Encountering death is an integral part of Medicine. Patients die on you. This is even more so for me as I work with geriatric patients. And I work with people who often want to die, and attempt or commit suicide.
The death of a patient hits me. Every time. I wonder if this will ever cease – or should it cease? The population base I treat usually has few resources or family. When they die, I often hear about it when the county calls to tell me so-and-so was found dead and he’s in the morgue waiting autopsy for cause of death.
I think I speak for many doctors when I say many emotional reactions occur upon learning of a death:
One emotion is ‘failure’. Somehow we could have/should have seen this coming or done something differently to avoid it. This emotion is aggravated by society which tends to believe all death = failure, and death = somebody is at fault.
One emotion is frustration. The specific cause of death is often not known or probably from multiple factors. Everyone wants to know ‘why did he die?” meaning what one thing caused it. It seldom works that way and we seldom find out.
One emotion is sadness. I see so many depressed and frustrated people with suicidal ideation and hopelessness. When someone is found dead, I ruminate did they commit suicide? I see suicide as a tragic loss.
I have to continually remind myself death happens; it is the inevitable conclusion of the accumulation of multiple factors for which no one has full mastery.
Even when someone commits suicide, a suicide is an act ultimately unstoppable when someone decides to do so. We try hard to thwart it/see the risks but I can not stop anyone if they so resolute to end their life.
All the same, a death or a suicide makes my job sorrowful.


19 comments
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September 30, 2008 at 9:08 PM
Robert
In a most twisted sense, I understand that it takes great ‘bravery’ to commit such an act.
September 30, 2008 at 10:16 PM
the hobbit
I’m sorry you’re blue about it. But I’m so glad that you tell us. Do you think it would be a relief to just shrug it off, or do you think you would worry for your humanity?
October 1, 2008 at 3:42 AM
Sean
Mortality always hits home to me. I always feel something when I hear of someone’s death, as I instantly think they were alive and played a role in life and now they’re gone and not part of the community of humanity any more and that saddens me on some level. I always thing of the line “ask not for who the bell tolls…”
I think compassion and a sense of loss over every death, although difficult, is a sign of a good heart and a caring soul.
October 1, 2008 at 4:05 AM
Lemuel
I think this was a marvelous post! It dealt with a topic that we often avoid and dealt with it realistically and sensitively.
October 1, 2008 at 4:37 AM
Donald
Sorry for that kind of sadness, no matter how inevitable.
October 1, 2008 at 5:28 AM
BentonQuest
When I have felt the most suicidal, one of the things that have kept me going is not wanting my therapist to feel like he failed. But suicidal thoughts are so often a feeling of extreme tiredness.
But, I thank you as a way of thanking all those who are in your profession for dealing with your own personal pain so as to help us deal with our pain.
October 1, 2008 at 5:32 AM
DougT
Interesting perspective. This is one of the things that dissuaded me from going into medicine. I’m glad that there are folks like you who are not so easily dissuaded. I also feel that it speaks well of you that you have been able to deal with this facet of your career without becoming callous as a coping mechanism.
October 1, 2008 at 6:18 AM
Chris
have not equated Death with Failure. I believe more in the Death just happens view.
Suicide is more complicated than Death for me. I have had some suicidal thoughts over the years, it was worse when I was younger. I have learned that when I have them it usually means that there is some need within myself that is not being addressed, or maybe I am sad about something and I need to release those emotions to feel better.
I had read somewhere that being suicidal is more a cry for help and that may not be true all the time. I still use the thoughts as a key to heal myself when I can or to call a friend to help me through the low periods. I also try not to do things when I am tired. I have very poor judgement when I am tired. Thanks for the post.
October 1, 2008 at 8:18 AM
Shawn
Death is a natural cycle. I truly do believe we die when we are supposed to. No it is not a man in the sky that says “It is your time my son, you are to come be with me” but a more metaphysical thing that keeps energy constant and moving from one form to another. I am not saying there is no god either, just something greater that we in our dimension and do not have a completely full grasp of, but through faith in ourselves, we can trust and can influence this greater energy.
The big thing with death, is yes it IS ok to feel sorrowful. But to really truly respect the life that was lived, is to look for and search for the GOOD. Then celebrate and be thankful! There is good everywhere even in and around those that are down enough to consider or attempt or even complete suicide. Concentrate on the good, compliment the good, appreciate the good. Through appreciation life is transformed!
October 1, 2008 at 8:57 AM
ElfBear
Thank you for offering such profound reflections on a topic that we rarely engage in, unless of course forced to do so by circumstance. Your words serve, in my opinion, as an affirmation that medicine is a vocation much more than a profession. I feel that professions can be practiced without any obligatory sharing on behalf of the professional; those who are guided by vocation must engage in a sort of intimate relationship that leaves the caregiver out on a limb should the patient die, regardless of the means of dispatch. Hats off to you for being able to share your richness; even though it may leave you weary and full of questions, it is a gift that no one else can offer; one that is priceless and does make a difference in the final analysis.
October 1, 2008 at 9:53 AM
Steven
I think that it is good that you still feel that way when any death is heard of. I know of many who have just become so numb to the news of a death as if the person was of no significance.
October 1, 2008 at 9:56 AM
Sassy
Great post. I’ve worked in a variety of medical fields for almost 35 years now. It’s nice to know that physicians feel the same as everyone else in the medical field.
October 1, 2008 at 11:33 AM
Birdie
It is easy to see how in the healing profession, death equals failure. Suicide is indeed a tragic loss, for more than just the patient. It has repercussions that are felt generations down. I know whereof I speak, because my father killed himself when I was eighteen. Apparently he had feelings like this for at least ten years and perhaps stemming from his experience in the Normandy Invasion decades before. We’ll never know for sure.
The conflict between knowing absolutely that he loved me and feeling completely abandoned is something I may never totally reconcile. That has created issues in my marriage of over 30 years and has affected my child-rearing. Now my children must deal with the issue as well—and my father died before they were born. Such is the devastation suicide can engender.
It is an escape from unbearable pain for the one who dies. But there are ways to deal with emotional pain. (I think suicide to escape an impending painful death is another thing entirely. But I would not speak for those who’ve been left behind to deal with that aspect.) I think I will never understand making the choice to commit suicide because I have chosen to live.
October 1, 2008 at 1:23 PM
e.a.j.
Both my mother’s brother and my father’s father killed themselves. I suppose in their bleakness they couldn’t see how it would affect all of us. But it has.
Neither of them were in any sort of therapy. I’m sure it would have helped.
October 1, 2008 at 3:07 PM
Mark H
I have GREAT admiration for what you do, partly just BECAUSE of this subject. The fact it has never gotten easier for you shows how you truly work at being the REAL therapist people need. I know, that doesn’t help the subject be any easier.
October 1, 2008 at 5:14 PM
cedrorum
Death does happen. And you are right, it is a normal part of life. I have a hard time believing that you wouldn’t do everything you thought possible to help someone trying to commit suicide. Great post.
October 2, 2008 at 3:04 PM
Maddog
I’ve had two friends commit suicide and a couple make a serious attempts to do so. I’ve thought long and hard about this and of course always wonder if there was something I could have done. The reality is no. It was ultimately and is their choice. We can’t know why they are driven to make such a decision but as with any decision I can only try to respect it. It doesn’t make me any less sad but it has helped me to realize that it’s not my fault, and that in truth it was never about me to begin with.
October 3, 2008 at 6:27 AM
javabear
I hadn’t really considered that in your specialty you would encounter very much patient death. I obviously wasn’t thinking it through. I typically associate the doctor/patient death connection with a more physical illness than mental illness. Even though I’ve had suicide ideations for years. (not consistently)
October 3, 2008 at 6:35 AM
zeph
As R. Kelly so aptly put it, “don’t take life so serious, son. It ain’t nohow permanent.”