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

Don’t let your job suck the life out of you. Click here for help.

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___

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 our teleseminar

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256 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!

      • Please contact me. I am the founder of FireFighters Down

        We suffer and I am saerching for resources to help my over 11 million Firefighters national pool.

        PTSD has our rates of self destruction at the highest ever.

        I look forward to the Future by utilizing your process.

        Great Things

        Captain

    • 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.

        • Pamela Wible MD says:

          You sound like my cousin counting down her days in nursing so she can get a job at Trader Joes.

          • Kristine says:

            I have been a nurse going on ten years and dream about a job working at Macy’s…or scooping ice cream on a beach. Mindless, no drama, no trauma, no waking up in a cold sweat in the middle of the night thinking about a patient you lost…

          • Pamela Wible MD says:

            How many nurses do you think have the same dream?

          • Sharon Aumani says:

            To Kristine & Pam: I am certain MANY nurses can relate.

          • Pamela Wible MD says:

            Yes! I mention other health professionals in the podcast. I didn’t leave ya out.

          • Storie says:

            I just want to work at an animal shelter.

          • Terri Ritterpusch says:

            Never wanted to go back to teaching preschool so much in my life. Ten years ICU nurse and counting. I can’t remember anymore how many times I’ve cried in the hallway after a particularly trying event. Any there is for the most part no real support. Because immediately after is not when you recognize you need help. It’s days and weeks later that you know.

          • Katrina Rollin says:

            I have been thinking about taking a mindless, fairly easy, low-paying job instead of bedside nursing. It’s draining and my mental health has never been the same since school started.

          • Pamela Wible MD says:

            I hear ya. I was on the verge of returning to my waitressing job until I took control of my working conditions as as self-employed doc. I hear more and more nurses are launching out in independent practices such as wound care.

        • Sara says:

          I am sorry you had a career like that. Mine started that way too in nursing school into my first job. My grandmother and aunt were nurses and they loved their jobs. So after my first trauma with no support, I knew I had PTS, it took me a while but I moved on to community nursing. Tried a lot of positions and found my place after 13 years of trial and error. That’s what’s great about nursing…not just stuck in one place. I’m sorry you never found your happy place. I hope you enjoy retirement.

          • Faith says:

            That was kind of my problem as well, I suffer from depression and after 5 years of being miserable and ultimately suicidal and committing myself, I finally found a job I like and am appreciated at in the prison system

      • Sharon Aumani says:

        Thanks for speaking up, Gail. The whole time I was reading this, I wondered about all of the unheard nurses also feeling desperate/pressured, on top of their perfectionistic nature.

  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.

          • Giselle says:

            This is only true in states that do NOT have community property laws. In the following states every loan you take out, even if it’s just your name on it, your spouse is liable:

            Louisiana, Arizona, California, Texas, Washington, Idaho,
            Nevada,
            New Mexico, Wisconsin.

        • Dandy says:

          Sign me up as a or to be in on the discussion!
          Student loans passed on? Absolutely, plus accrued interest unless they’re gov loans and you’ve paid faithfully for 25 years… But check with your lender as the policies vary!

    • susan says:

      Depends on the policy and when it was purchased.

    • Sinthea says:

      Depending I on the policy, what/ if something is payed out. My 14 year old niece committed suicide last month. The policy does not pay out if suicide is within the first 2 years it is initiated

  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 . . .

      • Leigh Canfield says:

        The hospital where I work has a counseling center. It provides short term counseling for free, I think up to six visits. Then referrals for extended care if needed.

  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.

    • Josh says:

      This is a great idea in theory, but it goes too far the other way. In tort law, states have sovereign immunity. Forcing an injured party to sue the state in the case of malpractice would in effect end all malpractice suits, even in cases of intentional malfeasance by a medical provider. This is already the case in the teaching hospitals that operate under state universities; it is extremely difficult or impossible to get a plaintiff’s attorney to prosecute a case in this circumstance, even if it’s clearly open-and-shut.

  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.

      • Pedro Cuevas Estandia says:

        The revival of the FAT MAN´S carrer seminar on the house of god.

        NPC = No patient care specialties

        Patient Care= will not be discussed
        We all know were the brutality is the greatest…..but all specialties should be tolerable to a well adjusted human being.

  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.

      • Sara says:

        I disagree. I am a nurse in the military and females are same rate of PTSD. It’s hard to statistically “count” because there are more men than women in the service. Men are in combat roles as most women are not, though there are some. Also, think about how women process…they talk. More men do not. There was a study of drone pilots vs combat pilots. Look that up. Drone pilots sit back stateside dropping bombs on adversaries and they are getting ptsd. They feel lack of humanizing you just sit at a screen and kill. Hope that helps your research.

        • Pamela Wible MD says:

          I’m sure they have same rate (or similar) of mental health issues. The completed suicide rate is 1:7 women:men in medicine.

          • Ace says:

            Several thoughts.
            1) Female medical professionals may be less likely to complete suicide because they give birth.They feel a different responsibility towards the children they may leave behind than do fathers. Not bashing all the great dads,but they don’t give birth,and in the US,despite improved involvement,no matter what the profession,
            mom’s carry the brunt of childcare.This may lead to a greater number of women than men that are depressed….
            because they feel trapped in their job and trapped in having no escape from life.
            3) Females seek help more because they feel they can’t contemplate suicide.The act of contemplating
            suicide does provide one with an ultimate feeling of control,which is something most people desire.
            2) Male medical professionals, especially MD’s, are more likely to carry insurance to cover the future financial needs of their family.They earn more than female counterparts in almost all arenas.This imbalance makes for a female to literally be worth less dead than a male medical professional.
            4)Males are more likely to feel weak and face more stigma than females seeking help. This in a society that stigmatizes virtually all mental health issues.
            5)Nurses are at incredible risk.They
            are mainly women.They have a greater percentage of being in abusive interpersonal
            relationships,
            experience more lateral workplace hostility and violence and are
            often natural enablers. They are frequently single parents.They are more likely to be the one to provide support of her aging parents and her spouse’s as well,when needed.These differences lend to them being financially less stabe than male medical providers. They may not have health care coverage that is comparable or money that allows mental health care,as a physician, irrespective of gender.They also care for more patients than MD’s, witnessing more traumatic events during their careers.
            5)Any health care provider seeking help also has the big concern of job security. Have asthma and no one will question your practice.If a known mental health diagnosis of any type exists,your fitness to practice is immediately a very much discussed topic,so you have the added stress of trying to perform at a level beyond scrutiny. In addition,
            concern for your licensing board to somehow be involved just heightens anxiety.

            It’s a crying shame that as helpers we are less likely to be understanding of those needing help.
            It is heartbreaking that we don’t care for ourselves as well as our patients.

            I wonder how providers feel as they ask the screening questions for depression and suicidality,
            while they are actually feeling the same way?
            And last of all,if we do seek help,many feel an additional concern for the person caring for us.Worry for them and any guilt or liability they may experience if ultimately suicide is complete. It seems an impossible vicious form of circular hell.
            I wonder who is even willing to disuss this?
            After pediatric ED work for 35 years,I am in the company of nurses on a mother baby floor that actually can’t bear to hear the events I have experienced.
            They see the happy mom and adorable babies born.
            I see the multiple children I have cared for that include:
            Infants that present to the ED
            Shaken
            Dead from sepsis
            Dead because mom has the child in her lap in a car crash or answered the doorbell leaving her toddler to drown in the tub
            Countless kids brought in after being left home alone
            An infant brought in by an addict because the child’s mom left him days earlier and now he doesn’t have formula or know mom’s or baby’s name
            Infants bitten allover their body by rats
            A teen that paints her fingernails at her dead 3 month old’s bedside before saying goodbye,you were a good baby as if she had just lost a doll,not a human.
            A heroin addicted mom thinking her baby is waving hi,as it seizes.

            I have the unfortunate distinction of knowing a coworker who lost 2 sons to firearms and one killed by stabbing in jail….none of them out of their teens.
            I worked with an amazingly brilliant,kind nurse who committed suicide by gun.
            I worked with an MD found dead from an IV OD in the locker room.
            I worked with a very promising new grad,that became addicted to drugs after caring for school shooting victims not much younger than he was.
            I worked with a nurse shot and killed by a neighbor after work,because of a dispute about his barking dog.
            I worked with a nurse that survived being shot by her partner.At least I wasn’t the poor nurse called by her, that had to wipe her friend’s bloody bare feet.
            Our pediatric ED staff had to resuscitate a beloved unit clerk,but despite the PTSD some experienced,she lived and finished nursing school.These were just the people with whom I directly worked.
            I guess that last story is what has me go back,because as I look at this miniscule number of events I have seen,I realize
            how very broken our profession is.
            We waste time taking the same mandatory fire safety,
            universal precaution tests every year.
            Mental health care should be what is mandatory.

      • Sarah says:

        I think you touched on something here. As a female paramedic who started when there weren’t that many women in the profession it was nearly impossible to ask for help. Women were expected to be tough “like men” and asking for help would just show that we were just “weak women”. So, in my profession, no one ended up being able to ask for help for a long time. The men felt like they had something to prove because they were men with societal and professional pressure and the women because we struggled to fit in and be accepted by the male-dominated industry. Now, so many of us suffer from PTSD and we have lost many.

        • Pamela Wible MD says:

          Exactly! I have seen this in medicine too. Producing “masculinized women” is not the answer obviously. Let’s get back to caring, nurturing, love, compassion—all traits that women are pretty good at by nature. We have a lot to learn from being fearlessly female.

  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?

      • Lisa says:

        As an er nurse, there are no support groups that I know of, although they are needed. My personal experience is that alcoholism is a major problem with er nurses because of the trauma we deal with day after day. Add to that a system that requires more and more from us every day with only complaints from management about throughput and door-to-discharge times and it’s a recipe for personal disaster. My dept had a 65% turnover rate last year so those of us sticking with it also have to deal with new, inexperienced nurses as co-workers. The stress is unreal.

    • 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.

    • Loice A Swisher, MD says:

      Richard,
      The increased risk for physicians has been known for more than 5 decades. There was a study published in JAMA in 1974 showing that physician suicide- especially in women- was higher than the general population.
      http://jamanetwork.com/journals/jama/article-abstract/353834

      It is interesting to me that the risk has been elevated before so many of the issues we talk about today were even a concern. I wonder if there is something of a ‘warrior mentality’ once one becomes a doctor (or a soldier or a police officer or a fire fighter) that is the true barrier for those with a suicidal mindset.

  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.

    • Bele says:

      Plenty of people with God and religion (aka delusional beliefs) in their brains snap. :/

      • Anita says:

        Totally agree! You can be a strong believer and still snap. Suicide never makes sense, but yet I, a Paramedic/RN as well as my husband, a Deputy Sheriff, have both come close at different times, and we are very much believers.

  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.

    • SueD says:

      What kind of “training” is this? No human being can work those kinds of hours and be rational. It’s almost as though some of these schools think that they can find the “best” clinicians by running everyone to near death and then seeing who survives. No patient (animal or human) can get the best care from a doctor who is on the verge of collapse. Do labor laws not apply to residents?

  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

    • Pamela Wible MD says:

      If you want to talk please contact me here Susan. And I am so sorry for the way you were treated. http://www.idealmedicalcare.org/contact.php

    • Taz says:

      Susan, have you asked yourself why they asked you to resign when they could have fired you? Probably because the reason for removing you was politically motivated to appease others. You were the highest “ranking” person so to speak, so you became the scapegoat. Gives the appearance that they did something. Do not allow them to cause you to doubt yourself. We(medical professionals) are our own harshest critics. You have over 20 years experience. If you are sure you did the right thing, then you did. Consider it their loss of a good nurse. Don’t forget, the doctor in this article will lose his job. Despite the fact that he and his group believes he is not accountable for the death of his patient.

      Where one door closes, another opens. Use this as an opportunity to explore other options in nursing where you and your expertise might be more appreciated.

      My two cents….

  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.

    • Pamela Wible MD says:

      He is receiving therapy and has quite an amazing support system of people who love him (as far as I can tell).

      • Taz says:

        Pamela,
        Not quite sure if this is the right forum, but if the doc finds his name has been submitted to the NPDB(National Practitioner Data Bank) for this case, he does not have to accept it. I just want him to know that it is possible to fight it and have his name expunged with a good lawyer and a sincere belief that he did nothing wrong.

        I was found accountable, along with four other physicians, for a patient’s death many years ago. Very heavy burden to carry. But I knew my management was above reproach, although I admit that I briefly questioned whether I did the right thing in light of so-called experts who said I did not meet the standard of care. The case was ultimately settled against my emphatic protest. I hired an attorney who commissioned the service of an expert in emergency medicine with impeccable credentials. It took two years, but I won my case and my name was expunged from the data bank. Bottom line: just because says you are wrong, does not mean you are.

  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.

      • Tim says:

        Think logically. Were the dogs going to be put down anyways? I didn’t see that addressed. If so it may be best to mourn for a moment then move on. If not, then I’d agree that’s an ethical problem! Surely they are not breeding puppies for this purpose?

        • Pamela Wible MD says:

          Logically, dehumanizing medical students and excising their compassion makes no sense. Not a good ending for the dogs either.

  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.

      • Jim J says:

        Thank You Pamela, I am trying to get into a appointment with a psychotherapist as John Hopkins says they have a lot of experience with these issue. I am also going to vestibular therapy for my eye movement and headaches. Thank Jim

        • Cheryl Van Epps says:

          Please consider checking out a Brain Injury peer support group. Your state should have a Brain Injury Association website that will tell you time and place they meet (for FREE!). For your state you can check the BIA of America’s website: http://www.biausa.org. Some local newspapers will publish their meetings too. I went years feeling like no one (especially my health care providers) understood what I was going through, isolated and angry until I sat in a circle of others experiencing brain injuries similar to my own- birds of a feather- that alone gave me so much comfort and was incredibly healing therapy. I wish you well! Baby steps, pats on the back for little things and take it day by day.

  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

  78. Moo says:

    From an older Doc who used to work in ER’s

    “Look to Him and be radiant; so your faces shall never be ashamed” Psalm 34:5

  79. Sara says:

    This relates so close to what I went through on my very first day as an RN with my first assignment off of just 2 weeks of orientation the hospital provided back in 2002 (new grads today get much more intense and longer orientation). The seasoned nurses never should had given me that assignment, especially as a new grad following an agency nurse. There was one patient out of the 6 they didn’t want to deal with…of course I was put there. Pre-op nephrectmoy princess they called her, along with 2 chest tubes, hemorrhagic GI bleed, an 18 year old newly below the knee amputee and a pneumonia patient. It was overwhelming.
    Anyway, the preoperative princess was on the light ALL DAY LONG. There really was nothing wrong with her except they found a mass on her kidney. But she acted like it was the Ritz. Her husband sat next to her and allowed her to constantly “harass” me. I would go in just to hand her her sofa from the tray. I am not lying. Every thing was miniscule. I eventually told them both if she doesn’t start moving out of bed, she’s going to get an embolism which is life threatening.
    At 7pm change of shift (my escape finally), her blood sugar dropped and while I was giving report I went in and helped my relief push D50. I headed home finally at 9pm.
    Next day I called into the unit to wish a secretary good bye and was told preoperative princess died overnight. I couldn’t believe it. She had a pulmonary embolism. Exactly what I warned her of. I was told the attendings all scoured their notes and orders to make sure she was ordered all proper meds and treatments.
    The husband and family came in and screamed we were murderers.
    I was devastated. I called out every day I could even with only working there a couple of weeks. I went to my preceptor…no help. I went to my nurse manager….”you’ll get over it. Happens to everyone.” I asked for counseling, support and there was nothing. I was scared to go back to work every.single.day. I thought I caused her death.
    I kept going to work but had horrible anxiety for a year after. The only person who knew was my husband at the time.
    I felt so much guilt, I constantly went into my shifts early and stayed really late on my own time to just make sure I did everything I could from then on.
    It was not a pleasant start to my career.
    I eventually moved on, but the toll that took on me as a clinical 22 year old nurse sticks with me the rest of my life. Probably why I will never work in a hospital again. Im greatful for my job now as an educator with the dept of health. Im grateful i got to work with families and their disabled children, Im grateful I was a hospice nurse, I’m grateful I delivered babies. Though, with my air force position I work in trauma often for training and absolutely miss and love it, I could probably never do it full time again.
    I relate with this man. I feel for him and his family.

  80. Mary says:

    There is nothing “weak” in what this man went through. Some people just feel too much and try to stay strong for too long. I know. God Bless…

  81. Vivian Hiatt says:

    Thanks so much for sharing your story, as a critical care RN for 28 years I see the stress and turmoil it can cause. The “burnout” is real. Hoping you are your family are healing.

  82. Sylvia Barron says:

    Thank you for sharing your life with us, my husband did not survive this nightmare.PTSD needs so much more attention! Massage therapy,yoga,etc… vitamins and down time, family time most important.

  83. Jocelyne McKenna says:

    It takes great courage to speak out publicly on our mental health “challenges”. Thank you. The symptoms you describe are classic PTSD which first responders can develop, the same as soldiers at the front. It wasn’t recognized till early 2000s (seeWu Albert W. Medical error: the second victim.The doctor who makes the mistake needs help too. BMJ 2000; 320 :726). And this is not to say anything you did was a mistake – but it is all part of the same phenomenon. People die, but we aren’t taught how to deal with that, just about the “saving” lives. Doctors: heal thyselves: we must develop the resilience to be able to weather the storms that will happen, even to the best of us, during a career in medicine. And teach the next generation how to do it. We are the leaders, we can make a difference: set our own limits, set an example, set the bar high for caring for one another. Get rid of the “macho” image of the doctor who knows all and never fails. We are all human.

    Another great resource : http://www.mitss.org a support group founded by an anesthesiologist and the patient who almost died under his care. For patients, their families, for clinicians, for administrators: Medical induced trauma support services an amazing resource. Check it out.

  84. Rafael Ruiz says:

    Great testimony that reflects the reality of our “corporate” work. I sat last week to rate my “Burnout” with an online depression scale while avoiding getting to work at an inpatient Psych facility. I got moderate depression. I know these signs as I have even been “board certified” on this. My thoughts after this were “what would I do if one of my patients complete suicide?” This haunts me every day. The interesting thing is that I have the respected title of being the “Chairman” for a state wide post suicide M&M. I know what my patients need, and most of the time is not a medication. These suicides are a sign of a larger population health problem. We need to start seeing and doing something different, but society and corporate health transfer the liability to us and we gave up lured by a paycheck as we were slaved in the student loan and mortgages prison. Social engineering at it best! We feel helpless, powerless & hopeless. I have lost colleagues to suicide. I know and have seen the aftermath to the patients and the communities. The sad story is that “corporate health” do a few “Burnout” prevention briefings and send you back to the same toxic work environment expecting the same or better numbers…
    How can we take our profession back and make it a humane one stemming from applying those principles to us a the most important factor in the whole equation?

    • Pamela Wible MD says:

      We’ve been controlled for too long with terror, psychological warfare. Docs & health professionals need to take this profession back. We have generations of wounded healers teaching the next generation. Cycle of despair, cynicism passed right on to the next gen. Let’s stop it.

  85. What is most disconcerting to me as a practicing psychiatrist is the way in which general medicine has historically dismissed the significance and value of psychiatric treatment and unfortunately has practically criminalized individuals who show up in the ER psychotic, suicidal, confused, depressed, and in need of psychiatric care. In my time as a consulting psychiatrist in a large metropolitan hospital I was often called to the ER to take “this crazy patient” up to the psych unit.If the training of physicians included the underscoring of the value of good mental health and how to achieve it then perhaps there would be less denial or dismissal of symptoms that in the end could prove fatal. This story is so helpful to promoting the agenda of comprehensive healthcare including mental health .

  86. Elaine says:

    Dearest doctor,
    Ithank God for your life.

    all of this experience was meant to be told to help others. You were chosen because you are the strong one that was used to help the weak.i have been a nurse in a variety of acute care setting and can totally relate. The politics of employers and colleagues will always be in place. Live your purpose, you are strong. Do not succumb to fear. Go back to the ED where you belong. You are a giant of a human being. God bless you and family greatly.

  87. Edmond Dufort says:

    I’m a teacher, my most important lesson to my kids is honesty about their feelings, it comes way before anything academic. I know that in general as a society we are perpetuating a culture of dishonesty in regards to our feelings. The result is addictions, loneliness, medical problems, broken families and the list goes on. I know this and so I work on being honest about one’s feelings first and foremost. I once worked in a foster home with rotating staff and it was required that we speak about how we felt before leaving each shift. I didn’t understand it at the time because I took pride and having a thick skin, now I have learned that nobody has a thick skin. I don’t know where we have taken on this ridiculous notion that were supposed to be tough, I do know that encouraging sharing circles would be of benefit in every line of employment that is out there.

  88. Anonymous says:

    Wow! Thanks for sharing. I’m a paramedic and recently quit my job. I was and EMT for 6 years before becomeing a medic. I’ve been a medic for 2 years. Was always good with pressure and nothing got to me till all of a sudden. Had a little girl that died of traumatic asphyxiation and what seemed an unusual increase in suicides… I was stressed out and my heath took a beating as well. Lost 35 pounds in 3 months and am not that big to start with. Finally quit my job. It’s been a year since it worked at that department and 6 months since I’ve even been on an ambulance. Currently work in the ED as a tech… not sure if I’ll ever work as a medic again or not. I still deal with anxiety at the thought of another medic job and lack confidence. I am doing much better then a year ago, but don’t feel 100% yet. Thanks for this story. One thing that helped me the most was when I realized I was not the only one. Made it easier to admit something was wrong instead of stuffing it down and trying to push through. Also, talking with people who understood and listened. Most people seemed to not understand (and they prob don’t) and seemed to have a “get over it” attitude. I think if I would have had more awareness when it first started I would have know what was going on and been able to stop it before it got to the point that it did.

  89. Noor Baig says:

    Thanks for sharing your experience.That’s amazing how “burn out” can break you into pieces and can even lead to end your life!it’s a lesson for those who think that “burn out” is a fancy modern day terminology or is not as serious as it is often projected to be. People are living longer,the bugs are getting stronger and more lethal and hence the turn over of patients in ED all the world is everso increasing. Under such circumstances it’s not too difficult for a doctor or a nurse to burn out and events like these can easily make them suffer from PTSD. High time for the stake holders to think something big about this.

  90. Marissa Villela says:

    May God help him and his family heal. Thank you so much for sharing. You are an angel in my eyes. I myself, working in ER I have found that we take too much, often times more than your bodies can handle, not counting additional stress from family problems, our children needs, ect, and yet we are never asked how we are doing. It’s sad.

  91. Sandi ZBair says:

    This goes for nurses too that worked in that environment in the 70s80s and 90s. A child would die and I felt guilty going home to my baby. I had child ask me if they were going to die. There was no after counselling or group decompression in those days.
    I went home guilty for living and having a child that was alive. I spent a lot of time crying when I went to bed and went into counselling. There was burn out and I didn’t want to become a depersonalized nurse with no feelings. I moved around a lot different ER different trauma.
    Those faces and patients stay with me and are a part of who I am.Good or bad.

  92. Pamela Wible MD says:

    Our message for all health professionals: Don’t let your job suck the life out of you. Watch video: http://www.idealmedicalcare.org/blog/doctor-dont-let-your-job-suck-the-life-out-of-you/

  93. Susan Wilson says:

    Until we all take responsibility for our lives nothing much will change, however maybe the first step is to accept reincarnation and the fact that our essence returns to do it all again if we haven’t taken responsibility or move on to other challenges with responsibility. Doctors are not responsible for the lives of others if they have done their best. Sometimes the best is not enough because there is more to a life than the physical that we see. Knowing this and living this is the first step to not being overwhelmed by the death of a patient because you (the doctor) really have no say in the life path and plan for your patients other than to administer what you have been trained to do.

  94. Sandra Mikelsons says:

    I feel sad for our medicos as they on the most part, try their hardest to help people. It’s just as bad at times for nurses.
    I gave nursing away as I was fearful that I might get things wrong & a patient in my care would suffer!
    It’s the sheer pressure of the expectations of people that we are perfectionists, but we aren’t! We have a gift for providing the healing process but it doesn’t always work & we, as human beings bury in our souls the pain of failures until sometimes we just can’t take it any more! Some of us leave the profession & some soldier on but destroy their own health in the process!
    There MUST be counseling more regularly!

  95. Wilma Fortier says:

    I feel a great deal of compassion for this Emerg Doc. and what he experienced. PTSD is something that effects a great number of people and is not taken seriously enough. Lacking the necessary support, all too many choose suicide.

  96. Jackie says:

    Those of us who work in the medical field, are faced with these stressful situations and expected to cope with all that comes with them. Stress is part of our lives, however as nurse, doctors, and social workers we are expected to heal ourselves. After all don’t we work in health care? Many are unable to work under constant stress. Many suffer catastrophic health problems due to stress and long hours at work. Families suffer the neglect by the health care worker as the facilities expect complete loyalty. We need comforting too.

  97. Terry says:

    I know being in the ED must be incredibly hard because of repeat trauma. I am a PA that works in Internal Medicine in a largely geriatric practice. It is not uncommon for several patients to pass away weekly. Sometimes I find myself having a really hard time dealing with knowing so many people that pass away all the time. I see our patients very frequently, so I become close with them, and to have 4-10 people I know die on me a month is sometimes heartbreaking. I know in my heart I am doing everything I can to make their last days healthy and happy, but there are times when I want another profession where I don’t have to face this type of sadness. My husband is a loan officer and I secretly envy him. I have even wondered if ER or urgent care would be better for me, just because I feel like the personal connections I make with my patients makes it so much worse when I lose them.

  98. David says:

    Doctors get paid well for their services.

    Don’t most doctors go on to be very wealthy with big houses and luxury cars? I suppose it’s all in how you see things. Don’t focus on the losses but the wins. Then if you need more, adopt the Islamic mantra that it is Allah’s (SWAT) will that the person died.

    • Pamela Wible MD says:

      What does getting paid well and driving a luxury car have to do with PTSD. As is money can reverse the damage? And I am happily living in a 900 square foot house and driving a Prius. Even shopping at Goodwill for my clothes. I know lots of docs like me.

  99. Aoife O'Sullivan says:

    Oh my God, that poor doc. I just know he told that patient/family that if her symptoms worsened they should return to the ER. That stuff rolls off our tongues when discharging patients. It sounds like they waited until she was almost dead to bring her back in. . How is that his fault? But if it was me, I know I would blame myself too.

  100. Kurt says:

    I’m sad to hear this happened to him. Angry at the despicable actions of the police. Police need to be privatized like insurance companies and held to account by the market. I sincerely hope he recovers and finds the joy in life he wants and needs.

  101. Heather Meehan says:

    Wow!! I stared working in healthcare 5 yrs ago and I was blown away by their practices! I could not imagine dedicating my how life to helping people and paying a lot for education to be used , abused and bullied. I could not believe what I was witnessing. Doctors care and they should be treated with respect that they deserve before they turn bad or commit suiside! I love Ted talks and Bravo to you for finally standing up for our doctors!

  102. Becky Smith RRT says:

    Michael, Thank you for your story and thank you for what you have done. You have helped people through your work and through this story. I think all healthcare workers face these same feelings to one extent or another, but to talk about and break the silent struggle. What an impact. I recently lost a friend to suicide and all I could think was, “I wish he knew how loved he was.” Pamela, thank you for you work. As a Respiratory Therapist with over 34 years in the field, so many of these people I will take with me to my grave. They live in my heart. I can name most of them and the places I’ve worked could care less of the toll it takes.

  103. Sharon says:

    So sorry to be reading your heartbreaking story!!! I hope it helps others in the same situation as you were, to get help before it’s too late!!! You are so brave to share your story like this…amd I wish you all the very best for a happy, healthy life with your family+friends…God Bless you+keep you well!!!

  104. Nancy says:

    Thank you for your honesty and courage in sharing your story. May you be blessed in ways that you cannot at this time anticipate, as you continue to heal.

  105. Evin Daly says:

    There is only so much we can take – no matter what our training – when faced with traumatic events. You have nothing to be sorry for. Yours was a natural reaction, an attempt to cope when nothing else was available. You’re very courageous in your honestly and in telling your story. I know many people and doctors who carry the trauma of their cases with them. You’re not alone.

  106. Yasmin says:

    I am so very, very sorry to read what you have endured. I have seen firsthand the toll the medical profession takes on those entering the field. You are constantly expected to perform at 100% in less than ideal conditions and often whilst exhausted and sleep deprived. How do I know this? My husband is a neurosurgeon and I worked in radiology for nearly 30 years. No other industry would allow their employees to endure the conditions you are just expected to cope with day in, day out. It is a vicious, brutal industry that takes, takes, takes and rarely gives. Society has the illusion that ALL doctors are extremely wealthy and living extravagant lifestyles. How wrong that is. A large portion of your income goes to various medical defense and registration boards just so you can practise medicine. No other industry has such massive overheads funded by a single source. You. No other industry expects their participants to endure brutal rosters, unpaid student teaching, total and flawless accountability on minimal sleep. Holidays are often interrupted because you are never off-call. It’s obscene.
    Thank you for being strong enough to share your story. I hope the medical industry changes. It desperately needs to.
    I wish you and those you love every strength and success for the future, no matter what path you choose to walk. Thank you again for shining the light of truth in the unspoken darkness that is the medical industry.
    You take care now. xo

  107. Stephanie thompson says:

    How sad this physician’s employer not only did not support him but terminated him. He followed all the guidelines and the patient was the outlier in the end. All physicians are their own worst critics and subject themselves to mental torment when patients do not fare well. When I hear that a patients of mine did not do well my first question is “what did I miss?”. How sad is that? Other replies have noted burn out, compassion fatigue, and litigation stress. I say yes to all three. My whole primary care department, physicians and nurses have this complex. How can you not when administration is constantly demanding more patients to be seen daily and faster, more
    documentation done and faster, and an emr which
    enables micromanagement by upper management. I cannot and do not encourage younger people to go into medicine. I will retire the second I can do so. What a legacy of pain out of an altruistic usually rewarding profession.

  108. Cynthia says:

    A friend likes the expression “responsibility without authority and authority without responsibility”
    That’s exactly how the field of medicine is today. Those with responsibility (drs, nurses) hv no authority, and those with the authority have no responsibility. Results in disastrous administrative and management decisions, chronic abuse of clinical ‘staff’.

  109. Carolyn Ross says:

    I understand psychiatrists are the leaders in suicide. But ER is diffinately the worse place in the acute setting. I remember my son, and ER nurse, telling me about caring for a 20 year old man who died from being a “mule” for drug dealers. He was “dumped off” at an ER door. What a sad situation and waste of a young life. We are in a war against substance abuse, especially heroin all across the country. Going through the pain of addiction and watching loved ones is trauma. What does that say. The physical trauma plus psychological trauma is overwhelming. Where is there enough positive energy to equalize the negative energy? As a working nurse for 39 years I’ve observed that it is all about energy exchanges.
    Scars are left on all the caregivers. Giving a part of our soul to help others. Learning to replenish is the challenge. But that makes us who we are. Keep the good memories. I believe god designed us to experience the good and the bad. That equilibrium is the way. Give out and get back. Is that why we are so tired at the end of our working shifts?

  110. K says:

    What an incredibly difficult and impossible job you have manage to do. God bless you I’m glad you’re still here and you are important. Your family needs you the world needs you too!

  111. I am very sorry for the pain & suffering of you & your family. Please hospitals & med. schools seek out these Doctors & students that may have reached their limit of trauma & death.. They are not robots but made in the image of God & have a human nature which makes their hearts & souls sensitive to the pain & sufferings of their fellow beings. Please have exceptional professionals on hand to be able to see thru their hearts & be able to assist them in knowing when they need some optimism in life & a possible change… They are of no use to the average individual that may need help when they themselves need a hand up…..

  112. Kathleen Hurd says:

    I have been reviewing all the comments. I didn’t read every single one, so I may overlap. We really are in the midst of a cultural change, and physician organizations particularly the AMA are among the largest fighting for and sometimes against the appropriate changes. Physicians should not even be allowed to work the long hours that allow them to make the astronomical sums of money in some Specialties. One of the reasons we are being replaced by nurse practitioners and physician assistants is that there are talented individuals willing to work for a very comfortable wage, with very reasonable hours, which many emergency room and surgical Specialties in positions filled are not willing to do. Pamela, you provide a very important counter to that culture. However until our legislation, our medical organizations, are all on board with refusing to allow anyone to practice in this unhealthy manner, I think offering Social Service of support, counseling, PTSD and crisis management is going to be a small fire to melt an iceberg. No strategy alone can replace the cultural and political shift thatis needed!

  113. contacr DOC MIKE WITORT @ wakeupwell.org

  114. "Michael" Lucky2BeAlive says:

    Wow. It has been six weeks now, and it is surreal. I look back and I can’t understand how I got to that point. My wife and I wanted to reach people, in hopes that we could help even one person avoid my mistake. When my story was posted, many of my friends figured out who it was and the outpouring of love overwhelmed me and my wife. We have been very private about this otherwise, and few people in our church, neighborhood, or acquaintances know anything about this. This platform has been healing to us, as the comments of empathy and understanding help my wife. This stress and pressure and trauma are foreign to her; she can not understand it but feels much better with other people understanding it.

    A few points I should clarify, it was not weeks, but a few days after the patient’s bad outcome when I had my review. I also should point out that my group has been very supportive for the most part. My wife understandably had asked for space, and they have found ways to support me even today. I do admit that the timing of my review was unfortunately close to the event, and it was a bad time to notify me of possible pending termination (I have since met with that administrator and it was the first thing he wanted to talk about and apologize for).

    I should probably give an update to the many of you who have shown care and concern. I have a wonderful psychiatrist watching over my progress, as well as a psychologist helping me to recover from this. I hired one of the best lawyers in town to represent me, and most of the bogus charges should be dropped. I have taken measures to protect my license (I am a long way from being able to practice any medicine, and can not fathom going back to the ER) by enrolling in a recovery program to monitor my progress. While they mostly deal with addiction (I don’t drink or do drugs) they also help with depression and PTSD, which many state boards would censure a license for.

    There may come a day when I can talk openly about this, but with my court date looming and hospital privileges at risk, not to mention the state medical board, the real possibility of retaliation forces my anonymity. I am still on medical leave and plan to continue working on healing mind, body and spirit.

    Much has been said about the police. In the ER I have worked closely with the law enforcement officers of my community. I respect them and realize I could not do their job. I also know my case had them worried. My wife was on the phone with 911 for over a half hour and was concerned I was going to shoot myself. While I had broken no laws, other than refusing to stop for them, they must have been concerned about me becoming violent. The remainder of my treatment as far as trumping up charges, jail instead of hospital, and some unnecessary experiences were mostly due to one young officer who does not yet have the experience and may never have the personality to serve the public long term. For him, I hold no malice and hope only he can learn to control his authority complex. My wife was part of the police chase and told the officers how thankful she was for them over and over, along with repeated pleas that he go to the hospital because, “He is an ER doc and smart and he will know how to kill himself!”

    I do hope nobody ever has to go through this, but the reality is they will. Doctors, specifically, but health care workers and first responders will continue to have struggles treating patients and dealing with bureaucracy. I appreciate the thoughts and words on my behalf, and only hope you can use this awareness to reach out to friends and family before they go too far. Please know that I am doing better and your kind thoughts have helped our family.

    • Friendly ER Nurse says:

      I just want you to know that I am thinking of you and miss working with you. Please do what is best for you and all I want is your happiness. I really miss working with you, you are a great doctor. Unfortunately we have all had the experience of a situation that truly brought us to our knees and as a nurse that has been in the ER for 12 years I have also had cases that rocked me to my core. I want you to know that I will always have your back. I wish and pray for your continued healing and hope to see you again one of these day.

    • those of us looking at this curse from the outside in Michael can see much more clearly what is happening to you doctors. it is all over the net. 400 drs a year commit suicide. lets wake up. revamp med school without the big pharma companies involved. DOC MIKE WITORT R.PMD.

  115. Frank Walshingham says:

    What a self effacing piece of crap! Do us a favor and us a gun the next time!

    • Pamela Wible MD says:

      So these are the types of comments that are very dangerous. Why be a bully?

      • "Michael" Lucky2BeAlive says:

        Its OK! I don’t get upset by this. To the contrary, Frank eloquently illustrates the judgement and attitudes that prevent physicians from asking for help.

        • Friendly ER Nurse says:

          Don’t listen to that doc…. the pos probably does not even know what we go through nor does he probably work in the same area as we do. And if he is a doctor he has no heart. Hate to have him on our team.

  116. Still healing says:

    I have had a 29 year nursing career. I have been bullied, emotionally abused, and worked in high stress situations. I have become an expert on death of patients and supporting families.

    I was fired a year ago for doing the right thing to keep future patients safe. I had a study patient die 8 days after being given the study drugs. He was the first person in the world to receive the combination. The autopsy Doctor requested to know what meds he was on so he could get the best tissue sample for study on cause of death. I unblinded the study and was fired. I took the situation to a grievance process with a lawyer as I was black balled and marked as Do Not Hire. I won the case in every way – the institution was literally upset and crying, my lawyer and I were joyful. The committee ruled against me and me and for the University and at that point I was not surprised, they couldn’t do what was right without consequences. The autopsy Doctor had to go on a mental health leave of absence, the Physician over the study suddenly was on an unplanned sabbatical at the time of the hearing and neither couldn’t testify against me. I know the best possible tissue was collected and hopefully the other 800+ patients to go on study will not have to die because of what I did.

    I have found a new job in a new company where I was not black balled. I am learning to be happy but still have ptsd often and have to talk myself down. More emotional support is needed as care providers cannot keep giving without support

  117. Nurse L says:

    Hello,
    I am a nurse in Texas. 4 years Med-Surg, 18 years ICU, currently nurse educator (15 years).
    An ER nurse friend and I are contemplating starting a support group for nurses. We realize this possibly could grow rapidly to include all people involved in caring professions.
    Do you have any suggestions for resources and tips for beginning a support group?
    Thank you,

    • Nurse L says:

      Please remove my comment, I did not intend to publish my email or credentials. Thank you

    • Cheryl Van Epps says:

      I am a 5th yr TBI patient, a Patient Advisor at my hospital and an Advocate Member of the National Patient Safety Foundation. I’ve experienced multiple trauma in my lifetime, my latest was the bungling of my follow up care, which was at times torturous- it essentially re-traumatized me. I don’t want to go into details here but for my volunteer work, I tell my patient experience story to audiences including hospital staff, medical students and I just let my tears flow freely. It is both healing- knowing that by “speaking up” I can perhaps prevent this from happening to another patient- and at the same time, it’s killing me. I suffer from chronic psychological and emotional issues, including PTSD and depression.

      In any case, because I did not receive the healthcare I needed when I needed it, and because I am a mother (and a former biomedical researcher) I educated myself about what was causing my symptoms and issues I was experiencing and I learned to heal myself. I had to, for my son. There was no other choice.

      For setting up Women’s Trauma Peer Support Groups:
      https://www.nasmhpd.org/sites/default/files/PeerEngagementGuide_Color_REVISED_10_2012.pdf

      The Substance Abuse and Mental Health Services Admistration (SAMHSA) has many resources such as the following. Please check out their website.
      SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. SAMHSA’s Trauma and Justice Strategic Initiative, July 2014.

      A Socio-interpersonal Perspective on PTSD: The Case for Environments and Interpersonal Processes. Maercker, A. and Horn, A. Clin. Psychol. Psychother. 20, 465-481 (2013). This article rang true for me. It occurred to me that my experience was basically a knock out experiment testing their social support systems model. The authors propose we need a combination of 3 tiers of social support to heal: close relationships (I lost my spouse through separation, my visual impairment cut off my family’s email communications), social groups/ clubs (hypersensitivity to sound and light, medically restriction from driving kept me housebound and isolated) and a positive, supportive society or community as a whole (when I did reenter my world, I received snarky, hurtful remarks on my performance).

      I did not see mention of “resilience” and strength of support networks in this line of comments. I’d like to bring these issues up. Nor mention of the ACE studies using at a point system for the amount of trauma one experiences, person’s coping resources and the ultimate effects of trauma on a person’s state of health… perhaps also a person’s “breaking point”.

      For my part to help combat the negative stigma on seeking mental health care, I’ll now call people out when they use “crazy” or other such phrases that give negative connotation to persons experiencing mental conditions. And I am very open with the fact that I am seeing a counselor and peer support group therapy.

      I know this is looked down upon in the medical field (through my close relatives) but it’s entirely unrealistic. For your safety and the safety of our community, this policy is unhealthy and has got to go.
      I appreciate that I am in a safe position to advocate- my head was damaged, therefore I go to a head doctor… I am titanium figuratively and literally. And I use this political capital.

      One last reference for advocacy: Caring Enough to Lead: How reflective practice leads to moral leadership. Leonard O. Pellicer. 2008 Corwin Press. Thousand Oaks, CA.
      An easy read. Keeps me grounded morally and emotionally when I have no other immediate personal support.

      Thank you for the reference (MITSS website) I didn’t know of this. I’ll check it out.

  118. Kari Sugars says:

    Doctors are not the only ones to suffer. Nurses are right there witnessing the trauma and struggles of patients and families too. I suffer from PTSD as well mine is not from my nursing but from finding my son after his suicide. My career has struggled and so have I since that day. Medical professionals are not the superheros we think we are, we need help and support to continue to make a difference. Unfortunately I do not see that help as readily available as it should be. I hope that one day changes.

  119. Ana says:

    I’m so sorry to hear what you went through without any support. There is an urgent need for Palliative Care ER physicians. It sound like clinically yo acted in good faith, sometimes patients fn’t read the book and there is a bad outcome despite best efforts and practice. I am a Palliative Care trained Physician and this may be an opportunity to expand your skills. Imagine each Physician blaming themselves for a poor outcome despite best efforts?

  120. Bonnie Foster says:

    You hit the mark straight on the button. So true…it gives me shivers to think how badly the medical field is treated….

  121. Joe Soper says:

    I am a bipolar paramedic I had to quit and go disability due to working private ems sometimes as long as 96 HRs on the clock and would go from oNE low paying fire station to another for days at a time to be able to feed my family I ended up in the hospital 10 to 15 times in 6 years a lot of times I couldn’t take my night meds they make me sleep and you can’t sleep when the tones drop my sleep would get out of line I once went to the hospital and told the ER doc I was going to hang myself with oxygen tubing as I thought it would be a comical way to end my life by stop oxygenation with the thing that’s supposed to assist it. It was not the closest I came I worked 6 of 7 days 24 HR shifts with e ought time to go from station to stain or just on the clock at private ems sleeping between run in the ambulance I came home slept 16 hrs not haveing taken any meds in a week I was all over manic one day depressed the next (I am bipolar 1 with mixed states) when I woke up I got into a fight with my wife and new just the right combination of meds to take to kill me using the clonazapam and lithium and a heart med and a few other things my wife took me to the hospital I was so mad I wouldn’t let her come to see me and told them I did not want visitors in the ER I passed out and woke up 11 days later in the icu they let my family come see me because they thought I wasn’t going to make it and it was father’s day and my children wanted to see me. I went into the hospitals pych unit for 10 more days and then into a 38 day treatment fucility. When I left I called my bosses and told them what had happened and why I hadn’t picked up shifts anywhere in 2 months my private transport ems compay told me I could have my job back if I could pick up 3 back to back 24 HR shifts the next day with no concern for what I had gone through or my safety or the patients safety who I would be caring for my wife told me I was not allowed to go back to ems again in anyway I have been doing OK for 3 years or so now on disability going to counciling weekly and see my psych Dr monthly and also got ECT treatments which have helped but I feel that in ems with all the bad that you see they just don’t care about you they care about making money

  122. Rae Whi says:

    I have been a nurse for over 40 years. I truly believe nurses can suffer from PTSD. No identifies this problem. Almost every nurse I know and work with are on antidepressants. Many nurses are bullies to one another. There is a major problem in health care and it is OUR dirty little secret. Best wishes doctor and thank you for sharing. It’s a beginning to dialog with others.

    • Pamela Wible MD says:

      HUGE, huge issue with nurses too. My close friend is a nurse. Here’s what she told me to tell a new nursing student: She is crazzzzzzy ! So many better professions at this stage in her life. And the pay is really low and the rewards very few. Patients are a pain in the ass most of the time now. Talk to any seasoned nurse and she will get the same response. Tell her to go into O.T. Or ultrasound tech. Anything but nursing. You will be blamed for every mistake that happens, even when you save the patients ass from a lethal order from the doc….. I can’t wait to retire from this miserable profession. Tell her to pick a profession with a union or just be a CNA in a docs office and draw blood and do ekgs. She will be on benzos., antidepressants and chasing her meds down with a cocktail if she chooses nursing…..and she will begin researching Dignatus in Switzerland to ensure euthanasia when she is ready. Give this women my number. I will tell her the real deal…..

  123. Angela says:

    Thank you for sharing. I’ve felt the same way at times, his story is very inspiring and my hope is he can help more people. Thank you again.

  124. Sue says:

    While I am not an MD, I am an emergency room nurse. We experience verbal and physical abuse from patients and families. And we too are blamed for being “weak” when we finally get to the point where we say something to the patient or family member. We get “written up”, under the guise of PATIENT SATISFACTION… because a patient “complained” that they were treated with disrespect, even though they were abusive…physically or verbally. We witness and take care of things that mainstream public could never even imagine. Addiction and suicide attempts are the highest per capita among healthcare workers. And I suspect even higher among emergency room doctors and nurses.

    I believe that until, if ever, our government allows us to tell people to stop the abuse or leave the ER, the abuse will continue.

    The abuse put upon all of us by the system keeps us from saying anything to anyone if we want to keep our job and NOT appear weak. There is NO decompression available nor is there any support by any institution/company that we work for without losing our jobs. Eventually, there will only be new people in the field with little experience because most of us will leave to save out own lives.

  125. C says:

    Life burns you out- you don’t have to be a doctor, but I am sure that must be an added tole. All you need be is a shuck that tries to do e right thing over and over again as life kicks you in the teeth & then loved ones die – that take advantage of people rise to the top and one cares enough to stand up for right. Life is hard & it seems to be getting harder.
    Thank the good doctor for his honesty- and that he was at least kind enough to give his wife that time & the God they found him. Not everyone is saved from that hurt .

  126. Marc Gelman,MD says:

    Thank you for your interesting and thought provoking column. I would like to share info regarding a documentary that examines PTSD in first responders. Although The Other Side of the Hero hasn’t been released yet, I believe that it will be very soon. Your readers can check it out here:
    http://www.theothersideofthehero.ca

  127. Jason Price says:

    Thank you Pamela, this epidemic has lived in the dark for far too long. I appreciate your work to bring it into full view. I have an observation. Having worked as a Paramedic for nearly 15 years I am shocked by how siloed healthcare is, especially emergency medicine. While I worked right beside ER Nurses and Physicians I rarely had an opportunity to break down or just huddle over a traumatic case. We all see it, we all feel it, but we seem to retreat and process it privately. Why is that? Where is our instinct to seek support in one another? Perhaps it’s a fear of judgment, as you mentioned. Maybe it’s an inability to be vulnerable.

    Another thought is the private security guard payed to stand by and intervene if something “bad” happens. Where is the mental health professional doing the same. Where is the witness to our trauma. There is a certain amount of the “frog boiling in a pot heated slowly” phenomenon going on here. It’s like we stack all the hurt in attic above us so it’s out of sight, forgetting how much is there until it crashes down on us. It’s seems like we should be cataloging this pain like a radiology tech with a personal dosimeter so at least we know where we stand. We are so far behind this thing that most states don’t even prosecute patients that physically assault healthcare professionals. A recent statistic said that 65% of all healthcare workers reported being hit by patients while caring for them.

    I applaud your work and I hope that every physician reading this knows that we need them and love them. That the work they do is important as are they for doing it. I have 4 kids and have seen my fair share of Doctors as a Dad and, job aside, I appreciate their diligence and compassion and I thank you all for your service.

    Pamela if I can help, in any way, please let me. I have a passion for those that serve in this capacity and I would be honored to give back.

  128. Suzie says:

    Very personal and touching however from the very beginning this physician blames others owns none of his behavior or actions. “Sheriff deputies me from my truck and tased me” and then how dare they charge him with a felony and two misdemeanors. He then reports through miracles he was brought back. How about the miracle that he didn’t hurt anyone when he chose to drive under the influence? He also failed to comply when they asked him to get out of the car and he chose not to. I don’t care who you are when you are under the influence you are unpredictable. He further reports his decision to end it all was 100% work related. I’m struggling with that too. He had choices prior to this, if he was unhappy he should have left ED and gone to a different practice area. He clearly states he followed proper protocol when treating a young girl with influenza before stating she came back in and ended on life support. He then states the family refused to withdraw care. What is the purpose of those statements? He again is playing the victim and blaming others to the point of saying, “of course the family complained”. Who does he think he is? That the family doesn’t have the right to withdraw care? That they don’t have the right to complain? The icing on the cake is when he states his review was days later and that this incident with a few other cases that were “trivial” would lead to his termination. ED docs lose patients, however they don’t terminate docs based on losing a patient if proper protocol was followed, they also don’t terminate docs for a few other “trivial” cases. Then he tells his wife he can’t face being terminated for her death. Yet he already said there were other trivial cases. He also states he followed all traffic laws and drove the speed limit. Once again he attempts to justify his actions and the fact that he believed he had done no wrong. He speaks again that he did everything right when treating the young girl and perhaps he did. He states he doesn’t want the attention drawn to him but hopes he can help others from doing the same thing. I’m sorry but when I read this it screams me me me and victim victim victim. Not once does he own his behaviors, show remorse or compassion for the family, in fact he blamed the family and his employer without outright stating it. This man might have trauma but it seems that he likely had problems before and some of those personality traits are very evident now. Trauma or the fact that he shouldn’t have chosen ED has his profession due to his personality or both? Either way he needs treatment and I truly hope with that treatment he is held to accountability that any other person would be held too. We have veterans that have severe PTSD, left their families and served our county for multiple tours and the ones I know hold their head high and don’t place blame on others and totally expect to be held accountable. This physician could learn a few things from them.

  129. Bob Coughlin says:

    I’m glad you survived and have retained your faith. Doctors are taken for granted in our society. If you ever feel resentful toward humanity, well, that’s only natural. Humanity does not appreciate the services it receives no matter how heroic. The result is our soldiers, police, firefighters, doctors, engineers, linemen, miners and all others who work through the night so that the majority can sleep in warmth, peace and health are ignored in their time of need. If I could, I’d give you an award for lasting as long as you did. May God bless you.

  130. Robert Kluttz says:

    I once interviewed a candidate for a healthcare consulting role on my team. She had begun her career as a Level 1 pediatric trauma nurse before transitioning to a quality/improvement position within her hospital. Knowing the intense passion that these nurses have, I asked her why she left pediatric trauma. She paused for a moment and then said, “I just got tired of putting 2-year olds in body bags”.
    I can’t imagine the emotional roller-coaster alternating between exhilaration and abject despair that goes with being a clinician in those types of situations. I’m about halfway through “Emergency Doctors” which details the minute-to-minute existence of ED docs at Bellevue. It’s such an important perspective as more and more hospitals focus on patient satisfaction/patient experience. Its easy to improve that experience at the expense of the clinicians that are putting their physical and emotional well-being on the line every single day. That approach is ultimately a disservice to both the patient and the doctors/nurses. If you want satisfied patients, you have to start with satisfied and engaged docs.

  131. TW says:

    I had 2 suicide attempts 8 and 9 years ago. I was simply under too much strain and had very little help. My family abandoned me and when my friends learned of the suicide attempts, they were distant. It was a horrible time. I had no visitors in the psych units which took me in which further depressed me. Where were my friends and family? The care I received there was superficial. Looking back, I realize I must have had a strong will to live underneath all the pain and heartache. I pulled myself out of the crises and got the help I needed. I started working again and supported myself. As time as gone by, I am proud of myself for making a fresh start. The only regret I Have is that my friends and family deserted me. Some have come back. At any rate, I’m glad I came through it and will not ever allow myself to get that depressed again.

  132. Jason says:

    Dear Pamela,

    Unfortunately, this is becoming an all too common issue in Australia with three doctors recently passing away recently in Sydney and two medical students. We have had a couple of recent media articles, including a prominent article on Kevin MD by one of my colleagues: http://www.smh.com.au/comment/three-of-my-colleagues-have-killed-themselves-medicines-dark-secret-cant-be-allowed-to-go-on-20170209-gu9crd.html I am also seeking to undertake the Doctor’s Health Portfolio for the AMA in NSW, Australia but don’t know where to start. I hope to start a charity ball and encourage the Doctor’s Health Advisory Service to undertake better promotion of its services in Australia through social media.

    Kind regards,

    Jason

  133. Dennis says:

    Dear Michael, I couldn’t stop crying while reading your story. I’m not a doctor nor do I work in the medical field. After reading everyone’s comments, it’s surprising how similar our work stressors and emotional struggles relate. I feel like the profession I chose goes unnoticed and unappreciated by most people. I’ve worked in a jail for 15 years and it can be an unpleasant job at times. Coincidentally, it was my team that saved you. I’m glad to hear you’re alive and have found a renewed faith in God. Your story has helped me find value and hope in what I do everyday.

    I would love to start a therapy dog program for first responders and medical professionals in the workplace. This service is often provided for patients and in my situation inmates but overlooked for those that treat or respond to the crisis. Unfortunately, I lack the knowledge and resources to make it happen. Perhaps the medical community could start this type of program to deal with the immediate impact of stress in the workplace.

    I wish you all the best in rebuilding your life and I’d gladly help you in anyway I can.

  134. Lawrence Earl Ross, Jr., RN says:

    Well written account of the daily rigors many, if not all, in healthcare and emergency response, fire response, and law enforcement face. This is not only the spearhead, but all parts – the 911 dispatcher, the beat cop, the detective, the firefighter/paramedic, the certified nurse’s aide, the RN/LPN/LVN, and the physician. Each day an onslaught of pain, disease, sorrow, mental health crises, yet most have little to no warning or pay no heed to the signs until a break like this. It is not only combat troops who deal with PTSD. It is refreshing to see the candor with which this article was written, and it will hopefully encourage others to check their mental status and to get help if needed.

  135. Bob says:

    This morning I listened to the story of the physician who attempted to take his life after the death of the young girl. I was moved by a my compassion for the physician and his family. I serve as hospital chaplain where I serve in the adult critical care units. Recently one the physician and I started a reflection round to discuss deaths and othe critical events in the ICUs. These have centered around what are you feeding/thinking about the event. These RR are being attended by 18 to 25 of the adult critical care team. We hold them monthly, we will be having our 4th one this month. Blessings and thank you for your work. Bob

  136. Pamela Wible MD says:

    Third-year med student writes me: “This morning I was on call and walked in to see the residents names on the white board with tally marks underneath their names. When I asked what it was for they told me that they started counting the number of times they considered killing themselves.”

  137. Pamela Wible MD says:

    A physician asks that I post this anonymously for him:

    I appreciate your work on behalf of physicians who are suffering. It is much needed and should have been addressed much sooner by our medical schools, residency programs and professional societies. I am hopeful that you will be able to shine a light on the profession wide lack of adequate avenues of treatment for depression and substance abuse that do not immediately give employers and licensure agencies reason to destroy your career overnight, leading physicians who are suffering and untreated with the forced choice between life without their profession, or a miserable life with their profession, unless they commit suicide or overdose or drink themselves to death accidentally on purpose. I know personally several physicians with one or both of these problems. The medical profession compounds the problem by being extremely close mouthed when it comes to speaking up or out about physicians with alcohol or drug dependence problems. The physician who needs help does not get spoken to, does not get placed in rehab, or on compassionate leave, but instead the problem is whitewashed. The physician’s clinical judgement is usually impaired at that point, obviously, but nothing is done to protect the patients from his/her impaired abilities and there is no good solution vis a vis rehab or addressing the problem. I know of at least two patients who were essentially killed by a physician like this. Big time drug use at work, no one wanted to address it, patients died. No one wanted to call him out. Patients come to us for help when they are the most vulnerable and our entire system fails physicians in need as well as the patients who count on them to be healthy and able to function in a very very stressful environment. Would you please continue to publicize this issue? As well as the widespread PTSD in the specialty of Emergency Medicine. Watch human beings suffer and die on a daily basis and it equals PTSD. It’s not rocket science. Not talked about, very prevalent. Absolutely untreated.

    Absolutely, publish anonymously. I can’t think of anything more painfully ironic then physicians being willfully ignored when they are themselves unhealthy, nonfunctional and suffering, dragging themselves to work despite all, encouraged by the corrupt system that they labor under to put themselves in harms way. Big Medicine doesn’t give a shit if physicians die in droves on a daily basis. Big Medicine is in it to make money. Period. Humanity and compassion is something physicians bring to the table. Big Medicine is happy to leave it there as long as they get their money’s worth before the physician kills him/herself.

  138. Gary Levin says:

    Why didn’t this patient take a flu vaccine shot ? Families that do this sort of angry outburst should be put in their place. This unfortunate physician was just in the way of an angry and dysfunctional family…Did they sue? When one is abused one rarely stands up for themselves…Keep up the good work Pam.

  139. Marie says:

    As a health care provider, I think it is important not take responsibility for my patient’s health and lives, it is their responsibility! That is asking to much of anyone. However, it is my responsibility to offer compassion, do my best to alleviate their suffering and practice medicine properly.
    I follow the law of karma. The Medicine Buddha scriptures state that if someone is sick, it is their karma and if they cannot find the right doctor or cure…that is also their karma. And death, most of all, is between that person and the divine. We are only witnesses to it.
    Doctors made a fatal mistake many years ago in taking too much responsibility for patients…and now the medical establishment has trapped us in it.

  140. Shannon says:

    Wow! Thank you for sharing your story. I wish I had been educated in this when I first married my ER Physician husband. It certainly explains a lot of his coping behaviors over the past 20 years. So sad I never looked into his heart to see his suffering before now. I just saw it as a job that he rarely speaks about. Thank you. It will make me a better wife to him after all this time. He is heading out the door now for the first of his 5… 12 hr night shifts. 😐

  141. Julie, RN says:

    Hello,

    Thank you for sharing your experience with us.

    This is the story of an ordinary man who had an extraordinary calling. By its very nature, being an ER doc (or policeman or fireman or paramedic) is not a job for sissies.

    However, the toxic environment (unreasonable hours, lack of support from administration, and unrealistic expectations) was almost as tiring as the carnage itself. That is totally unacceptable and must stop.

    Taking care of the caregiver is essential. Perhaps some hospital systems are waking up to this fact. That is a subject for another web site or blog. However, I am glad to see that Dr. Wible has a great webinar planned to address this subject.

  142. Anne Z says:

    Why one of the first thing Board Certfied Chaplains (BCCs with a 4 year graduate degree and a full clinical residency) are taught the gospel of self care, and regularly utilize licensed pastoral counselors to offload our crap… we.know.our.stuff.

  143. Gunther says:

    I know a head nurse who informed me when she retires, that she was going to head the LVN program at the local community college. I informed her that while she is there, she might as well teach the nursing students about office politics, uncaring, unfeeling supervisors and higher nursing managers, etc. Of course, there was a wildcat nursing strike at the workplace and she helps cause it because of her putting so much work on the nursing staff and not cracking down on the supervisors who were treating the new nurses like garage.

  144. Ann says:

    This poor MD, I find it terrible that he was arrested instead of immediately taken to the hospital. And I am very glad he lived. It sounds like he just had trauma after trauma. Also that he is a true believer in the Lord, which I am also. I had my life saved by an ER MD, many years ago. My MD had misdiagnosed peritonitis as a bladder infection. Though I followed his recommendations, my fever shot up to 107.6; and I was vomiting and could not stop. At which point my husband took me to the ER. The outcome was that I was hospitalized for about two weeks, and on 4 IV. antibiotics. The ER MD did tell me a couple of times that ” you very well could die tonight. “. I was not worried, though as I knew I was saved in Christ, and that the hospital was doing all they could. I was grateful to the ER MD, and thanked him for saving my life. I do believe that since they have many traumas, there should be counseling, support, etc. in place to try to prevent their suicides.
    The ER MD in the example here did his best, and no wrong. And MDs are only human, and can only bear so much. I am praying his life will get better, and he will healed from these traumas.

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