Doctor, you are not alone

Lynn Holden, MD (UBC 1974) killed herself on 1 December 2015. She was 67 years old. Her family remembers her as a generous, kind, vibrant person, an accomplished baker, highland dancer, trumpet player, pianist, and poet.

At the time of her graduation from medical school she wrote:
    I dream I was alive
    Energy suspended
    The first rocket of a firecracker
    Ready to burst in lightening beauty of hope
    Radiant blush . . .
    I am waking up.
    My time is now.    

Unfortunately, it was not her time. During her internship and moving toward a residency in neurology, Dr Holden developed a fatigue that signaled the beginning of a severe clinical depression. Her medical career fractured and over the years, with recurrent bouts of depression, several of which required hospitalization, she never established a stable medical practice.     

    I am a vaulter whose pole broke
    I am a sprinter who keeps looking back
    I am a cyclist with only five gears
    I am a swimmer who sinks
    I am a diver who is afraid of heights
    I am a discus thrower who keeps going around in circles
    I am a gymnast who loses her balance
    I am a broad jumper who keeps landing backward
    I am a doctor who is a patient.

In 2015, a few months before her death, she contacted me, responding to my advertisement in the BCMJ looking for BC physician-authors with literary publications to be registered at the website. I asked her to send me a sample of her poetry. 

    Today has come and dreams are gone
    It’s just enough to struggle on,
    I live for you – please let me go –
    It gives me no joy and I resent it so.

It was only when I read this and other samples of her gripping poetry that I learned about her psychiatric history. 

She explained to me that she became broken, bitter, and old as a result of her recurrent depression and the variety of treatment-related side effects. She said that in a way she got over the broken and old parts. However, the bitter feelings still hounded her because of the unexpected bad response from her colleagues. She felt rejected by most of her medical friends whom she held in high regard.

    Many doctors I had befriended
    Then their friendship subtly ended.
    There are many reasons for this I can see
    And not all directly depending on me.
    First, they took a wife, then child –
    Multiple distractions, however mild.
    Then illness began to afflict me one day
    And the “poor old” doctors knew not what to say.
    And finally our financial and social groups parted
    Leaving none of the good I’d confidently started.
    So alone am I with my needy friends
    And my needy self on them depends.

As Christmas of 2015 came closer, we exchanged upbeat greetings and she sent my ailing wife a nicely packaged homemade Christmas cake. She did not answer my thank-you email so I phoned her at home. Her sister answered my call. Between her tears I learned that, unexpectedly, without warning signs, she had taken her own life.

Almost prophetically, 20 years before her suicide Dr Holden wrote:

    I want to sleep deep and long
    ‘Till all has healed and been made strong.
    I’m tired of working hard on me
    And want the change done passively.

    I’ll just lie back and take pills
    Let Medicare pay all the bills.
    I can’t take more unhappiness–
    I’ve reached my limit, I confess.

There are no reliable statistics about Canadian doctors’ suicide rates. Estimates from the United States suggest that male doctors take their own life twice as often as other men, and female doctors perhaps three times as often as other women. This is a tragic situation for all, but focusing on physicians, it is somehow related to the adage coined by the Greek playwright Aeschylus about 2500 years ago: “Physician heal thyself.”

This culturally absorbed saying implies two ideas: one, if you, doctor, cannot fix yourself, how could you fix anyone, and two, if you, doctor, have a problem, fix it yourself. The paradox is that physicians do go to their doctor colleagues for help with physical ailments but when experiencing symptoms of burnout—which are now recognized as manifestations of depression—they keep to themselves. In some situations the exhausted physician may even consider the symptoms to be a mark of heroism, of doing more than anyone could ask for, and as a doctor, something to be proud of. In contrast to doctors’ hesitancy to seek help in emotional distress, police, fire, and military personnel now recognize that work-related emotional distress (not too long ago branded as a sign of cowardliness in the line of fire) is a legitimate health issue.

Monday, 10 September is World Suicide Prevention Day. A perfect time for doctors—and everyone—to throw out the old Physician Heal Thyself cry, and adopt mental health associations’ motto: You are not alone! Doctor, believe me! You are not alone.
—George Szasz, CM, MD

Additional reading
Lynn Holden. ABC Bookworld. Accessed 10 September 2018. 

This posting has been approved for publication by Dr Holden’s family. It has not been peer reviewed by the BCMJ Editorial Board. 

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