Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, September 01, 2007

Shattered Lives - Part One

Several years ago I went downtown once a week to sing with a University choir. It was musically intense, which was what made it fun. The people, mostly medical, were nice enough and several pre-rehearsal and post-concert parties provided some social interaction.

One young Peds resident was a particularly nice guy. He was married to one of the altos, who was something other than a physician. I chatted with him several times, and was impressed with how enjoyable the interactions were. He had a sweet, gentle way about him that made even passing conversations memorable. He was also funny as hell and had a lovely baritone voice.

About three weeks after the Winter Concert -- where he did a beautiful job with a difficult solo -- I came home to the following message on my machine:
Michael Smith passed away yesterday.
followed by information about the memorial service.

To say I was stunned is to say Antarctica is chilly. What the hell had happened?

It has been referred to as the Black Dog. Some have recently opined that we are overdiagnosing it; medicalizing the normal vicissitudes of life. However you feel about those issues, it cannot be denied that depression can be a fatal disease.

If I had been asked to line up everyone in that choir in order of likelihood that they were depressed, Mike would have been at the very end of the line. I had had no idea. It turned out no one had. Whether or not he was under treatment, he hid his misery masterfully; right up until the end. It was a gun. His wife found him. No further details were forthcoming; none were needed.

The service was on a weekday afternoon in an old stone church in a quiet neighborhood in New Jersey. It took forever to find a place to park. Cars crowded along both sides of the tree-lined street. It was startling to see how many people managed to squeeze into the tiny church. I knew practically no one but it didn't matter.

His wife read this, by W. H. Auden:
Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.

Let aeroplanes circle moaning overhead
Scribbling on the sky the message He is Dead.
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last forever: I was wrong.

The stars are not wanted now; put out every one,
Pack up the moon and dismantle the sun,
Pour away the ocean and sweep up the wood;

For nothing now can ever come to any good.
I was able to hold back my tears, until her voice cracked. Then I lost it, as did many others. People spoke of him; his gentle nature; his humor; his music. The agony was palpable, seeming to congeal into the unspoken word "Why?" asked over and over, because it was unanswerable.

After the service there was a receiving line of sorts, filing through to greet the family. His wife was the only person I knew. The older lady with the parchment skin and vacant eyes was clearly his mother; the sturdy man beside her obviously his father; the girl with red-rimmed eyes so like his had to have been his sister.

What do you say? You murmur, "I'm so sorry" and hope it sounds at least as sincere as the thousand other times they've already heard it. They say, "Thank you for coming," over and over, and eventually you realize they're not really listening. Their bodies are there, overdressed for the time of day though not for the occasion, but their souls are twisted in grief somewhere far away. They aren't crying, but only because it's the first time in days they've been able to stop.

I got pulled over for speeding on the way home. I apologized to the plainclothes cop and told her I was distracted, that I had just come from a funeral. I hadn't intended it as an excuse, though, so I was pleasantly surprised and grateful when she came back with just a warning. I felt like an intruder; an interloper; a fraud. Why did this hit me so hard? I hardly knew the guy. Still, my distress and grief were real.

I lost my mother twenty-one years ago and a dear uncle five years ago. I've lost patients -- including some young and unexpectedly -- though none to suicide. I've been at arm's length to my fair share of life's tragedies and in general I tend to cope well enough. But that one really got to me, and I never did figure out exactly why.

Gradually I was able to stop thinking about Mike every day. The sadness lifted. I can only hope his family has found some measure of peace in the ensuing years, though I really didn't know them, so there was no way to keep in touch. Life has moved on.

But now it's happened again.


At Sat Sep 01, 05:38:00 PM, Blogger Bardiac said...

I'm sorry. Words are inadequate, even Auden's.

At Sat Sep 01, 05:57:00 PM, Blogger rlbates said...

Bardiac has it right, but I felt the same way when a cousin of mine (whom I would never have guessed would) took his own life this past January. Deaths by depression to me are so much tougher to grasp than those by other diseases.

At Sat Sep 01, 08:32:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

We lost a classmate to suicide in med school, and again it was the last person anyone would have expected.

To feel so bad that even the thought of what it would do to one's family isn't enough to stop a person from taking their life - how dark a place that must be, I do not even want to imagine it.

At Sat Sep 01, 08:44:00 PM, Blogger Lynn Price said...

Beautiful post, Dino. Your observations are so keen and spot on. I've known a few people with severe depression, and the reaction was always the same; we never knew.

I'm sending you the same hugs you sent me.

At Sat Sep 01, 10:43:00 PM, Blogger The Tundra PA said...

most people have never been truly seriously depressed and can't imagine how dark that place must be. so much pain and hopelessness. I am thankful never to have known that level of grief; but I have known those who have. Suicide does not end the pain.

At Sat Sep 01, 11:35:00 PM, Anonymous Anonymous said...

ohhhh . . . I'm so sorry . . .

At Sun Sep 02, 12:51:00 AM, Blogger frizzzzle said...

My goodness. You're certainly not a fraud -- even though you barely knew the man, he could be anybody. Since you can't always see it, knowing there's nothing you can do to prevent such a tragedy is an awfully helpless feeling.

Touching. You put your thoughts so well. Here's looking forward to part two.

At Sun Sep 02, 05:46:00 AM, Blogger Elaine said...

I did not know the man at all, but I am sitting here, stunned, as it brought back memories of a friend and former colleague. You are right about not seeing it coming. I am so sorry.

At Sun Sep 02, 11:19:00 AM, Blogger Midwife with a Knife said...

I'm sorry.

At Sun Sep 02, 11:29:00 AM, Blogger CrankyProf said...

Oh, Dino -- my deepest sympathies. You and your friend are in my thoughts and prayers.

If you need to talk, let me know.

At Sun Sep 02, 05:47:00 PM, Blogger Laura said...

This is one of those glimpses at another's life that I agonize over hearing, yet can not bear not to hear. It poses quite a challenge. Fot those of us that have lost a loved one to depression, it brings back some painful memories. The shock and surprise and the false belief that "I should have seen warning signs or SOMETHING." I think those feelings are especially difficult for those of us who are trained professionals: physicians, counselors, etc. We believe that we should have some superior intuitive/fortune telling skills that can proptect those around us.

As a cousnelor, I appreciate those who tell me "I am depressed." I thank those who share their suicidal thoughts with me. Those are the souls who are calling on me to help them. Those are the ones I can help. If you come to me, I will do my best to help you. If I don't know about it, I can't help.

Neither my neice nor my cousin (both died within a year) came to me for help. This saddens me, but ultimately, it taught me that I am neither all-seeing nore all-wise.

I am sorry for your losses. It is a difficult road, harsh and raw. Thank you for sharing it with us, Dino. I am preparing myself for the rest of the story, and am sending prayers and blessings your way.

At Sun Sep 02, 06:34:00 PM, Blogger Mimi said...

Very sad indeed and what a good job you did describing the sadness.


At Mon Sep 03, 12:06:00 AM, Blogger Bo... said...

It is horribly sad when somebody is so hopeless about the future that they take their own precious life. And I thank God for the kind and understanding docs who have helped me with my own battle with the Black Dog. This was a beautifully written post.

At Mon Sep 03, 09:34:00 AM, Anonymous Anonymous said...

Beautifully pure piece of writing. Thanks for sharing your heart.

At Mon Sep 03, 11:35:00 AM, Blogger Sara said...

This is the dark secret in medicine.

Waiting for your next post.


At Mon Sep 03, 02:24:00 PM, Blogger Hygeian said...

My god that is so sad.
It is also beautiful - not the death. Your reflections on it and the aftermath are though.

We had a series of suicides on campus at my university last year. Your writing reminds me how much a death under these circumstances can affect even someone who is removed from the person, especially when they are both part of the same community. I don't believe that your reaction is inappropriate or intrusive. I think it is an indication that you are a strongly empathetic person.

I hope you are well and I appreciate your sharing this experience, as painful as it is.

At Wed Sep 05, 04:49:00 PM, Blogger Carrie said...

The poem you quote was given to me by my aunt in the days before my brother's funeral. I was fine until I read those words again and cried for my brother and for myself, at work, at the computer.

I find reading writing about death and grief comforting usually; it is such a hidden part of everyday life that sometimes I forget that I am not alone.

Thank you for that.

At Tue Nov 27, 01:31:00 PM, Blogger A Girl said...

This is good writing.

One of my patient's killed himself the night after an office visit with me. Took a bottle of some benzo he'd gotten from somewhere...not me fortunately.

But I was hysterical. I understand this shock you describe.....I called the sheriff of the small town where he lived because I knew they would have done the investigation, after he was found dead at his home. I had to talk to someone....get some "information." And his family just weren't the ones...

Sheriff actually talked to me. There was a note. Something about his daughter. More stuff too, although the sheriff wouldn't say. I keep thinking it was related to his medical problems, but sheriff was being kind to me....maybe not.

But I saw him THAT DAY. In the OFFICE. As his DOCTOR. How could I not HAVE NOTICED SOMETHING? S O M E T H I N G????

It is truly terrible. Again, good writing.


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