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A death in the family.
This week, we mourned. Mourned the loss of a beloved friend and colleague, Rich Walker. A resident in Plastic Surgery at Johns Hopkins, he killed himself with a shotgun blast on September 1, a day that I will remember as long as I live.
Word travelled back to the West Coast quickly via the e-mail grapevine, and one of his former anatomy partners, now a resident in Internal Medicine, took upon herself the heavy task of informing all his classmates and friends, and organizing a Memorial Service at Stanford.
There was no note. We have but rumors and guesses as to how life became so untenable and painful for Rich. He was apparently unhappy with the program at Hopkins, and wanted desperately to come back to Stanford. But he had a girlfriend; he took her out for her birthday the night before. He had even just bought a house. Somehow, these positive seeds of hope for the future became overwhelmed by a despair so powerful and dark that he felt trapped, and knew no other exit than death.
He was clearly tremendously sleep deprived, coming off of four months of every third or every other night call. One friend said at the memorial service that he must have been so tired that he wasn't even himself anymore. Others said that he had become isolated in the program. That's hard to believe, because he was such a "people-person". Ironically, he was a former co-chair of the AIMS council (a committee of students and faculty organized to be a support service for students in need), and as memory after memory was offered at his service, it was clear that he was exceptionally giving and warm-hearted. Some told of his making excuses to stay home with his 95 year old landlady, to give her company. Others told of his breaking dates to be with a troubled friend. Still others related accounts of his meticulous work ethic, and high standards (perhaps too high standards). All his t-shirts were on hangars.
A dean said he was going to investigate the matter further, to find out if there was something about being a physician that caused him to take this extreme action. Another professor wondered aloud whether there was something inherently wounding about being a physician, and related his own experiences with depression as a young man. He went to a counselor who happened to be Chinese; after discussing his angst and even suicidality, she remarked that the Chinese character for man was two lines leaning against each other. For too long, perhaps he had tried to soldier on, without leaning, trying to be a single line. Perhaps he needed to be more of a Chinese man. And he gave a moving account of his own feelings of becoming drier, humorless, without even noticing it until one of his loved ones said to him in one way or another, "Why are you so dry? Why are you so cold? What happened to your sense of humor?" This process of becoming a physician, of being a doctor, can cut you off from your emotions, isolate you, dry you out. It seems paradoxical, this leeching out of humanity in such a giving profession. What is the answer? Perhaps just this kind of reminder of our humanity and imperfection, being able to lean on each other, and cry.
What was most striking came out of the discussion on the grueling hours and brutalizing force of a residency. Nearly every intern who spoke was in tears over their own mistreatment, their own feelings of inadequacy reinforced daily by snide comments of attendings and even other residents. But we made an implicit pledge on that day that this would end with our generation. We would do everything we could to support each other through this process, and make it more humane for those who follow. Perhaps we would even unionize to lobby for improved work conditions.
Regardless of what we do with our rage at a senseless death, our despair at our own condition, we will always remember Rich as the compassionate, stellar individual he was. And we dedicate our efforts to humanizing medicine to his name.
If anyone is provoked by what I have written, or has ideas about how to spread humanity in our training programs, please write back. At the very least, revisit Liz Lawrence's essay on depression, seen in another part of MedWorld.
Ravi
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