‘ What kind of SURGEON can’t even KILL HERSELF properly?’
Doctors are committing suicide at alarming rates, prevented by perfectionism from seeking help
Dr. John Bradford remembers taking the block heater cable, the kind of cord that doesn’t stretch, into the house.
He had just returned home from visiting his daughter, his eldest girl, in Montreal. On the highway back to Ottawa, he thought about driving his car into an overpass. But he worried. “What happens if you survive?” he remembers thinking, “and you’re left paraplegic?”
Inside his house, he thought about where he could loop the cable. He wondered if he would leave a suicide note.
He was in the most lethal phase of posttraumatic stress disorder, a deadly dissoci- ative state where nothing seems real “and you’re only thinking about one thing.”
Then, his daughter called from Montreal. “I’m worried about you,” she said softly.
“I had been with her just 2 ½ hours before. We went to a movie; we’d spent time together,” says Bradford, the worldrenowned forensic psychiatrist who suffered an astonishing mental collapse in 2010 after watching horrific videos of sexual sadist Canadian Air Force Colonel Russell Williams raping and murdering two young women.
“She’s a clinical psychologist and she didn’t now how suicidal I was, but she was worried about me …. Intuitively, I think she felt something was wrong.”
The call, and another soon after f rom a f amily f riend, broke t he s pell. Bradford “kicked out of i t ,” he says. “These were signs, good signs, that I should not be doing what I was planning to do.” He called two psychiatric colleagues. He returned to the doctor who first diagnosed him with PTSD nearly two years earlier, the doctor whose advice Bradford originally ignored.
Like most doctors, Bradford was a bad patient. “I didn’t follow what I was supposed to do.” This time, he wasn’t given any latitude. “He said, ‘ this is what you’re going to do.” Bradford started on psychotherapy and anti- depressants. Since then, “I’ve been — touch wood — fine.”
Bradford chose several years ago to speak openly about his depression, and the demons of PTSD, to warn others in the medical field that what happened to him could happen to any of them. This is the first time he has publicly revealed the depth of it. “Everybody saw me as this tough forensic guy, that nothing would faze me. Well, that was bullsh- t, right? More than that, it nearly was the end of me.”
When Dr. Michael Myers read of Bradford’s struggles, he reached out. When doctors go public about their own struggle, Myers always sends an email or a card to thank them. “Because they make it easier for other doctors.”
“We’ve done pretty well with the general public in terms of reducing the stigma associated with going for help,” says Myers, an Ontario native and professor of clinical psychiatry at SUNY Downstate Medical Center in Brooklyn, N.Y.
“But we still have so far to go in the house of medicine.”
Statistics suggest doctors kill themselves at a higher rate than the rest of the population. Male physicians die by suicide at a rate nearly twice that for other men. For female doctors, the risk is two to threefold higher. A random sample of more than 3,200 doctors from the 2007- 08 Canadian Physician Health Survey found nearly a quarter reported a two- week period of depressed mood. “Anhedonia,” a kind of flattened emotional numbness, was reported by one- fifth. In Ontario today, 300 doctors are on disability — the majority for mental illness.
Myers, a past president of the Canadian Psychiatric Association, has dedicated his career to treating doctors in mental distress, to studying what he describes as “the tragedy and enigma” that is suicide among the healing profession.
He and others say the very personality traits that drive people to medicine — perfectionism, an obsession with detail — can make them vulnerable to depression and, in extreme cases, self- annihilation. Not helping matters is the heavy work demands, the stress, and the emotional aspects of dealing with patients — the burnout.
Yet doctors are notoriously bad at seeking help, because to declare any kind of mental illness, to admit to “anything less than perfection,” as one surgeon describes it, can be seen as a sign of weakness. Others fear risking their licence, their hospital privileges or professional lives.
In his new book, “Why Physicians Die By Suicide: Lessons Learned from their Families and Others Who Cared,” Myers chronicles the “the inner conflict and the irony of self-destruction and despair” among doctors. He describes doctors struggling to “uphold the demands of their professional persona,” working as if nothing is wrong — never late to the OR, answering pagers and cellphones, inserting breathing tubes or cutting into organs — while slowly coming undone.
“When I did this research,” Myers said, “and I saw there were these families where the ( doctor) husband or wife went from well to ill, to death, without going to anyone, like a family doctor, an internist, a psychologist, a social worker, the clergy, a psychiatrist, none of that. They killed themselves. And I thought, this is unprecedented in medicine.”
It’s also a risk to patients. Untreated depression can put patients at risk of medical errors, of substandard or medically dangerous care, he and others say. “People who feel burned out feel overextended and tired, with nothing left to give,” Dr. Paul Garfinkel, professor emeritus at the University of Toronto writes in his book, A Life in Psychiatry: Looking out, Looking In. “They can become negative and cynical and lose feeling for other people, including patients.”
Myers once believed the myth that work is the last thing to go; that doctors are so driven they can work even when their life is in utter shambles. The reality is there are “subtle ( and not so subtle) changes in precision and safety,” he writes. A near miss in the OR. A medication error. Sometimes coworkers enable the dysfunction, he says, covering up for the person, “making excuses and taking up the slack.”
Tragically, when doctors on the edge contemplate suicide, they are deadly strategic. They know which drugs produce rapid loss of consciousness and death, or which ones are exceptionally deadly in overdose. “They want to get it right; they want it to be foolproof; they want to die quickly and completely,” Myers says.
In his book, he describes one female surgeon who, an hour after waking in an ICU after a near- fatal suicide attempt, told Myers, “What kind of surgeon can’t even kill herself properly?”
Canadian data is lacking. In the United States it’s estimated 400 doctors die by suicide every year. Myers believes those numbers are low. Some deaths are ruled “natural” or accidental. Or a physician or coroner may cover up the true cause when filling out the death certificate.
There have been tragedies in Canada: In 2000, Suzanne Killinger- Johnson, a family doctor and psychotherapist who specialized in depression, jumped in front of a Toronto subway train, her six- month- old son in her arms. The baby was crushed to death. His mother, who had been suffering untreated postpartum depression, died eight days later of her injuries.
More recently, in December, Montreal pediatrician Dr. Alain Sirard, under investigation by the Quebec College of Physicians for allegations he had falsely claimed some parents had abused their children, took his life inside his hospital.
Public humiliation and shame are among the leading triggers of suicide, Myers says. Licensure investigations can be even more traumatic than lawsuits, he says, “because they threaten the doctor’s identity so intimately associated with meaning and purpose in one’s life work.”
Doctors can be haunted by mistakes or failures, he adds. “It’s the price to pay for having set the bar so high.”
Pure, natural adrenalin fuels Dr. Mark Bernstein, a neurosurgeon who specializes in brain cancer.
By his estimation, he has operated on more than 5,000 patients with brain tumours. Still, he worries before every one — the night before surgery, on the morning drive to the hospital. In the rarefied and high- stakes field of neurosurgery — and Bernstein is among its stars — there are always technical problems. Arteries in places where they shouldn’t be. Tumours right in the speech or motor part of the brain. Tumours with crucial blood vessels inside them or stuck to them.
“Some operations you go into knowing that you’re likely going to produce a neurological deficit for this patient,” says Bernstein, of Toronto Western Hospital, a pioneer of brain surgery on awake patients. “You do an excellent job; you do everything right. But despite that there’s a decent chance the patient is not going to be a perfectly happy camper at the end of the day. And, that weighs on you.”
But arguably the biggest risk Bernstein has taken in his career was a story he wrote about a brain surgeon in the advanced stages of burnout and depression.
I WAS JUST IN SUCH BAD SHAPE ... I DIDN’T HAVE A CHOICE.
The creative, non- fiction piece, written for the Canadian Medical Association Journal, was stimulated by his own brief bout of depression.
Bernstein describes waking drenched in panic and sweat, struggling with feelings of “inadequacy and insecurity,” and sobbing like a baby after hanging up from a call from one of his daughters.
His wasn’t a serious depression. Bernstein didn’t miss any work, “although I’d have to be dead before missing work. But there was no question. It was clinical depression.”
By exposing himself, the risks weren’t just theoretical. “If all the family doctors and neurologists who send me brain tumour patients, if they all read this article and said, ‘ this guy is depressed, I better not send him any more cases,’ I could have seen a drop in referrals.” It didn’t happen. Instead, “I had people reaching out,” he remembers.
His brief depression, in 2003, never progressed to the point it affected his medical judgment. While the stigma around mental illness isn’t as strong as it once was, with more attention being paid to burnout, depression and physician “wellness,” it lingers still, Bernstein says. “I think, underneath, covertly, it’s still there.”
The very nature of the work itself can sometimes be depressing. Bernstein recently operated on an 18- year- old girl with brain cancer. “So her parents, these lovely, lovely people, were there with their precious daughter, who they know is probably going to die of brain cancer before she sees her 20th birthday,” Bernstein says.
“If that doesn’t get you, then you’ve got to hang up your spurs and get another job. Because you can’t stop caring.”
Doctors do learn to compartmentalize. “I think the bigger piece is the workload, the bandwidth issue — the making patients wait, t he not-having- enough-hours-in- the- day …. the administrative crap, the system imperfections, the constant worry that you’re not going to serve patients well enough ... It’s that sensation of drowning all the time. And that’s the way a lot of doctors are functioning in our system,” says Bernstein. “It’s frightening and it’s exhausting and it leads to depression.”
In a recently published survey of more than 2,100 physician- mothers who belong to a closed Facebook page, half of them believed they met criteria for a mental illness at some point in their careers — but had never sought help. Only six per cent who received a formal diagnosis reported it to their licensing boards.
The survey’ s lead author, Dr. Katherine Gold of the department of family medicine at the University of Michigan, was surprised how often the women would warn each other against seeking treatment. “Instead they would say, ‘ if you need help, go to a different town or make sure you pay cash for your prescriptions.’”
Many confessed to writing their own scripts for tranquillizers or antidepressants, or asking a trusted colleague, “I’m going through a rough time, could you write me for some Zoloft?”
“We just really need to make it normative for physicians to get help if there’s a problem,” Gold says. “We need to help them realize it doesn’t make them a worse physician or a worse person.”
When Dr. John Bradford realized he was in serious trouble, he contacted the Ontario Medical Association’s Physician Health Program, which refers doctors for assessment and treatment of problems related to stress, burnout, mental health, addiction and other issues. The program monitors about 140 doctors at any given time, 90 per cent of them ending in “satisfactory completion.”
“They jumped on it immediately, they did everything right,” Bradford recalls, adding his hospital’s CEO was also supportive.
“But to take that first step was anxiety- provoking. I was just in such bad shape at that point, I didn’t have a choice.”
Myers, in his research, found some physicians are dressed as doctors when they take their lives. One of his patients changed out of her street clothes and into her surgical scrubs before injecting herself with a lethal overdose. Another male doctor was found on his examination table, his wrist tethered to an IV pole with his belt.
“Could t he means of death or setting of death have medical meaning?” Myers writes. “That in the moment of time, the individual is really in the role of physician?
“We can only hope the doctor has found some good memories and comfort in those lonely final moments of life.”