Amazon’s cart is dangerous spot – especially those “recommendation” banners alongside the bottom of the screen. In ordering When Breath Becomes Air, by Paul Kalanithi and Abraham Verghese, the Jan 2016 highly acclaimed memoir written by a dying neurosurgical resident (phenomenal, by the way!), I came across Physician Suicide Letters, Answered by Pamela Wible, M.D. (Pamela Wible, M.D. Publishing, January 2016). I clicked, and both showed at my doorstep two days later. To complement Dr. Karen Broquet’s piece in this Bulletin on promoting wellness, I opted to resurrect this column and share my thoughts on Wible’s book.
The concept of “wellness” is broad (it’s not simply the absence of pathological states, but also encompasses resilience factors), and while “burnout” is not synonymous with depression, it can contribute to states that may culminate in suicide. Through her collection of correspondence with surviving families and struggling medical students, residents, and physicians (among others), Wible boldly exposes physician suicide, as well as components of medicine’s culture that erode wellness. As psychiatrists, dealing with suicide is daily work. Yet there is something uncomfortable about the topic when it involves physicians. Wible’s book is on the one hand a sobering and haunting reminder that we lose too many healers to suicide, and on the other hand, a hopeful and rallying reminder for those left behind. It is a sobering read, and whether or not the reader agrees with how she chooses to address certain letters or certain proposed policies, the reader is likely to find the letters elicit sadness, understanding, compassion, as well as calls to action and moments of hope. There are moments where the urgency to pay attention to the culture of medicine, stigma, and lack of care for the caretaker take center stage, and there is power to the collective voices of colleagues who ended their lives by suicide, and those left behind. There is serenity and sadness when the reader encounters letters from grieving families, and there is relief when letters describe a return from the brink. And there is an appreciation for the extent of the problem. No doubt, many of you may know colleagues, or know of colleagues who lost their lives to suicide. Wible’s book is a worthwhile read to remind us that physician suicide should not be “business as usual.”
Physician Suicide Letters is a paradoxically uplifting reminder that medicine has its own cultural context. As psychiatrists, we treat patients who are suicidal. As educators, we train students and residents to treat patients. More importantly, though, as an academic psychiatrists AND clinician-educators I feel we share a duty to ensure that our trainees are empowered to take care of themselves so that they may take care of others – and also empowered to change the culture of medicine for the better.
AAP Bulletin – Spring 2016, Page 4 of 7
