Editorial Comment: Recovery; and death

 

1) This week’s listings include several items that are likely candidates for future ADM curricular and MOC content.  The AAAS EurekaAlert article derived from a Nature Neuroscience discussion of the ADH1B gene’s association with alcohol dependence (sic) is an example.  


2) Fatality is a companion in our daily work.  When we do speak of it, it is generally in terms of its prevention, maybe of how to reduce the pain experienced with it.  We seem less likely, perhaps less willing to speak of its experience and its impact on those who know the dying.


For psychiatrists, there are perhaps fewer deaths among the patients, or at least fewer in proximity to treatment, than in surgery or internal medicine; but the type of death that most associate with psychiatry is suicide. It is a  territory shared with the clinician who practices addiction medicine.  Venture some steps further into that territory, into the recovering community and then into the community of recovering physicians, and we find that death has special significance.  I believe, while conceding that the belief is supported only by conversations and case series, that all of this last group will have contemplated suicide at some time, even if not actually to the point of planning or an attempt.  It is one of the classic triad of consequences of drug and alcohol use: jails, institutions, and death.  …It's also what some of us may have caused in our patients, however inadvertently, and for which the spirit still requires amends.

 

Unsurprisingly, death dwells on the periphery of our consciousness as a result of our becoming older.  While those with addictions other than alcohol may have arrived in relative youth, those self-designated as alcoholics generally made it into their 40s-60s before they were able to turn the ship around. Death is an even more proximate concern for older recovering physicians, and one that is particularly manifest at this time in the year.  



I don't obsess over my own shelf-life as much as I just register it; but I find myself spending more time considering the futures of my friends, more time watching and listening to those among my colleagues at risk.  The season demands it.


Reading incidental to physician mortality:

 

Medscape on physician suicide, https://emedicine.medscape.com/article/806779-overview  


Isaac Sakinofsky 1980, Suicide in physicians and physicians’ wives, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2383598/ 


Oxford 2002, mortality in alcoholic doctors in Britain, (omitting suicide), https://academic.oup.com/alcalc/article/37/4/370/161256 (full text)


2013 NIH causes of death, suicide in physicians (without alcoholism/addiction rates) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549025/


FEB 2018, MD Magazine on physician suicide, https://www.mdmag.com/medical-news/suffering-in-silence-the-scourge-of-physician-suicide 


Cambridge Core, UK NHS rates and discussion, https://www.cambridge.org/core/journals/bjpsych-bulletin/article/doctors-suicide-and-mental-illness/A8375D7DE2537B26392D74CEB33996E6/core-reader 


- Dr. William Haning