“Aunty blew her brains out a few weeks ago!” Words I shall never forget.
For weeks, she had been in my thoughts. But I never called her. I didn’t because of all the myriad reasons we often give ourselves for not checking up on each other.
In my case, they sounded like this; “I am 7 months pregnant, and it has been a difficult pregnancy.” “I am in an abusive marriage.” “My pediatric practice is struggling.” “I have a 2-year-old son,” and so forth. When I eventually dialed her number, her niece told me she had killed herself. She was only 33 years old. A surgical resident. My friend and colleague. The news of her death sent me into preterm labor with my now 20-year-old son.
Earlier this year, we read about Dr. Laura Breen, a female emergency room physician’s suicide, and numerous other female physicians across the globe, causing the Indian Medical Association to dub it “a public health crisis”.
I myself have also struggled with active suicidality. I am a Black, immigrant, United States Air Force veteran, divorced single mother of three Black sons, and a female physician practicing in the United States. Apparently, those are essential ingredients for suicide.
Physicians should be brilliant, resilient, and darned near perfect. We cannot afford to make mistakes (no pressure).
We must show up 100% each day with our game faces on, with a smile, ready to serve and save lives!
We must never tire; we must love our jobs and not give-in to overwhelm or toxicity at the workplace.
We must thrive regardless of near inhumane working conditions. But what if we can’t? What if we are actually human? What if the rest of the world sees us as one of them? What if we see ourselves as human and as such fatigable, maybe even fallible?
What if we save our patients but not ourselves? What if “first do no harm” protects everyone else but us? What if our beloved profession becomes a noose around our necks?
What if we are unable to cope with life during a pandemic; family, relationships, money, illness, colleagues, workplace abuse to name a few? What if we find themselves hopeless, helpless, and trapped in our “perfectionism”? What if we pay the ultimate price for all this with our lives?
Does anyone notice? Are we missed? Is anyone counting?
Globally, physician suicides are at an all-time high. And female physicians have a higher mortality rate by suicide than male physicians in the United States…and like most suicides, it is grossly under-reported.
I know, I am a female physician in the United States, and I have been suicidal.
More women are entering medicine than they were before 1980, but women in medicine still face a wage gap, a risk of sexual harassment, motherhood, relationship issues, and other disparities that can contribute to mental health challenges and suicide.
This burden is worsened by fears of being seen as less capable, an educational system that stresses care for others over care for self, and licensing and credentialing requirements that often punish physicians who accurately report their diagnoses and treatments.
Results of a systematic literature review and meta-analysis show women physicians are 46% more likely than their female counterparts in the general population to die by their own hands. Sadly, the Covid-19 pandemic has worsened physician moral injury, burnout and suicide.
It has exposed the inefficiencies in healthcare systems across the world, particularly in the United States, and exacerbated the toxic stress physicians have been experiencing for a while now. To my knowledge, there has been one reported physician suicide each weekend for the last 4 weeks in the United States.
And no one is really talking about it.
However, what is our role in preventing our own suicides? According to Dr. Ann McCormack’s article in the Medical Journal of Australia, “Among the medical workforce, work–life balance is poorly practiced and modelled.” “In fact, there is a subtle undertone rampant within the medical fraternity, in which late-night emails, missing a child’s school concert, publishing multiple articles a year, and not taking annual leave become unvoiced indicators of a truly committed doctor.”
No truer words, if we be honest with ourselves…
Thankfully, there is hope;
1/ According to the American Medical Association (AMA), Physicians can seek help, and not be “punished” in most states of the U.S.
2/ Healthcare institutions can put processes in place for physician wellness and ensure physician adherence.
3/ Doctors themselves should invest in activities that will build resiliency and support their physical and mental health, and model such behaviors to their colleagues.
3/ Physicians should be encouraged to be each other’s keepers through kindness, and practice empathy and compassion towards one another.
4/ The general population should be educated to end the silence, shame, and stigma associated with the word “suicide”.
5/ We should normalize discussions around emotional trauma and mental health challenges and avoid any repercussions towards doctors who speak up and speak out.
6/ Medical students should be selected based on both academic performance and aptitude tests, and regular enquiry into, and support of their mental health should be a high priority.
I am sitting in my home office on a sunny Thursday afternoon, as I write this letter to you.
In the past year since I quit my full-time job as a pediatrician to start speaking on child, teen and young adult depression and suicide, (read about it here and here). I have discovered a different side of me. The side that loves to write, and speak. The side that is an activist for a cause. The side that was lying dormant until the passion to actively save the lives of children and teens through creating awareness was ignited when my then 7-year-old patient attempted to hang himself in May of 2018.
I have always known that medicine, pediatrics, in particular, is my life, and public speaking is second nature, so it was sort of a natural progression for me. I have never had any trouble speaking in public to air my opinion, so when this opportunity to practice medicine in the most preventative way picked me, I had no hesitation to say, a resounding…yes! As the good book says, “many are called, but only a few are chosen”.
Though I don’t know when it will get published, I couldn’t think of a better day to write this letter than today, the 12th day of September, two days after September 10, which is recognized as World Suicide Prevention Day. This week marks National Suicide Prevention Week 9/8 to 9/14. A week which eerily includes September 11, a day suicide bombers set our country on a never to be forgotten path, a day that will forever go down in infamy, in the month of September, suicide awareness and prevention month.
This letter is, however, not about suicide days and suicide bombers. It is about a path that has led me, a Nigerian-born mother of three, a board-certified pediatrician, to become a speaker, bestselling author, and activist on youth suicide. It is about how finding a new way to practice medicine is allowing me further my cause. Every time I tell people what I speak about, it never fails, they look up, and suddenly get interested, no matter what they were doing before I started speaking. Some look at me with concern, some look at me with disbelief, and yet some look at me with sorrow, especially when I tell them my story, my why, which you can read here. Usually, by the time I am done, a majority of my audience wants to know where they can find me, where I practice.
For the past year, my response to that line of questioning has been a combination of the following…” nowhere in particular”, “I don’t have a practice”, or “I quit medicine to speak publicly”. To which even more eyes look at me with a mix of wonder, pride, gratitude and amazement… and then after a brief thought, pretty much everyone says a combination of “that’s such an important topic” or “that’s so needed” or “wow, thank you for the work you are doing”, etc.
As I have continued to speak locally, around the country and internationally, and as the questions have continued to come in, I have had to finally admit to myself that I have missed practicing medicine. I have missed clinical practice, but most of all, I have missed having physical contact with my patients. Those who know me, know my patients are my “anti-kryptonite” (if that is a word). That been said, I have known in my heart that I did not want to go back to traditional medicine (what I call “assembly line” medicine). The kind that is run by CEOs with little or no knowledge of what it’s like to have boots on the ground. The kind that has enslaved us doctors and caused burnout to now become a household phrase. The kind that puts profit and the bottom line before patients and providers. The kind that you, me, we, did not sign up for. The kind we did not dream about in our days in medical school. The kind that has unfortunately driven too many of us (400 per year at last check) to early deaths through suicide.
I knew that kind of medical practice was definitely no longer for me. So, I tried out Locums, but with my son still being in grade school, I am unable to travel out of town as much as most locum gigs would require, plus, I am only licensed in Texas so that limits me as well. I know the hospitalist route is not for me. So, while I was still pondering my next move, I happened upon a facebook group called DPC Docs. A two-thousand strong community of doctors practicing medicine on their own terms. I had actually heard of DPC about 2 years ago. Direct Primary Care. Three words that are turning out to be life-changing for those of us who care to look closer, look further and farther, think outside the box, and dare to be bold enough to say “enough already” to the big bosses and take back our lives.
I happily jumped in with two feet. You see, Direct Primary Care is exactly what Dr. Universe ordered for me. A spin-off of Concierge Medicine, DPC seeks to allow doctors to practice medicine the way it was meant to be. I had heard about it through a podcast that featured one of the true pioneers in DPC practice Dr. Josh Umbehr of Atlas MD in Wichita, Kansas. I remember excitedly running to find my spouse to tell her all about it that evening. I was so intrigued by the model, I was immediately hooked. And even though I knew the traditional medicine model I was in as an employee at that time was toxic for me, it still took me nearly 2 years to act on it. Not because the process is hard, but because I needed the right mindset and star alignment to get over the voice in my head telling me to stay put.
As soon as I decided to start back clinical practice, I knew it had to be on my own terms. My first order of business was to call the Texas Medical Board and enquire about my idea to only attend to at-risk youth aged 8 years to 18 years who are the exact population that I speak and write about. When the lady on the telephone told me I could, that was one of the happiest days of my life! Her words were something like “ma’am, as long as you are licensed to practice in this state, you can see only those born on the 5th of May if you like”. That essentially spun off my dream to open my own youth health center that would cater to the children that had picked me those many moons ago!
Do you know that it took me less than 6 weeks and cost me less than $10,000 to set up? I have a micro DPC practice model, that means I have no front or back office, no fancy equipment, no staff, and an expected patient panel of less than 300, compared to nearly 2000 which I had at my last place of employment. The way my practice is set up, I shall see only 6-8 patients a day for up to 1hour or more per visit, three days a week, compared to 35-45 patients at my last multigroup practice employment. My monthly overhead is far less than I had when I owned a traditional practice, my EHR is user-friendly and convenient, my stress level is low, my patients are happy, and so am I 🙂
While this might not work for many, it works for me and others with a small niche. My friend, Dr. Amber Price of Willow Pediatrics up in Chicago, Illinois’s niche is only newborns. She incorporates home visits as part of her practice. Yet another friend, Dr. Sara Sultz of the DOC group up in College Station, Texas does home visits as well as telemedicine as part of her pediatric DPC practice. She even gives vaccines and IVF right there in the patient’s home! Such is the new way to practice medicine, and I am proud to be a part of it, and to announce that I am the first and only pediatrician in Texas and the US with my specific niche in this particular model.
So, what exactly is DPC? And why is #yourstruly so elated about it? Ironically, many of the doctors that I speak with have never heard about it. A few have heard about concierge medicine, but not many, much like I was a few short years ago.
In the Direct Primary Care practice model, the emphasis is on affordable care. In its purest form, no insurance or third-party payer is accepted. That right there puts the first nail in the burnout coffin! I was like “whaaat?” No insurance means; I. Get. To. See. My. Patients. For. As. Long. As. I. Want. To! Yassss!! We do encourage patients to keep their health insurance, and some practices will even generate invoices that might be reimbursed by the patient’s insurance after each visit. The model is based on a flat monthly fee in exchange for services, longer times spent with the patient, more intimate doctor-patient relationship, overall lower healthcare costs, direct access to patients both virtually and in person, improved work-life balance for physicians; thus drastically reducing burnout, reduced patient load, and reduced administrative costs and overhead burdens. The increased intimacy with patients is a huge win for me, especially with the niche I see. Like any business, the fees vary depending on location and market competition.
The key here is; it is a membership model, much like Netflix or your gym membership. My patients have access to my cell phone number to call, text, email or facetime me whenever they need to, and they can be seen, as many times as they like to, each month! My question to you is; when was the last time you had that kind of access to your doctor? Let’s take for instance a 14 year old who is experiencing a depressive crisis at 2pm in the afternoon while at school, they would have the ability to call or text me right away, and not have to wait until they get home, inform their parent, who calls the next day only to get an appointment for the next week, take time off from work and school to arrive at the appointment, only to wait for one hour in the waiting room, and the doctor spends all of 10 minutes seeing them. Then wait another 2-3 months to get an appointment with the psychiatrist who may or may not accept their insurance, or is very likely to charge them 2 or 3 times my monthly fee for only one visit! Get it? #aintnobodygottimefordat!
Some DPC doctors are set up like traditional practices with office staff, laboratories, X-ray equipment, EKGs, and whatever else they need. Depending on state laws some also dispense medication in their practices, (Texas aint one of them…:) all for the same flat monthly fee. It’s just like a gym membership or Netflix for your doctor! In my case, for less than a cup of coffee at #Starbuxx my patients can see me everyday. Oh, and they don’t need to live in San Antonio Texas, I also have telemedicine included in the practice, so I can consult with patients virtually. Other services I am so proud we offer are a teen-2-teen support group (because teens speak teen, they don’t speak adult) and parent coaching, both of which I facilitate.
For now, I am loving DPC. It affords me time in my week to “mother” my children the way I want, be an awesome spouse to my Beloved, make time in the week to blog, work on my speaking gigs, record and edit my podcast; Suicide Pages with Dr. Lulu, The Podcast, you can subscribe, download and listen to it here and everywhere you listen to podcasts. I am finishing up my second book, a chronicle about Teen Life (my first book; a Parenting Guide, can be bought here). I have many more tricks up my sleeves in the coming weeks, so #staytuned.
In conclusion, I believe I have found my happy place in medicine again. While DPC might not be for everyone, it is for me, and it might be for you too, think about it. You never know. Here’s what you do, first start by conquering, silencing or banishing that voice telling you you can’t do it, the rest will fall in place. Ultimately, Happy Patient: Happy Doctor is what we all seek, right? Keeping it simple is what our mom’s taught us, yes?
So, I ask this time, dear doctor, will you DPC?
“We can’t be afraid of change. You may feel very secure in the pond that you are in, but if you never venture out of it, you will never know that there is such a thing as the sea, or an ocean. Holding onto something that is good for you now, may be the very reason why you don’t have something that is better.”
― C. JoyBell C.
After a month-long hiatus from my Rideshare seat, I finally got to do some Uberizing this past weekend.
Oh, you didn’t think a doctor could be a Rideshare driver? Dude, I have heard about company executives doing just that, try it, you just might like it. You can thank me later.
Dr. Lulu’s Rideshare began as some sort of a dare. My eldest son at Stanford was spending so much money on Rideshares at school, that I was like, “son, with all this money you are spending on Uber and Lyft you should probably be driving Uber to help your mama out when you come home on your vacations”. He agreed in theory, but in the end, since he was too young to sign up, he said, “mom, you are over 21, why don’t you sign up?” you love to meet people, and you love talking. One thing led to the other, and I found myself driving Uber/Lyft, and totally LOVING it! The “funnest” part has been the facial expressions I get from most people when I tell them what my “day job” is. It is so different, yet similar, to my life in a white coat. I ask questions, I listen to stories and I give feedback. And with all the talk about physician burn out, this has indeed been a much-needed stress reliever for me personally, I can go incognito, or I can go as myself, but in the end, it is has been about the people and their stories.
So, buckle up and enjoy the ride… my Uber tales.
After class that Friday (I am currently getting my executive MBA at UTSA), I picked up a family headed to the Alamodome for the UTSA vs Texas State game, go RUNNERS! As it turned out, they were from out of town and were going to watch their first ever live college football game! I was delighted simply to be their preferred mode of transportation. Their excitement was palpable. And in the 18-20 minutes, it took for the ride, I got to listen and learn from one of them basically breaking down the game of football to all of us; from interceptions to fumbles, to 6-point touchdowns to Hail Marys and field goals, and everything in between. I gladly shared that my sons played instruments in their respective high school marching bands, so I have heard those words often thrown around, but never really knew their meanings. I thanked them for the free lesson. First clients for the day… that, went well.
Next, were about 3 short trips around the downtown area, mostly to the game or to hotels around town… I was so glad to finally pick up clients headed out of the downtown area… all those one-way streets, road closures, and human traffic can give a girl a slight headache. The passengers, 2 girls both dressed in black skimpies, destination, Still Golden, a bar on Broadway Street. They appeared irritated and annoyed about something. They spoke in Spanish to each other in short sentences. They were either not in the mood for banter, or had had enough for the day, I was only too happy to leave the downtown area, so I was totally cool with their demeanor. After one wrong exit, and a U-turn, I eventually made it to their destination, they got out and said their thank yous. I kind of sensed that wrong turn did not help their moods too much, but oh well, it was all good by me. Next, I picked up a very happy group of middle-agers going only 1 1/2 miles up the road but didn’t wish to walk. I said, “hop in, and I will gladly take you”. During our short but interesting convo, they were very content to encourage me and my side-hustle and blessed my day with their presence. The main lady has just moved to San Antonio and is wishing to learn as much about the town as she can. We exchanged similar stories about raising teens in midlife and memories. Her, two boys and a girl, are about the same age as my tres hijos. Driving down Broadway, I mentioned that the Witte museum was actually around the corner from their destination. As soon as I said that, we drove up to it, and I pointed it out, to which she eagerly exclaimed… “I have been meaning to go there and visit!”, and I laughed aloud at her reaction as I responded, “so now you know exactly where it is, you should”. We bade each other a joyous farewell, and I drove on.
Next, I went back to the apartments across from Still Golden to pick up a young millennial couple heading up to the Japanese Tea Gardens. Ironically, I had observed the male of the pair earlier while dropping off the girls in black. He was walking back to his apartment building, his little dog trotting behind him. I don’t know why I singled him out in my people watching exercise, but I did. He was dressed in a well-ironed or maybe wrinkle-free white collar shirt, turn up blue jeans and a pair of loafers. He looked fresh and clean. Something about him reminded me of my eldest son…was it the turn-up jeans, the little dog he was walking or just the air of LGBT about him? I will never know, but when I picked him and his woman up, I shrugged and let the thoughts go. They informed me that the annual San Antonio Jazz Alive festival was going on at Travis park downtown. I exclaimed and offered that my eldest son and his Jazzy friends the “Four O’clock Five” had performed there only 2 years ago, I had noticed evidence of activity at the park earlier while driving through the streets of downtown, but did not know what was going on. This mention of music playing by my son sparked off keen interest from Mr. White-collar-shirt.. He eagerly asked me what instrument my son plays, and that led to a lively discussion about Flutes, Trumpets, rival football games between Brandeis high school and O’Connor high school, state competitions, marching band competitions as well as the Battle of the Band competitions in San Antonio etc. He joyfully shared that he had played the Tuba at Reagan high school. I smile and ask him if he still plays, sadly he said he hasn’t “in a while”, and I encourage him to start again. In hindsight, I guess it was the musical-instrument-playingness of him that I had sensed earlier while he walked his dog…
Driving people to and from their various destinations always gives me a mix of emotions, but every now and then, I pick up the occasional unlikely ally… like the older couple that I picked up from the airport. They offered that they haven’t been to San Antonio “in a while” and are here for what they described as a “long weekend”. I enjoyed watching the excited energy with which they entered my car, they made some nice comments about its cleanliness and nice smell and thanked me for picking them up. During our very light-hearted discusses, it came to light that the lady works as an assistant program director of a family practice residency program in Virginia. When I explained that I am a not only a Pediatrician, but I lived in Northern Virginia during my residency training at Howard University, she excitedly wanted to hear more about me. I smiled and shared a very truncated version of my story to date, she was so happy that I am following my passion and not letting anything stand in my way, that she promised to get her program director to invite me to speak to their residents about physician burnout and of course, depression and suicide in young adults. Wow! I smiled widely, looked up to the heavens, offered a wink, and whispered: “thank you”.
I believe the highlight of my night, however, was the young teen couple I picked up to take home from the game. Though San Antonio dwellers, the young girl, and her beau attend Texas State University at San Marcos. They were leaving early because according to her, the game was “pretty much over, and UTSA was pounding Texas State. She, however, cheered up when I asked her about school, and she, in turn, asked me if I had any children. I informed her that I have two in college, and one in middle school. She probed further. Wanting to know what high schools they had attended, and what schools they attended. My responses started an avalanche of excited exclamations from the two of us! She, a junior was glad to know my eldest is also a junior. However, her joy settled in when she realized he not only attended Brandeis high school, but he is at Stanford where her very best friend also attends school! She exclaimed that she was on her way to visit with him in October for her annual game day visit. I told her I might even know the kid a few moments later, it turns out I described her friend to the tee! This tickled her pink as she declared that was him! Right there in the car, she texted him and told him all about it!! Teens, what a breath of fresh air. I ended the trip by giving her young heart a hug and wishing her all the very best in life.
My last clients were 4 teenagers that had requested UbeX, all girls. I figured their ages were between16 and 19 years. One of them is in college, the other three are in high school. I enjoyed listening to their excited banter about who was coming to the party, who wasn’t, how they planned to crash another party after the first party and so on. Luckily, their destination was at The Dominion, a huge neighborhood on my side of town, home to some of the San Antonio Spurs players, their coach, and a host of other crème-de-la-crop. Prices of some of the homes begin in double-digit millions. One of the girls complimented me on my car, another complimented me on my hairpins, both made me smile, and renewed my faith in the younger generation of women. We somehow started talking about the need for us women to always uplift each other, and naturally, that was a golden opportunity for me to talk about teen depression and teen suicide. I ended up making them promise me they would always be kind to each other. We arrive at the neighborhood gates, and I discover, none of them had their IDs… what? I shook my head and smiled. Luckily, the security detail at the gate noticed my Air Force Veteran plate and shared that she had been in the Navy. We bumped fists, I gave her a knowing wink, identified myself as the Uber driver, showed her my ID, she thanked me for my service to this country, and the gates opened up. Phew!
Hopefully, you have a smile on your face, as you finish reading this piece. Hopefully, now that you know a little more about Rideshare driving, you agree with me that, indeed, life is always about the stories, the faces, the beating hearts, the people…
BB
“Be proud of who you are and not ashamed of how someone else sees you”
PS : Happy to announce that my blog was featured on the Top 40 Women Lifestyle Blogs in 2018, check it out here.
Words by Black Butterfly 