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First Drink, Then Jump


Montauk Point Rock

Suicide is a serious issue, problem, dilemma—you pick the word. Whichever one you use it all means that suicide is seen, by too many, as a viable answer to life’s overwhelming problems. Today, the media carried a story of a 21-year-old man who walked into a Manhattan hotel rooftop bar, ordered a drink, which he didn’t touch, ran to the edge of the roof and jumped to his death . Few noticed.


The questions swirl around in your head as you think what must have prompted that young man to make such a devastating decision and then there’s the question of why he left his backpack. Perhaps as some token of his existence? Something that would remind people that he had lived and now he was dead?


Imagine how the bartender felt or the waiter busying himself with the needs of the few people in the bar that night. The young man wasn’t lost in a crowd. Anyone sitting there would have or could have seen him race toward the edge of the roof and then disappear as he jumped over it. How do you erase that memory? You don’t. We know that the most painful, the most shocking memories are the ones that remain with us.


The patrons in the bar, very few at that hour of the night, kept up their conversations and laughing, never noticing the tragedy that was unfolding feet away from their tables. Only one woman, on a date, expressed shock afterward when questioned by the police regarding what she saw as he dove from the edge of the building. All that remained was his backpack, left at the bar. Sixteen stories down, his body landed with crushing force on an apartment roof, waking its residents. And it was done.


Newspaper reports would attempt some measure of civility for his grieving loved ones with measured bits of information leaving out the one comment that was too much for anyone. But one paper, knowing what its audience craved, quoted a witness. “I saw it all. When he hit, half his face was gone.” Yes, that would sell papers.


The newspapers said he’d come from Europe but nothing more was revealed until his relatives were identified. Special skills would be needed by the police photographer and the pathologist who would attempt to recreate an identifiable visage after the fact. The backpack, obviously, carried the requisite information about the end of a life that was just beginning and the remorse that would follow. People in a town in Europe would awaken to the gruesome news that accompanied the sun this day.


The young man wasn’t alone. He was one of scores who have given up on life or were cheated of their years by tainted drugs. I know. A relative had recently died as the result of an OD.

Many years ago, I lived in an apartment complex where two sisters rented a small studio apartment. One of the women stayed home alone as the other went into Manhattan to a secretarial job. They shopped together, ate dinner, brought their rocking chairs out into the large open hallway and sat drinking iced tea on warm summer evenings, inviting all who passed by to join them; none did.


Two or three years passed, one of the sisters (the older one) became ill and died suddenly leaving her sister alone. For a time, the woman carried on, drove her car to the stores, took the bus to her job and all was apparently as before. But gradually, the car wasn’t moved from the parking space in the lot near the building, it acquired a thin coating of dust attesting to its solitary existence. Empty vodka bottles began appearing in the garbage room and the regularity of the trips to the bus stop seemed to cease. The younger woman wasn’t seen much and never sat in the hallway drinking iced tea. The rocking chairs, too, were never seen again. All the signs were ignored as the women had been for all these years.


Passing her one day, I was taken aback as she shrank from me as I tried to pass on my way to open the building door. Perhaps I should say she recoiled, pulling up her arms tightly against her body as though she were suddenly afraid of me; something that had never happened before.

No smile, no “hello,” nothing but a frightened look on her face as she pressed herself against the wall as though she wished she could sink into the paint and be safe. Her eyes were wide and wild. She drew her breath in suddenly in one sharp gasp. Why? I had no idea. Not an inkling of what I was witnessing or what was to come.


Days later, as I left my building to go to buy the Sunday Times, I passed a neighbor who told me she she’d seen a bundle or rags at the edge of the building that morning. Rags? Who would leave rags? The woman remarked that she felt the same way, went on to the store and thought little of it. Returning no more than forty-five minutes later she was confronted by a police car, an ambulance and a small crowd huddling in the snow near the edge of the building. The rags were nowhere to be found.


The bundle of rags had been my neighbor’s body. She had jumped the prior evening. I didn’t want to be a gawker, left and then wondered if this had been connected to my next-door neighbor saying she was awakened by something on the roof during the previous night. Deciding it was nothing, she returned to her bed.


Now, my curiosity got the better of me. In measured steps, I slowly made my way up the staircase to the roof door opening, not know what I would find and yet half-knowing what I wished I wouldn’t see. Swinging the heavy access open, the story unfolded before me in a wordless tableau that revealed all.


A fresh snowfall now crusted into ice laid bare one set of footprints leading to the far corner of the roof. Another set, leading half way back to the door, and then a third set had been pressed on the other side of the small fence onto the sliver of material that edged the roof. The snow held the story for all to see.


Pacing, she had been pacing on the roof and that was what my neighbor heard. Undecided, trying to get up her courage, she’d left yet another empty vodka bottle in the garbage room at the foot of the stairs. Then, on closer inspection, the single footprint at the very edge of the roof was all anyone needed to know which foot went off first; her left.


The empty bottle, too, told another piece of the tale as it had for these few months without a word from anyone. No one noticed. But vodka, which she may have believed concealed her drinking, hadn’t quelled the fear, the sense of loss, the anxiety and depression that washed over her in an emotional tsunami at the loss of her sister. All of the anchors were lost. She was alone in painful and lonely turmoil.


She lived in a building of strangers who refused the offer of iced tea and a bit of neighborly small talk. All of them had smiled weakly and walked briskly by. No one knew her name and she didn’t know theirs. None of them had stopped to introduce themselves nor to welcome the two women to the building. It was as if they were new additions that could easily be dismissed in the world of others. Two spinster ladies with nothing but iced tea and an empty chair to offer. Not the stuff anyone wanted.


Her death, too, would go unnoticed as the local newspapers failed to mention it as they had failed to note the women who came from foreign countries and jumped to their deaths from the high rises that imprisoned them as their executive husbands left for the day, the week or the month. Not speaking the language and shunned by women who saw themselves as being from an upper class, they were unseen until their bodies struck the pavement, leaving bright and expensive robes covering their shattered bodies.


One surprising statistic about suicide is not the calculations of the young who are bullied or the addicted who get a bad batch of drugs, it is physicians. Physicians are one unsuspected group that incurs the highest rate of suicide death and, according to one article, it is higher than any other group in this category of death statistics.


Again, today, I read one of the best medicine-related blogs and there it was, an article about a young, altruistic woman physician who had killed herself. She tried for years to care for the forgotten, the poor, those on Medicaid, but the struggle meant working 16-20 hours a day, 7 days a week and it proved too much.


How she killed herself isn’t important. The fact that our physicians are winning the race to death is of serious concern. Too many medical students jump from roofs, residents die in stairwells or walk into the woods and put a gun to their head or heart or plunge a syringe into their arm. Those who save us are killing themselves and there still isn’t a way to help before it’s too late. We lose far too many if only one.


The National Institute of Mental Health tells us that 47,000 people take their lives each year and suicide was “the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54.”

The data was gleaned from death certificates, but there’s the problem when it comes to physicians and persons with a high profile; shame, peer resistance and insurance policies.


I wrote a paper on suicide during my master’s studies in college At that time, it was enough to get the suicide statistics from New York City. After I wrote the paper, within a short period of time, the regulations were changed and only deaths where a suicide note had been found would be listed as suicide. All others would be indeterminate cause of death. But when I wrote the paper I quickly found that the statistics for suicide were skewed against revealing the true cause of death for physicians. In many instances, even the death of physicians wasn’t carried in medical journals. If they were, they appeared years later after the actual death. The healers who are there to heal us couldn’t help themselves and they’re not unique.


Shame keeps families silent as may peers. Insurance usually has a death benefit clause. Commit suicide before having the policy for a certain number of years and it does not pay the death benefit, so families are protected, at least financially, by the silence that shrouds physician suicide. How high is it, then? Much higher than we’ve begun to know.


One physician who has tried, valiantly, for years to help physician experiencing burnout and suicide is Dr. Pamela Wibble who runs a yearly camp in the woods for physicians coping with burnout and potential suicidal thinking. The 13 reasons Dr. Wibble believes physicians or medical students kill themselves actually boil down to three; lack of mental health care, inhumane medical education, and unethical medical practice (whistleblowers among them).


I still hear the voice of a kindly older physician joking with his peers about a surgeon friend who had been having breakfast with him. “Well,” the surgeon laughed as he rose from the table, “I have to go and perform another unnecessary procedure.”


Days ago, a physician railed against a major medical center that had asked him for a $10,000 contribution to their medical school. He was a graduate of that school, but his anger boiled up as he told me that he would not contribute a dime to a school that re-named itself after a corporate raider. “Let him give them another $10,000,” he steamed.


Another physician I spoke with the week prior told me why she had joined a large medical group. “You just can’t practice medicine as a sole practitioner anymore,” she said. “You just can’t.” She comes from a long line of family physicians and now she’s an employee, something I suppose she felt she’d never be if she went into medicine. The office staff was completely changed and the large advertisements for medical procedures were evident in the office, which was filled with patients at a very early hour. Things had changed.


Why do talented, bright and caring physicians kill themselves? Medicine has become a meat grinder where survival is like trying to avoid the blades while the process goes on. Some turn to alcohol, some to drugs, others hide their anxiety, their fears and their loss of a belief in medicine as being a wonderful career. Medicine kills them and it isn’t getting better.


Today, physicians are little more than clerks who fill out forms and try to put down the correct codes for reimbursement rather than take time to examine the medical record and come up with the most appropriate treatment. Physicians have seen their practices gobbled up or run into the ground by aggressive hospitals or national chains that drive them out of business and either they become employees or retire and leave the profession entirely. We are losing the most talented, the most caring and fostering an atmosphere of bottom-line thinking that cares little about diagnoses as long as the code on the form is reimbursable.


The bottom line for you, the medical consumer, is that your diagnoses may not be your diagnoses at all. Reimbursement takes the day and checkmates diagnosis every time.

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DR. PATRICIA A. FARRELL