It’s a story I feel compelled to tell. It may be therapeutic for me and possibly others. It’s a story that need to be told. But I hesitate. I fear the stigma. I am afraid of being judged. I fear breaking the silence. I ruminate about the potential repercussions.
What if I, a psychiatrist, wrote about my own emotional conundrum after a patient chose to end his life?
Can I open the private vault of personal grief that filled me with his untimely and unnatural departure? I want to narrate the tumultuous aftermath of patient suicide, the distressing combination of grief sans closure, perilous self doubt and professional impotence to undo it.
Suicide is the tenth leading cause of death in America and every 40 seconds someone commits suicide. It happens and it happens a lot. But it’s hardly talked about by the “treating survivors” of patient suicide, the psychiatrists, therapists and others mental health care providers who cared for them, the ones that lost their lives via suicide.
The hesitation and the apprehension is real. Suicide is also the number one cause of lawsuits brought against mental health providers.
Should I take a chance and disclose this vulnerability?
Should I disclose that I had played our last appointment over and over in my head to look for clues for what I could have done differently? That I had stressed my brain to recall all details of that half hour in the office. His mannerisms, what I had said, what he had brought up, my responses, the color of his outfit, the time of the day, the pauses between his sentences.
Is it okay to say that I had questioned my ability to assess suicide risk despite all my training and experience? Could reveal that I had reviewed quietly in my head, standard of care that I had provided?
Should I say that I cried? Should I say that I mourned?
It is customary in a psychiatric appointment to ask an individual about suicidal ideations and thoughts. This is especially true when treating individuals with depression. Suicide is often a complication of depressive illness. Depression which envelopes an individual in a cloud of darkness that swirls around them day and night, with no access to the light of the outside world. It’s visible through the eyes of the depressed and you look for that glimmer of hope to reassuring you that they will hold on to life. They , sometimes, verbally reassure you, ” Doc I am not going to do anything, I won’t be the patient you will get the call about”.
You reassure them that they will get better, the appointment ends and they leave with another appointment card.
Then, you pick up the next chart and get busy with another life and another story.
But then you do get the call one day.
The call that is mechanical yet doom-ridden. It can be from an ER or police department asking if you knew this person. The past tense in knew, makes your heart stop and sink. Your mind flashes to the last appointment.
The film reel starts to run. Beginning to the end. 30 minutes that get burned in your memory for you relive them so much that they singe any other comforting thoughts trying to crowd them. Despite everything you did, you keep asking yourself, “Could I have done more?”
You experience sadness and loss but you can’t disclose why. You feel anxious, isolated and apprehensive. You are engulfed by grief and fear simultaneously. Grief of the loss and fear for you couldn’t stop what you think you were hired to prevent.
It’s a grief that must be felt in private just like those sessions are, private and confidential.
May be your own family understands your dilemma but the confidentiality of your profession stops you from openly talking about it. Sometimes the malpractice attorney tells you to stay silent. You think about calling the family or going to the funeral, you try to do the right thing.
What if I admit that I have doubted my professional abilities after since I heard it had happened? I even wondered if I am in the right line of work.
Is it okay to say that I took a week off after it happened to regroup? Can I justify in writing those pangs of anxiety I had felt every time a depressed patient left the office?
Losing a patient to suicide affects how one treats subsequent patients. The perceived “reasons” of what might have caused it remain at play.
Sometimes there is the overcompensation to ask each and every patient depressed or not , if they are feeling suicidal at every appointment even though it annoys some of them. Sometimes its avoidance of patients with suicidality.
” Are you having thoughts of harming yourself?”
” I told you, suicide is not an option, I don’t want to go to hell.” or ” I would never do that to my kids”.
But in your heart do you really trust the monster of depression not take the best of their fragile frame of mind? Those few moments before they actually do something, they aren’t rational. When they pull the trigger or take the pills or take that knife to their wrist, their decision making is impaired , that’s what the research says.
You focus on the trivial.
May be the number of suicide hotline should be enlarged more and put at more places in the clinic? May be the waiting room needs more literature on this topic? May be I should attend another training on “Suicide Risk Assessment”?
You question your treatment choices. May be they never filled the prescriptions.
May be the medications taken did not work? May be they worked too soon.
The risk of suicide with antidepressants in highest in the initial two to three weeks, when treatment improves energy enough to follow through with a suicidal plan but the mood is still profoundly sad.
Can I say that I had a hard time sleeping in wake of such an event? Is it okay for a physician to accept their vulnerability and write about it?
What if I wrote his story? What if I wrote about how it changed my own story?

Let’s face it. There is a lot of sad and traumatic stuff that happens all across the globe. Children murdered, killed and molested, women burnt and raped, men killed and mauled in acts of terrorism, barbarism and crime. Our every day is filled with tragic news and depressing information. It’s all right at our finger tips, easily accessible and very close.
This ongoing sadness can put a hole in everyone’s emotional resources. Every emotion has a cost and serious impact. When we enjoy things and spend time with those we love, we replenish our emotional resources with positive, loving energy. Every piece of distressing information robs us of our emotional energy. When we feel emotionally drained, we are likely to experience sadness, anxiety and fatigue.
Among other things that cancer has taught me, I have learned to be very mindful of how and when I spend my emotional reserve. I have also become selective of who is deserving of this. Call it a bit narcissistic and selfish but I am more apt to walk away from drama and craziness that doesn’t belong in my world. In that context I live in a constricted world than before and it’s OK.
I am in no way encouraging insensitivity to social and emotional pain of others but one has to develop the ability of “zooming in” and “zooming out” of life. By the time I finish writing this, it is likely someone got assaulted or killed somewhere in the world. It’s infinitely sad that this is the world we live in. Humans have become brutal and murderous. There is rage all around us. But if one gets consistently preoccupied with every tragedy and every misfortune, it is likely to affect the mood in very negative ways.
Here are ten tips I have to preserve your sanity in midst of bad news all around:
1) Practice Gratitude: Take a mental note of all the things that you are thankful for and review all your blessings in your mind. This will distract you as well as have a positive effect on your mood.
2) Recognize your limitations: You must realize that you have limits on what you can do and feel. You will still have to go home and cook a meal or attend a meeting or read for school even though someone died brutally in some country far away.
3) Practice Compassion: You may not be able to influence ISIS or the Palestinian conflict, but you sure can help someone right around you. Look for a way that you are helpful to others.
4) Try deep breathing or meditation: you can close your eyes for few minutes, visualize a positive image and send good vibes to those you fear are suffering. If you are a religious person, pray for the folks you want good to come to.
5) Make a donation: Send some money to a cause that is close to your heart. This way you won’t feel completely helpless and isolated but connected to some greater good.
6) Try listening to some music: Music has a very soothing and calming effect on a distressed mind. Listen to few favorite tunes and turn off the news. Better yet, go for a walk while listening to music. This will help clear your mind and engage your other senses.
7) Smile at others: You will be amazed how much positive energy you can gather just by smiling at others.
8) Put the phone aside or log out of the app that your are addicted to. If there is too much bad news, take a break from FB or twitter.
9) Call a friend or family member you have been thinking about. Never underestimate connecting with people that make you feel good about yourself.
10) Believe in yourself and your abilities: You may not be able to make a change today but that’s ok. If you are honest to a cause, an opportunity will arise that will translate into action.
Life is a dynamic situation, navigating each day is hard but there is beauty in life and in every moment. If you are not paying attention or distracted by negativity, you will miss the real treasures, the ones that linger in the memory for a long time.

 About two years ago, I wrote an obituary .It read as follows:
Lt. Colonel Mammary G(land).
The Twin of the Lt. (only surviving family) would like to report the unfortunate demise of Lt. Col. Mammary G(land). on August 8th, 2013 at the University Hospital. The services of the Lt. are acknowledged and regarded by those who knew her well. Besides performing aesthetic duties for a number of years, the Lt. served two tours of lactational duties from 2007-2008 and then again from 2011-2012 with honorable discharge both times. Lt will be recognized by the highest honor and a silicone trophy will be erected at the grave site.
In lieu of flowers, please send donations to Dr. Plastic’s office.
A soldier had fallen ! The war against breast cancer had claimed another comrade.
I became a “monoboob”.
Monoboob, odd and awkward. Mutilated and Broken. Lopsided and out of balance. My womanhood and body image was under attack.
My life stood still as I coped and recovered from losing a piece of my femininity as well as faith in my own body. Cancer happened to me. Complex information came at me with words like chemotherapy, hair loss, tiredness , radiation and reconstruction. I desperately tried to keep my head above water.
The day before, I was trying to emotionally prepare for a” mastectomy”, the fancy medical name for getting your breast lopped off, I stood in front of the mirror hiding one breast to assess what I would be sans my left breast. I was trying to process my grief. The morning of surgery, I had pictures taken, thinking one last time, I would look whole for the pictures.
It needed to happen. I had cancer in it. I had no choice. I was one in the eight women in the country that get afflicted by breast cancer. Play time was over, life got serious. Very serious.
But did I need to be serious? The answer gradually unfolded.
Shortly after leaving the oncologists office after receiving my verdict of 16 chemotherapy cycles and 30 plus radiations I made a lame joke to my husband. I said, I will no longer be stereo.( one breast being “mono”)
He laughed and looked relieved. I laughed too and before we could let all the impending trauma sink in, I was chattering nonstop, making quips about the doctor, cancer and breasts. Sometimes laughter comes easier than tears.
I needed to find things to laugh about and smile. If I didn’t I would have drowned.
Humor is a powerful defense mechanism and it works great. Ask my friends, I have always been the funny one.
My left breast had gone rogue, filled with rogue cells. What is a woman to do? I decided to laugh all the way to hell and back. I named by blog “Left Boob Gone Rogue”.
After the surgery, recovery was slow and painful. 2 years later I still have pain in my arm off and on.
Initially, the biggest accomplishment of the day for me was flip through a Victoria’s Secret Catalog and not drop a tear.
Losing a breast isn’t easy, I constantly feel like taking a right turn (don’t have the left boob) because I feel that I swayed to the right, like the right turn signal is on!
My run doesn’t have the same rhythm, the plop-plop plop-plop is just plop…plop. every time I look in the mirror, my chest winks at me.
I do thank the surgeon for leaving a small part in the middle intact so could pull together a deceiving cleavage , if I dare to bare it.
Another advantage of having both breasts is, it hides the little protuberant belly. Now with the breast gone, I get a better view of the steroid-enhanced roundness, and believe me, I don’t want to see that. Steroids stimulate appetite and after chemo there is only so much salad and cucumber a gal can eat before she opens the cookie box. It’s not me, it’s the steroids!
I remember the night before the surgery. I had showered so I would sleep better. My two and half year old daughter was laying in my lap, and then she fell asleep, cozily nuzzled between the two soft and friendly entities. And there she was breathing softly with her face burrowed in my chest and I knew that this was the last time she had this comfort. But I knew that I needed to do the surgery so she still has a mom to hug and cuddle with.
I remember when my son was born. I wanted to breast feed him right away. What I didn’t know was how newborns root for the nipple. I panicked, thought my baby was blind and couldn’t really see where to latch on. Thank God it was just a fear. I breast-fed both my children for at least one year. Those are some of the wonderful memories of the “mammaries” and the love and bond they created between me and my children. I feel the loss and I think they do too, in their way as if one of their favorite childhood comfort toy got broken.
The great thing about children is their resilience. They don’t obsess over stuff for too long. Not like adults. Something we can all learn from the little ones in our homes.
For over a year I tolerated grueling treatments and side effects but I loved myself and my life more. The scar on my chest healed with patience and openly sharing my struggles.
At the end of the day, it is just a body part. It doesn’t define me or my femininity. I am still loved by those that matter. That message was loud and clear through an entire year of treatment.
Its two years later, I have made it through and much more comfortable with my body. Cancer has pushed me to be more accepting of the here in now and the blessings of every day .
I think I have moved forward with my body image, with sass and attitude. I have my groove back , cleavage of course is a whole different story.
I am” Uni-Titty”, whole and complete with a full appreciation of life and that is infinitely sexy.

I now have the web link to my interview published in Health Monitor’s Thrive Magazine. They featured it in their ” True Insipration” section. Click here for the story : www.bit.ly/uzmamd1

 

   
   

I just read the dreadful news of Dr. Carolyn Kaelin passing away at 54 years of age. She was a breast surgeon who had breast cancer herself and subsequently wrote two books on the topic. “Living through Breast Cancer” was a wonderful read and so was the other exercise guide book ” The Breast Cancer Survivors Fitness Plan”. I read and re-read both.As a physician I identified with her dilemmas and struggles.

As I was going through my treatments, her words were inspiring and precise. I learned a great deal from them and I felt that she was my mentor through all of it.

Just as I was starting to wonder whether I needed to continue blogging and consider if I should or should not write a book, this event occurred. I realized with intensity that I was connected to Dr. Kaelin through her words and she will continue to heal others through her words and writing. I cried for her today.

Sharing one’s struggles openly is such an incredible gift to others. Today I experienced what some of you have told me, that my words inspired you and have helped you. I felt the strength of the connection of words tofay. I felt today like a friend died. Her untimely death  inspires me to continue sharing my journey with you all. RIP Dr. Kaelin, you live through your words.

http://www.washingtonpost.com/news/morning-mix/wp/2015/08/03/breast-cancer-surgeon-turned-patient-carolyn-kaelin-dies-at-54/

 My 20 year medical school reunion is coming up soon. I am sharing my thoughts and reflections on my training in this post–
I don’t know your name. But would it have mattered? I would have treated you exactly the same way as I did. It is possible though that knowing your name would have made you more human than I would care to accept. Not knowing your name made everything so much easier. It was the best way to maintain the distance I needed. But what about your wishes? your needs? I never considered them. I blocked them, never wanting to go down that road.
I was selfishly satisfied with your quiet consent. You had offered yourself as a noble sacrifice and then my curiosity trumped all emotions. I wish I had expressed my gratitude. I wish I had said a prayer for you. I wish I had acknowledged.
Now 25 years later, when I can still remember your face and the wiry silver beard, I realize fully how much you gave to me. Every week for a few hours , I was spending time with you, studying you closely, learning all about you. You gave the knowledge I so craved, you gave me the confidence I was so lacking.
I had often wondered what your story was. The beginning and the end. I feel guilty for having prolonged your end or at times triumphant at your immortality. Sorry I didn’t let you sign off right at the end and you were made to stay longer.
Your short cropped silver hair gave away what your age may have been. You lean body, told me that perhaps you had a hard life or a slow painful end. The lack of fat on you was the envy of the group next to me. You didn’t have any scars or missing body parts. You, Cadaver #9, and I , young medical student and the connection between , a shiny sharp scalpel.
You helped me start a journey that I am still on today. My eyes that used to burn with formalin vapors that preserved you are well trained to assess human suffering and pain. Although I never closely studied your expression, these eyes of mine have mastered that skill.
You were the very first among the countless others who helped a naive, neophyte medical student into a self assured physician.
My hands did shake the first time I put an incision in your leathery thick skin. You seemed like you were carved from wood, much like the Indian that is sometimes standing outside the cigar shops. The cut didn’t lead to any bright red blood, the hallmark of life. It was comforting to know I was not inflicting any physical pain on you. Because of your permission to cut you repeatedly, I was hold to hold a scalpel steady at my first surgical procedure and make a cut in a warm breathing human body.
It was awkward and distressing for the first few weeks. The smell of the anatomy lab was strong and lingering. It had permeated into my unconscious. I often had haunting dreams of you.
Given how unreal you looked, it was easy to arrive in the lab and focus on a certain “body part”. Bit by bit as me and my six other colleagues worked on you, you hardly had any skin left. We would be so enthralled by the details we would find inside you as we uncovered fascinating anatomical displays.
The blood vessels, the nerves and the organs. All were there just like the anatomy dissector text had said.
I clearly remember rejoicing as I had neatly dissected all five branches of the facial nerves after hours of meticulous cutting.

I remember having a hard time eating after the first few times of dissection and then I got numb to the idea that I was in the presence of a dead human and would shortly after the class dig into meaty curry at the cafeteria. The gloves would often get greasy from the body fat and we would sometimes be sloppy with the white coats that got some grease on them. My mother however, always had them washed separately and treated them like the plague.
You must have had a story, that I was never privy to as I looked into your abdominal cavity carefully assessing each and every organ. I was always respectful and kept you at least partially covered as I worked on you.
The relationship of a medical student to their cadaver is perhaps a single odd and unique relationship that can be had in this world. Working with cadavers is a lesson, not just in anatomy but life and death. Death an essential part of medical training, a force that every physician fights against and humbled by.
We all work to sustain life but it does all start with a wooden silent dead body known as the cadaver, In my case, Mr. Body # 9. Thank you sir! I and my countless patients thank you for your sacrifice.