Doctor revived after suicide. Here’s what he says.

In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life.

Dear Pamela, I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted the police. Sheriff deputies were upset when I did not pull over to talk to them after overdosing. After boxing me in, they threw me from my truck into the slushy street and tased me. After charging me with a felony and two misdemeanors, they nearly provided the perfect assist to my suicide. Through a series of miracles I was brought back. I am missing four days of my life including three on life support, but I am alive. I have to repair almost every relationship I treasure from the betrayal of my weakness, a chore I will perform with as much love and patience as I can muster. I may never practice my specialty again, but I am alive. My family has a husband, father, son, and brother.

My wife once asked how we do it in the ER, to be there for everybody’s worst day and also for their best. My worst day was almost my last. Funny thing is I was as happy as I had ever been in my personal life. My decision to end it all was 100% work-related.

Pamela Wible MD Suicide Quote ED Doc

I had just lost a young girl in the ER a few weeks before. Influenza. I followed proper protocol, gave her a couple of treatments and she felt better so I discharged her home with appropriate warnings. Thirty hours later she came back, in respiratory arrest. She ended up on life support with family refusing to withdraw care. They, of course, blamed me. And, of course, complained.

My review was days later. While my employers were very sorry about the case and stated support for me, the result would likely lead to termination due to this incident and a few other cases that were trivial. I thanked them for their honesty. At first my wife and I talked about it, and I was fine. I could likely go back full time where I used to work. I returned to work that night sad, but comfortable with my likely outcome. When I got home in the early morning hours I was just sad. I cried for the girl and her family. I cried myself to sleep and woke up still sad.

There’s a saying we have in the emergency room when we witness trauma and death among the innocent: “A little piece of my soul died.” We’re never offered counseling and in the end you get the jaded emergency doctor who struggles to care. My psychologist says it wasn’t just the last girl. It was trauma after trauma after trauma.

PamelaWibleMD-DoctorSuicideQuote

Pretty sure I have PTSD from the Haiti rescue and recovery trip. From bloated bodies liquifying in the heat to starving kids begging in the street. Years later, walking into a Mexican hotel with similar tiles and stucco walls, I was overwhelmed by the smell of rotting flesh. Other times when opening a large perirectal abscess, I could smell dead bodies.

Tip of the iceberg. Horrible cases. A drug-related killing where a kid was bludgeoned to death with a baseball bat. Barely alive when his druggy friends dropped him in the ambulance bay. Child shot through the head when crack addict mom didn’t pay up. I had to assist taking clothes off siblings to obtain as evidence since they were covered in blood and brains. Shootings. Stabbings. We do this every day.

Yet I’ve never been depressed per se and never suicidal. I just snapped.

PamelaWibleMDDocSuicideQuote

Sitting alone with my grief, I grabbed what I needed and drove up to the mountains. I thought my wife would be better off without me. I texted: “I’m so sorry. You deserve better. I have tried to be strong. I can’t take it any more. To have that girl die was too much. To have to face being terminated for it? I can’t go on. I’m sorry. I love you to the end of the world and back but after one final hurt, I can finally stop hurting you. You have your family and church to help you and you have your finances taken care of.”

I took a handful of pills with the final thoughts that my student loan debt would not pass on to my wife and at least she has my life insurance to take care of her. Then came the police cars. I don’t know why, except not wanting to talk to them or face my wife, I continued driving. I obeyed all traffic laws, never exceeded 22 mph and in no way endangered pedestrians or other motorists. At one point I pulled to the side, and multiple officers took cover and aimed guns at me. They wanted to know if I had guns, and I told them that they were in the vehicle and they could have them. I kept my hands visible as directed but refused to exit the truck because I did not want to talk to them. Ultimately, I was thrown from the truck, tasered, cuffed, and put in the back of a police car.

I requested to go to the hospital. I was surprised that they took me to jail. Seemed weird because I thought all suicidal people came to the hospital first. I started to get sick from the overdose. Sweating and nauseated and a little unstable on my feet. They had me sit in a holding cell in the booking area, and that’s the last I remember.

Of the next four days I have almost no memory. I am told I went into respiratory then cardiac arrest in the jail and they started CPR. I was finally transported to the hospital, where they got a pulse back. I was critically ill on ventilator support. My family was told I was going to die. Then my sweet daughter found what I took, and the appropriate meds were given. I improved. Couple days later I was off the vent and out of the ICU.

Almost every day, since that worst day, my wife just looks at me and repeats “I can’t believe it even happened!” The people I’ve told about this are utterly shocked. I have spoken with a few residents I used to teach and they can’t believe it. I can’t either. Could happen to any doctor. Seemingly without warning.

Nobody would have ever guessed this would happen to me.

I, however, have the residual aches and pains to prove it happened. As we try to heal, I spend my time reading scriptures, praying, and trying to get some level of fitness back (you might be surprised how hard a few days on life support can be on your body, not to mention chest compressions).

I am not sure of my return to the ER. Those few shifts worked after the girl died were awful. I was very unsure about everything. I could not make a decision on patients. If you can’t discharge a young patient with the flu, who can you discharge? Even though I did everything right, I still have trouble sleeping. I mourn for that family. Emergency medicine once defined me. I loved going to work every day. I think at one point I was a good doc who cared about his patients. Now I am just very anxious even thinking about going back to work.

Still, I’m trying to make sense of this. I’m certain of one thing—the Lord saved me for a reason! I am just horrified as I read through my chart of how very close I came (pH of 7.1, lactic acid of 15, heart failure, renal failure, elevated cardiac enzymes, and rhabdomyolysis).

Thank you again for all you do to educate and advocate for those that did not make it, and for helping to prevent even more suicides. Of course you can do anything you want with the story. I don’t want the attention drawn to me specifically, but I hope it can reach someone before it is too late. ~ Michael

PamelaWibleMD-SuicideQuote

Pamela Wible, M.D., reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered. Need help? Contact Dr. Wible. Want to love medicine again? Join out upcoming teleseminar

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128 comments on “Doctor revived after suicide. Here’s what he says.
  1. Amanda says:

    Very kind to share your experience and remind all of us in the trenches, the s*%$ we see builds up. Our medical culture wrings its’ hands and thinks we are weak, and we feel shame. For my “burn out” I have gone into locums so I can decide when and where to work. No Level I for me. And if the situation is dangerous, understaffed etc, I move on. I am intolerant of the unrealistic situations and expectations. It took a lot of therapy to get there.

    • Pamela Wible MD says:

      Glad to see you put “burnout” in quotes. “Burnout” is a smokescreen for human rights violations. I’ve been writing about the dangers of using the terms of our oppressors for years. See my blog category called: Physician “burnout”

      • Andy Walker says:

        You area absolutely right. As I have written, “Burnout is the normal response when a good emergency physician is put in a malfunctioning ED that he is not allowed to change.” It is also the normal response to repeated injustice, and this physician was clearly treated unfairly when he was fired for an unforeseeable death.

        • Loice A. Swisher says:

          I believe a physician have a variety of different variety of dysphoric conditions all at one time. “Burnout” is only one but is getting quite a bit of press these days. PTSD, compassion fatigue, depression, litigation stress, workplace violence issues as well as others. My thoughts on this colleague is that he is acutely suffering from Second Victim Syndrome. Many places are addressing the “second victims” with peer to peer support programs and have been working towards Just Culture. Since the unexpected, bad outcome is likely to continue forever (since we are human) these organizations developments may make a big different in similar situations.

      • It’s ironically sad that when see a doctor who has symptoms such as intrusive thoughts, feelings of detachment and avoidance, behavioral arousal, hyper vigilance, etc. We say she’s “burned out”. But when we see those same symptoms in, say, a combat veteran or trauma survivor we’re quick to diagnose (or at least suspect) PTSD. Why the different treatment? It’s frustrating and heart-breaking!

    • Pamela Wible MD says:

      “Burnout” is a complete mental and physical collapse from overwork. Psychiatrists define it as a job-related dysphoria in an individual without major psychopathy. Which means—your job sucks. You’re normal

      Smokescreen is an artificial cloud of smoke that hides the perpetrator’s true intentions. This cloud of smoke may take the form of a statement or word used to obscure the truth so victims don’t understand what the heck is really going on. For example, apply the victim-blaming term “burnout” to deflect attention from oppressors who are guilty of human rights violations.

      Read more about “burnout” here.

  2. martina Nicholson says:

    THANKS for telling this story. I hope many at-risk docs will read it. I wish I could believe it would change the way we practice medicine, and maybe over the next generation, it will. But not quickly, not easily. It will require the courage of each doctor to start saying “NO”, to backing down, to learning about emotional abuse and applying the priniciples to our own lives. It is so easy to justify being special and different, where the same events do not cause the same outcome. Please mention “HALT”— hungry, angry, lonely, tired”. These are limits doctors are trained to not notice, routinely overcome. They are the first line of defense. Help make the committees in your hospital for physician well-being REAL. Talk about vulnerability. Talk about exhaustion. Talk about PTSD. THANK YOU.

    • Pamela Wible MD says:

      Funny you should mention learning how to say NO as I have a blog coming later this week called: “How to say NO (for people pleasers).” Look for it.

  3. The poor doc said it: trauma after trauma after trauma.

    Dr. Bernie Segal, cancer surgeon and writer, says that all of us docs have PTSD because of trauma after trauma after trauma.

    • Gail Gustafson, RN BSN LNC says:

      So do nurses. We spend more time at the bedside with the pts and family. It’s heartbreaking and stressful as hell.

      • okiern says:

        I spent 43 years of my life nursing. I’ve seen it all. This altruistic profession can be so unkind and cruel. It all started in nursing school and continued til I retired. The politics of the employers is unbelievable. I am writing a book for my kids and grandkids about my career. When asked what they wanted to be, both my girls said “NOT a nurse!” They only caught half of what was really going on, so I want them to know what I really went through to earn a living for them. And yes, I was suicidal several times, but dealt with it on my own.

  4. Jo Post says:

    You are so brave to tell your story! Hugs! I hope your heart and body will heal completely….please try to focus on the lives you saved, not on the ones you were unable to save!

  5. Esther Wright says:

    I am so sad to hear your story and I can imagine the struggle to deal with the situations you described. If you have a kind heart and generous spirit, these kinds of experiences would indeed kill your soul. I pray that you will recover and find a way to serve others without destroying yourself. Blessings and much love and healing are sent your way.

  6. Noelle says:

    Dr. Wible – My father was a Deputy Coroner when I was only little. I toured around town in the 80’s perched on the middle consul of the body van. I saw my brave and steady dad up into the wee hours recovering from various traumas and coping with the sadness that his profession saddled him with.
    My brother is a doctor and he is literally running from room to room trying to manage his ridiculous patient load with his core commitment to providing quality care.
    You can imagine – your talk struck home with me immediately.
    Without fail, each time I hear a patient complain about the “poor care” they’ve received by a doctor or emergency worker, I remind them of the absurd expectations these professionals – these people – perform under.
    The conversation certainly must be had with medical schools and hospital administrators. Patients must be brought into this conversation as well. We, as patients, must exercise compassion and contribute to the solution.

    Thank you for your important work to improve the lives of our medical professionals.

    • Pamela Wible MD says:

      Wow. So you have been in the thick of this culture since your childhood. Intense. I hope your brother gets psychological support and I wonder if your dad ever reached out for help. Is he still alive? I think medicine took a toll on my dad when he was in private practice. Then he did pathology. I think he preferred caring for the dead. A calmer and less demanding patient population. Here’s a eulogy for my dad that summarizes our adventures through the morgue in my childhood (you may be able to relate): http://www.idealmedicalcare.org/blog/eulogy-to-my-father-dr-theodore-krouse/

  7. Hayley says:

    I’m sorry this happened to you. On a side note, if you overdose and commit suicide your wife doesn’t get to collect life insurance

    • Nancy says:

      Not true…….not all life insurance policies have that stipulation and most that do it is only if the suicide takes place in the first two years after taking the policy out.

      • Pamela Wible MD says:

        Yes. I have heard both sides on this and I’ve been curious the truth on life insurance. Do all student loans just disappear after death of the med student/doc? Would they ever get passed on to family members?

        • Angela Laster says:

          Traditional student loans are the sole responsibility of the one who took them out so they are not passed on to your survivors. Exceptions are if you reconsolidate into another vehicle with spouse as a guarantor.

        • Pamela Wible MD says:

          Per Nancy some additional info: Student loans are only in the student’s name so that is the responsibility of only that person. Some creditors try to come after the estate of the deceased, checking to see what is in bank accounts or other assets the person may have in their name. Life insurance is something creditors cannot touch, the beneficiary of the policy does NOT have any obligation to pay any bills from the money that was left to them. Creditors will continue to send bills and then turn in over to a collection agency, but the people left behind do not have to pay. If the deceased had everything in their own name and nothing of great value there does not even have to be an administrator or an estate. That also means that if the deceased was single and had no children when they passed, and had a house with a mortgage or a car with remaining payments, the relatives usually don’t have a right to sell or keep those things, the vehicle would be taken back by the finance company and the house would go into foreclosure. Some banks may offer to turn the loan over to a relative if they qualify for it, but they are not obligated to pay the outstanding debts. The only way someone would be liable for a bill is if they cosigned or it was purchased in both names. Does this make sense? I am not sure if this applies to all states, but I can’t imagine why it wouldn’t.

    • susan says:

      Depends on the policy and when it was purchased.

  8. Sana says:

    Physicians or any healthcare professionals shouldn’t have to work long shifts. They say if you chose medicine as your career, you will be married to medicine first and your personal life and family are second. I worked in the ER and after a while if you don’t grow a thick skin and become numb to others pain, you can’t function. You really have to. Long hours, lack of sleep, seeing trauma on regular bases takes it toll on people. It happened to me. I changed my jobs. But the memories of people dying in my hands are still fresh. Even when you try to forget some things, they don’t disappear.
    I just wish healthcare was cheaper for medical professionals and mental health was made a priority. A mental analysis and counseling should be made available for free.

    • Pamela Wible MD says:

      “A mental analysis and counseling should be made available for free.” Agree 100% and should be on-the-job support accessible at all times in hospitals. We already have chaplains, social workers and all manner of help we can call for patients. Why not for each other? Culture change required. Michael’s letter has led to a long-overdue conversation. And some inspiring solutions that I hope the ED DOCS reading this will post. I don’t want to give it all away, but a group of ED DOCS on Facebook has spearheaded an amazing support group as a result of this article. More to come on that . . .

  9. Katy says:

    My heart goes out to this doctor! I had colon cancer then. Y colon burst.i was on a ventilator for almost 3 months! The thing I hated most was the feeding tube in my nose. I liked the ventilator, it would hiss and it helped me sleep.The thing I learned is that God called us home when He wants us. Love and healing to him and his loved ones!

  10. This is so sad, and highlights what is wrong with our medical system. I believe that the medical malpractice is harming us all. Bad outcomes are considered the fault of the doctor who must deal with sadness and often false accusations. It wears us down and makes us practice defensively.

    I believe that a solution lies in combining real charity with the state protecting doctors who volunteer. NJ S239 is a bill that would have physicians donate 4 hours per week in a non-government free clinic in exchange for medical malpractice protection in their private practices.

    A plaintiff would have to sue the state. Volunteering doctors would be heroes again and would be thanked instead of always second-guessed. And it would bring charity back to the communities where it belongs.

  11. It’s hard to see how medicine can recover from it’s decline. Conditions are intolerable, non-physicians are apathetic or overtly hostile. The process of replacement (by PA’s, NP’s and other low-cost substitutes) has been ongoing for decades. It is accelerating, and in 30 years it will be complete. I hope that this physician is able to find something creative and meaningful to do with his life and doesn’t return to the toxic hell that almost finished him.

  12. You are one amazing young man and as you recover you will become ONE OF THE BEST. There is nothing like experience to bring out the best in us. You are here for many reasons, your beautiful family, your colleagues and friends and the rest of the world to try and make sense of some of the absolutely out of context occurrances especially in the medicine, nursing and midwifery. Most of us prefer prevention, sometimes we have to deal with the illness and for that reason we are the salt of Mother Earth and you are a Leader. Thank you for sharing your story and I look forward to hearing wonderful things as you recover and re establish yourself into the future. Warm wishes.

  13. Helen Willoughby says:

    Dear Doctor,
    So very human,so very compassionate,empathetic & normal! We all have seen suffering & injustice in these medical roles,but emergency medicine must be the worst,& not having complete support from your peers just unrealistic,as well as unworkable. Yes,I remember a young girl with a fever whom I sent to hospital,while letting the Mum know that she may well curse me,only to have that girl finally get her meningococcal diagnosis after the rash appeared,& the Mum had complained to me for sending them there. Just luck. Lean on all the people you need to,while you regain some emotional strength. All of us docs dread such cases as your young girl with flu.

  14. Fish says:

    Thank you for sharing this. I’m a doctor in the UK, where at least our hours are shorter and our student loans a little smaller. I originally started training in Emergency Med but I got to the point where I hated my job, dreaded every shift and lived in constant fear of missing something with catastrophic consequences for both my patient and my career. Quite early on I had a patient kill themselves in the department while the curtains were drawn despite clearly denying suicidal intent when asked. I did my best in that case but the legal fallout was very unpleasant and left me fearing for my safety (the family very much blamed me). I’m not sure that I ever really got over that case but 7 years ago I started training in anaesthesia (anesthesiology) instead and it’s the best decision I ever made. I went back to loving my job and I’ll finish my training soon (7 years in the UK, partly because we’ve stopped trying to kill our young doctors with crazy hours).

    Emergency Med is utterly brutal. I still find it interesting but the psychological improvement that came with switching to anaesthesia (a well travelled path, at least in this country) has been enormous.

    • Pamela Wible MD says:

      Might be a worthy goal to study the health implications of various specialties. Ya know, along the lines of informed consent for potential applicants.

  15. Anne Sharpe says:

    I understand. I’m sorry for what you’ve gone through but excited to hear about your honesty and growing relationship to God. I am appalled at the world of medicine, and once respected Dr’s are degraded to losing their job for doing everything right but losing a pt. Hospitals – Shame on them! To be a true healing physician you feel the triumphs and the tragedies. You give it your all! The system is defective now. It used to be we were allowed to be human. I pray evert person in the medical field be allowed to be human. God bless you for sharing and going on.

  16. dave says:

    Doc, thanks for sharing this! I am a retired soldier and have PTSD. Much of what you described mirrors the experience that I have had. I never hit the point of trying to commit suicide but too many of my brothers and sisters have. Lucky for me my best friend and wife had the courage to tell me that I needed to get help. For me the stigma associated with getting help was the obstacle I couldn’t overcome. I was amazed at how easy it was once I did get help. I hope more people from many difficult occupations read this and get help before they hit the wall and make the decision that can’t be reversed. God bless you!

    • Pamela Wible MD says:

      Dave, do you feel this is a uniquely male issue? Asking for help seems to be much easier for women. In medicine, for each women we lose to suicide, we lose SEVEN male docs (though the profession is 2/3 male the numbers are still skewed). I have a theory that men in police, fire, medicine, and military all have more of a hurdle to overcome in asking for help. Your thoughts appreciated.

  17. Autumn R. says:

    I too can relate to this on some level as an emergency room nurse for over 17 years I have seen medicine change drastically from doctors who really practice medicine to now doctors who conform to the political stringent arena of what patient satisfaction scores dictate they must do in order to have their scores up. In the emergency room the stress is unbelievable and constant and it is truly and adapt or die mentality unfortunately I have learned to adapt I don’t know if that is good or bad. As you learn to how to compartmentalize every trauma you see dead baby goes in this box 14-year-old suicide goes in that box young man who hung himself in another box and it goes on and on from the young to the old each one gets their own box so that you can shut the lid and forget however their faces pop up in my mind every day I allow it to flash and then close the lid otherwise you cannot function and cannot give the next patient trauma or the next emergency your full attention such is the life of the ER doctor and ER nurse.

    • Pamela Wible MD says:

      Oh Autumn, have you ever received therapy for any of this? Is there a support group among ER nurses that could be formed? We must do something about this. I don’t know the suicide stats among ED staff in general. It’s not just the docs who are in pain. I would assume many are living with PTSD and suffering in silence. Unacceptable. We must help one another. What do you imagine could be done at your hospital?

    • Taz says:

      Hi Autumn, I know exactly of what you speak and can empathize. I have been practicing ER medicine for nearly 22 years. I did adapt…for awhile. I was not happy; therefore, I made a decision to work part-time. Then I took some advice my father gave me when I was having difficulty with my department chair while in the U.S. Army. He said, “You cannot control what others do. They will do what they do. Do what you do best and take care of your patients. Everything else is secondary.” I have been following this advice ever since. I pay no attention to patient scores because I get no complaints, my patients are very happy. My conflict is with colleagues, nursing staff and departmental leadership because I do not conform to the business of medicine. It is not a comfortable position to be in, but I had to make a choice. The status quo or my patients. I chose the latter. I am a true clinician and proud of it.

  18. Pamela Wible MD says:

    Great news just shared with me from an emergency doctor:

    I discovered that someone in the Facebook Group EM Docs posted your blog 12 hours ago… It has resulted in the following spontaneous formation in the Social Media Emergency Physician Lounge – called “EMDOC needs to Talk”

    Check out what your blog has accomplished.

    *EMDOC needs to talk*
    Safety Net/lifeline!!

    OK, time to step up our game to support one another. From today forward if you need to vent privately – bad case, stressed about unrealistic expectations, lawsuit, family struggles, etc

    WE ARE THE SAFETY NET for ONE ANOTHER!!

    just type
    *EMDOC needs to talk*

    for those off that day (or awake in the middle of the night) just reply:
    *PM me*

    then share phone numbers by PM and call each other!!

    We can’t lose good EM physicians to suicide!!!! Even the strongest among us get widdled away…

    Talk to each other and heal the little aches before they become big one!! Then meet up face to face at national gatherings!! You just may find that helping your colleague (EMDOC brothers and sisters) through a tough situation is actually healing TO YOU since you have likely felt that same sting at some point!!

    Please bump or comment if you are willing to be a lifeline for a colleague!!

  19. Pamela,
    Has there been a rise in physician suicide over the last 10-20 years? Doctors have been taking it on the chin for at least that long. What has been the toll of higher patient volume with less and less time per patient, flat or declining payment, loss of autonomy, massive debt, and on and on?
    Maybe the answer is to get off the treadmill and open a direct pay practice. Spend as much time as you need with each patient, and set up a fair fee schedule. The many doctors I’ve met over the years who have gone this route have rediscovered the joys of true medicine, and have a more balanced life.
    Something to consider. It can’t all be about the training, which in many ways is more humane than it was in the past.

    • Pamela Wible MD says:

      Docs need to be more autonomous and to work human schedules with emotional support and free time to recover. One way to take back one’s career is to be self-employed. I opened my ideal clinic 12 years ago and I’ve never been happier. Here’s a free guide to launching your ideal clinic for anyone in outpatient medicine wants to find ultimate fulfillment.

  20. Karen says:

    A similar thing occurred to a fellow resident a couple years after graduation. He worked in the ER and snapped a few days after the horrific death of a young patient (not his fault). But instead of trying to kill himself, he went home after shift and killed his wife. When the police came and he realized what he had done, then he tried to kill himself. He’s now in jail for life. They were both the kindest people. Such a shame.

  21. AQ says:

    Thank you for sharing…I give talks to the PA profession on ‘second victim’ (a healthcare professional that experiences the trauma of a medical error or poor patient outcome).

    I wish we could all support each more, nurses, PAs, NPs, pharmacists, and docs. The system actually encourages us to throw each other under the bus and find someone to blame.. we are all stronger together..

    • Pamela Wible MD says:

      Thank you for helping heal the healers. So many are wounded. We must reach out to veterinarians and others who are suffering as well. Not just ED docs, nurses too . . . EMTs. Thanks for helping PAs!

  22. Taz says:

    Interesting…what he refers to as a “weakness” I view as being human. Every human being has a saturation point, including doctors. With his experiences in Haiti and Mexico; let alone what he experiences during each shift as an ED doc, it is no wonder he reached his. It is unfortunate that his employer chose to terminate him, especially after voicing support for him. Makes no sense. Physicians are tools God uses to intervene medically to treat disease, heal or prolong life–if possible. However, we are not God and people do die. If one does everything he can to provide the best care possible and meets all standards of care, then there is nothing else left to do. Therefore, there is nothing to feel guilty about. Of course the family will blame someone, it is only natural when they lose someone they love. However, we do not have to accept that blame. His employers betrayed him. They did not remain loyal nor did they stand behind him; all in the interest of being politically correct. Therefore, their words of support are meaningless.

    If I could send him one message, I would tell him, “Do not apologize for being human. It is not a weakness to express dismay at the loss of a patient. It is a strength.” Of course, suicide is never the answer.

    In college I worked as a Pathology assistant at the county coroner’s office. We had a saying: “If one is thinking of committing suicide, he has already hit rock bottom. There is no where to go but up.” If those in the depths of despair understood this, they would understand that things do indeed get better.

  23. Pamela Wible MD says:

    Just a plea that we not use the term “committed” suicide. http://www.idealmedicalcare.org/blog/7-shaming-words-stop-saying-now/

    Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark ages and use proper language to discuss the cause of death. It’s died OF pneumonia, heart attack, stroke, suicide. Say died OF suicide (or died BY suicide).

  24. Joanne Holland says:

    The problem is that medicine is a managed by as a profit making system by corporate interests which are required by federal law to have as their first goal increased income to their stockholders. This is a logic problem. How do you maximize the profit on sick people? Well, you take the money, and also ask the sick people to cough up some for their care, and then make a system that almost but not quite cures them so they return repeatedly. The system also has to use someone else for the fall guy when they die. That is where the physician comes in.
    Pam, you are right that having your own practice allows you and others to avoid that trap. I believe we physicians should go farther and advocate actively to get corporate profit out of medicine. The rest of the Western World has figured this out. This is a political problem and both parties in our American system are at fault here.
    If you want a detailed analysis of the moral dilemma created by limited medical resources and conflicts of the business of medicine vs the vocation of medicine, read the George Bernard Shaw play and preface “The Doctors Dilemma” (1909) Then mull over how long it has taken the United States to catch up with Europe on this issue.

    • Pamela Wible MD says:

      Oh Joanne, it’s wonderful to hear from you! I always love your wisdom and insight on medicine. I so agree with you!

  25. PARACKAL OOMMEN THOMAS. says:

    EVEN IF EVERYTHING IS GREAT FOR A PERSON
    IF THE GOD ELEMENT IS NOT IN ONE”S MIND
    AND HEART ANYBODY CAN SNAP.

    THIS ASPECT OF SPIRUALITY – CALL IT BY THE
    name of any RELIGION – it does not matter
    is a basic element in one remaining a
    normal human being.

    DOCTORS ARE HUMAN BEINGS AND AS SUCH VULNERABLE
    TO all faults.

  26. I love this piece! Thank you for shinning your light. I am a Nurse Practitioner and I must admit Nursing school was a hazing to me. One of the worse things I had ever been through next to witnessing my mothers murder. It was that brutal! Belittling, humiliation, being treated as a child, told I wasn’t capable of higher education, constant threat of being a failure and/ or killing a patient. The list goes on. I am sad to hear this and even more occurs to med students. Had no idea it was so similar. I do pray one day mental health is taken seriously and not used as a ridiculing tactic. That’s for us and our patients alike.

    I am very interested in your concept of proving an environment that harbors happy patients thus happy providers. This is something to investigate. No one wasn’t to spend all this time and money for their profession/ degree and have to abandon ship or start all over because of the working conditions.

    Thank you for all that you do.

    • Pamela Wible MD says:

      Victoria!! Oh no . . . nursing school was the worst thing you ever went through next to witnessing your mother’s murder. Oh do we need to revamp our fear-based training tactics. I would love to speak to you. Please consider (if you want to have a ton of fun) opening your own little clinic. I can walk you through all the steps. Contact me here and I will send you several inspiring things to get you started: http://www.idealmedicalcare.org/contact.php

  27. Emergency Physician, MD says:

    Dear Michael, Thank you for sharing your story with us. And thanks to Dr. Wible for providing this discussion forum. My first exposure to this type of ongoing tragedy was losing a beloved classmate to suicide in medical school 20 years ago. I am also a work-distress-related suicide survivor. Last month, one of my friends and EM colleagues was not so fortunate (dead at age 59). Over the course of my career, I have personally known (or learned of) numerous other physician suicide contemplaters, survivors, and completers. I applaud your (our) efforts to find new ways to support one another and avoid risking more physician lives from suffering in silence. Helping to initiate peer-to-peer counseling relationships through social media outreach is a brilliant idea, IMHO. Kudos to Dr. Kay Moody! Now, if we could only find a way to prevent medical licensing boards from publicly suspending, investigating, and sanctioning physicians whom they discover have sought professional help for symptoms of depression, “burnout”, and other “mental illnesses”…perhaps more of us would be able to actually get effective help. I do not feel that I can risk signing my real name here, because MY state medical licensing board publicly disciplines suicide survivors. I sincerely hope that Michael’s state board doesn’t find out his identity.

    • Pamela Wible MD says:

      There are too many state medical boards that publicly discipline and shame suicide survivors. I get quarterly lists in my mailbox of all the docs who are in trouble. And then some are mandated to AA-style PHP program ill-equipped to deal with mental health issues. Don’t get me started. I have too much to say on the punitive environment of our current physician “safety net.”

  28. Roxana says:

    Thank you for sharing your story! It takes lots of courage, a caring heart and a bright soul to do so. May you heal, rejoin and love life again! Everything happens for a reason… We may have to go thru the suffering to see it. Although I have never worked in an ER, as a nurse practitioner, I too can relate to the feeling of being used and abused, overworked and underpaid. I have never crashed so hard but I too said “enough is enough” and left a negative work environment just last month. We all need time to heal. Someone once said “heal the healer”. How can we heal others when we are so wounded? “The wound is the place where the Light enters you”(J. Rumi). I pray the light will guide us all.

  29. Dale Howard says:

    Your value is in what you know and even more so because you survived. Had you died what of the doctors who rendered aid to you. Would your condition have thrown them over the edge? A vicious circle of affairs only best depicted on “The Twilight Zone”. As you stated perhaps returning to the ER especially if procedures conjure up past experiences that bring up negative memories is not suited to you. However, there are other occupations where your training and education can serve others and help you re-establish your self worth.

  30. Amber says:

    I am not a physician, but a nurse who works at a fast paced office. Just 2 weeks ago when I left work all I could think about was ending it all because I was so burnt out and was getting no support from my employer. It is a very hard field to work in and so often we don’t take care of ourselves and each other enough.

  31. Heather says:

    I am a psychiatric NP who has treated people from all walks of life – even physicians. In my observation, there is a culture of “bravado” in medicine. This is whereby we think that our training and experience somehow allows us to rise above the suffering that we see and become emotionally detached. The reality is that the repeated trauma, the long hours, and pressure to see “just one more” only eats away at our soul, making us vulnerable to psychological and physical symptoms. No easy answers to fix the problem. I cope by getting outside, regular exercise, a vegan diet, no alcohol, and prayer and devotions.

    • Pamela Wible MD says:

      “I cope by getting outside, regular exercise, a vegan diet, no alcohol, and prayer and devotions.” Exactly what I do. Plus chocolate helps at times.

  32. TerryLynne Ramsey says:

    I am so glad God spared this doctors life. I am a mental health nurse and it’s a difficult job. People judge and shouldn’t. I so hope he continues his walk with the Lord and someone points him to Celebrate Recovery. It’s not just for drug and alcohol issues it’s so much more. I pray for his healing.

  33. On Behalf Of Veterinarian says:

    I was pushed to the brink during my rotating internship in small animal surgery and emergency medicine. In the vet med field, this or a similar kind of internship is generally required before going on into specialty field internships and residencies. Everyone knows that the internship year is rough – but hope to land somewhere where this reality is offset by good mentorship with a built in support system. My internship was in a highly respected institution (I was excited when I matched there), but the hours and extreme mental fatigue from day one left me in tears that continued for months (I am not one, historically, that cries easily). I was scheduled for 118 hour overnight work weeks every month (they were always longer than that – phone calls, paperwork, etc), and was required to start that hell with a 24 hour shift. Often, I was the sole doctor during those shifts. Euthanasia after euthanasia, angry owners seeking free care and accusing me of not loving animals for being unable to provide it. The 2.5 days I was guaranteed off a month were at the end of those weeks, and were used to right my hours back to days (slept through). Sometimes if I was on easier rotations, I would have a weekend day or two off – but that was never a guarantee. My fellow interns experienced the same.

    I understand the extreme emotional distress that comes from doing everything right, but having a poor outcome anyway. The buck stops at you, and many still blame you. Sometimes you blame you. By the end of that internship I didn’t want to see, be spoken to, or speak to anyone about their pets ever again. Compassion fatigue set in. With time, that feeling has faded as I have moved on into a specialty I am suited for.

    I’m glad that you’re still with us, and I’m sorry for your distress. I hope you come to realize that even if you do not return to the ER, you have immense value – whether that be teaching, motivational speaking, etc. in your professional life. You matter. And for many, you have altered their lives in a positive manner. Simply speaking out about this experience shows character and bravery. Hold on.

    • Pamela Wible MD says:

      So what field did you finally settle in? How did you recover? Did you seek therapy? Do veterinarians have to complete job applications with mental health questions? Just curious. Glad you made it. Medical training and practice needs to be humanized. Your “training” experience should have been illegal. Somehow labor laws just don’t seem to apply to medical professionals. Just absurd.

  34. Cheryl says:

    I’m sorry he has to join those of us who have been affected work-related mental health issues as physicians. Recovery is a slow, lonely road.

  35. Oh Pamela, thank you for sharing!! I have chills reading this. My heart breaks for this doctor, for all of us experiencing what we do in what we thought was (IS) a healing profession and yet too often is a compilation of traumatic experiences, some of which are the passing, almost subtle messages from your boss (or patients) that you’re not measuring up, and some of which are these life-altering moments which break you. Doctors are human, too. How hard is that to understand? We all need the time and space to safely process, grieve, heal, and grow. Yet martyrdom is still rewarded above true resilience in our profession. We must–and we will–change this, for our future doctors, for our patients, for ourselves.

    • Pamela Wible MD says:

      You are a beacon of hope for us all Lissa. So thrilled to help you launch your dream clinic in a few months! We can all inspire each other by simply practicing in alignment with our highest values, reaching out to help the still-injured healers among us, and remembering to always ask for help when we need it. You are loved. <3

  36. True Mcmahan says:

    So my question is: can we introduce a bill or do ANYTHING that will stop the nonsense of “patient satisfaction” in an ED visit??? This could nclude yelp reviews and google and CMS metrics and on and on…I can’t take another complaint when I work so hard, care so much, forget my aches/pains/hunger/bladder and get…”the doctor didn’t explain…” when they thought I was the nurse (yes I’m a petite Asian female) or when I’ve explained until I’m out of patience and they ask to explain it again. I’m also the director of my group, and I love my job and I love my patients and my team…but I am so tired of the sniveling nit picky imperfections that get magnified and glorified to shock level sensationalism! Trolling by regular people!

  37. Linda Godowsky-Bilka says:

    Thank you for your courage to share what you experienced. You have opened my eyes. They have been closed to long. God speed.

  38. Kate says:

    Such an important message to share. I am an ER nurse and I feel your pain and you are not alone. We are not given adequate debriefing after events. We are overworked and expected to move on to the next patient without blinking. There is no time for grief. Weakness is not tolerated. I’m so sorry for what you have been through.

  39. Rose says:

    As a veteran nurse and a 20 year ER nurse I’d like to say this affects all staff. The doctor is ultimately responsible for the discharge or admission decision but we see it all too. As a 30 year nurse I have the confidence to lovingly talk with the physician if I disagree with their decisions. My doctors know me and trust me and will listen to what I have to say. I’m a strong nurse and I hear their challenges and listen to them. We all need an ear at times. Let’s not forget all staff.

    • Pamela Wible MD says:

      All staff included in expanded podcast discussion of article. Please listen to link after first paragraph or download MP3.

  40. I am profoundly moved by the deep,deep pain you are in, asking myself,”How did/do we allow doctors to be so isolated,driven to despair, without any emotional support in the face of the overwhelming trauma they deal with day after day after day?”

    Thank you for your courage in writing about your experiences. You have touched my heart; I am sending you love, peace, gratitude, and the energy of healing. May you recover to be the good physician you are.

  41. Linda Skalsky, ARNP, PMHNP-BC says:

    I am surprised you limit this to physicians only. The stress on other medical professionals is high too. The injustices also apply to the overworked and understaffed nurses. Great article on a very real problem. It sounds like those police officers need to take Mental Health First Aid. This program has helped our local law enforcement officials more effectively handle cases like this one.

  42. Susan, RN says:

    I am an Associate Degree R.N. I too have contemplated suicide. Just Thursday I was asked to resign from my position as school nurse supervisor because of an incident that I feel I wasn’t responsible for. There are several factors including the parent, the teacher, another nurse and a lack of orientation to a new job. But because I was present and because of the RN after my name, I no longer have a job. I did my best. I did the right thing. Or so I thought. Maybe I should have lied. I worked in the ER 20 years prior to this job. I left it and hospital work because of the fog and ensuing PTSD. And it continues

  43. Judy Posner says:

    Gut wrenching. How courageous that Michael would write and share such a transparent look into his soul. He didn’t mention that he is receiving counseling, but I hope this is the case. Prayers for his return to total wellness. Perhaps it’s time for someone else to do ER duty and minister to those hit by catastrophes. He almost gave his all. He should be proud of all he’s done. Time to walk away and heal.

  44. Melissa says:

    It’s not only Dr’s we need to worry about in healthcare. RN’s, CNA’s, MA’s who have the most contact with PTs are having side effects from stress, overload on PT load where they can’t even do their jobs. Abuse from PTs and seeing trauma,being abused by PTs. I know first hand because I was a CNA on surgical floor until my brain said enough. I struggle now with conversion disorder. After a year of therapy and Dr spots. I have lost my job, my license and have a pile of bills. It’s ok, at least I am still here. I am now on disability because of it. The stress and abuse in healthcare is unbelievable. Healthcare needs to address these issues.

  45. James M Larson says:

    Shocking though I shouldn’t be shocked.

    I wrote a Haiku years ago that was published in The Annals of Emergency Medicine.

    Haiku for the Caregiver

    Leaving the ER
    I feel like a glass vessel
    Full of unshed tears.

  46. Bele says:

    So where are all the ever present hospital admins while this is going on? Why are they not responsible for these heinous conditions? Time for doctors to make friends with attorneys.

    Also never call the police unless you’re ready to die and/or have the person you called them on die. Because the police will kill you today and make up an excuse tomorrow why you deserved it.

    I’d happily take a job following ER docs around and hugging them at appropriate intervals. 🙂

    • Pamela Wible MD says:

      “I’d happily take a job following ER docs around and hugging them at appropriate intervals” Please do. Anyone could go by their local ED and drop off a care package. Try it. Maybe ED docs need “HUG ME I’m an ED DOC” T-shirts. I’m sure this would be a hit at their national convention coming up this fall. Who’s in?

  47. Lidia Monye says:

    Dear Pamela, it is so strange to read and hear w what you said in sympathy with the collegue who at the time of a loss of girl patient could not continue to be a robot but was deeply upset on the loss and at same time on unfair judgement that was awaiting him.
    Everyone including doctors/nurses themselves are so used to think that these profesionals do not feel anything when loosing patients. It is generally thought they are used to it.
    I recently was involved in a resuscitation of an 81 year old female patient whom we lost.
    It is so deeply true that with each patient gone part of you is gone also.
    But the next day when I had to write a death certificate the relatives were astonished that I looked so sad.
    People do not see us as usual human beings. It is beleaved no matter what we are supposed to go on. We are seen as unbreakable.
    When we fall ill we feel guilty if we have to stay away from duty. The others, including the collegues, find it even funny that the doctor is sick.
    Sometimes, you wonder how you even cope living like this.
    But we do. We just continue living our lives lonely most of the time as others may find it difficult to undestand if you try to explain.
    We are actually never free of our patients. Even if we are back home from the hospital. Those thoughts that you could have done better in managing your patients never leave you. We go to bed with those thoughts and we wake up with them.
    Our world is rotating around patients. And our gratest happiness is not always that where our family is involved but most of the time it is that of our patients getting well, survived. Only then you loosen up a bit and briefly remember husband/wife, kids.
    Can a doctor even ever live happy life with his family? Here he is also constantly feeling guilty of not being able to be there for them.
    I am so deeply touched, Pamela, that there is someone out there to show sympathy to the medical professionals. This is unusual, strange, almost unreal.

    Dear Pamela,
    I thank you so much for your caring soul and words. I am deeply touched.

    • Pamela Wible MD says:

      Oh Lidia, it has been really a strange process for me to experience our dehumanized medical education system as an empath. I feel everything so deeply and to watch my classmates lose their ability to feel and go numb when forced to do things that are unethical or forced to move at a pace that does not allow them to process their pain. I knew that if I stopped crying I would potentially go numb and start losing my own soul. I cried my way through medical school especially when I was assigned to kill a dog in our “dog labs”: http://www.idealmedicalcare.org/blog/bambi-syndrome/ I was ultimately (after protesting and starting a petition) exempted from the horror of this physiology lab though I feel as if I have been carrying the injured souls of my classmates ever since.

  48. John says:

    the AMA is now, and has been an “industry” not a profession for healing or a calling to help the grow of healthy living,,,,,,,,,,,it’s about profit$$$$$$$$$$$$$$$$$$$ and profit and healthy living and HEALTH science are not compatible. It is that simple,,,,,,,the medical industry and all it encompasses are well over a Trillion dollar “industry” and “they” will never allow anything to get in the at way of those $$$$$$$$$’s

    • Pamela Wible MD says:

      Some of this is just the medical culture we have been groomed in. Stoic. Don’t ask for help. Self-neglect and self-abuse are prized values in medicine.

  49. D Wor says:

    I’m a firefighter paramedic. About a year ago we transported a 4 year old girl who had been beaten to death by her teenage brother. We “worked ” her for the 15 minute transport to the hospital, but they called her as soon as we arrived at the hospital. I can still feel her little head in my hands!

  50. Holly Danyliw says:

    Hi Doctor Michael.
    My name is Holly Danyliw. I wanted to thank you for being so brave and open enough to share your story. Believe it or not, it could save some lives.
    I know about wanting to take your own life. I tried when I was fifteen years old and failed too. Unfortunately….I do have Bipolar and suicidal ideations and I have for all of my adult life.
    I wanted to reach out to you to offer my listening skills and kind heart and ear if you ever want to talk about the feelings of a suicide attempt…or stressful feelings in general.
    Pamela has my email.
    Warmest wishes for your recovery,
    Sincerely, Holly

  51. Linda Mick says:

    I appreciate reading stories like this but I sure do wish that more people recognized pharmacists in all this. We see people after they are discharged from the ERs and clinics. They have been sick and poked, prodded, etc. They go ballistic on us and we have to just endure it as well. I am not suicidal either. But after a 6 year old patient died in my parking lot one day, basically because the insurance would take pay for the med and the parents refused to pay, I was having serious acute traumatic stress response. The only thing our corporation said (post autopsy) was, well, at least we won’t be liable. I was fortunate that an off duty paramedic was there to give compressions. I was trying to give rescue breaths but his throat was blocked. It was horrible. 10 minutes before I was trying everything to get their medication inexpensive enough that they would take it.

    And like you say it is the tip of the iceberg. Shrinking time, Long shifts without breaks, angry patients, ridiculous corporate metrics in place keep us hovering on the edge all day every day. All it almost took to push me over the edge was the death of that little boy while I just sat there helplessly trying to force air into his lungs. I don’t know own how ER docs deal with it all. I don’t know how we do either. I don’t know the answer, but I suspect corporate profit as primary motivator is not it.

    Thanks for being a very informative voice for very stressed professionals!

    • Pamela Wible MD says:

      OMG, “6 year old patient died in my parking lot one day, basically because the insurance would take pay for the med and the parents refused to pay” This is unreal.

  52. Maura Schulz says:

    I am glad you are alive. You were in a dark hole. You have a family who loves you and you are doing an exhausting job. ER? You are not bulletproof. PTSD kills and you are alive. Be gentle with yourself please.

  53. Pam Reither says:

    Having been a nurse for over 40 years, I have seen more than enough misery and death but the death of a child we had just seen the day before in the ER was almost the ruination of me, too. I can certainly feel the heart cry of Michael. Why is it, that medical personal are not offered counseling on these occasions or maybe just at some regular interval?

  54. Jim J says:

    Dear Pamela, I have the thought of suicide in my mind all the time. I am gutless because I can not find the strength to do it. I don’t want to leave my wife, children and grandchildren upset. But I suffer everyday. At 38 years old at the peek of my career I was making money supporting my family putting them through college without debt. I feel at work as a Supervisor for a Ironworking company in NYC and had major back surgery. It failed after trying to go back to work. Then in 2003 I had my first brain tumor with left me deaf and no balance some facial paralysis. I have dizziness headaches can’t be around large crowds and on my third brain tumor after a 11hr surgery for 1 and Gamma Knife for 2 now I don’t know what for 3. I try to stay Happy show no fear and live with all this I can’t walk far nor go to a large restaurant and think wouldn’t my wife at 58 yrs old be better off. No she needs me but does she? I live with this and it is horrible to think I will go to hell for killing myself oh how selfish right. But these are my thoughts and I try every day when I awake to open my eyes and see how do I feel. It is the same everyday. Terrible but yet I make breakfast and diners my own bread for my wife but i need to feel like a i am doing something that brings in some money but most of all makes me feel like I did something I made that I am successful and not just sucking hot air needlessly. I know its wrong but the feeling is there and I don’t want to feel that I am a doer I like a challenge but I am getting tired. Does That make sense?

  55. Jean Guarr says:

    I am shocked at the police response to your situation.

  56. Nicole says:

    Very insightful article.

  57. SandyF says:

    Burnout sucks. Thank you for sharing your story. It’s the harsh reality of our field.
    I am a nurse who vocalized about staffing and safety. From that moment on I had a bulls eye on my head. Now, a year later, I was fired. The last 3 weeks have been TERRIBLE. Agree…it is PTSD. I shake, don’t sleep, then sleep till noon, don’t leave the house, and put myself down in my mind wrongfully. It is difficult regrouping.I don’t even know if I want to stay in the medical field that I have succeeded and loved over the last 30 years. Your article came just at the right time. Thank you.

    • Pamela Wible MD says:

      It is a much deeper than “burnout.” These are serious human rights violations (lack of sleep, no time to grieve, bullying, punitive/toxic workplace). Generations of wounded doc who have been victims now teaching the next gen. It’s a cycle.

  58. Robert Loesch says:

    Thank you for your story and for your life work. I hope you and all those in medical and nursing professions find the support and treatment for PTSD and facing the trauma after trauma of work. And the ways to cope with these stressors in your life and work. May others find ways to follow HELP and other resources to stay well and safe.

  59. Tammie says:

    As a RN I read this with tears streaming down my face because I get it. The emotional toll is unbearable at times. Many thanks to all in Healthcare that do what they do and for sharing this story!

  60. Gus W. Krucke, M.D. says:

    There are many who find themselves at the edge. How they find healing occurs for a myriad of reasons; most of which do not come from our own profession. Medicine abandoned it’s mission, purpose and moral authority a few decades ago leaving its missionaries to fend for themselves. The young physician whose story is so beautifully shared gets it wrong. He was a victim of abuse, plain and simple. It’s our duty to bring him back to health while taking his wisdom back to the practice of Emergency Medicine. What he doesn’t get right now is that his narrative did not end as a coward; rather, it continues as a hero having walked through the fire of tragedy into the light of truth and healing. I would take that man any day and at any time into my world of patient care as he is far more qualified than the rest to speak to that which makes Medicine a disgrace and the jewel of humanity.

  61. Marcie says:

    Michael, as a recently retired ER nurse and now a mental health I want to thank you for sharing your story so others understand the mental demands put upon healthcare workers on a daily basis. It is not just a 9-5 walk out the front door in the morning and return in the evening to your family kind of job.

    Doing and being good at what you do takes not only physical strength, but mental and emotional as well. We wear our emotions on our sleeves and you will see us at times laughing or crying and wonder if we’re crazy? It’s our way of coping with the intense stress of the job. Bottling up all your emotions are a setup for explosions. I’m sure that families wonder at times why we look like “we’re having fun or just goofing around”, when what’s really happening is the release valve is being opened a bit! Employees who don’t do that, who don’t take down time during their shift to unwind their brain a bit end up in burn out.

    We take care of, as you pointed out, extremely critically ill people. If we aren’t sharp and ready to perform every second, mistakes would be made. It takes being able to give our brain mini breaks in our hectic routine to keep them sharp! Yes we are supposed to get scheduled breaks, but practicality says differently….sick calls, heavy patient loads, numbers of critical patients in your department at the time, time of the season, and last number of codes going on in your department at one time! Soooo, being to tell each other a joke, or laugh about a family vacation or some other silly thing for even 30 seconds can reset your brain for the new inbound code so you are ready! We have to treat our staff and ourselves we’ll!

    Also taking 5-10 minutes after a difficult case to debrief and talk over what went well and what could be changed for next time strengthens your team!

    Taking care of my docs was a primary goal as they had the entire department on their shoulders. Nurses only had a third of it! Having a happy cohesive team lead by a doc who had your back was beyond awesome. And our docs got to rotate through UC for a break on a regular basis.

    If you really love emergency medicine, which I did and still do, maybe starting back at a slower pace in an UC would help with the PTSD.

    Again thanks for sharing your story. Best wishes in your recovery journey, and I will pray that God will guide you each step of the way.

  62. Claire says:

    What are we doing to our doctors? This has to stop. I am just an Administrative Secretary for three pediatric orthopedic surgeons at a large hospital system, but it concerns me what all of our physicians are being forced to do by administration who see nothing by Press Ganey scores. We need to protect our providers. They need care and consideration. It pains me so to see them overworked and treated this way. How do they do it? My heart breaks for them.

  63. Vivian U Farlow says:

    Pamela, My heart is hurting after listening to your touching speech. I am an RN who worked 44 years in CoronaryICU. I have spent hours with all levels of doctors from Med students to attending in Baltimore and at Duke talking about specific patients in post code conversations to post death situations. I’ll never know if I talked with onyone who felt like you described but I know I helped some fell better about themselves or more accepting about losing a patient. Sometimes I spent a long time with families with and without a doctor with me after a death. Often the doctors are torn between the dying who can only be made comfortable and the critically ill who can survive. I have assured them that the nurse is with the pt and family and another nurse will help him(her) with the ill pt. This teamwork is the way many of us can work through these situations together. Thank you so much for your work helping needy doctors. If you ever speak in the area of Durham, NC, please let me know. I would b honored to b these.

    • Pamela Wible MD says:

      Teamwork, love, and compassion could go a long way in medicine. Self-love should taught (not discouraged) in our training. We’ve got generations of wounded doctors, nurses, and other health professionals. Time to help one another heal before we lose anyone else. Shine the light of truth on doctor suicides. Thank you for caring Vivian. <3

  64. Emily Boyle says:

    I support him
    100 % all my thoughts and good wishes

  65. Jim J says:

    Dear Pamela, I have the thought of suicide in my mind all the time. I
    am gutless because I can not find the strength to do it. I don’t want
    to leave my wife, children and grandchildren upset. But I suffer
    everyday. At 38 years old at the peek of my career I was making money
    supporting my family putting them through college without debt. I feel
    at work as a Supervisor for a Ironworking company in NYC and had major
    back surgery. It failed after trying to go back to work. Then in 2003
    I had my first brain tumor with left me deaf and no balance some
    facial paralysis. I have dizziness headaches can’t be around large
    crowds and on my third brain tumor after a 11hr surgery for 1 and
    Gamma Knife for 2 now I don’t know what for 3. I try to stay Happy
    show no fear and live with all this I can’t walk far nor go to a large
    restaurant and think wouldn’t my wife at 58 yrs old be better off. No
    she needs me but does she? I live with this and it is horrible to
    think I will go to hell for killing myself oh how selfish right. But
    these are my thoughts and I try every day when I awake to open my eyes
    and see how do I feel. It is the same everyday. Terrible but yet I
    make breakfast and diners my own bread for my wife but i need to feel
    like a i am doing something that brings in some money but most of all
    makes me feel like I did something I made that I am successful and not
    just sucking hot air needlessly. I know its wrong but the feeling is
    there and I don’t want to feel that I am a doer I like a challenge but
    I am getting tired. Does That make sense?

    • Pamela Wible MD says:

      Yes. Makes sense. Are you getting therapy? Do you have someone outside of your family who you see professionally to help you with your suicidal thoughts? Please. Please. Do not isolate. It is not your job to “stay happy.” Any feeling fully felt changes. Feel your pain with the help of a guide, a counselor. You are having the normal reaction that many would have to your life circumstances.

  66. JG says:

    I think all players in Healthcare suffer to some degree. As a mid level provider (PA), we are expected to perform with the same level in quality of care as our physician colleagues but often given less respect and from coworkers and patients as well as fewer accommodations. I have worked for 15 years in acute care Hospital setting as well as outpatient specialty Medicine. Though I have not hit the wall where I considered taking my life, I’ve experienced feelings of hopelessness and extreme stress at times. Ranging from witnessing suffering and death to blatant mistreatment by supervisors, physicians and administration. I many times debated leaving medicine, then that one patient reels me back. It truly is a labor of love but as he says a part of your soul gets chipped away over time.

    I’ve heard several stories of medical providers where suicide was tragically involved…and of course often wondered where the studies and mental health initiatives were hiding? Google it and there are a few hits. I believe it’s a hidden crisis. Not unlike the vets who serve and then sadly end up homeless on the street with untreated mental illness. Everyone and their service is ultimately dispensable and someone else will fill their shoes. There is a lack of value and care for those providing service. It has to change.

  67. Tiffany says:

    This article reached deeply into the corners of my minf today. I have been on an extended career sabbatical from Hospice Nursing/Complex non healing massive gapping Wound Care.

    I hit an emotional wall hard 4 years ago and was fortunate to get intensive therapy immediately. I did not think it was even 50% my careers fault, and no one else wanted to suggest that it might be the 15 years of death I attended to. Instead it was blamed on ME, my “Disability” – I had “depression issues”- “marital issues” – “family issues”. Anything but my so called work of an angel.

    I will be needing to return to work this year. My dad said to me in a conversation last night about why I was dreading going back to work.”I thought you loved being a Nurse?”. My answer was incomplete because I cited the above quoted deterrents. This article really filled in that last piece. I’m a hearing impaired person that does very well with hearing aids. I was regularly discriminated for being “deaf”… however I speak perfectly, can use phones, my stethoscope is state of the art technology and I could hear more than any average stethoscop. My patients gave me r highest marks out of all the Nurses they had and I did an excellent job. My specialty became the extreme family dynamic/breakdown that is often present when their loved one is very close to death.
    Today I finally gave some deep thought to the fact that I can still remember many deaths that I was the final nurse for. The extreme grief.. the woman that screamed NO NO.. when I had my stethoscope on her husband’s heart to declare that he had crossed over. She threw herself onto me and knocked me to the ground in pure visceral agony. I held her there on the ground for 10 minutes as she screamed and wailed in grief.
    That was the missing piece. I could not do it anymore after 15 years. But anytime I tell anyone that I’m a hospice nurse, I get praise and told I’m an angel. I squirm from this, I get this sick feeling in my stomach from thinking about it.The praise makes me feel e a fraud because of how I could no longer handle it.
    It’s been 4 years and I literally do not want to go back to the bedside ever again. I loved my career. I loved helping people. But the very thought of going back creates an anxiety that stops me cold. It’s a shame and clearly the PTSD is creating a huge loss of amazing talent. I do not think I will return to Nursing going forward. The support is just not there for us secondary victims. Because of the very reasons you highlight in this piece.
    Thank you for crystalizing that last piece by sharing your journey and recovery.

  68. Linda says:

    I’m not a doctor but I was an ER nurse. Notice I say was. So sad. I loved my job. Then I hated going to work, hated my job & would get physically ill with headaches & nausea. I used up all my sick days. I didn’t realize it but it was anxiety. And I didn’t care. I’ve struggled with depression since my husband died in 2002. But this was much worse. Day after day of overcrowding, bullying by peers & Drs. Day after day. Year after year of trauma. Compartmentalizing all of them so I could carry on to the next non trauma pt. I never cried. I always went to my ” other place ” to deal with the carnage & the horrible things seen daily. Then, one day I couldn’t do it anymore. I went to my doctor. She put on 6 weeks of ” stress leave ” that thrned in to 2 years of LTD. I saw psychologists, counsellors & was diagnosed with major depressive disorder and was told I could never work in the ER again. Upper management doesn’t like the term ” stress leave “. I was only supported by 1 colleague during my leave. Most of my colleagues had no idea I was struggling. It was the suicide of a colleague that opened my eyes. ” That could’ve been me was all I could think “”
    Now, almost 6 yrs later I still can’t walk into that ER without having an anxiety attack. I retired from the work I loved never to look back and I don’t miss it. I finally have my emotions back, I can actually cry. I
    I still think I had PTSD but was never diagnosed with it. With all the carnage we saw & dealt with there was never any Critical Incident Stress Debriefing. We only had each other to talk to. It’s still that why.
    Everything this ER Doctor describes totally resonates with my soul. I’m glad he’s gotten the help he needed

    • Pamela Wible MD says:

      Thank you Linda for courageously sharing what so many nurses, EMTs, docs are feeling. I’m in family medicine (not nearly as bad at all) and yet I still got sick and felt like I would vomit every time I saw the logo of the clinic I used to work for. I even avoided streets that had billboards of my prior employer because the mistreatment I sustained was so sickening to my soul. I’m sure you had it 100x worse than me. I could never do emergency medicine. I am in awe of anyone who can handle patients in the midst of life-threatening catastrophes on a daily basis. Unreal. Sending you a big hug & kiss. <3

  69. Roland O''Leary says:

    It isn’t just Docs, or nurses, or the military….
    It’s also police, fire, and EMS…. It’s starting to become a major problem….

    Just took the last 2.5 years off from EMS to drive a truck… Was just burned out and burned up…

    In EMS we wonder why most people stay less than 5 years… This is part of it…

    Why do we have an alcohol problem?? I wouldn’t know… Why do pop pills? Another good question….

    Come walk in my shoes…

    Over 30 years on the line..

    • Pamela Wible MD says:

      Absolutely, I agree 100%. All serving in high risk professions need help. On-the-job, non-punitive mental health care. Confidential.

  70. christine says:

    I am an Emergency Medicine physician and was sent a link to your this post. I cried reading it as I know very well how he feels. I have struggled majorly with depression, primarily related to work experience. Depression is incredibly isolating as a physician. No one talks about it and you are shamed if you do. I started to speak up about this issue last year with a couple of my colleagues who swore me to secrecy as they admitted having struggled with depression, suicidal ideations and substance abuse. Mental health amongst physicians is an area that needs more light shed upon it. It is real and it starts as early as medical school. There is little support, for if we ask for help, we are forever labeled on every medical board application, every hospital credentialing application, for everyone of the public to search us. It is shameful and it prevents us from asking for help until it becomes too late for some of us. This recent post of yours about the surviving physician was my introduction to you and your work. And I am so grateful to have found it. Thank you for posting this letter. Thank you for saying something. Thank you for speaking out. I wish more of us would have the courage to tell our stories.

  71. Jennifer A. Scruggs M.D. says:

    This broke my heart. You know half the problem is we internalize the dehumanization tactics of those perpetuating the sick system as though it’s supposed to make us “real” doctors, or better doctors. These so-called authority figures (who never seem to have any authorities overseeing them) are always looking over us and sadly, that “authority” is now within us.

    In some way I wonder if this incident was 100% work-related. Not to contradict myself, but to say our love for ourselves has got to be stronger than our breaking for a system that has no interest in nurturing us. The system wants to nurture itself and its reputation and pockets. It and its champions are interested in how things seem, not how things are.

    This made me think of all the time I felt sick inside for how I was being treated but somehow said “no” anyway. I felt weak and beaten down, but now I realize those were my strongest moments and define who I am, and why I am here.

    I am so glad you were saved dear doctor. You are a healer and no one will ever take THAT from you. We must all gather together to change what oppresses us and Pamela Wible has it right.

    Much Madness is divinest Sense –
    To a discerning Eye –
    Much Sense – the starkest Madness –
    ’Tis the Majority
    In this, as all, prevail –
    Assent – and you are sane –
    Demur – you’re straightway dangerous –
    And handled with a Chain –
    BY EMILY DICKINSON

    Take care of yourselves. Nothing is more important than your lives, your families and being well enough to care for your patients. There are ways. Reach out and find them.

  72. Pamela Wible MD says:

    If anyone out there is a doctor, nurse, EMT, veterinarian, pharmacist or any health professional who is suffering, please contact me if you’d like to attend a healing retreat. I’ve got something for you: http://www.idealmedicalcare.org/contact.php

  73. James Kenyon says:

    Pamela, It is a very sad thing to see this happen and even sadder to see it happening more often. I appreciate the work your doing in trying to make the medical profession more compassionate which is how it should be and certainly was in the first place. I also understand the nature of folks who have been tempted to take their lives as I have been there myself when all hope seemed lost. Right now I have some hope for humanity because of people like you who have a genuine care for what`s happening to humanity. Thank you so very much for all the love you show this world. Best always, James

  74. Jana Reed says:

    I’ve been in EMS for almost 15 years now, 12 as a paramedic. I’ve always considered myself pretty resilient as far as the things I’ve seen, but feel I’ve been touched by suicide often. 3 coworkers, my best childhood friend, my cousin, my pastor, church family, and all the completed suicides I’ve had to declare dead. Every suicide I hear about kills a little part of me even if I don’t know them. I know the devastation left behind. I’ve dealt with depression for years, but my biggest problem now is most certainly compassion fatigue. The helplessness of some people wears on me-that it’s rational to someone to use an ED for a sprained ankle speaks to that. It affects my marriage-I have very little to give emotionally to my family, good or bad. We’re in marriage counseling now. I’m not suicidal, and have never considered it, but I understand the feelings that lead people to that place. After 2 suicides in less than a year of fellow Paramedics, we finally got a peer support team together, and I’m working on a support dog for the team. EMS as a whole has been slow to acknowledge the rough side of the job, in comparison to fire or PD. I’m hopeful it will improve, though everyone is so “tough” in this field that it’s hard to get past the stigma-especially for men.
    I’m so glad this doc didn’t succeed, and that he has found a new life and spirituality.

  75. Bridgitte says:

    Wow, so sorry this happened. I can’t imagine it’s not a common occurrence for ER MD’s.

  76. Pam says:

    This applies to nurses too…I’ve been in the profession for 24 years…I’m tired, weary of the demands by both patients and management. You’re a hairs breath away from being sued.Too late to start over, will be glad when I’m done.

  77. Patricia McAfee says:

    I have been a nurse since 1985, I have many friends who are doctors and remember there excitement when they were residents. Life and death is real and doctors believe it or not are human, I know my own personal experiences in this field have changed me. I can see that it can take a toll on a person seeing people at the worst and children dying just because of the color they choose to follow, the innocent people who are at the wrong place at the wrong time. I am so glad you survived, practice again this will make you a better doctor. And I worked in a county jail and it is absolutely the procedure to take a suicidal person to hospital to be evaluated, especially because you committed no crimes. God speed

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