There is something special about that childhood friend. It’s a bond that lasts a lifetime, something we can only experience fully in our formative years. My friend was Richard. We were inseparable in school growing up, then roommates in college, growing into manhood together. When it came time for medical school, I went to Dallas, and Richard to Houston, where he would start his career. We drifted apart in those pre-cell phone years, each in a different world, each of those worlds with its own all-encompassing gravitational pull. I knew he had been depressed at times as far back as high school, but he always seemed to snap out of it. We took a vacation together on a break that last summer, and he just wasn’t his old self. I couldn’t quite put my finger on what had changed, but he was different. Our minds and energy were so preoccupied in that pivotal time as our careers were forming.
A few months later, I got the call one evening from a mutual friend in Houston that he had taken his life. As I tried unsuccessfully to piece it all together in the days and years that followed, there were fragmented stories of those last weeks, none fitting together. To this day, I have no idea if he made any attempt to get help or if anyone tried to help him.
The current seismic movement in medicine to address physician burnout has its roots in a realization more than two decades ago that we were losing our colleagues to suicide at an alarming rate, much higher than the general population. In the last ten years, there has been an explosion of research in this field, with a long overdue realization that the physician wellness crisis has little to do with the personalities we bring into medicine and everything to do with the environment we are placed in from the day we enter medical school until the day we retire, or change occupation, or worse.
Since our county medical society started a counseling program, I have seen courageous colleagues get the help they needed with counseling or a recovery program, escaping a toxic work environment, cutting hours, developing healthier habits, connecting with colleagues, reconnecting with family, or leaving direct patient care. Still, we find in some of our colleagues a certain sense of cynicism or anger or hopelessness, sometimes even a sense of shame that prevents them from getting help.
In a New York Times article, Clay Routledge writes about suicide as an existential crisis and notes that “In order to keep existential anxiety at bay, we must find and maintain perceptions of our lives as meaningful.” He goes on to say, “How do we find meaning and purpose in our lives? There are many paths, but the psychological literature suggests that close relationships with other people are our greatest existential resource.”
My friend Richard may be the best friend I’ll ever have. I have many happy memories of growing up together but also regrets. It is a difficult story even four decades later. We all need to pay close attention to self-care in the many forms that may take. We need to get help from professionals, lean into our family and trusted friends when we sense trouble, and listen when those around us express concern. We also need to look out for each other. Check-in with colleagues, especially if you sense they are struggling. What you think might be an awkward conversation with a friend might just save someone’s career, or marriage, perhaps even their life.
Brian Sayers is a rheumatologist.