National Physician Suicide Awareness - Observe, don’t judge

Dr. Peter Cianfrani was loved dearly by his patients. During his 40 years as a family care physician in Montgomery County, he cared for many of them from the time they were born until they were adults and had children of their own.

Dr. Cianfrani started his medical practice in 1977 in the small town of Pennsburg. His wife, Leah, remembered the growth his practice experienced in the early years. At one count, Dr. Cianfrani had more than 10,000 charts. Leah served as his office nurse, receptionist, bookkeeper and custodian when he first opened his practice and he was the sole practitioner for a number of years, she said.

As managed care became the norm, Dr. Cianfrani eventually made the decision to sell his practice to a health system and despite changes in ownership, Dr. Cianfrani’s dedication to his patients never wavered.

“He always continued to care for his patients regardless of the health system he was associated with,” Leah said.

Dr. Cianfrani was instrumental in getting a medical facility built in the area, which housed his practice, as well as a laboratory, physical therapy, x-ray services and a number of specialists.

Leah recalled the many activities her husband enjoyed outside of medicine.

“He was a voracious reader,” she said. “He spent a lot of time going to an old archive book store where he would buy 10 books at a time.”

He also enjoyed cooking, playing his “beloved Martin guitar” and exercising, often going on long bike rides with friends.

“We had a house full of people most of the time. We entertained a lot,” Leah said. “He had a full, active life.”

But Leah said her husband was also an introspective, quiet man.

“He didn’t share anything,” she said. “He never talked about his patients – the good outcomes or the tough diagnoses.”

Leah said her husband had always been a worrier, but she noticed he had more worries in June 2017. He was turning 70. He was concerned about his board recertification exam. He was worried about the new computer system coming into the health system. He grappled with thoughts of retirement and if it was the right time.

“His worrying didn’t set off any red flags, because he always worried,” she said.

But Dr. Cianfrani had visited a psychiatrist outside his health system after a blood pressure scare in May 2017, and that doctor had prescribed him Alprazolam. It was something that he did not reveal to his wife until his abnormally reclusive behavior became a concern on a family vacation to Cape Cod that summer.

When he told his wife about the prescription, Dr. Cianfrani said the doctor had given him a list of things to do and he was trying to do them.

While on a European vacation several weeks later, Leah’s concerns for her husband were met with validation from one of her three sons traveling with them. She decided upon return, she would help him make a plan for retirement to ease some of his worries.

But one day shortly after returning from their trip to Europe, Dr. Cianfrani left for work and didn’t come home.

Leah began a search for her missing husband. She called the doctor listed on the empty bottle of Alprazolam she found – a prescription he had refilled a few days before he went missing. The doctor told Leah she should call the police.

Dr. Peter Cianfrani's body was found on a trail where he walked his dogs every weekend. He had overdosed on Alprazolam.

“It completely shocked us all,” Leah said. “I truly believe that the Alprazolam is what took him. I believe he was taking more than he should have. One of the side effects is suicidal ideation. His worries converted from rational to irrational as his anxiety became more apparent.”

If Dr. Cianfrani never talked about his patients at home, it wasn’t for a lack of caring or impact on the community. Leah said more than 1,000 people attended the memorial service held for him. A local business, and patients of Dr. Cianfrani, posted “God Bless, Dr. Cianfrani” on their roadside sign and it remained there for months for all to see as they drove past.

“I found out how much he meant to his patients because they came through the line and told me the stories of how he had helped them,” she said. “At Christmas, a patient always brought a container of pizzelles. He would bring them home. I didn’t care for pizzelles, but he would enjoy them until they were gone. She came through the line and said she would bring him the pizzelles every Christmas because she said, ‘I went through a similar situation you’re going through right now and he would stop by my house and check on me on his way home from work.’”

After the memorial service, Leah handwrote more than 300 thank-you cards to patients, family and friends who had personally reached out to offer condolences and comfort. She felt a responsibility to his patients – to comfort them in return.

Leah believes there needs to be a change at the systems level.

“The way his hospital system reacted to his death was unconscionable. They pretty much ignored me with the exception of having HR contact me immediately to tell me what my benefits were. As far as my pension and his retirement funds that were through them would be distributed. They were very matter of fact about it,” she said. “The way they treated me, I’m sure they wouldn’t have been understanding or helpful to him if he expressed any of the anxiety he was experiencing. I’m sure they would’ve insisted that he not get help but retire.”

When her husband was missing, she asked one of his close practice associates if she thought he was depressed. The associate replied, “We’re all depressed.”

“Because of the way health care is today, the summer before he died he often remarked, ‘it’s just not fun anymore,’” Leah said. “And it’s not fun anymore because physicians can no longer make decisions they once made with autonomy. It’s now based on insurance reimbursement conditions and approvals for care, and the forms they are required to fill out, and the electronic medical records that guide them to make some decisions that may not be necessary.”

She believes her husband was frustrated by these circumstances outside of his control, affecting the way he practiced medicine.

“They’re not allowed to make decisions based on their experience, observation, medical knowledge, and knowledge of the patient,” she said. “I think that’s part of what is the overall umbrella of worry that formed this perfect storm for him to just say, ‘you know what, I’ve had enough.’”

She also believes he was prescribed a drug that should never have been prescribed and then not managed. Dr. Cianfrani cancelled a follow-up appointment with his psychiatrist but was still permitted a refill of the Alprazolam prescription.

“What do you do?” Leah asked rhetorically. “It’s always in retrospect. Unless someone has made an attempt – he never talked about suicide.

He never talked about anything that would lead me to believe that this would be the outcome of his frustration. I think one of the things my sons and I realize is that we need to communicate more openly. Even with painful topics, you need to talk about them and get them out. It’s changed all of us.”

She said her family has adopted a new mantra.

“Observe, don’t judge,” she said. “We never know what someone is going through. What pain someone is going through if they don’t share it.”

Leah said the grief comes and goes, and it hits at times when least expected.

“We are doing just OK,” she said. “We aren’t doing great.”

She said the stigma surrounding a death by suicide makes it harder to deal with publicly.

“If he had died of cancer, there would be a better explanation,” she said. “Dying of mental illness, there is no good explanation. Because I believe the kind of help you can get for cancer doesn’t exist for mental illness.”

And for the loved ones of physicians and other medical professionals, Leah has a piece of advice: “Try to communicate,” she said. “If you see a change in behavior, take it seriously.”

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.