And then there were eight

First appeared in the Pharos winter 2008.

My medical school class is smaller now because my classmate Mike is not here.  Last quarter Mike was in my small problem-based learning group.  He stood out when I first met him because he was tall and handsome with dark shiny hair and a cheerful grin.  I came to appreciate that he was also charming, curious, funny, and enthusiastic.  I noted that he asked questions with a maturity and interest beyond that of some of the other students.  He eagerly shared life experiences and knowledge with our group. He carefully listened while others in the group shared views that were new to him.  His enthusiasm made the group meetings fun.

Mike was quieter and more tired than usual as the December exams approached.  The whole class seem to be feeling stress and fatigue and Mike’s demeanor was not unusual.

A few weeks after the last problem-based learning session for the fall semester, my class took its biochemistry exam.  As I finished and turned in my exam, I was handed a small pink slip of paper announcing a class meeting at 4:15 that afternoon.  Once there, it was an utter shock to hear the Dean say Mike had “taken his own life through suicide”.

“Who?”  I asked.  “Can you repeat the name?”  I could not believe Mike had fallen so deeply into depression so quickly.  We milled in the lobby, stunned, crying, hugging, and asking questions.  Through the torrent of shock, confusion, anger, grief, and fear, I wanted a clear and definite explanation for what had happened to Mike, or someone to blame.

Why?  Why?  Why?

When the classes returned from break the whole school still suffered the loss of Mike.  Some students attended his visitation and funeral.  His white coat hung near his coffin.  The empty coat with a reminder of the great doctor he was supposed to be.

At my first small group meeting after the holidays, I half expected that Mike would be in his regular seat.  Instead we had two empty seats at the table.  Another group member had decided to take a leave of absence for personal reasons.  Her choice was a reminder of the alternative Mike rejected. Out of the 10 of us who started in September, now there were 8.  The cost of a career in medicine never felt more real.

Mike’s death is not my first experience with suicide.  When I was a child one of my parents attempted suicide.  A few years later another family member deliberately took an overdose.  All this happened in the 1980s.  Back then, the tools to treat depression were more primitive than they are today.  Mental illness was strongly stigmatized. In those days, I could not talk to anyone about what was going on at home.  This was before Oprah Winfrey and others in the media helped normalize discussions about depression and brought counseling to the mainstream.  At that time, a family member with mental problems was an embarrassment and shamefull.  Few people had insurance with mental health coverage. Drugs like Prozac and other antidepressants have not been developed yet.  And sometimes, even when people reached out, there were few effective therapies. Fortunately, my family members were able to get professional help.

Since then I am glad to see there have been changes in mental health care.  There are new drugs and new treatments.  Clinical trials have demonstrated proven and effective therapies for many mood disorders.  Psychiatric intervention can now prevent suicide in many patients with major depression.  Access to care has improved and broadened.  Laws require parity in health plans so the treatment for severe mental illness is covered as completely as coverage for severe physical illnesses.

More and more… Students are matriculating on antidepressants.

The increasing use of psychiatric services today means less stigma for those seeking mental health treatment in the general population.  State governors, professional football players, and business leaders have publicly acknowledged seeking help for mental health concerns.  The 2000 Center for Disease Prevention and Control health report documented that 10% of women and 4% of men took an antidepressant medication that year.(1)

Mike was offered the latest tools and therapies for his severe depression.  He received emotional support from family and friends, consultation and treatment from personnel in the medical school, and continuous care from his treating physicians.  Our medical school is progressive and proactive about mental health care.  During orientation, the Student Affairs Dean describes symptoms of depression in detail. Any medical student could call or go to several places for confidential and professional services, and mental health treatment is provided by professionals who do not teach or evaluate students directly.  The medical school has a unique contract with mental health professionals to establish mental health treatment for students, including the proviso that students do not have to wait more than 2 weeks for an appointment.  The cost is covered by student insurance, and any out-of-pocket expense is minimal. Sessions not limited–students get the care they need to succeed in medical school.  A 24-hour helpline is available, staffed by peers on the student wellness committee, as well as confidential counseling, separate from the College of Medicine administration.

Mike was being helped for his depression.  A team of caring professionals was actively trying to help him and the best current treatment was offered.  All this effort was not enough–he refused treatment that might have saved his life.  I struggled to comprehend his final act.

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