National Physician Suicide Awareness - Honoring a life lost

“He elevated the mood in the room wherever he went.”

This is how Mara Rice-Stubbs describes the second-year resident she worked with during her time as an emergency room nurse prior to returning to Pennsylvania. He died by suicide at just 27 years old.

“From the outside, he was one of the happiest people you ever met, always smiling,” she said. “He was very engaging with patients and a joy to work with as a nurse. He always involved us in the patient’s care.”

Rice-Stubbs worked with the resident just two days prior to his death. His mother was in the ICU at the hospital, but she didn’t notice any change in his demeanor.

“He was his same lively self,” she said.

When she returned after the weekend off, she heard that there had been an incident. The resident was brought into the emergency room after a carbon monoxide poisoning. His mother subsequently died in the ICU just two days later.

“Everyone was shocked,” she said. “No one anticipated it. No one recognized the problem until it went that far.”

Rice-Stubbs, now a fourth-year medical student at the University of Pittsburgh, describes her experience working in the emergency department as one of a big family. The resident was succeeded by his dog who is now taken care of by his former colleagues. The emergency room residents also take a wellness retreat once a year, honoring his memory.

“They take a day and go to a national park to get away from medicine to reconnect with one another,” Rice-Stubbs said. “They talk about their experiences as emergency physicians, both the ups and downs. They take time to check in with one another in an environment free from the stress of wait-times and patient satisfaction scores.”

The hospital systems’ reaction came from place of fear, rather than recognition.

“The culture of the hospital was to sympathize that a sad event occurred, now get back to patient care,” Rice-Stubbs said. “The hospital’s clear intent was to move on as quickly as possible.”

She said the emergency department team held a vigil and had a dinner while working, but no one really talked about what had happened. No one really knew what to say.

“A few people who were really involved told his story at national meetings,” Rice-Stubbs said, admitting it was up to the individual to spark change in the face of tragedy.

As a fourth-year medical student, she bears witness to a lot of stress.

“I’ve learned that people are very good at covering their emotions and [mental] state,” she said. “I am a keen observer of changes in my colleagues. I definitely don’t take the words ‘I’m fine’ at face value.”

She relays advice she was given by a medical student two years her senior – “ask people how they are doing twice.”

Losing such a jubilant colleague to suicide was an eye-opening experience for Rice-Stubbs.

“It’s changed how I have gone through medical school,” she said.

While there are many individuals recognizing the need for a change, the recognition needs to move to the systems level.

“It’s not necessarily in the hospital’s best interest to be discussing concerns of physician suicide,” Rice-Stubbs said. “So it’s up to the providers. No change will be made unless we start to speak up.”

The issue of physician suicide should be a rare occurrence. But more than 400 physicians nationwide die by suicide each year.

Rice-Stubbs believes open communication and human connection are key.

“Medicine is such a busy profession,” she said. “We are actually doing 10 things at once in our mind, and only truly present in our environment half the time. This makes it challenging to identify changes in colleagues.”

She added that while there may be hesitation about reaching out to those who are struggling, concern doesn’t have to come from a place of judgment.

“Saying, ‘I noticed you seemed a little stressed lately,’ is not an accusatory statement,” she said. “We all recognize that stress is inherent in medicine and it invites the other provider to open up. Be an open ear and listen. Listening is key and is therapeutic by itself.”

“We all must understand and be able to recognize the difference between being stressed vs. being depressed. Stress is expected, depression should not be,” she said. “We need to stay connected to one another as human beings first and foremost and secondarily as colleagues.”