Suicide after dismissal.

[gutonc]

I'm surprised it took to post 57 before Burnett's Law was invoked.

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[dl2dp2]

If you're acutely suicidal, and you're in your 50's, and you're an educated person in the healthcare field... I still wonder what we can do besides make resources available (which we already do), and tell people the signs to watch for (which we already do), and have education during residency (which we already do). We can't be with people every hour of the day, we can't give them constant hugs and reassurance (that's their family's job and their own inner sense of self-worth). So when that acute moment hits, either they have good coping skills and know where to turn, or they disregard all of the safety nets we have in place and choose to end their life regardless. So it goes. Bad stuff happens.

I am a psychiatrist and a researcher, and I partially agree with you. I work with a leading suicidologist on a specific project on suicidality, and the entire literature suggests that while suicide attempts are predictable, suicide completion is very difficult to predict.

This is a sad case. However, in some ways I agree with you in saying that I don't think it's very different from someone who suffered a subarachnoid and died. Both cases would be sad. While I empathize with the family and the patient's suffering prior to his death, I don't think there is necessarily a whole lot we can change in these scenarios. The fact that this particular individual responded to a particular stressor in this way is almost entirely unpredictable, similar to say someone who had a minor car accident ended up having a subarachnoid and died.

There is some conjecture that there's too high of a stigma which prevents access and subsequently causes an increased rate of completed suicide. This conjecture has not been substantiated in large epidemiological studies. My sense is that completed suicide is probably a mathematically chaotic event and potentially unpredictable IN PRINCIPLE on an individual basis and not just in practice. There is a danger in over-attribution of guilt in treating suicidal/suicided patients in the medical community, and this as you may know is the #1 malpractice liability for mental health providers. In my mind it's probably very rare that a completed suicide is causally linked to provider negligence.

Several other things... mental illnesses are diagnosed with similar consistency across different physicians using a standard set of criteria. So it is certainly possible that people could have no mental illness and commits suicide. However, research indicates that >90% of those who complete suicide have a history of mood, anxiety, psychotic, personality or substance use disorder. Things like psychological autopsy have shown that at the time of suicide, the point-prevalence of meeting criteria for one of those (i.e. not in remission) is also very high (in the 90s). Successful outcome from treatment of these disorders do tend to decrease rates of both attempts or completed suicides, though because the latter is very rare, the absolute effect size (i.e. NNT for preventing one completed suicide) is often tiny.

Suicide attempt is a much more tractable clinical outcome, though using suicide BEHAVIOR per se, as opposed to ideation or symptom severity, as the pre-specified primary outcome is a fairly new development in treatment studies. Certain treatments are pretty convincingly efficacious at decreasing the risk suicide attempts in high risk populations (clozapine, DBT, ECT, +/- lithium, these 4 prolly have NNT in the low teens or less for attempts) in moderate/large clinical trials, but most other existing treatments (i.e. either meds or therapy) are not very good at preventing most of the suicide attempts, and often large pragmatic studies exclude suicidal patients. Because it's so rare, having a few suicides in a large study often triggers data safety monitoring review. There's still a ways to go in this area.

 

[Siggy]

Suicide = mental illness?

In general, short of the "I'm dying of a terrible disease anyways, so can we please stop the pain a few months/years early?" type of suicides, yes.

 

[Siggy]

So basically, if you kill yourself for a reason that has recently become socially acceptable, that's not mental illness.

But if you do it for any other reason that is not socially acceptable (my wife left me, I have to declare bankruptcy, my mom kicked me out of the house because I'm gay, I'm getting bullied at school), that's mental illness.

Are we really having a conversation about whether suicide because of your examples should be seen as something to be expected out of a rational individual with good coping and defense mechanisms?

 

[Siggy]

No, we're having a conversation about why you have one specific example where good coping and defense mechanisms are not expected from a rational individual.

I got kicked out of school. My spouse left me. I have locked in syndrome. One of these things is not like the other. One of these things just doesn't belong.

 

[Siggy]

Because why? That's what I'm asking. Who's making the decision on what's serious enough? And why does severity correspond to mental illness vs no mental illness? People with mental illness don't have really bad things happen to them?

Where is the fine line made? On a case by case basis that should include both specialists in what ever field the primary disease is (i.e. an oncologist for terminal brain cancer) and a psychiatrist.

Sure, people with mental illness have bad things happen to them, and I have no problem with the concept of someone with [insert terrible end stage terminal condition here] who also happens to have [insert mental illness here] requesting death due to their [insert terrible end stage terminal condition here]. That's different than requesting death because of [insert random life event here].

I'm also sympathetic to certain [insert random severe mental illness here] acquiring death. Those, however, aren't your standard major depression or med controlled schizophrenia patients who just happen to be off their meds. The major mental illnesses are near the top of my "worst diseases to have" list (you know, the list essentially everyone develops during medical school) because of how insidious they are and how they impact quality of life as a whole. I'd rather have lung cancer than severe incapacitating schizophrenia.

 

[CDI]

Why is this such a big deal? Some resident, who had access to the same helping resources we all have, chooses this as the answer to adversity. And I'm supposed to feel bad for him?
Sure, I feel bad for his family. And I feel bad for the other residents (who now have more call to cover, although they incurred this extra work when this guy was dismissed).
But I don't feel bad for him. And I certainly don't blame the program. Any more than I blame any other company who has an employee off themselves.
Some people have bad coping skills, and we can try and try to keep them from making bad choices. But at the end of it, they are the ones with a gun in their hands, a bottle in their hands, or whatever else. And if they feel that's their only option, so be it. It's one less person to have to devote limited resources to.

Here; I'll save you all some time.
You're a bad person; You don't care about people; You're a terrible doctor, You're cold callous and heartless; You're a mean and hateful person;
Just quote whichever sentence you think is most applicable.

<shrug>... life goes on.

Well... except for him.

Who said it was "such a big deal"? It was an event that occurred, and it was shared here in the general residency forum (not directed towards you). And, no one said you had to feel bad for him.

In real life, I'm sure you are good at pretending to feel bad since you are still employed in medicine (as we all are) where you are paid well to prolong the inevitable. You could've done that here...but I understand, in some juvenile way, it's cooler being a tough guy online. Or something.

The son messaged me directly requesting further info. All I could do was apologize...about this thread.

 

[Doctor Bob]

Who said it was "such a big deal"? It was an event that occurred, and it was shared here in the general residency forum (not directed towards you). And, no one said you had to feel bad for him.

Correct. As with every other thread in all of these forums, I posted an opinion. Don't take it personally.

In real life, I'm sure you are good at pretending to feel bad since you are still employed in medicine (as we all are) where you are paid well to prolong the inevitable. You could've done that here...but I understand, in some juvenile way, it's cooler being a tough guy online. Or something.

You're correct again. I'm good at projecting an air of caring in real life.
But I'm not getting paid to care here.
I don't get the notion that if I don't have a sense of compassion in this case (or any other given case) that somehow i'm being an online tough guy... as if this just isn't how I am. If I could get away with talking to people in real life the way I would like to, I would. It would get me fired pretty quickly because although it's not bad medicine, it's bad customer care.

"You came to the emergency department because 4 days ago you got a sunburn and you're demanding percocet? Are you f***ing stupid? Do you really think this was an emergency or are you just trying to waste my time? Get the f*** out."
Oh, that would make my day. But in this customer service era of medicine that's not particularly nice and not a good way to keep one's job.

Trolling on the internet is taking a stance with the intent of being inflammatory... just to rile people up for the fun of it.
This was just me, seeing a thread on a topic that comes up over and over and over, and taking the opportunity to speak my opinion on the topic without the usual customer service filter.

I liked how the thread evolved into a rather interesting discussion on whether all suicidality is mental illness or not; rather than the usual hugfests that these threads are often filled with.

The son messaged me directly requesting further info. All I could do was apologize...about this thread.

Ok.

 

[Frederica]

Pretty shocked by a lot of the comments here.

Some dude gets dumped by his residency program 3-4 months before finishing, kills himself and the predominant reaction is 'who cares'? For shame.

I sincerely hope many of you do not exercise this level of callousness in your day-to-day lives as physicians and physician trainees.

We do not know for sure that the victim was dumped by their program. There is nothing mentioned in the articles the OP posted.

 

[CDI]

We do not know for sure that the victim was dumped by their program. There is nothing mentioned in the articles the OP posted.

Google:

http://www.idealmedicalcare.org/blog/doctors-death-an-inconvenience-for-patients/

Pamela Wible picked up on it.

 

[Mad Jack]

No, we're having a conversation about why you have one specific example where good coping and defense mechanisms are not expected from a rational individual.

They're very different scenarios. A rational person with good coping mechanisms can only bear so much, and can be broken by things such as torture or medical conditions that are, in many ways, worse than torture. You can get a new wife, you can recover from a bankruptcy, etc. Those things can be repaired in time. ALS doesn't get better. Every day, you will physically deteriorate until your body fails you, and every moment of your last few months of life will be an agonizing struggle to breathe, not choke on your food, etc. It isn't all in your head- it is a physical, objectively horrible disease process that does not get better and only ends with your death.

And, much like with torture, there comes a point where even a reasonable, sane, otherwise mentally stable person can bear no more and begs for it to be over, to simply be allowed the privilege of death because they can take no more and there is no end to their torment. That isn't mental illness, it is a rational decision to end senseless physical suffering.

 

[DermatoFIGHT]

If I was stuck with $300,000 principal loan debt accumulating $20,000 a year interest that is compounding and going up with zero way to pay it of, I would spend 1 full year enjoying life to the max racking up debt. Then I would take my life.

I say this with sound mind. If you find a job for 40,000 a year you cannot even pay the interest, your life will be garbage your bad credit will prevent you from even getting an apartment. You will never have a quality life. You will not be able to have or support a family. When you look at life it is all about the quality right? Grandma is on a vent again is that quality? Nope. Talk about a strangle hold and kicking a man when he is down. I would not hesitate to suicide or maybe have a huge life insurance policy and walk in front of a bus so my family is taken care of financially at least.

Why live my life on someone else's terms? Live it on yours. The only thing that gets you through the bad is hope, but with the way this world is setup especially in medicine they strip you of all hope. When hope is lost, what else do you have? We all have to meet our end some day.

 

[Mad Jack]

If I was stuck with $300,000 principal loan debt accumulating $20,000 a year interest that is compounding and going up with zero way to pay it of, I would spend 1 full year enjoying life to the max racking up debt. Then I would take my life.

I say this with sound mind. If you find a job for 40,000 a year you cannot even pay the interest, your life will be garbage your bad credit will prevent you from even getting an apartment. You will never have a quality life. You will not be able to have or support a family. When you look at life it is all about the quality right? Grandma is on a vent again is that quality? Nope. Talk about a strangle hold and kicking a man when he is down. I would not hesitate to suicide or maybe have a huge life insurance policy and walk in front of a bus so my family is taken care of financially at least.

Why live my life on someone else's terms? Live it on yours. The only thing that gets you through the bad is hope, but with the way this world is setup especially in medicine they strip you of all hope. When hope is lost, what else do you have? We all have to meet our end some day.

You could always, you know, leave the country. Set up a new life abroad, far away from FICO and the US government. You could also realistically declare bankruptcy, as you would be able to successfully demonstrate the two major conditions required for student loan debt to be discharged in bankruptcy court: First, you must not be able to repay your student loan and also maintain a minimal standard of living based on your income and your expenses. Second, your situation must likely persist for a significant portion of the repayment period of the loan. Finally, you must have made good faith efforts to repay the loans.

The thing about this guy though- he had no debt. He had been dismissed, but was otherwise fine.

 

[charmiedermie]

Correct. As with every other thread in all of these forums, I posted an opinion. Don't take it personally.

You're correct again. I'm good at projecting an air of caring in real life.
But I'm not getting paid to care here.
I don't get the notion that if I don't have a sense of compassion in this case (or any other given case) that somehow i'm being an online tough guy... as if this just isn't how I am. If I could get away with talking to people in real life the way I would like to, I would. It would get me fired pretty quickly because although it's not bad medicine, it's bad customer care.

"You came to the emergency department because 4 days ago you got a sunburn and you're demanding percocet? Are you f***ing stupid? Do you really think this was an emergency or are you just trying to waste my time? Get the f*** out."
Oh, that would make my day. But in this customer service era of medicine that's not particularly nice and not a good way to keep one's job.

Trolling on the internet is taking a stance with the intent of being inflammatory... just to rile people up for the fun of it.
This was just me, seeing a thread on a topic that comes up over and over and over, and taking the opportunity to speak my opinion on the topic without the usual customer service filter.

I liked how the thread evolved into a rather interesting discussion on whether all suicidality is mental illness or not; rather than the usual hugfests that these threads are often filled with.

Ok.

It's like your posts are getting worse, even after knowing that his son who hadn't seen him in years was actively looking for him to find out what happened. I know you don't care, but your post sounds sociopathic.

 

[j4pac]

 

[laserbeam]

Does anyone actually know why he was fired? Does anyone personally know him? I do not know how people can write so many words (emotions, arguments) without knowing much about the actual situation.

 

[Doctor Bob]

It's like your posts are getting worse, even after knowing that his son who hadn't seen him in years was actively looking for him to find out what happened. I know you don't care, but your post sounds sociopathic.

I'm comfortable with how I feel about this topic.

Edit* ok, now that I've dealt with the situation at work that drew me away from the computer, I'll finish my thought.

Sociopathic? That's a bit harsh. Perhaps it's best if we reset the conversation and start again.
What is it about my stance on things that you are so irked by? Perhaps if I can understand that then I can address the specific point. I doubt I'll change your opinion (as you're not going to change mine) but as least then we can have a conversation on the merits rather than just namecalling.

But if you're just irked that I don't care, then there's not much to discuss. My feelings are my own and should be of no concern to you. If it makes you feel any better, I don't care about your feelings about my feelings about the matter either. So at least I'm consistent.

 

[Raryn]

If I was stuck with $300,000 principal loan debt accumulating $20,000 a year interest that is compounding and going up with zero way to pay it of, I would spend 1 full year enjoying life to the max racking up debt. Then I would take my life.

I say this with sound mind. If you find a job for 40,000 a year you cannot even pay the interest, your life will be garbage your bad credit will prevent you from even getting an apartment. You will never have a quality life. You will not be able to have or support a family. When you look at life it is all about the quality right? Grandma is on a vent again is that quality? Nope. Talk about a strangle hold and kicking a man when he is down. I would not hesitate to suicide or maybe have a huge life insurance policy and walk in front of a bus so my family is taken care of financially at least.

Why live my life on someone else's terms? Live it on yours. The only thing that gets you through the bad is hope, but with the way this world is setup especially in medicine they strip you of all hope. When hope is lost, what else do you have? We all have to meet our end some day.

You could always, you know, leave the country. Set up a new life abroad, far away from FICO and the US government. You could also realistically declare bankruptcy, as you would be able to successfully demonstrate the two major conditions required for student loan debt to be discharged in bankruptcy court: First, you must not be able to repay your student loan and also maintain a minimal standard of living based on your income and your expenses. Second, your situation must likely persist for a significant portion of the repayment period of the loan. Finally, you must have made good faith efforts to repay the loans.

The thing about this guy though- he had no debt. He had been dismissed, but was otherwise fine.

There's other strategies too... Starting with IBR/PSLF for any public loans. You can't be liable for more than 10-15% of your income greater than 150% of the poverty line. If you got that $40k/year job, especially if you got it at a charity or for the government, you'd still be able to live reasonably comfortably. You won't even be in default of the loans. The tax hit 20 years later might be a problem, but that's theoretical at best.

If the loans are private, it gets even simpler. File a hardship petition and, assuming that the circumstances theorized above are true, the debt is pretty routinely partially or totally discharged.

Or if you do get behind and the above are not immediately available, there's a variety of ombudsmen and others you can call to work out a payment plan so you can get back into compliance and start the IBR/hardship/whatever process.

Or if you somehow become unable to work, getting declared disabled discharges all student loans. This is kind of a nuclear option though, because getting declared "totally and permanently disabled" is an expensive process with no guarantees.

Basically, while it is not impossible to theorize circumstances in which it might be rational to commit suicide... high student loan debt is not one of them.

 

[Mad Jack]

There's other strategies too... Starting with IBR/PSLF for any public loans. You can't be liable for more than 10-15% of your income greater than 150% of the poverty line. If you got that $40k/year job, especially if you got it at a charity or for the government, you'd still be able to live reasonably comfortably. You won't even be in default of the loans. The tax hit 20 years later might be a problem, but that's theoretical at best.

If the loans are private, it gets even simpler. File a hardship petition and, assuming that the circumstances theorized above are true, the debt is pretty routinely partially or totally discharged.

Or if you do get behind and the above are not immediately available, there's a variety of ombudsmen and others you can call to work out a payment plan so you can get back into compliance and start the IBR/hardship/whatever process.

Or if you somehow become unable to work, getting declared disabled discharges all student loans. This is kind of a nuclear option though, because getting declared "totally and permanently disabled" is an expensive process with no guarantees.

Basically, while it is not impossible to theorize circumstances in which it might be rational to commit suicide... high student loan debt is not one of them.

The tax bomb is in no way theoretical. You will owe the IRS income tax on the amount forgiven. They will take your 401k, home, and property to get that money from you. You will very realistically be starting from scratch in your late 40s.

 

[Raryn]

The tax bomb is in no way theoretical. You will owe the IRS income tax on the amount forgiven. They will take your 401k, home, and property to get that money from you. You will very realistically be starting from scratch in your late 40s.

Except that the program has been around for ~8 years, the earliest someone can hit the tax bomb is 17 years from now (given that in its early years it was a 25 year gig), and there have already been proposals before congress to get rid of the "tax bomb". So yes, it is real... except that it hasn't been yet and might not be in the future.

 

[Mad Jack]

Except that the program has been around for ~8 years, the earliest someone can hit the tax bomb is 17 years from now (given that in its early years it was a 25 year gig), and there have already been proposals before congress to get rid of the "tax bomb". So yes, it is real... except that it hasn't been yet and might not be in the future.

You shouldn't plan for what might happen. You should plan for what most likely will. Most likely, debt forgiveness will either be dropped altogether or the tax bomb will remain, as it's basically politically untenable to add such a huge item to the national debt, and has been for decades.

Still, I don't think it's worth suicide. You'd be better off skipping country.

 

[Frederica]

Google:

http://www.idealmedicalcare.org/blog/doctors-death-an-inconvenience-for-patients/

Pamela Wible picked up on it.

Nothing in that op-ed noted anything related to his status (was he current or had he been fired?) as a medical resident, leaving me to again wonder how do we know he was dismissed from his program?

 

[Mass Effect]

The tax bomb is in no way theoretical. You will owe the IRS income tax on the amount forgiven. They will take your 401k, home, and property to get that money from you. You will very realistically be starting from scratch in your late 40s.

There's no tax hit on the PSLF. Ten years and the rest is forgiven.

 

[Mad Jack]

There's no tax hit on the PSLF. Ten years and the rest is forgiven.

To date, no one has used this program and there is already legislation in the works to limit the amount of forgiveness to under 60k.

 

[Mass Effect]

To date, no one has used this program and there is already legislation in the works to limit the amount of forgiveness to under 60k.

It's my understanding the limitations will not be retroactive.

 

[Mad Jack]

It's my understanding the limitations will not be retroactive.

I was looking into some of the provisions of COBRA in regard to student loan bankruptcy, and, as it turns out, they have a precedent for making terms retroactive in regard to student loans.

 

[Mass Effect]

I was looking into some of the provisions of COBRA in regard to student loan bankruptcy, and, as it turns out, they have a precedent for making terms retroactive in regard to student loans.

They may have precedent, but the legislation itself applies to new borrowers. So unless they re-write the legislation or propose new legislation after this passes or gets shot down, it won't apply to anyone who already graduated.

 

[calvnandhobbs68]

If I was stuck with $300,000 principal loan debt accumulating $20,000 a year interest that is compounding and going up with zero way to pay it of, I would spend 1 full year enjoying life to the max racking up debt. Then I would take my life.

I say this with sound mind. If you find a job for 40,000 a year you cannot even pay the interest, your life will be garbage your bad credit will prevent you from even getting an apartment. You will never have a quality life. You will not be able to have or support a family. When you look at life it is all about the quality right? Grandma is on a vent again is that quality? Nope. Talk about a strangle hold and kicking a man when he is down. I would not hesitate to suicide or maybe have a huge life insurance policy and walk in front of a bus so my family is taken care of financially at least.

Why live my life on someone else's terms? Live it on yours. The only thing that gets you through the bad is hope, but with the way this world is setup especially in medicine they strip you of all hope. When hope is lost, what else do you have? We all have to meet our end some day.

Wtf is this? I guess the 20% of the world's population who lives on less than a dollar a day should go off themselves then...

 

[DD214_DOC]

Quality of life is determined by much more than just physical health.

 

[DermatoFIGHT]

Wtf is this? I guess the 20% of the world's population who lives on less than a dollar a day should go off themselves then...

The curse of being ambitions is the potential to fail and fail large. This isn't that part of the world in fact, the USA puts lien on your belongings, takes from your income, prevents you from getting housing, and frequently turns its back on individuals. It is a cold hard world out there when you don't have a mommy and daddy to bail you out. Ever live in shelter or on a park bench? Wonder why so many homeless have alcohol and drug problems? Lot's it is to dull the pain of the reality until they die. You cannot live a fulfilling life on $40,000 a year, have family, and pay off ~$500,000 student loans. Income after tax is about $30,000 to live on. You cannot even pay the interest. You cannot live on a dollar a day in the USA. You cannot compare a 3rd world country to the USA.

 

[calvnandhobbs68]

The curse of being ambitions is the potential to fail and fail large. This isn't that part of the world in fact, the USA puts lien on your belongings, takes from your income, prevents you from getting housing, and frequently turns its back on individuals. It is a cold hard world out there when you don't have a mommy and daddy to bail you out. Ever live in shelter or on a park bench? Wonder why so many homeless have alcohol and drug problems? Lot's it is to dull the pain of the reality until they die. You cannot live a fulfilling life on $40,000 a year, have family, and pay off ~$500,000 student loans. Income after tax is about $30,000 to live on. You cannot even pay the interest. You cannot live on a dollar a day in the USA. You cannot compare a 3rd world country to the USA.

You sound like the kind of person that does have mommy and daddy to bail you out, considering you can't fathom having large amounts of debt without killing yourself. It's also really funny how your initially 300k in loans went up to 500k right there. Getting more and more dramatic are we?

There are much, much worse situations out there that people are living through than the debt collection system in the USA. Hell, there are plenty of people living through this system without going and killing themselves. You have a very overly dramatic view of your life.

 

[styphon]

You could always, you know, leave the country. Set up a new life abroad, far away from FICO and the US government. You could also realistically declare bankruptcy, as you would be able to successfully demonstrate the two major conditions required for student loan debt to be discharged in bankruptcy court: First, you must not be able to repay your student loan and also maintain a minimal standard of living based on your income and your expenses. Second, your situation must likely persist for a significant portion of the repayment period of the loan. Finally, you must have made good faith efforts to repay the loans.

The thing about this guy though- he had no debt. He had been dismissed, but was otherwise fine.

I thought federal student loans are not affected by declaring bankruptcy?

 

[colbgw02]

I thought federal student loans are not affected by declaring bankruptcy?

They can't be discharged, but they can be renegotiated (alternate payment plan, e.g.), as I understand it.

 

[Mad Jack]

I thought federal student loans are not affected by declaring bankruptcy?

They can be if you meet certain terms. Never being able to realistically pay them back and the loan payments causing substantial financial hardship are the two big stipulations. Pretty easy to meet those criteria with 400k+ in debt and have no real job prospects.

 

[DermatoFIGHT]

They can be if you meet certain terms. Never being able to realistically pay them back and the loan payments causing substantial financial hardship are the two big stipulations. Pretty easy to meet those criteria with 400k+ in debt and have no real job prospects.

How can you meet those criteria and prove no real job prospects?

 

[Mad Jack]

How can you meet those criteria and prove no real job prospects?

It's at the court's discretion. If you're working at Best Buy and are deep in six figures of debt from a Caribbean medical school with zero shot at a residency, it'd be pretty easy to prove, for instance. A medical degree with no residency is basically a worthless piece of paper.

 

[DermatoFIGHT]

It's at the court's discretion. If you're working at Best Buy and are deep in six figures of debt from a Caribbean medical school with zero shot at a residency, it'd be pretty easy to prove, for instance. A medical degree with no residency is basically a worthless piece of paper.

If this is true, I need to tell the med school graduate working at Best Buy this (truth).

 

[Dredge]

I don't want to pile on the "cherished members" of our little forum here, that seem to be rather proud of their inability to scrounge up an ounce of empathy for this poor guy.
Actually, that's a total lie, that's exactly what I want to do. The lack of compassion on this thread by some people is embarrassing.

 

[Crayola227]

Often times yes.

I dunno.. for some reason the phrasing there makes me sound like Voldemort... "this poster... (he who must not be named)"

Thanks for pointing that out, sometimes that is how I think of you! I didn't put together the resemblance before.

I don't see it as too strong of a statement. I can't (and wouldn't) hospitalize a suicidal person for life. At some point they've got to have the inner fortitude to ignore the desire when they are alone. If they can't... then that's where it ends.

I wouldn't argue that we should hospitalize a suicidal someone for life (although with schizophrenia being an incurable organic brain disease that is difficult to treat and sometimes does lead to a need for longterm hospitalization and suicidality, I'm not sure we don't end up doing so, maybe those people should be handed the knives they desire and given reign to kill themselves), but I'm not sure that if their suicidality is due to a mental illness like depression which we know can be successfully treated, that this is a matter of relying on their inner fortitude. Specifically, depression affects this "fortitude" and that many people with great great inner fortitude who experience great depression find that the illness blocks their ability to call upon it, and that with treatment and resolution of their depression their great inner fortitude re-emerges. So getting over depression or depression-induced suicidality is not a matter that at some point there is a requisite inner fortitude that one must use to ignore the desease. You don't expect inner fortitude to stop a hemmorhage from a torn off limb, I don't know why it would be the stopgap point for treating mental illness.

Nope, I'm just a person with an opinion. I may be wrong. I may be right. But my opinion is mine borne from my experiences, as yours comes from your experiences. Neither is wrong because we aren't debating a topic with a factual basis. We are discussing how we should feel about a topic. Why are my feelings about this topic somehow being portrayed as wrong? If you don't like them, then don't feel that way. But you aren't going to argue and make me feel any different about this topic.

My opinion and feelings come from my experiences of having family members kill themselves as well.

Maybe there is more to be learned from those experiences.

I knew someone who was hospitalized for their eating disorder, recovered, was well for years, and I NEVER expected their relative to say "wow, it looks like you've put on weight" to them knowing this and when the weight that they were at when this was said was aesthetically and medically desirable. Sort of an insight into maybe what kind of family influence/consciousness/insensitivty about weight may have been at work in her development of her illness.

Point being, everyone learns from experience, but maybe they just don't learn what they need to to help others more effectively

I would be interested in uncovering any personal and family dysfunction in the wake of a loved one killing themselves
I might wonder if myself or my family were the kind of people that you felt you could go to for help and sympathy or if we were sources of shame and belittlement. No man is an island unto himself, so no suicide happens in a vacuum, nor is any individual absolved of responsibility for their own suicide. However, in medicine, we talk of extrinsic and intrinsic factors for disease, knowing there are elements that can and cannot be controlled for.
So one thing I'd like to control for is not being an insensitive dingus, that way I know being an insensitive dingus was not a contributing factor to a loved one's suicide.

Food for thought

 

[Crayola227]

If I was stuck with $300,000 principal loan debt accumulating $20,000 a year interest that is compounding and going up with zero way to pay it of, I would spend 1 full year enjoying life to the max racking up debt. Then I would take my life.

I say this with sound mind. If you find a job for 40,000 a year you cannot even pay the interest, your life will be garbage your bad credit will prevent you from even getting an apartment. You will never have a quality life. You will not be able to have or support a family. When you look at life it is all about the quality right? Grandma is on a vent again is that quality? Nope. Talk about a strangle hold and kicking a man when he is down. I would not hesitate to suicide or maybe have a huge life insurance policy and walk in front of a bus so my family is taken care of financially at least.

Why live my life on someone else's terms? Live it on yours. The only thing that gets you through the bad is hope, but with the way this world is setup especially in medicine they strip you of all hope. When hope is lost, what else do you have? We all have to meet our end some day.

The curse of being ambitions is the potential to fail and fail large. This isn't that part of the world in fact, the USA puts lien on your belongings, takes from your income, prevents you from getting housing, and frequently turns its back on individuals. It is a cold hard world out there when you don't have a mommy and daddy to bail you out. Ever live in shelter or on a park bench? Wonder why so many homeless have alcohol and drug problems? Lot's it is to dull the pain of the reality until they die. You cannot live a fulfilling life on $40,000 a year, have family, and pay off ~$500,000 student loans. Income after tax is about $30,000 to live on. You cannot even pay the interest. You cannot live on a dollar a day in the USA. You cannot compare a 3rd world country to the USA.

I'm almost speechless. There is someone I know who is living this reality. They have lived in a shelter and on a park bench, and they were more hopeful then than they are now after finishing med school but now with physical disabilities and no residency and debt... They have been to a 3rd world country and thought of escape to there, but again, if physical disability is why you cannot work to pay off that debt than you won't be wanted elsewhere. Guess it's the job of the family they don't have and never started for a medical career to give them a hug or compassion or the mommy and daddy they don't have to bail them out. Thank God they don't read SDN or if they did that they have the inner fortitude to live the worse career nightmare and personal nightmare of anyone or anything described on this board despite the total insensitivity of the medical profession as a whole and as seen on this forum. As Dr. Bob suggests, if they can't be restored to a contributing member of society, ie all they are is an intelligent person who may never be able to be fully self-sustaining economically, maybe they will do everyone a favor and kill themselves. Maybe the next time they end up in the ED, Dr. Bob can use his amazing bedside manner to help this former doc realize what a burden they are and they can choose death not life.

Maybe quadripeds with bedsores and the like are contributing members of society from the standpoint of the people that love them?

I dunno, but my friend above said the only reason they didn't off themselves was that their elderly disabled father really didn't want them to. They decided they loved him too much to end their own suffering and cause him more. I'll be sure to let this person I know that they and their father should change to no code and consider that living for the sake of the love they have for one another isn't reason enough.

 

[sazerac]

Except that the program has been around for ~8 years, the earliest someone can hit the tax bomb is 17 years from now (given that in its early years it was a 25 year gig), and there have already been proposals before congress to get rid of the "tax bomb". So yes, it is real... except that it hasn't been yet and might not be in the future.

Umm, the tax bomb is alive and well today, it's been around for years, and ironically it isn't hitting the rich doctors but rather the disabled who really have no ability to pay the debt or the taxes.

http://mobile.nytimes.com/2014/03/2...r-a-tax-bill-from-the-irs.html?referrer=&_r=0

At least you can negotiate with the IRS if the tax debt is truly unpayable.

 

[michaelrack]

Umm, the tax bomb is alive and well today, it's been around for years, and ironically it isn't hitting the rich doctors but rather the disabled who really have no ability to pay the debt or the taxes.

http://mobile.nytimes.com/2014/03/2...r-a-tax-bill-from-the-irs.html?referrer=&_r=0

At least you can negotiate with the IRS if the tax debt is truly unpayable.

the person in the article should have wiped out the student loans during bankruptcy rather than after- that would have gotten rid of the tax liability

 

[Chicago2012]

the person in the article should have wiped out the student loans during bankruptcy rather than after- that would have gotten rid of the tax liability

Problem is that you can't touch student loans with bankruptcy. They are immune to bankruptcy proceedings.

 

[michaelrack]

Problem is that you can't touch student loans with bankruptcy. They are immune to bankruptcy proceedings.

I realize that student loans are very hard to get rid of, but since the person in the article qualified to have his student loans eliminated shortly after his bankruptcy, I think he would have qualified within the bankruptcy.
http://www.nolo.com/legal-encyclopedia/student-loan-debt-bankruptcy.html

 

[Chicago2012]

I was not aware that that was even an option. Thank you.

 

[Shorin-Ryu]

Why is this such a big deal? Some resident, who had access to the same helping resources we all have, chooses this as the answer to adversity. And I'm supposed to feel bad for him?
Sure, I feel bad for his family. And I feel bad for the other residents (who now have more call to cover, although they incurred this extra work when this guy was dismissed).
But I don't feel bad for him. And I certainly don't blame the program. Any more than I blame any other company who has an employee off themselves.
Some people have bad coping skills, and we can try and try to keep them from making bad choices. But at the end of it, they are the ones with a gun in their hands, a bottle in their hands, or whatever else. And if they feel that's their only option, so be it. It's one less person to have to devote limited resources to.

Here; I'll save you all some time.
You're a bad person; You don't care about people; You're a terrible doctor, You're cold callous and heartless; You're a mean and hateful person;
Just quote whichever sentence you think is most applicable.

<shrug>... life goes on.

Well... except for him.

My father was a cardio-vascular surgeon, my great uncle was a military general surgeon and my other great uncle was a trauma surgeon. This would have been their exact line of thinking. But, of course, any death matters. Lost one childhood and one college friend to suicide.

Rest in Peace, Dr. Azkue. My condolences to Dr. Jon Azkue's family and colleagues.

 

[medicalgas]

I have been following this thread...
To gloat about senseless demise of an underdog------exposes your inner thought process.
Some of the thoughts expressed are truly appalling and distressing. Its alarming that seemingly 'normal' psychopaths are roaming around as 'successful' doctors and in key decision making positions. To think they would be involved in assessing people in 'eye popping'.

Their heartless words prove they are living embodiment of 1984 , a society filled with dysfunctional, heartless robots ......the taxes, loans and interests have truly enslaved your minds and shackled you. To see the discussion drift to loans demonstrates the actual reasons for people becoming so insensitive. But it is still distressing how the victim was dehumanised just as a number and his adversity an inconvenience. The extent of callousness is reflective of much deep seated attitudinal issues. Even more distressing was people having a blase approach to how trivial the death ( of someone from their own ranks ) was treated.

People wonder overseas how can USA choose such a president....its no surprise, there is a small Trump inside in many people ....and it shows every now and then. A system doesn't regurgitate a dysfunctional person for the top job unless top people are indeed sharing the same values.

Thank you for showing your true self and exposing a face of your country which people had suspected but ignored for benefit of doubt.

The elephant in the room is the slave industry thriving in form of residency training. Everyone knows about it and no body wants to address the issue. How is it that the programs are very happy to buy indentured servants for below minimum wages and shrug off any reponsibility of taking the slack when things do not go as per plan.....every tom, dick an harry can be trained.....the problem is with 2% who won't or can't be trained.....this may sound cognitively dissonant to you, but programs can't sign off those residents...after all they had taken up the responsibility to train them and it is their( programs and not residents') failing if they can't train them to minimum standards........the market is monopolised and cartelised....this is how mafias work....

 

[hallowmann]

I have been following this thread...
To gloat about senseless demise of an underdog------exposes your inner thought process.
Some of the thoughts expressed are truly appalling and distressing. Its alarming that seemingly 'normal' psychopaths are roaming around as 'successful' doctors and in key decision making positions. To think they would be involved in assessing people in 'eye popping'.

Their heartless words prove they are living embodiment of 1984 , a society filled with dysfunctional, heartless robots ......the taxes, loans and interests have truly enslaved your minds and shackled you. To see the discussion drift to loans demonstrates the actual reasons for people becoming so insensitive. But it is still distressing how the victim was dehumanised just as a number and his adversity an inconvenience. The extent of callousness is reflective of much deep seated attitudinal issues. Even more distressing was people having a blase approach to how trivial the death ( of someone from their own ranks ) was treated...

As hard as it is to argue, I don't actually think people in this thread are heartless or psychopaths. It's certainly disheartening to read some of the comments from individuals who see humanity at its worst and to some degree are tasked with restoring the "useless" to a "productive" state, but at the same time I think that jaded attitude only comes from being stuck in the medical world too long and ultimately believing you know what is best for others.

When you start thinking you can judge the value of a life (that you very much know nothing about) or when you start suggesting things are futile, if anything its depressing to me because all I can think is what the heck have you seen or experienced to make you lose that part of yourself that puts yourself or a loved one in the shoes of your patient.

Maybe the fact that its primarily coming from an EM doc is telling. They see time and again people who they consider worthless never getting better. Why care for such people? They're just going to drink themselves back into my ED or one of these times the OD will be their last.

I suspect one of the problems to be that in the medical field, especially in the hospital, you're exposed to such a narrow subset of the population. Regardless of what you may think, everyone isn't sick, not everyone who has a mental illness, who attempts suicide, who has an addiction, who is homeless will never turn it around and become "productive". They aren't just a strain on your energy and your country's resources without ever being able to give back. Get out of the bubble. You'll find plenty that contradict what you've been conditioned to believe by years in the ED, OR, or on the floors.

I don't know, I started out depressed by this thread, now its just motivation to not get stuck in that mindset, something that seems to undoubtedly happen the longer you're in that environment without a reality check.

 

[caffeinemia]

The thing that confuses me most about this thread is .. how come we never post stuff like...

Resident gets dismissed, dies from car accident? dies from asthma exacerbation, dies from heart attack. Crap like that happens all the time to doctors and yet no one here seems to get so sassed about it. So is it something unique about suicide? If you say it's because it's directly attributable to residency, I can tell you that the stress of residency hasn't helped my cardiovascular health one bit... I dunno what's so additionally tragic about suicide versus a disastrous stroke or cancer or whatever that it merits a huge thread...

Though I want everyone to feel good and live well, I have to admit that Em Doc Bob makes some valid points in this case.

 

[j4pac]

People wonder overseas how can USA choose such a president....its no surprise, there is a small Trump inside in many people ....and it shows every now and then. A system doesn't regurgitate a dysfunctional person for the top job unless top people are indeed sharing the same values.

Thank you for showing your true self and exposing a face of your country which people had suspected but ignored for benefit of doubt.

Just when you think this thread couldn't get any worse...you pull in politics for the coup da grace.