Starry, starry night
Paint your palette blue and gray
Look out on a summer's day
With eyes that know the darkness in my soul
On a bright June day, pedaling along the straight open roads of Wisconsin’s sand counties, Don McClean’s “Vincent” became an earworm penetrating my thoughts. Cruising the quiet roads, my mind began to wander: “What if Vincent Van Gogh had access to today’s treatments? Would he have committed suicide? What about Marylin Monroe or Judy Garland, or other famous and not-so-famous people? How much progress have we made?” Depression, anxiety and other mental health problems continue to overwhelm those we are charged to care for.
Now, I understand what you tried to say to me
And how you suffered for your sanity
And how you tried to set them free
They would not listen, they did not know how
Perhaps they'll listen now
Last summer our community lost two physicians to self-inflicted injury. One retired just 3 months, the other new to town. The pain, the pressure that brings someone to that decision is hard to fathom. A colleague shared with me “Physician Suicide Letters Answered” by Pamela Wible, MD. I’d invite you all to read it.
Sadly, we don’t just bear the weight of our own life challenges. Listening to and caring for our patients we can’t but help share their burden. And their burden continues to grow. Before the pandemic, anxiety among adolescents was identified as a major problem. The pandemic, the social isolation, the social and economic disruption associated with the pandemic and national events did not help. The USPSTF now recommends screening all adolescents for both depression and anxiety.
Late 2021 and into 2022 national health care and advocacy organizations were identifying a “mental health crisis”. One-and-a-half to 2 years into the pandemic, really?! Now? Where have you been? In May 2020, two months into the pandemic, our colleagues across my system and across our Academy were raising the questions:
The answers we got were mostly like this:
This is what we were seeing:
Before official sources, some medical news sources did report what we were seeing:
When I look at these numbers I’m filled with sadness, not just for our patients, but for those caring for them. In family medicine, we share their pain and help carry their burden. Our need to support one another is needed now as much as at any time during the pandemic.
Starry, starry night
Portraits hung in empty halls
Frameless heads on nameless walls
With eyes that watch the world and can't forget
On July 19th my sister called. Her grandson, my nephew’s 13-year-old son, Zakk, had just taken his life. He was not a statistic; he was a piece of our lives. Now gone. An unfillable hole. It was unexpected and whatever darkness filled his heart he had not shared. I don’t even try imagining his parents’ grief. The parent’s loss of a child is a place I cannot, and hope I never need to go.
And when no hope was left inside
On that starry, starry night You took your life as lovers often do
But I could have told you, Vincent
This world was never meant for one
As beautiful as you
Talking with friends and colleagues I’ve discovered that unfortunately by now, almost all of us have lost someone close to suicide or overdose: family, friends or coworkers. And this is just what is visible. The unseen millions suffering mental health problems, impacting their health, their families, their jobs, and above all their happiness goes unrecognized.
Now, I think I know what you tried to say to me
How you suffered for your sanity
How you tried to set them free
They would not listen, they're not listening still
Perhaps they never will
As another colleague told me, we are the tip of the spear, leading the charge. Family medicine, now more than ever is the foundation holding up our health care system. We are now over two years into the latest crisis. It has been a challenge, but we continue on, holding our practices together with “duct tape and baling wire”. And we are being heard. Next month we’ll explore how family medicine is leading the response to the mental health crisis. Thank you for all you do for your patients, your staff and above all your communities. You are their rock.
Songwriters: Don Mclean / Elysa Sunshine / Vinny St. Martin
Vincent lyrics © Songs Of Universal
Physician Suicide Letters Answered
By Pamela Wible M D · 2016
Depression Rates in US Tripled When the Pandemic First Hit—Now, They’re Even Worse
Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System. Journal of Primary Care and Community Health. 2022 Jan-Dec;13:21501319221089775.