Suicidal Ideation in Healthcare

I’m post-op day seven of my first “C” ever in nursing. I know some of you are thinking, “This chick is nuts, I’ve had plenty of Cs,” some are thinking, “I’ve never had a C,” and some are thinking, “I know exactly where she is coming from.” Why am I so uptight about this? Well, for a number of reasons.

As I’ve stated in previous posts, I love nursing. I love nursing more than anything I have ever done and I take my education very seriously. I genuinely try really hard. I eat, breathe, and live nursing – every day circulates around nursing in some form or another. Also, at this point, I am accustomed to doing better than this and it is a feeling I’m not familiar with anymore. Finally, this has been a semester of setbacks. It felt like every day, something was going wrong – I’ve been told “no” about 1000 times, I’ve felt a lack of encouragement from everyone who should be motivating, every day has yielded uncertainty in some form or another (Will I graduate on time because of my doctoral project? Will I pass this class? Will I be able to keep working? Will I lose my mind? Am I still cut out for this?), and naturally, real life has been more stressful as well.

While I feel very isolated, I know I am not alone. I look at my classmates and I can see the vacancy in their eyes that ceased to exist the day we started. We have been transformed into robots by the vicious cycle – class/study/clinical/study/work/study/family/study. This is sad considering these are the brightest people I have ever been around. Not only did we all have the highest GPAs in undergrad, but most of us have had unique life experiences, making us well-rounded, ideal, candidates. I would bet money, any of these people who have made it this far, will be exceptional, doctoral prepared, nurse practitioners. Yet, the stress can still be unbearable and misunderstood by anyone outside of the medical community.

This brings me to the last few months. I was definitely at a low point. Other than the “normal” stressors, I was even more sleep deprived and lonely. I’m single and some nights it’s hard to come home to my dog, but it’s nearly impossible to meet anyone with my intense schedule. Normally, I am a positive person who is eternally hopeful, but all of these traits seem to work synergistically to deepen the pool of depression. The more I study, the more tired I become, the more tired I am, the more “off” my emotions are, the more “off” I am, the more lonely I become, the more lonely I become, the more I isolate myself. Then, before I know it, I am home studying every night, while simultaneously missing my friends, and wondering what I have done with my life? Those feelings then transition to a robot-like, survival mode, where I feel as if I have nothing left to give to anyone.

I remember sitting on my couch with all of the above thoughts circulating, feeling completely out of control of my life, and wondering what would happen to me if I didn’t make it through school. At this point, I’m in so deep, and I have student loans to pay back when I finish – dropping/failing out is not an option. Then, the thought of suicide creeped into my mind. Yes, I said the dirty word; did it make you squirm a little? I quickly regained control of my emotions and scolded myself for allowing that poison to overtake me for a very brief moment. Then I thought about all of the patients I had cared for who attempted or successfully committed suicide, but one in particular stuck out.

I hadn’t even been working as an ICU nurse for 6 months when I admitted a 30 something cardiac arrest. I didn’t think much of it until I received report and learned the code blue I heard overhead was in fact for a resident found in the on-call room with used bottles of intubation drugs and a needle. This shook me. I cared for him for three days in a row and when he thankfully woke up, I remember him expressing concern that his school would expel him. His classically beautiful wife was there to comfort him and his door was revolving with colleagues and medical school faculty. I could tell people liked him and his smile was magnetic, but when I was alone with him, it was easy to tell his heart was heavy. The rest is really a blur for me, but I now wonder what happened to him.

Then, there was a coworker of mine who was starting nurse anesthesia school. He was a beautiful human being, nothing further needs to be said. He was also found with a needle and paralytics, dead in his home.

There have been many stories of residents committing suicide and every story I read, I feel deeply. Physicians have the highest rate of suicide by far and struggle with a specific set of demons, but other healthcare providers are next in line. The medical community is rough. We are sleep-deprived, sometimes egotistical, over-achievers, who are trained to assert ourselves or prove ourselves. If we don’t we are ridiculed, if we do and we are wrong, we are ridiculed even more. After awhile, this can become too much for some.

Luckily, I am a nurse. Although, I was stressed and having a low moment, I knew I could talk to my best nurse friends and I wouldn’t scare them. So, after my brush with suicidal ideation, I called my friend and told him. He said, “If it makes you feel any better, I thought about suicide last semester.” I was shocked. We talked about it and shared many of the same thoughts. Another friend of mine, who is also in nurse practitioner school, single, and working, asked me how the semester had been. I’ve never been one to mince words, so I told her how awful it was. She identified and told me hers was terrible too. As we began to share stories, I let the cat out of the bag and told her my secret of suicidal ideation. With relief she looked at me and said, “me too.” Another nurse friend who is starting grad school in the fall witnessed the conversation and said we were scaring her, but I’m glad she knows. I want everyone to know.

Intertwined in all of these thoughts is one last story about a female resident I met who was doing her rotation in a cardiovascular surgical ICU where I worked. We had become fairly close over the several weeks she was there and during one horrific day, she started to tear up and told me she couldn’t “take it.” We were in the midst of multiple dying patients, short staffing, and chaos. I took her aside within the eye of the storm, put my hands on her shoulders, and said, “Yes, you can, suck it up.”

I have thought many times about how I responded to her and I could have done worse, but could have done so much better. I was abrasive, in a hurry, and had no time to cater to her feelings. I wish I could relive that moment and validate her, encourage her to keep going, and remind her that the terrible day was only temporary. Instead, I fell into the ICU nurse stereotype and perpetuated the culture.

Here I am again talking about this crazy culture we entertain. In fact, I’m nervous to write this post because of the mental health stigma in the United States and healthcare. Another story: two years ago I became so exhausted playing this school/work/life game I burned out and had to take six weeks off of work. I wasn’t sleeping (again) and was getting chronic strep throat, ear infections, and pink eye because my immune system was shot. I told my boss I needed time off and sleep to recover. She instantly assumed I had lost my mind and sent me to the employee mental health counseling center for an evaluation. However, she didn’t tell me that was what she was doing. When I went to the counselor, he agreed I was sleep deprived and needed a break. He recommended I work dayshift only upon return.

Once I left for my break, I received countless calls, texts, and cards from my coworkers. They had no clue what happened, but also assumed I had a mental breakdown because I basically just disappeared. They told me stories of their “breaks” from work and how ICU nurses could fill the appointments at employee mental health services, but no one ever spoke of it or actually took advantage of it. So many of them identified with me, I was taken aback.

When it was time to return to work, sparing the details, it was anything but easy. I received backlash from my boss and administration. Although this was one of my favorite jobs, it was never the same once I returned. I was perceived as weak. I later found out that my boss was approaching the charge nurses and questioning whether or not I could handle my assignments. Of note, I have never made an error in my six years of ICU nursing, caring for some of the sickest patients in the country. I’ve also never had a complaint filed against me, been fired by a patient, or even reprimanded. My coworkers were still supportive through all of this, and agreed what was happening was wrong, but there was nothing I could do. I didn’t have the time, energy, or money to fight it and I was punished for trying to take care of myself. I learned so many lessons through the experience; the main one being that the mental health stigma is very real.

Carl Jung introduced the term wounded healer in 1951. He proposed the idea that a diseased soul was the best possible training for a healer. I believe this to be true and have noticed a trend since the beginning of my career. Most practitioners are wounded, bruised, scarred, or cut open and raw. We heal others because in some distant, misunderstood way, we are trying to heal ourselves. Being wounded provides us with experiences to identify with those we are trying to heal. After all, being an expert in knowing people is what this is all about. Understanding the highest level of science and physiology is irrelevant when it cannot be accurately applied to real people. Wounded healers are special, and they are necessities. These personality traits create the best healers, but our society has created a culture that doesn’t care about the healer.

Back to suicide – did it feel less uncomfortable the second time I typed it? To tackle the issue of suicide in medicine, many medical schools have switched to a pass/fail system to decrease competition amongst peers. Some are even taking steps to remove themselves from the US News and World Report rankings. Providers are speaking out regarding their experiences with these topics.

While it could be way worse for me, these ideations still weaseled into my mind for a brief moment and that was enough for a wake-up call. So, I have used several coping mechanisms to help. I see a therapist every two weeks to talk about life and I have sought advice from trusted faculty for encouragement. I have been reminded of perspective and that these grades do not define me, especially in a terminal degree. I have been told it is about the journey, which is cliché, but very true. This sounds contradictory, but I also love to take care of patients. I try to pick up an extra shift at the bedside here or there, since I only work PRN now. Taking care of others pulls me out of my negativity and once again, puts life into perspective. Finally, I know myself very well, which helps with resiliency; knowing myself is my certainty in this uncertain world. However, I do not take advantage of this fact and I never assume I will always be okay. In my mind, we are all one inch away from cancer, a tragic accident, organ failure, addiction, and suicide. So if you see a colleague or coworker having a hard time, ask them how they are, and truly listen to the response without judgment. You never know who you could be saving.