On the Death of House Officers

[On receiving Lawrence Smith's account of the death of a resident, we invited other medical educators to reflect on such events. Drs. Fitzgerald and Murray wrote the following separate perspectives in response. -The Editor]

Dr. Fitzgerald: In the second month of his internship, having for half that time been at home on medical leave under therapy for depression, my intern Jeff cut his throat from ear to ear.

I had not known him well. At the welcoming party for new housestaff in my backyard, he appeared cheerful and interactive. Three weeks later, a perceptive chief resident brought Jeff to my office, where he told me of the debilitating depression he had had in college, its current and insidious return, and his incapacitation by it. Two weeks later I spoke to him again; now on leave and with the help of his therapist and brother, he felt better. He asked about resuming his internship, and I assured him that the place was his when he and his physician thought he was ready for it. Two weeks after that he was dead.

How had I not seen an anguish so great that the violence he did against himself was the lesser torment? Of course, I blamed myself, and was blamed-as program director-by both his family and his medical school classmates. All assumed that it was the stress of internship that precipitated his suicide. Intellectually, in retrospect, it seems unlikely; on an emotional level, however, one is compelled to look for an external event with an impact sufficient to explain the magnitude of the horror that was done. The inexplicable is too terrible, …