I HAVE recently been catapulted back to the UK from New Zealand in the wake of my intensive care consultant husband’s death. My children and I are still reeling from Richard’s suicide, which took place 6 months ago, at home, while my daughter and I were walking the dog.
Richard and I met as junior doctors in Brisbane, and have also worked in Perth, Dunedin and, latterly, Whangarei, after 10 years back in Herefordshire, England. We shared a deep love of both Australia and New Zealand, and chose to return to the latter in 2016. It had been increasingly difficult for British doctors to find intensive care consultant posts in either country in recent years, and when a job came up in Northland, New Zealand, and we became aware of the area’s incredible natural attributes, including the world-renowned Tutukaka coast, Richard felt compelled to apply.
Just as we prepared to make the journey across the globe, including packing up our possessions into a shipping container, making arrangements for our two dogs to fly out to join us and selling our house, Richard received the letter all doctors dread – notification that a complaint had been made against him to the General Medical Council (GMC).
This effectively put our plans on hold indefinitely and caused us months of stress. Camped out in a holiday cottage, living out of suitcases, we sent our children back to the school they thought they had left for good, and returned to the jobs we had resigned from. Finally, the complaint resolved in Richard’s favour, we left the UK, assuming that our emigration would be permanent, and we were determined to put the GMC investigation and all the associated anxiety and uncertainty behind us.
Unfortunately, the effects of a complaint – even one statistically highly likely to be found in the doctor’s favour, as in Richard’s case – last far longer than the period of investigation. Richard did a lot of soul-searching during those months. He had always been known for his sound clinical judgment and for his decisiveness at work, for his steadiness under pressure, for his relaxed and calm manner and his sense of fun – he loved to banter with the nurses and doctors he worked with and had an open and forthright manner with everyone he met.
This sense of having been born to do the work that he did was something he exuded effortlessly, and I envied him this, having always questioned my own place within medicine and my choice of general practice as a career.
In the aftermath of the complaint, however, he talked to me much more about the ethical dilemmas he faced at work, all of which cropped up in intensive care, rather than during the course of his anaesthetic work, which continued to come easily and naturally to him. He began to question his decision making. He began worrying about cases that previously would have caused him no concern. He brought his work home in a way that I hadn’t seen him do before.
By this time, he had settled into his new role at Whangarei Hospital and was enjoying getting to grips with a new system, despite the challenges of adapting to a new country and different ways of working. He was popular with his colleagues, and his direct communication style went down well with his patients, who appreciated his warmth and his honesty. He enjoyed learning about the Māori culture, and would give me and the children impromptu tutorials on Māori word pronunciation, having been inspired to make headway in this area by some powerful and thought-provoking cultural awareness teaching at the hospital.
At home, however, it was clear to us both that his mood was slipping downwards, and it seemed that the long months of anxiety and powerlessness in the face of the GMC complaints procedure, coupled with a move across the globe, were catching up with him.
Richard did well on antidepressants and weaned himself off them after 6 months, with his doctor’s blessing. He threw himself into our new coastal lifestyle: running, cycling, diving and fishing. He frequently had his morning coffee in the sun while gazing at our astonishing view, which took in the gleaming blue of the harbour waters, Mount Manaia in the distance and the shimmering greens for which New Zealand is famous. He deeply loved his new environment, and we often walked on the beach together, marvelling at our good fortune in having landed in a place so heart-stoppingly beautiful.
The illness then recurred some 6 months later, slowly taking hold, fuelled by his on-call rota and the associated sleep disturbance that, constitutionally, he had always found difficult, but which this time took a disproportionate toll on his mental health. He went back onto his medication, but this time, agitation was an increasingly prominent feature of his illness, and it became clear to us both that he was on the wrong drug; that, this time, he needed something different. He was 3 days away from his first appointment with a psychiatrist when he took his own life.
I have written elsewhere about finding Richard dead, trying to resuscitate him while knowing it was entirely futile to do so, helping the children to say goodbye to him, watching the paramedics drive him away, knowing that I would never see him again. Fielding the policemen’s questions, thanking the neighbours for their help, shutting the door on them and at the same time on our old life, unable to imagine how our new life could possibly take shape without him. Suffice to say that we did – somehow – survive those early days, and that our new life is unfolding without him, though it still seems incredible sometimes that such a thing should be possible, or even allowed.
We have returned to the UK, to the security that comes from living near family and old, dear friends, though I have made friends for life in New Zealand and will never forget their kindness in the aftermath of Rich’s death. We are adapting to life as a unit of three, rather than four. I have returned to work, compelled to do so as soon as possible by my new status as sole breadwinner, and by the absence of any life insurance pay-out. I am taken out of myself and my troubles by my hospice work, and am well supported by my work colleagues, many of whom are close friends.
Richard’s mental health troubles were, in comparison with those of other doctors who have taken their own life, short-lived and intense. He had had one previous episode of depression in his early 20s; there was no recurrence for 23 years, until the period following his GMC complaint and our emigration. He was open about being investigated (probably in part because he was confident that he would not be found guilty of poor clinical judgement, on which count he was correct) and found his colleagues to be uniformly supportive and reassuring. He still died.
It is hard to predict who will succumb to suicidal thoughts both during and after an investigation. He would not have been on anyone’s “one to watch” list. It is debatable how much of a factor the GMC investigation was in causing his death, since his suicide occurred 22 months after first receiving the “letter of doom”, as we called it. I personally feel that its effects were insidious, that a complaint, however minor, has deep and long-lasting ramifications for doctors, who tend to be sensitive to any suggestion that they are not looking after their patients properly. Of course we make mistakes. Some of us even commit crimes. The vast majority of us are just trying to do our best, however. We genuinely want to help our patients, do some good in this troubled world, go home to our families feeling that we made a difference – however small, however temporary.
Here in the UK, I am working with the Association of Anaesthetists of Great Britain and Ireland, which is looking into the suicide rate among anaesthetists. This is well known to be higher than average, due in large part to their easy access to lethal injectable drugs. Of course, many suicides have nothing to do with complaints. Some are substance misuse-related, others associated with long term chronic health conditions, physical as well as mental (although the distinction between the two is artificial and not always helpful).
One of the goals of this work is to put in place ways of trying to reduce the risk of suicide for individual doctors, while equipping hospital departments to offer better support to those affected by such tragedies when they do occur. Colleagues are hit hard by the loss of a doctor in their midst to suicide, and the remorse and guilt that I feel as Richard’s wife are felt by his friends and workmates too.
I am no expert in the field of doctor wellbeing, and am learning as I go along. I am grateful to those who are teaching me, and allowing me to play my own tiny part in the work that is being undertaken in this area. Richard’s death was simply unimaginable to me, knowing as I did – do! – how much he loved his family. I have to live with the consequences of this failure of imagination every day, as do my children and everyone else who has been affected by his death.
I miss him desperately. I miss our life in New Zealand, our enchanting peninsula, the greens and the blues. I long to go back, but, for now, I belong here in Britain, lashed by rain, Brexit a constant background rumble of discontent. Richie is with me wherever I am, as is the grief – a deep dark central weight within. Not for one moment do I doubt how much we were loved by him, not for one moment do I think that he knew what he was doing to us by leaving us. Sometimes that helps; more often, it doesn’t.
Postscript from Kate (17 May 2018):
I am so touched by your responses and will re-read them in the coming days, because so much of what you have said – collectively – is so thoughtful, and profound, and deeply helpful to me. I am really moved by the support that I have received in the aftermath of Rich’s death, both in person from my army of friends (both in the UK and in NZ) and my family, and ‘through the ether’ from people like you who have taken the time to respond to what I have written. I have been particularly struck by those of you who confirm that Richie was in no way himself when he took the decision to end his life. I guess I knew this to be true already, certainly rationally it MUST be true, but it helps to have it confirmed. I don’t know if it will be possible to fully come to terms with the guilt that I continue to harbour about his death. Perhaps it has to be come to terms with, accommodated, made space for, rather than eradicated – surely that’s too ambitious a goal. I take comfort from the kindness and understanding that I have been shown. Mainly, I keep going. Get out of bed every morning, take a deep breath, get through the day. Repeat. Try not to go round in pointless circles in my own head. Focus on the moment. Raise the kids. Walk the dog. Trust that it will All Get Better, sometime in the indeterminate future. Hope that the colour will return to life, a different life, a life I wouldn’t have chosen, but have no choice but to embrace.
Dr Kate Harding is a hospice doctor and part-time GP now working in Herefordshire, UK, following the death of her husband Richard. She lives with her two children and her cavalier King Charles spaniel, Mo. She can be found on Twitter at @KateJH1970.
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