I opened my email recently and blurted out a heartbroken expletive that I can’t print here. Another member of our health care family had died by suicide. I didn’t know them well, nor had I known our colleague who died from suicide just a few months before, but I felt as though I had been punched in the gut. An image came again that has been arising in my head, repeatedly and unbidden, of someone drowning.
Drowning prevention campaigns remind us that it is typically silent and unremarkable, unlike the flailing arms and loud cries portrayed on television. Someone right next to you in the water could be in distress, and you can miss it if you aren’t actively looking. It turns out, facing suicide feels a lot like looking up at the blue sky from two inches under the water’s surface, struggling to breathe, and trying to find the energy to pull yourself up for air. Feeling invisible to those around you, at some point, you’re too exhausted to swim anymore.
November brought a personal anniversary that, until recently, had been steadily fading in significance as my fulfilling life has been lived. Eighteen years later, there is no great milestone to reflect on. But I am watching too many friends and colleagues fight to keep their heads above the water. The smoldering problem of an unacceptably high suicide risk in medical providers has blossomed into an emergent 5-alarm fire. We are in an epidemic of psychological drowning that we must face head-on.
I’ve found myself exploring the memories of my anniversary more deeply in an attempt to see what went right and what went wrong. It’s not a pleasant memory. Its tenderness, only partially dulled with time, makes it one I don’t visit often. While I’ll continue to hold some details carefully and close, the rest of this story feels too important to keep private anymore.
As a fourth-year medical student, I had already been taking sertraline to address the fact that I had started daydreaming about lethal accidents. However, I hadn’t yet faced the relentless perfectionism and insidious self-loathing that I had mistaken for healthy self-improvement and striving for excellence. One evening, concern about what would happen to my cat paused my suicide attempt long enough for me to consider reaching out to someone. That November night in 2003, I called my sister two states away to let her know how close I had come. It wasn’t until I heard her voice crack that it even occurred to me anyone would really care if I was gone. This call initiated a flurry of pain and panic that ended in my escort by police to the San Francisco General Hospital psychiatric emergency department, while they mused that it didn’t make any sense for someone doing as well as I was to kill themselves.
The psych ED was cold. I awaited my disposition in the tiny “women’s” room off the large main “men’s” area, where three of us attempted to get some sleep in hospital recliners. At some point that night, one of my psych-mates finally got a bed in the inpatient unit upstairs. I awoke to them covering me with their blanket as they were leaving. That moment remains one of the best memories of my life, the realization that even the most broken people can have such beautiful spirits and lift others up. The next “surprising benefits of mental illness” moment of my life happened a few months later, when I got up the courage to attend a support group for medical students with mental illness, only (to both our great surprise) to run into the other medical student on my rotation. There are just so many of us. She remains to this day one of my dearest friends.
Too many of us are struggling to swim right now. Too many of us have not been seen and offered a hand, and too little has changed in 18 years. We must start looking for drowning colleagues, not waiting for them to decide whether to end their lives or call for help. We must treat this like the emergency that it is.
Eighteen years ago, the general response from the few I told about my suicide attempt was surprise, because I was doing so well at school even as I was silently drowning. Eighteen years ago, I hid that I was in therapy with the secrecy worthy of a dead body in my closet. Eighteen years ago, I needed to hear these things in no uncertain terms, so I will say them to all of you reading now who feel your faces slipping under the water:
We see you.
You are not alone.
You are worthy of a helping hand.
You don’t need to be on the edge of survival to get help.
Mental illness is common in medicine.
Mental illness makes you neither weak nor a bad doctor, nurse, or advanced practice provider.
You can have a wonderful and fulfilling life even after all of this.
You may even find that you will have the opportunity to provide someone else with a warm blanket or that you have developed the power to spot a drowning colleague, reach out, and grab their hand before they slip too far beneath the water’s surface. As Leonard Cohen reminds us: Forget your perfect offering. There is a crack, a crack in everything. That’s how the light gets in.
Please. We see you. Hold out your hand.
For a resource, please visit the National Suicide Prevention Lifeline.
Allyson Hart is a nephrologist.
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