors.

Medical students with preexisting mental health conditions deserve informed consent about mental health risks per specialty. I have premed students calling me who’ve had previous suicide attempts or panic attacks that are poorly controlled right now and they want to go to medical school. They deserve to know this information just for their own sanity and survival.

To fill in the gaps of this underreported epidemic,  I’ll review 13 reasons why doctors die by suicide through case studies by introducing you to 13 our best and brightest colleagues who have died by suicide.

First, a quick recap on the language of suicide. Because this is such a taboo topic, people have been afraid to even say suicide aloud. By the way, at that memorial service that I went to they never said suicide out loud. Everyone knew that he shot himself in the middle of the day at Mount Pisgah in Eugene, so it wasn’t hidden. He’d had a public death in a public park, but nobody at the memorial service said suicide out loud. In the bathrooms and milling around, everyone kept whispering, “Why?” Everyone wants to know why and nobody will say suicide out loud. Imagine if we we were afraid to say diabetes out loud but we had to sneak into the bathroom to whisper about our diabetic patients. How far we would be with treating diabetics? Imagine if patients had to sneak out of town and pay cash and use paper charts to keep diabetes off the EMR. Insane. Right?

My plea here is let’s destigmatize suicide so we can actually discuss this crisis factually with data—and without such terror and shame. We can actually solve this problem. Because we don’t often know how to talk about suicide I’d like to encourage correct terminology.

“Committed” suicide is actually a very antiquated, stigmatizing way to discuss suicide because it makes it sound like a crime (like committed burglary or rape). Really suicide is a medical condition in which people are dying prematurely and should be discussed like every other medical condition—died by diabetes, died by heart failure, died by or of suicide. I know it’s hard because it’s like a knee-jerk reaction to say “committed” suicide. Even newscasters are still saying “committed” suicide, but I’ve been schooled on this through a psychiatrist who is the parent of a 29-year-old internal medicine physician who died by suicide. She was one of the first who commented on my blog Why Physicians Commit Suicide and she wanted me to know the title of my blog was stigmatizing. I didn’t know any better. I was just starting to discuss this myself and it was a great teachable moment for me, and so I’d like to pass that on to you.

Next, the idea of a “failed” suicide. How weird is it that when a physician attempts suicide and actually survives that should never be framed as a failure? Call that an attempted suicide in which we now have salvaged the person’s life by the grace of God. “Successful” suicide. To die as a 29-year-old internal medicine resident is not success. That’s a completed suicide which shouldn’t have happened in the first place. To prevent the next 29-year-old internal medicine resident from dying by suicide, I would ask you all to please destigmatize the suicide conversation.

Now I’ll share 13 case studies and 13 reasons why we’ve lost some very beautiful and brilliant people to suicide. I could talk about each of these amazing people for hours. Due to time constraints I’ll give just a thumbnail sketch of each case (some have been discussed in far greater detail in my other articles and keynotes).

First meet Dr. Ben Shaffer. Ben’s sister just sent this newspaper clipping to me. Ben was voted Most Likely to Succeed in high school. That has a new meaning for her now. He was also voted Most School Spirit in junior high. You can see this guy is awesome, charismatic, loving. He was the top DC sports surgeon at the time of his death. They called him Dr. Smiles. Nobody had any idea he was suffering. Such a smiley guy cracking jokes up and down the hospital hallways.

Why is he now suddenly dead by suicide? Read more ›

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Eulogy to 10,000 Doctors →

During Suicide Awareness Week, I hosted a free two-day retreat in NYC (in collaboration with Emmy-winner Robyn Symon’s preview of her award-winning film, Do No Harmsold out both nights at Angelika Film Center’s largest theater). Nearly 500 physicians (from as far as Hawaii and Alaska) joined in activities on September 12 & 13—from afternoon empowerment sessions to evening receptions and open mic until 2:00 am where doctors shared their suicide attempts openly. For many the most poignant moment was the Manhattan Memorial March to the site where one of medicine’s pioneers died by suicide earlier this year. At the location of her death, I delivered this eulogy to the countless doctors we’ve lost to suicide (fully transcribed & mildly edited for clarity).

View full photoessay here

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Dr. Pamela Wible: We are gathered here today to honor the many people that we have lost to suicide in medicine and in particular, Dr. Deelshad Joomun.

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This is the spot where she died in January. It was a Thursday afternoon at three o’clock.

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And today, Thursday, September 13th, we traced her very last footsteps that she walked to come here leaving Mount Sinai Hospital around 3:00 PM.

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And she went into this building where she lived for six years and pressed the elevator to go up making her way 33 floors to the roof.

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Dr. Deelshad Joomun then stepped off the roof dying in this spot right here.

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This amazing, brilliant, beautiful physician, Dr. Deelshad Joomun, was a pioneer in our profession—the first female interventional nephrologist in the United States. That meant she completed her internal medicine residency, nephrology fellowship, and then advanced fellowship in radiology so that she could do very specific procedures on the kidney (for those of you don’t know what interventional nephrology is). I never knew there was such a specialty.

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She was very passion-driven. It was her soul’s purpose to be a physician and she was extremely happy as a physician. Her name Deelshad actually means “happy heart.” An idealistic happy person who loved being a physician and loved serving humanity.

How in the world did somebody three days into her first job as an attending—she was only there at Mount Sinai for three days—how did she end up wanting to walk across the street in the middle of the day—in the most populous city in the country—and die this way?

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Why “happy” doctors die by suicide →

He was the go-to sports guy in Washington, DC. A masterful surgeon with countless academic publications, he trained orthopaedic surgeons across the world and was the top physician for professional sports teams and Olympians.

Dr. Benjamin Shaffer had it all.

Yet Ben was more than a stellar surgeon. He was a kind, sweet, brilliant, and sensitive soul who could relate to anyone—from inner city children to Supreme Court justices. He was gorgeous and magnetic with a sense of humor and a zest for life that was contagious. Most of all, he loved helping people. Patients came to him in pain and left his office laughing. They called him “Dr. Smiles.”

Ben was at the top of his game when he ended his life. So why did he die?

Underneath his irresistible smile, Ben hid a lifetime of anxiety amid his professional achievements. He had recently been weaned off anxiolytics and was suffering from rebound anxiety and insomnia—sleeping just a few hours per night and trying to operate and treat patients each day. Then his psychiatrist retired and passed him on to a new one.

Eight days before he died, his psychiatrist prescribed two new drugs that worsened his insomnia, increased his anxiety, and led to paranoia. He was told he would need medication for the rest of his life. Devastated, Ben feared he would never have a normal life. He told his sister it was “game over.”

Ben admitted he was suicidal with a plan though he told his psychiatrist he wouldn’t act on it. Ben knew he should check himself into a hospital, but was panicked. He was terrified he would lose his patients, his practice, his marriage, and that everyone in DC—team owners, players, patients, colleagues—would find out about his mental illness and he would be shunned.

The night before he died, Ben requested the remainder of the week off to rest. His colleagues were supportive, yet he was ashamed. He slept that night, but awoke wiped out on May 20, 2015. After driving his son to school, he came home and hanged himself on a bookcase. He left no note. He left behind his wife and two children.

I feel a kinship with Ben, partly because I used to suffer from chronic anxiety that I hid under academic achievements, but mostly because I’m a cheerful doctor who was once a suicidal physician too. In 2004 I thought I was the only suicidal physician in the world—until 2012 when I found myself at the memorial for our third doctor suicide in my small town. Despite his very public death, nobody uttered the word suicide aloud. Yet everyone kept whispering “Why?” I wanted to know why. So I started counting doctor suicides. Within a few minutes I counted 10. Five years later I had a list of 547. By January this year, I had 757 cases on my registry. As of today that number is 1,013. (Keynote delivered at Chicago Orthopaedic Symposium reviews data and simple solutions to prevent doctor suicides).

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33 orthopaedic surgeon suicides. How to prevent #34. →

Dr. Wible’s keynote delivered at the 19th Annual Chicago Orthopaedic Symposium (begins with a beautiful legacy to the life of Dr. Dean Lorich by Dr. Matthew Jimenez). Downloadable MP3 above.

Thank you. I’m truly honored to be here and extremely grateful that you have given me more than 10 minutes to discuss doctor suicide. Looking at your agenda (three days of q-10-minute lectures back-to-back) as a family doc, I’m just a little blown away that you can cover complex acetabular fractures and mangled lower extremity grade IIIC salvage versus amputation in 10 minutes when I can barely treat a patient with a UTI or step throat in 10 minutes.

I’d like to dedicate my presentation today to Dr. Dean Lorich—and to the many orthopaedic surgeons we’ve lost to suicide. I’ve had the opportunity to get to know many of these men through their colleagues who reported their suicides to me and more intimately through their mothers, sisters and children left behind.

Today, for the first time, I’m sharing my data—what I’ve discovered from investigating more than 1000 doctor suicides—and specifically the suicides of 33 orthopaedic surgeons. Data—often devoid of emotion and humanity—means little without a human face so I’ll start by sharing the incredible lives of two orthopaedic surgeons whom I deeply admire, Dr. Steven Ortiz and Dr. Benjamin Shaffer.

Most of you know Dean. Just curious how many of you know Steve or Ben?

Though we know each other professionally, how many of you feel you really know each other personally—the deep feelings and inner world of your colleagues? I want you to truly know these two men—not just as skilled surgeons—but as the amazing human beings we were blessed to have on this planet. And then I’d like to invite you to get to know each other (while you are still living) as deeply as I’ve gotten to know Steve and Ben posthumously. I’ll begin with Ben . . .

The orthopedic community suffered a devastating loss with the suicide of Dr. Ben Shaffer. He was in practice 25 years as a much beloved and trusted orthopaedic surgeon in Washington DC. Dr. Shaffer graduated from the University of Florida College of Medicine, completed his orthopaedic residency in NYC where he was chief resident, then specialized in sports medicine with a fellowship at the Kerlan-Jobe Orthopaedic Clinic.

The author of more than 50 publications (21 were textbook chapters), Dr. Shaffer trained orthopaedic surgeons around the world. He has an impressive 41-page CV (officially the longest I’ve ever read). He was the medical director or team physician to a gazillion professional sports teams in the DC area. Dr. Shaffer was also consultant to the National Ballet, NHL physician for the 2010 Olympics in Vancouver, PGA Golf Tour, Women’s World Cup Skating, and the list goes on . . . Impressive! Right?

Yet Ben was more than a surgeon, he was a kind, sweet, brilliant sensitive soul who could relate to anyone—from inner city children to supreme court justices. He was gorgeous and magnetic and he loved helping people. So why does a guy this successful end his life?

As with most suicides Ben’s was multifactorial. He had marital distress, diminishing reimbursement, and personal health problems. He was recovering from recent back surgery and still dragging his foot so he couldn’t run or work out (activities that would have made him feel better).

Ben also had chronic anxiety. He saw multiple therapists during his lifetime. His psychiatrist had recently retired and passed him on to a new one who didn’t know him. He had been on anxiolytics for years and was weaned off two months before his suicide. Ultimately it was Ben’s uncontrolled anxiety and insomnia (related to sudden change in medication regimen) that led to his death. For insomnia, he was told to take Benadryl or meditate—both ineffective as he was still sleeping just two or three hours per night and trying to operate and see patients each day.

Eight days before he died, he was prescribed Prozac and Seroquel which worsened his insomnia, increased his anxiety, and led to paranoia. Then his psychiatrist told Ben he’d be on medication for the rest of his life. Ben was devastated, hopeless that he’d ever have a normal life. Ben told his sister he felt backed into a corner with no good options and it was “game over.”

Days before Ben died, his therapist asked him if he was thinking of suicide and he said, “Yes.” He then asked Ben if he knew how he would do it and Ben said, “Yes.” He then asked, “Are you going to do it?” Ben said, “No.” (Ben was smart enough to know that “yes” could potentially cause a problem for a physician.)

Ben knew he should check himself into a hospital, but he was panicked because of career ramifications due to the stigma attached to doctors seeking help for mental health. He was terrified that he’d lose his patients, his practice, his marriage, and that everyone in DC—team owners, players, patients, colleagues—would know about his mental health problems and he’d be shunned.

The night before he died, Ben finally told his partners he needed the rest of the week off because he wasn’t sleeping well. He was ashamed, yet they were fine covering for him. Ben left the hospital in sheer terror. He wanted to tell them that he had changed his mind.

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