We lined the the road, waiting for the van carrying the body of my fallen colleague. Everyone was stunned at the sudden loss of the trauma surgeon we all looked up to. And even in that moment, I could feel my work friends looking at me a bit differently. Because he seemed so… OK. Now we all looked at each other wondering, “Is she okay? Is he okay?” No one had a clue this could happen. And if it could happen to him, it could happen to anyone. His suicide rocked my community. There are no answers, and there likely never will be. But I can’t help feeling like we have to take care of each other to help prevent the next physician suicide. 

We are vulnerable… though we don’t see ourselves that way

The resident who followed me a couple months ago offered a hug- when most of us haven’t given or received a hug outside our immediate family for many months due to COVID19. I ran back inside, to a patient awaiting their biopsy. I compartmentalized, waiting till I arrived home to cry.

If he was vulnerable to depression and suicide, we all are. 

He called his colleague of 30 years to ask if he could cover his call, and take care of his family, as he drove to the site he’d take his life. He was patient-centric until the end. But did he give too much? I wonder. We lost a pillar of our community in an instant.

Pillar of the community is a phrase that’s tossed about, but I don’t use it lightly. This is the kind of man who will leave a gaping hole in the community where he used to exist, with his tall frame, his respectful presence, his endless teaching, his collaboration, his gravitas. He was the white haired father-figure we looked to for reassurance, whether our patient was crashing, or our own family member was injured.

A pillar in a hierarchical world

Yet he treated us– trainees, early attendings, nurses, hospital staff– as equals. It is one of the most brilliant things about him. When a young woman stabbed herself one Thanksgiving Eve, he asked for my help, then complimented me on the work I’d done. It was under these kinds of heartstopping conditions that we bonded. Yet now, I feel I never knew him. Behind the face he shared with us, the ever-professional gentleman, he hid his pain. To abruptly truncate that kind of legacy, it must have been a searing, drowning pain. And that’s what hurts the most. 

It feels senseless when we lose a talented, kind, magnanimous colleague. In his career, he saved the lives of thousands of trauma patients. He used to say “trauma” with an exaggerated “ow” sound, like he’d stubbed a toe. I always found it so funny, and I wondered if it was some old school pronounciation or a remnant of his training. I wasn’t sure why he said it unlike anyone else. Maybe because he was like no one else. And in his roles, he was a giver until his very last day. But did we give enough back to him? Did he have the support he needed? I wonder.

The complex layers of physician suicide

Sometimes I’ve felt afraid to receive from others, whether it was kindness, some attention, or help of any kind. Medicine selects this kind of an overachiever, who often harbors a sense of feeling “not enough,” so she can continually keep striving to get better. And it’s a competitive path, through which weakness of any kind is frowned upon. Certainly, you wouldn’t want to put an impairment of any kind on a medical staff application. That would make it official, thereby needing explaination for the rest of your career.

I think that’s what takes some physicians down. We are susceptible to this kind of mentality, and therefore, to isolation. I’ve distanced myself from others in the past– out of what, self-protection? All while operating within one of the most stressful environments in modern life: medicine. I fear that isolation coupled with stress hastened the end of my colleague’s precious life. I’ve begun to learn that it’s opening up to people and connecting that makes life truly rich. 

Connection as survival

Then, jarring events like this week made me realize that connection is survival. It’s the kind of thing we don’t always appreciate when we have it, when things are going fine. But in medicine, it’s vital to have a continuous supportive connection with those around you, who understand your challenges in ways that others outside the medical world can’t.

As the van carrying his body passed on its way to the coroner, my friend, a hospitalist with 2 kids, announced we should get together. Even though we’ve known each other for years, it’s always just seemed a little too busy to get together regularly with our young children. Instead, we haphazardly run into each other at work, sometimes not seeing each other for weeks. It was a real, immediate gesture, and I respect that. Tomorrow isn’t guaranteed, and maybe our connection is part of our survival.

How can we take care of each other better?

I don’t pretend to have an answer to physician suicide. I’ve been touched by it lately like never before. My response is to learn more. I want to watch the documentary “Do No Harm.” I want to learn how to take care of my colleagues. The camaraderie and venting has bonded me with my colleagues and gotten me through rough times. Not suicidal times, but challenging, stressful times. 

The paradox is that when we share our challenges, we can feel as though it places an undue burden on our already overburdened fellow physicians. But I hope that when I’ve shared my challenges it’s made someone else feel helpful. As physicians, we thrive on this feeling of service. We must fill our own cups, so we are prepared to help each other, and reach out across the ether that divides us.  

So if you think that person you exchange pleasantries with at work wouldn’t want to hang out with you outside of the hospital, or that they’re too busy, reach out anyway. You might help them more than you imagine, just by fostering a connection. Some of my greatest friendships have blossomed in unexpected places.  

On a consult call, ask the other person how they are doing, and mean it. There is time. Hold space. Whether the person is coupled, uncoupled, nearing retirement, or fresh out of training, you can’t make assumptions. Offer a moment of connection; they might need it. 

The precious beauty of caregivers

I see an intense beauty in all of my colleagues I’ve worked with over the course of my career thus far. I’ve gotten to know them, and see them advocate for their patients, each with their own brand and style. And even when we’ve disagreed or butted heads, we have learned about each other, and it has enriched the relationship. Over time, I’ve come to realize that actually, they are part of my family. 

That’s why I feel a fierce and protective loyalty toward my colleagues. Being in a leadership role, when I hear a complaint or criticism of one of my fellow physicians, I assume the best of them, knowing they always act in the best interest of the patients. And I know that the pressures we are under are often greater than those complaining can comprehend. 

So although I don’t know if anyone could have prevented this week’s tragedy, I ask you to consider how you can take care of your own work family. How you can momentarily check in, human to human, so they know someone cares. You can open a window of opportunity for someone who is struggling– a window to let in some light, some fresh air (that’s you!) and some assistence. 

In honor of Dr. Frank Ercoli, please take care of yourself, and of one another.