You Can’t Hide the Bridges

Lauren S. Hughes

doi:10.1370/afm.1759

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

What code is in the image? *

Enter the characters shown in the image.

Vertical Tabs

Jump to comment:

Lessons Learned from Suicide
Michael Myers

Published on: 16 March 2015
Coping with Traumatic Deaths
Katherine J. Gold

Published on: 11 March 2015
How is this experience different for a physician?
Thomas L. Schwenk

Published on: 10 March 2015

Published on: (16 March 2015)
Page navigation anchor for Lessons Learned from Suicide
Lessons Learned from Suicide
Michael Myers, Professor Clinical Psychiatry
Dr Hughes has written a beautiful, heartfelt, gripping and important story. It is important because medicine needs more humanistic accounts of how our lives are affected by traumatic events. For too long, our medical culture has eschewed such normal vulnerabilities. For too long medical students and residents are expected to "man up" when they witness disturbing psychological and medical events. Instead, Dr Hughes gives...
Show More

Dr Hughes has written a beautiful, heartfelt, gripping and important story. It is important because medicine needs more humanistic accounts of how our lives are affected by traumatic events. For too long, our medical culture has eschewed such normal vulnerabilities. For too long medical students and residents are expected to "man up" when they witness disturbing psychological and medical events. Instead, Dr Hughes gives us a blow by blow account of her immediate and short term reaction to a horrific event, watching someone die by suicide. The powerlessness is palpable - and this touches the hearts of all of us who have trained in medicine.
Recent research on survivors of suicide is illuminating. Cerel and associates have categorized people exposed to suicide into four nested tiers - Exposed, Affected, Suicide-Bereaved Short Term and Suicide-Bereaved Long Term. The details are not relevant here but what is salient is that you can have anything from a mild to severe reaction to a death by suicide without even knowing the deceased victim. The substrate is a sense of helplessness and this is akin to what subway train drivers experience with track suicides or what tourists on the Golden Gate Bridge experience with jumpers. You are an uninvited witness to something you have absolutely no control over.
Dr Hughes describes her ambivalent feelings about writing a note to the man's wife. Although her clinical mentor discouraged her, perhaps because this man was not her patient, my hunch is that physicians as a group could be divided on a course of action here. Some might have leaned more on the "more expansive human" side. Having personally known and having treated many family survivors of suicide (Myers & Fine), I do know that most individuals who have lost a loved one to suicide appreciate, if not crave, any and all sincere overtures of empathy and kindness. The sense of loss and stigma after suicide is so profound that unsolicited acts of compassion are very comforting.
Finally, Dr Hughes' piece corrects the erroneous assumption that exposure to suicide causes only damaging effects. Not only has she moved forward since that day but she has experienced post traumatic growth (Calhoun & Tedeschi): "I have not forgotten him, however. I honor him every time I ask my patients about their mental well being...openly, sincerely, routinely. I don't retreat from what I may not be able to influence". Wise words, words that are emblematic of how our individual life journeys make us better physicians.
References
Cerel, J., Mcintosh, J. L., Neimeyer, R. A., Maple, M., & Marshall, D. S. (2014). The Continuum of Survivorship: Definitional Issues in the Aftermath of Suicide. Suicide and Life-Threatening Behavior. 44(6);591-600.
Myers MF & Fine C (2006). Touched by Suicide: Hope and Healing After Loss. New York, NY. Gotham/Penguin
Calhoun, L. G., & Tedeschi, R. G. (2006). Handbook of posttraumatic growth: Research & practice. Mawah, N.J.: Lawrence Erlbaum Associates Publishers.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (11 March 2015)
Page navigation anchor for Coping with Traumatic Deaths
Coping with Traumatic Deaths
Katherine J. Gold, Assistant Professor
This powerful essay by Dr. Hughes leaves me reflecting on the images she paints so clearly that I feel as if I were on that bridge with her. Although medical training is getting better at teaching about palliative and hospice care at the end of life, this story reminds us that we rarely teach trainees how to cope with acute or unexpected deaths although these comprise such a large number of the deaths that we witness as...
Show More

This powerful essay by Dr. Hughes leaves me reflecting on the images she paints so clearly that I feel as if I were on that bridge with her. Although medical training is getting better at teaching about palliative and hospice care at the end of life, this story reminds us that we rarely teach trainees how to cope with acute or unexpected deaths although these comprise such a large number of the deaths that we witness as physicians. I once evaluated a list of the locations of hospital deaths at our institution. By including most deaths of children and deaths in transient locations such as the emergency department, operating rooms, non-clinical areas, and PACUs, I made a rough estimate that about of third of these deaths could be considered "unexpected" or "traumatic." While Dr. Hughes witnessed a suicide--an event that fortunately few people will see--all physicians are witness to unexpected and traumatic deaths, losses for which we are ill-prepared to cope. And yet, we rarely talk about these losses. Our training needs to better help students and residents understand that these deaths affect us differently from the gradual or expected deaths and that our usual responses and coping methods may not work. Instead, we may have exactly the type of acute stress reactions with which Dr. Hughes struggled.
I was also struck by Dr. Hughes' recognition that she could honor the jumper indirectly by addressing mental health concerns in her own patients. By its very nature, a traumatic event involves a sense of feeling helpless and without control in the face of a terrible event. Finding a way to create meaning from her experience allows Dr. Hughes to regain some sense of control after an otherwise bewildering event. She could not stop the jumper. Sharing her presence at the awful last moments will not bring relief to the family. But by focusing on what she can do, by allowing this suicide to affect her and change her, she regains a sense of internal control and changes her practice in a way which could help someone else. This is what we can model for our trainees, that these experiences are difficult and confusing, but that there are ways to process our feelings and sometimes, to make meaning out of things that we cannot control and things that should not happen.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (10 March 2015)
Page navigation anchor for How is this experience different for a physician?
How is this experience different for a physician?
Thomas L. Schwenk, Professor of Family Medicine, Dean
The key issue for me in reading this thoughtful and well-written essay is how such a shocking and tragic experience is experienced differently when the observer is a physician. Dr. Hughes weaves this issue into the larger experience of witnessing this event. She considers attending the man's funeral, or perhaps sending a note to his family, as she might if the man were her patient. She wisely chooses to do neither. S...
Show More

The key issue for me in reading this thoughtful and well-written essay is how such a shocking and tragic experience is experienced differently when the observer is a physician. Dr. Hughes weaves this issue into the larger experience of witnessing this event. She considers attending the man's funeral, or perhaps sending a note to his family, as she might if the man were her patient. She wisely chooses to do neither. She searches for what she can make of this incident, eventually settling on how it makes her a better physician by sensitizing her to the needs of her patients with mental illness who may be at risk of suicide.
I am struck by how intensely physicians feel the responsibility to help others, even those for whom they are not responsible, and for making every human experience into something of value for their service to others.
At a time when most people would be entirely absorbed in their own feelings, thinking only of themselves, Dr. Hughes dispenses with that task in a single sentence. "I put a lot of pressure on myself to sift through my reactions as quickly as possible so that I could be emotionally available for my patients."
What harm do we do to ourselves for believing we cannot experience these events as an uninformed lay person? And how do we benefit because we can make these events into something of great value to our patients?
Competing interests: None declared
Show Less

Competing Interests: None declared.