Wednesday, August 19, 2015

Suicide and Physicians

This week, it was announced that my colleague and pulmonologist was found to have committed suicide. He disappeared about two months ago and his body was found about a month ago. The medical community in the Fox Valley and Waupaca has lost a wonderful and compassionate physician.

I first knew Jeff as a colleague when I was working as a Family Doctor in Waupaca. I referred complicated pulmonary cases to him as well as getting ICU consults. He was always incredibly professional, but also just a nice guy. After I quit practicing, I went to see him for a sleep study and I was diagnosed with obstructive sleep apnea. I saw Jeff as a pulmonary patient once a year. Again, he was professional and a nice guy. And he always asked about my migraines and about whether or not I was close to being able to come back to practicing medicine.

He hid his depression well, as those of us with depression tend to do. But, 400 physicians every year commit suicide. 400. That's a lot. Too many. According to what I've read, the primary underlying cause is depression or bipolar with substance abuse coming next.

Why so much suicide? I've done a little research and what I've read confirms what I experienced. Even in physician groups that try to do a good job of finding depression in patients, physicians are terrible at taking care of ourselves. Many physicians don't have a primary care physician themselves. Many don't recognize the symptoms of depression to see a physician.

And then, there is the stigma of depression or, even worse, substance abuse. Admitting to substance abuse can affect licensure and future practice. This is devastating to a physician.

There are remarkably few support structures for physicians who are depressed. Apparently, Jeff was known to have a history of depression, so he, at least, was in the mental health system. But, he was in a minority. Most physicians with depression or otherwise at risk for suicide don't seek help and don't have much help available.

Working in medicine can be stressful and overwhelming. I worked in a large medical group that did make some attempts to provide some mental health resources in times of stress. After a case where we lost a baby, both the clinic and the hospital did debriefing sessions to help us process our feelings. At the hospital debriefing, the (humanist) chaplain said, "Well, we know that life has no purpose, but we can still find meaning in it." I left soon after. I was reading the book of Lamentations at home and trying to find meaning through God. I didn't find the chaplain helpful at all. At the clinic debriefing, we were led by an EMT and didn't try to find any religious meaning, but talked through our actions on the day in question. It was much more helpful. So, the current structures to help are iffy, at best.

But, it's not just the bad days that are the problem. Medicine is inherently overwhelming. Physicians are expected to not make mistakes day after day after day. Working in an ICU has the immediate life and death decisions, but even the day to day work of a family physicians has the overhanging dread of making a big mistake. And this is just wearing.

I'm going to miss seeing Jeff once a year for my pulmonary visit. I'm sure his friends, family, and colleagues are devastated by their loss. And what is so sad is that Jeff had an illness that probably could have been treated.

I've written before about depression. Untreated depression leads to suicide. And it leads to suicide more often for physicians than for other people. 

Please, whoever you are, if you are depressed, contemplating suicide, or even just thinking that the world would be better without you, talk to someone. If there's no one around to talk to, call 911. They know who to contact to get you help. 

Depression is a fatal illness. And it hurts more than just the person who has it.

Sunday, August 16, 2015

Depression, Medications, and Me

A number of years ago, I read a letter to the editor of the journal of the Christian Medical and Dental Association that questioned the use of anti-depressants. The author suggested that if some of the authors of the Bible like David and Jeremiah had lived in modern days they would have never written their portions of the Bible because they would have been medicated. At the time, I disagreed with the assertion, but I didn't have the confidence or experience to write back. Now, fifteen years later, I'm going to respond to that unknown physician.

Anti-depressants are used to treat depression, not sadness or guilt. Depression is not ordinary sadness. Yes, the primary symptom is sadness, but it also includes lack of motivation, inability to feel happiness, and physical symptoms such as sleep disorders and appetite changes. 

We know that anti-depressants work when someone starts to feel normal emotions, not just happiness. In fact, someone on anti-depressants will feel sad at appropriate times, but will be able to feel happy at reasonable times, as well. A depressed person can't feel normal emotions. I can speak to this because of my experience as a physician who has prescribed anti-depressants to patients, but also because of my own depression.

There's no evidence that David was depressed. He was still able to write much of the book of Psalms. A depressed person has difficulty doing things because of a lack of motivation. According to Psalm 51, David did feel appropriate regret and remorse from his "affair" with Bathsheba and his subsequent murder of her husband.

Jeremiah was very sad about the state of Judah and the prophecies that God had given him, but he was also able to continue to prophecy. Again, there was no evidence that he was depressed.

So, the whole issue comes down to whether or not anti-depressants make us "not ourselves" and whether or not God wants us to use them. After all, if they would change us so much that God wouldn't be able to use us to do something like inspire the writing of the Bible, then they must be pretty bad.

Hogwash! Depression is an illness of the brain. It makes it's victims feel sad and melancholy and unable to feel happiness. Anti-depressants don't make a person feel happy; they make a person able to feel normal emotions, both happy and sad.

I've felt the stigma of depression, but I'm glad I've been willing to accept treatment. My risk for depression was really high based on my family tree. There is depression and addiction scattered throughout my family tree on both sides. I was fortunate that my first bout didn't happen until I was in my 30s. Now that I've got chronic migraine, depression is an unwelcome companion.

Without treatment, I wouldn't just be sad, I'd be sitting on the sofa and doing nothing. My doctor and I are titrating up my dose of amitriptyline, which is the second anti-depressant I'm on (I'm also on citalopram). I don't really like the side effects of the amitriptyline (dry mouth, hunger, fatigue) but I've spent this summer being sad and headache-y from trying to go without my medication. 

My depression meds aren't my entire treatment. They help adjust my brain chemicals, but they are helped significantly by counseling, exercise (when my head doesn't hurt too much), and a (somewhat) healthy diet. 

Depression is real. It's treatable with non-medical treatment and with medications. It seems to me that if God is OK with antibiotics for strep throat, then he's OK with anti-depressants for the biological illness of depression.

And the meds work. I'm still having headaches, but my mood is finally better. I'm tolerating the headaches better. I'm not happy about the headaches, but i can feel a range of emotions again. And it feels so good.

Just stuff . . .

  • Chronic migraines suck. Really. I'm on Day 4 of this one and going crazy.
  • The increased dose of amitriptyline is decreasing the intensity of the headaches so I tolerate life a lot better. I'm increasing up to 100mg (with my doctor's permission) tonight to see if we can stabilize things even more.
  • The liquidators came this week and bought the last of our yarn, notions, and fixtures. They didn't pay near what they're worth, but we knew that. The fact is, they paid something and they took the stuff away.
  • Wild Man has the music room in the shop looking good. And we still have a good incentive to replace the old windows and update the heating and cooling system since he's keeping musical instruments in there.
  • When my head calms down, PWM and I are going to spend a night at a hotel with Sleep Number beds because we think that we want to purchase one. There's a hotel in the Valley that has those beds, though, and we'd like a full night's sleep to see if they're as good as advertised. Then, Rosie Girl can have our queen sized bed in her apartment and the double bed will go in the guest room out in the shop.
  • Poor Wild Man has a cold and went to see the NP today for the cough. He doesn't need antibiotics, but he got steroids, and inhaler and cough suppressant. The combination of steroids and inhaler makes him quite jittery and he's not happy about it! But, he's not coughing as much and will probably be able to sleep tonight
  • Rosie Girl has a real, live boyfriend. They don't get to see much of each other because of work schedules in the summer, but they'll get more face time when school starts!
  • I've been pondering 1 Corinthians 11. It's the chapter about head coverings in worship and it's quite confusing. The interpretation that makes the most sense to me is that Paul was having a mock conversation with the Corinthians. Here's a link to a good post.
  • I've been distressed this week at how little I've been able to do. I cooked dinner on Monday and Tuesday nights. Other than that, we've had food from The HItching Post, leftovers, and PWM grilled. So, we're not starving. I just feel bad when I'm sitting and reading a book when others are working.
  • We got a new deck. The contractor was just going to replace the sections that had been made with untreated lumber and leave the good stuff. It turned out that there was untreated lumber even all the way up to the house, so we had them just start over. Now, we have a brand new deck with all the railings up to code and the stairs with proper width, etc. I keep forgetting to take pictures. And, we have to stain it in about a month after the lumber all dried
  • Our tags for our items for the fair came in. We're still a bit confused about when to take our stuff and where, but we know who to ask now. The tickes had misspellings that had to be remedied and I didn't now that I could only submit one item per category so they just put my second item under PWMs name. I think we understand the basics now.
  • Well, it's probably time to try to sleep. I had a three hour nap today, so I'm not super tired, but I could probably sleep if I had a chance. We'll see.

Wednesday, August 05, 2015

Sin Management or Grace

First, you need to go read this post by Chaplain Mike at Internet Monk. Done? Good.

I don't want to talk about depression today, although I could and probably will spend lots of time talking about it later, especially now that I feel better. Instead, I want to talk about "sin management".

I grew up Evangelical and Modern and Productive and I'm very good at sin management. This is what Dallas Willard calls our tendency to find a sin in our lives and then make a project of getting rid of it. Our Christian bookstores are full of books to help us deal with our various sin issues. We find the problem, get to the root of it, deal with it, and we're done. I like that approach. We do that in medicine. Have an ear ache? I'll figure out what's causing it, give you treatment, and hopefully you are cured.

But, is sin management really how God works. Some people would say no. In fact, a majority of people, if pressed, might agree that sin management is hit and miss at best. And it's not really scriptural. Have you noticed how the self-help (sin management) books have to do a lot of proof-texting of bible verses to make their plain work? Have you noticed that Paul doesn't write letters saying, "Hey, here's a four step plan to quit drinking, a three step plan to quit lusting, and a six step plan for success in your business." Yeah. The greatest preacher in history didn't write much in the way of how-to.

So, what does Got want us to do? I mean, I grew up in a world of solving problems. That's what I do. When I was working in medicine, my job was to try to understand a person and their illness (not just the illness), figure out the problem, and come up with a rational treatment plan. And that's how I lived the Christian life for a long time, too

When I read the Bible, though, I find something different. In the Old Testament, God has given us the story of Israel. I think God wants us to get to know him through these stories. And I think he wants the same thing when we read the New Testament. We meet Jesus in the Gospels. Then we walk with Jesus through the Epistles and learn through the letters to the churches how we can use that wisdom in our lives today.

The sin management thing hasn't worked for me. And, nowadays, my biggest problem is pain. I don't need God giving me assignments. I'm just too tired. I need grace. I need to walk with Jesus. And when I slip and fall, he's still there when I come back. He hasn't chosen to heal my pain. Yet. 

And then, as Chaplain MIke reminds us, joy can break in. Because God is doing everything, not me. I just walk along with Jesus and do as I'm told. Because grace.