Why Do Female Physicians Keep Dying By Suicide At This US Hospital?

It was an early Friday evening, and two dozen doctors were standing outside a 33-story residential building across the street from the hospital where they spend most of their days. They were used to working evening hours — feeling exhausted and empty, fuelled mostly by the knowledge that they were there to save lives. But this time, the lives were their own.

In the middle of a pile of bouquets, cards, and electric tea lights on the sidewalk in front of them was a photo of Dr. Deelshad Joomun*. Just nine days earlier, on her third day as a nephrology attending physician at Mount Sinai St. Luke’s, Dr. Joomun leapt from the 33-story building to her death. Many of her colleagues were standing at the windows of the building across the street from her, horrified at the sight of a falling person who was wearing the same white coat they were in.

As one friend and former med-school classmate put it, Dr. Joomun was the last person anyone would expect to end her life. She was at the top of her class, a pioneer in her field, and outwardly confident in her abilities.

But at the same time, Dr. Joomun was the third Mount Sinai hospital employee in two years to die by suicide while at Mount Sinai. First-year internal medicine resident Esha Baichoo died in March of 2016 and fourth-year medical student Kathryn Stascavage died in August of that same year.

Doctors follow a precise methodology to figure out what went wrong after losing a patient, but the same wasn’t being done for Dr. Joomun. Worse yet, their superiors didn’t even acknowledge that there was something amiss. According to at least 14 doctors who spoke to Refinery29 under the condition of anonymity out of fear of professional retribution, Mount Sinai St. Luke’s — an institution Dr. Joomun dedicated her life to — was treating her death like a dirty secret, one that many feel they actively worked to sweep under the rug.

Refinery29 spoke to many physicians who claimed that Mount Sinai St. Luke’s administration was doing little to help those in the program cope with the tragic losses, let alone adequately investigate the circumstances that led three young women with promising futures to jump to their deaths.

“They’re doing nothing,” one said, tears welling in her eyes.

The death at Mount Sinai comes amid a broader trend of physician suicides that are happening across the country. And the reaction of Mount Sinai as an institution is reflective of a broader crisis at our nation’s hospitals. According to the American Foundation for Suicide Prevention, the rate of suicide among male physicians is 1.41 times higher than among men in the general population. For women, the risk is 2.27 times greater.

The Accreditation Council of Graduate Medical Education, the governing body of residencies, does not track suicides or suicide attempts, according to a spokeswoman. “However, the ACGME has done extensive research into the wellbeing of physicians in training,” the spokeswoman told Refinery29. And according to data published by the ACGME, between 2000 and 2014 66 residents died by suicide, the second-leading cause of death among all resident physicians after cancer.

The root causes, according to the Committee of Interns and Residents, a union that represents physicians, including those employed at Mount Sinai, are often institutional: Residents across the country endure abuse in the workplace and unmanageable workloads and do not feel empowered to speak out or seek help out of fear of losing their jobs.

According to Dr. Pamela Wible, an outspoken advocate of physician suicide awareness and author of Physician Suicide Letters — Answered, “Some people in the medical profession believe the public doesn’t need to know that doctor suicide is a real problem, as if a healer being in pain is shameful and would frighten patients.”

In an initial email following the death, which occurred on Thursday evening, the hospital’s administration sent a curt and impersonal note to its staff. “I am writing to inform you that a former tenant at 515 West 59th Street, a Mount Sinai-owned residential building, was found dead there earlier today, possibly a suicide,” the email said. “The NYPD are investigating, and as soon as we learn more details we will inform you.”

Without any confirmation about who had jumped from the building, residents were left to whisper through the halls of the hospital in an effort to piece together what happened. One told Refinery29 she was in a group chat with other residents, trying to confirm they were all accounted for.

Several said they only found out about the incident through word of mouth or by coming home to see police tape and a body bag in front of their building.

The next morning, before sending a formal message announcing Dr. Joomun’s death and offering condolences, the administration sent an email reminding staff of the hospital’s media policy. (A Mount Sinai St. Luke’s spokeswoman said that the hospital media policy is “general” and that she couldn’t recall an email about the policy being sent out following the suicide.) Refinery29 reviewed the email and confirmed it was sent the morning after Dr. Joomun’s death.

“Please take a moment to review Mount Sinai Health System’s policies surrounding Press and Media inquiries and Social Media policies. It is very important that all faculty, staff, and students understand these policies and adhere to them,” the email, obtained by Refinery29, read. “Do not respond or speak to any reporters, as well as current or former employees, regarding a pending news story.”

Then, the administration sent a third email: “It is with sadness that we share with you the news of a tragic loss of life of a member of the Department of Medicine faculty (with a secondary appointment in Radiology) at Mount Sinai St. Luke’s and Mount Sinai West. We are not providing further details out of respect for the family’s privacy.”

In the days following the suicide, one doctor said she was told by an administrator to take down Dr. Wible’s blog post about Dr. Joomun’s death that she had shared on her personal Facebook page. (Mount Sinai St. Luke’s full social media policy can be viewed here.)

Another said that a few days after Dr. Joomun’s death, her program had a resident meeting — not to address the death, but to discuss an upcoming survey by the ACGME that would let physicians evaluate their residency programs.

According to the resident, their program director was tone-deaf about what they should and should not include on the surveys, advising them not to air their dirty laundry out in public.

In the meantime, Dr. Joomun’s profile on the hospital’s website was removed. While the profile was visible Thursday night, by Friday, only a cached version was available. A spokeswoman for Mount Sinai St. Luke’s said she “didn’t know” why the profile was taken down but suggested that it could have been something her family requested. Her family could not be reached for comment.

"[Physicians] were told to basically keep quiet and if they were to ever speak to a reporter it would break their contract and then they would be terminated," Wible told Refinery29. "Nobody has been allowed to grieve properly."

This code of silence is only fuelling the high rate of physician suicides across the country, according to Dr. Wible.

Although the hospital made grief counsellors available, many physicians who spoke to Refinery29 said it would not be easy to utilise these resources due to their demanding schedules or that they simply did not feel safe to speak to them.

“These counsellors they have are extremely underutilised because people don’t feel safe to talk to a counsellor that’s attached to their boss,” Dr. Wible said.

In a statement to Refinery29, a Mount Sinai St. Luke’s spokeswoman said, “Wellbeing initiatives and programs that promote work-life balance for students, faculty, and staff are integral to sustaining an environment that is collegial, collaborative, and inclusive. Providing compassionate care and teaching compassion among our physicians and employees is at the heart of our mission.”

One physician scoffed at the statement. “They say ‘resources are available’ without changing any of the [circumstances] that are creating the conditions that would require these resources to be available in the first place,” he said.

When asked to point to specific ways in which Mount Sinai St. Luke’s is addressing wellness, a spokeswoman referred Refinery29 to a 2017 Wall Street Journal article about the death of Stascavage, the medical student who died by suicide in 2016.

CIR offers confidential wellness resources that are independent of the hospital, Dr. Eve Kellner, the union’s president, told Refinery29. “Residents suffer from inability to sleep, traumatic stress, depression, and other mental health challenges that are extremely difficult to manage as a result of the absence of what are considered coping and soothing options,” she said.

“With all of that said, when one physician takes her life, and months later another does as well, at the very same facility, it is fair for patients to look at the loss of two of their doctors and ask if there is anything that could have been done to prevent these tragedies,” Dr. Kellner continued.

Dr. Kellner could not speak to how Mount Sinai West internally handles wellness, but posed the question, “Does hospital administration consider resident wellbeing to be a priority?”

In New York state, residents cannot work over 80 hours per week and must have a full 24 hours off each week, according to regulations by the ACGME and the Department of Health.

Several Mount Sinai St. Luke’s physicians who spoke to Refinery29 said they’re all regularly working well over 80 hours a week.

While the exact reasons Dr. Joomun took her life will never be known, colleagues say the gruelling work schedule and and financial burdens faced by physicians at Mount Sinai St Luke’s most probably came into play.

“Imagine working 100 hours per week, everyone constantly telling you you’re not doing enough, all while you are completely sleep-deprived, deep in debt, and unable to take care of yourself,” one said.

“I've always just blatantly lied about my hours,” one female Mount Sinai St. Luke's resident, who claims she has performed major surgery on a patient after being up for 20 hours straight, said. The resident went on to explain that they’re regularly given emailed and verbal reminders about making sure not to log hours that would go over the limit. Five other physicians related similar stories.

Though the claim sounds shocking, Dr. Wible said this is common practice, and not unique to Mount Sinai St. Luke’s.

“They blame and shame the person for working over. And what happens is, the person obviously doesn’t want to get bad evaluations and be kicked out of the program, so they start putting 80,” Dr. Wible said. “We’re teaching these basically compassionate, loving, highly ethical people when they start to be unethical as a lifestyle in medicine; that lies are okay, that lying on the computer is okay; that falsifying data is fine.”

When asked about the assertion that residents are breaking regulations, Mount Sinai St. Luke’s said it was not possible to do so.

“We have an elaborate electronic tracking system to track resident hours, this would be impossible to manipulate and would be against our policies,” the spokeswoman said. “Also, it would be harmful to patient care.”

Dr. Kellner said there are likely no formal duty hours violations against Mount Sinai St. Luke’s (or any hospital in New York State, for that matter) because residents would not risk reporting it.

In fact, from 2016 to 2017, the New York State Department of Health only found four facilities to have some level of non-compliance with state law.

“If residents were to report duty hours violations, and an investigation revealed a violation, then action would be warranted under ACGME, their RRC [Residency Review Committee], and state law,” Dr. Kellner told Refinery29.

“These consequences put all of the interns, residents, and fellows at a given hospital in danger of carrying around the Scarlet Letter of a tarnished program, or in danger of not finishing their residency program. Because it is not possible to match everyone to an existing program elsewhere in a timely manner, awareness of these possibilities creates a disincentive to report duty hours violations,” Dr. Kellner explained.

According to Dr. Wible, stats on how many physicians die by suicide each year are probably severely underestimated and don’t encapsulate what the loss of a doctor really means.

One million patients lose a doctor to suicide each year, she said.

"When they call for appointments, patients are told they can’t see their doctor. Ever. The standard line: 'We are sorry, but your doctor died suddenly,'" Dr. Wible wrote in an op-ed for the Washington Post. "Sometimes they are just told 'your doctor isn’t here anymore.' Patients are left wondering what happened to their beloved doctor."

And in the wake of Dr. Joomun’s death, physicians who spoke to Refinery29 are not hopeful that anything at all is going to change.

“I fear that if we don’t something and bring light to this, Mount Sinai will do nothing and, inevitably, more residents, fellow (and patients) will die,” one attending physician at the hospital told Refinery29.

Despite a trio of suicides, many feel they have few answers as to why three exuberant, driven, and compassionate young women took their lives. What’s worse, they say, is they feel there has been no attempt at solutions to stop it from happening again.

“We have all these protocols in place for reporting adverse patient outcomes and anytime that happens it immediately goes to a committee, and then it goes to another committee that looks for a root cause analysis,” one said. “That never happens with faculty or house staff, or with residents. You would think given the fact that this has happened three times in the past three years in the Sinai system, there would be some mechanism in place.”

But there is none.

According to Mount Sinai St. Luke’s website, empathy is a tenet of its hospital system.

“We are straightforward, warm, and always strive for a deeper understanding of our patients, students, and colleagues,” the website reads.

But the treatment Dr. Joomun received by the hospital in her death is the antithesis to this mission according to those who knew and loved her, who saw how much she cared for patients and how passionate she was about medicine.

“Deel loved being a doctor,” one tearful friend said. “She deserved better.”