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).

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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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1,009 doctor suicides—and still no investigation, coverup continues →

Today I woke up to another email regarding the suicide of a young resident physician: 

“Hi Dr. Wible, an intern resident at our pediatrics program died by suicide this past weekend. I am profoundly angered and disturbed by many aspects of the institutional reaction to this tragedy. I find it alarming that members of administration, so soon after her death, are making comments that focus solely on her pre existing health conditions and not the circumstances/surrounding environment that may have contributed. What I DO know is true is that many who have graduated or are in the program currently will agree that it is not difficult to understand how/why this could happen here, and it must change.The private hospitalist group that unofficially controls the program and its admin is dysfunctional and has bullied and abused residents for years. Their involvement is a conflict of interest. The “confidentiality” of spaces like psychiatry absolutely cannot be trusted. Then take into account this horrific tragedy comes on the heels of increasingly poor ACGME scores, constant work hour violations, poor morale, and a highly toxic work culture that silences residents. The deceased is survived by her husband who was also just starting his journey as a pediatrics resident in the program and their young son. We will not do the memory of this amazing young woman justice by ignoring what everyone knows, that these issues already existed and have harmed others here. This is an unacceptable status quo deserving of further investigation.”

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Death row colonoscopies? →

Death Row Health Care

Medicine is full of ethical dilemmas that we often have to face alone. Here’s one I’ll never forget.

As a med student at University of Texas Medical Branch at Galveston, I had to provide health care for Texas prison system inmates, many on death row.

They say everything is bigger in Texas, and they’re not just talking about hair, land mass, and guns. Turns out Texas leads the nation in executions performed per year (1/3 of all US executions)!

In fact, the prison hospital is conveniently attached to the main university hospital like right next to my apartment.

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