An odd suicide
When I was a senior psychiatry resident, it was common practice for the psychiatric attending physicians to ask the residents to cover their patients for them when they went on vacation. It was a reasonable arrangement. The psychiatrist would know that someone was available to their patients in case of an emergency or for any other reason. The residents, for their part, could expect to charge a fee.
I was sitting in the doctors’ lounge one day when one such attending popped his head into the room and asked me if he could give my name to one of his patients when he was away on a fishing trip. I did not know the psychiatrist, but I told him, “sure.”
I asked him a few questions about the patient. He told me her name, but not much more.
“The only thing you need to know is that she used to see a psychiatrist who killed himself when he went on vacation one year. You just need to reassure her that I’m really going to come back in a month.” He smiled at me.
The woman did not call me during that month; and I forgot about the matter. Then I heard that the psychiatrist to whom I had been speaking killed himself during his vacation! According to the story I was told, he swam away from his fishing boat and drowned.
“Impossible,” I protested. “It must have been an accident!”– but he had left a note.
My first thought was of his patient and whether or not I had some responsibility to speak to her. I knew nothing about her except her name. Probably, I would have difficulty locating her. And she knew nothing about me. And it was probably too late. And what could I possibly say to her, anyway.
My second reaction was to get mad at the psychiatrist. Even if he was so desperate as to want to commit suicide, he had some responsibility to the people left behind. He knew exactly what his patient’s response would be because he indicated that much to me. If he had to kill himself, couldn’t he have waited until he had returned and, perhaps, have sent her to see someone else? The coincidence of two of her psychiatrists killing themselves under the same circumstances would, of course, affect her terribly. I could imagine her blaming herself, since that is the sort of thing people do. And how would she react in the future when a family member or anyone else close to her took a vacation?
Mulling over this incident over the years, I think it shows certain elements common to all suicides. First of all, I do not believe the attending psychiatrist who spoke to me intended at that moment to kill himself. If so, he would have had no reason to speak to me in the first place. And he seemed at the time to be in a good mood. And I do not believe he was motivated by malice in figuring out the most destructive thing he could to do to injure his patient. He was planning at that time on returning from his vacation. The impulse to kill himself must have come over him not long before he actually killed himself.
Some points: A major depression can overcome someone within a matter of days. Suicide, which is sometimes a consequence of such an illness, can occur seemingly for no reason, suddenly. The illness can strike anyone. Psychiatrists, it seems, are more liable than other medical professionals, in large part, probably, because of the example of some of their patients. Suicide is contagious. A famous person killing himself/herself may set off a wave of suicides. Suicide predisposes to other such attempts among members of that person’s family.
When someone attempts suicide, that person may have lost all concern for the consequences to others of that act—such as was the case with this psychiatrist; but, surprisingly, such considerations do weigh heavily on others who are equally depressed. Many people have told me that they would kill themselves if it were not that their children would suffer and be alone. Still others purposely kill themselves as a way of getting back at someone else. They, too, are only too aware of what will follow their suicide.
For my part, I was reminded that very likely, I, like other psychiatrists—in fact, like everyone else– was not immune to the illnesses I treat, no matter how well I understand them. (c) Fredric Neuman