Saturday nights on my couch are usually late and peaceful. But my old friend, civil unrest, crept into my reprieve. Do I do one more “to-do task?” Or do I or continue my aimless net surfing? But it’s not exactly aimless now. I’d just stumbled across an online article: “When You are the Friend of a Physician Suicide.”

The physician-author’s narrative about his friend’s death and the reader’s posts, mostly from physicians, led to a silent nag, stuck in my head. Why? I’m a psychiatrist who has had friends, and former patients take their lives. What more did I have to think or say about it?

In the article, the deceased doctor had been well-loved by patients, respected by colleagues and cherished by his wife and young sons. How can “life” go so wrong when everything seems so right?

But for the past few months, the author sensed changes in this man he believed he knew. Perhaps the author had first felt the less visible ones, an indefinable remoteness — maybe a stiffness — that had settled on his friend’s face like a mask. If the psyche could be touched, the author may have felt emptiness in his own gut. His measured, casual inquiries only elicited his friend’s rehearsed-sounding, “Everything’s fine.” The door never swung opened to ask, “What’s up?”

Suicide is a wordless anguish. There are none for those who take their lives. They decide and vanish in spirit, sometimes long before pulling the trigger or looping the rope. Those who are “left” search but can’t find words to make this a digestible event. It isn’t to me after all these years. Could I have done more: An arm around that slumping shoulder? Some kind of forced smile that’s supposed to communicate you understand, but you don’t?

About four-hundred physicians commit suicide each year. I wanted to tell the author how brave he was by putting it all out there and how messy real life can be, even for us trained with white-coats. The next two hours, I dug deep into what I knew and what I didn’t, and I wrote my post. Oddly, some software glitch kept me from submitting it, even for the next few days.

Here’s what I wrote:

Being fond of someone who’s having this struggle, whether a friend or patient, doesn’t necessarily lead to insight about his or her despair. We like them and can’t see most of it. Part of us may not want to see it — especially, if that person hides from her own desperation. While a medical student, my friend, one of the eight other women my year, became depressed. She was eventually hospitalized in the psych unit where our classmates did clerkships. Six months after discharge, she shot herself in our dorm.

I didn’t see it coming. Another friend of mine did, but she was helpless. If you’re the parent, friend or doctor, suicide is a life-changing loss. Never again will I imagine to “really know” someone, no matter how much I care. Our souls are mostly hidden, even from ourselves. To think otherwise feels arrogant. I am thankful we sometimes have unconscious resonances that surface to help us help others.

You don’t know how much good you may have done, receiving and responding to your friend’s texts. He was trying to stay connected, but maybe he could not bridge the gap between how he was feeling and how people saw him. Being loved by many can be a tremendous burden if you are not convinced you deserve that, or worry you will ultimately disappoint others.

My comment was not published. I thought about the time involved. Just a few less hours of to-do’s not done, maybe. Yet Sunday, I got a text from a patient, a single mother who had many ODs and hospitalizations. She looked good in the office a few days ago. We both shared a moment of victory, her one-year anniversary with no hospital admits.

Her text: “I feel really sad. I can’t stop crying. I just lost a good friend. I even talked to him the day he died.”

A suicide.

I called her. I could get right into the resonance about that loss and how she might feel. I realized those few hours the night before had prepared me. Time well-spent. Once more, I learned that sometimes we don’t know our real priorities until the day is done.

Peggy Finston is a psychiatrist and can be reached at Acu-Psychiatry.

Image credit: Shutterstock.com