Before I can share his illness and death I feel it is important to reflect on Dan’s accomplishments and his blessings. He was a successful double board certified physician practicing, allergy, asthma, and immunology in both adults and pediatrics, in Portland, Oregon. He provided compassionate comprehensive care to patients and their families. Dan recognized that being part of someone’s healthcare was a privilege for which he was so grateful. He enjoyed working with adults but was most impressed with the children he cared for. He said on more than one occasion that he learned more from the children than they learned from him. He admired their resilience and honesty. He wanted patients and families to be active participants in their disease processes and made every effort to never rush his patients during appointments.

Dan had been elected to the executive council of the Northwest Allergy Forum for Oregon and Washington Allergists. Dan worked with the Immune Deficiency Foundation. He served as honorary chair for the Food Allergy Research and Education organization. Dan served as the medical advisor for the Oregon Chapter of Food Allergy and Anaphylaxis Network.

Dan loved being a physician, but what he was most proud of was being a committed husband and father to me and our three children who at the time of his death were 7 years old, 4 years old, and 8 months old. The words most commonly used by Dan’s friends to describe him are accomplished, compassionate, soft-spoken, humble, selfless, and giving.

Dan was active, engaged, successful and in a supportive marriage. Dying from suicide does not seem to “fit” for such a man. I wonder how many times I dwelled on this thought in those first days and weeks. I wonder how many times his family and friends considered this thought and still do. As his wife and a registered nurse of 14 years, I did not consider suicide was a possibility for Dan.

I believe therein lies an extremely important discussion. We have created an image in our minds of what the sufferer from anxiety, depression, and suicide looks like. I believe most of us do not consider a successful, “strong” man like Dan as a sufferer from mental illness. In truth, Dan was strong, and succumbing to anxiety, depression and ultimately suicide does not change that truth. “Strong” people suffer in silence with mental illness every day.

I believe that in order for this blog to be useful in dispelling current stigmas surrounding mental illness I need to share the details of the eight weeks that preceded Dan’s death.

Dan’s annual medical continuing education conference was scheduled in San Diego the weekend of February 27, 2014. As it approached he asked me to join him with the three kids. The kids and I would have enjoyed going with him but Dan worked so hard as a husband, father, and physician; I felt it was best for him to attend alone. The conference is jam packed with lectures and can be mentally exhausting. I wanted him to be able to attend the conference throughout the day then perhaps grab an early evening nap before going to dinner. Typically the evenings are occupied by spending time with old friends and colleagues. It is a wonderful time to share one another’s insight on medicine, disease processes, patient care, and to just catch up on the details of one another’s families. If I attended with three kids it would make it difficult for him to attend the conference and to get much needed rest and relaxation time with his friends. I told him I thought it was best he attend without us; I believed I was being supportive.

I decided I would take the kids to Arizona to visit his family and he would join us once to conference was finished on March 3, 2014. While I was in Arizona and he in California we spoke multiple times a day as usual. He seemed a bit stressed regarding the ICD 10 lecture but otherwise seemed to be himself. He socialized as usual and even completed a running race with friends. But when Dan got off the plane in Arizona he was a different person. He was still kind and loving but he had trouble getting out of bed in the morning and was really averse to engaging with his extended family. It just seemed as though routine activities were requiring more effort than they should have. Despite his fatigue and resistance to engage with others he did attend family events and conducted himself in a manner that did not cause alarm for those around us. I was concerned but thought his behavior was related to a strenuous conference schedule and hoped some rest would alleviate his withdrawn state.

Upon returning home Dan continued to perform at 100% in clinic. His physician colleagues and patients can attest to this. As one of the members of his nursing staff, I can attest to this. At home he continued to be “slower”, “off,” and experienced extreme difficulty sleeping. He seemed depressed, and in our first week at home he said he was anxious three times. By the third time I told him I was concerned because over the course of our 12-year relationship he had never used the word anxious to describe himself. I feel confident saying that he had never used that term before because I suffer from anxiety for which I have been treated at different times of my life with an antidepressant. Dan and I had discussed that it was something he had never struggled with. When I told him I was concerned he asked if I thought he should see his primary care doctor. I said yes and was truly surprised to see him make an appointment within a week without further encouragement. His doctor started him on a commonly used antidepressant, a sleep aid, and supplements to help him with his anxiety and depression.

Over the course of the next six weeks he continued to provide excellent patient care at work while struggling from depression and anxiety. Dan and I followed up with his doctor over the phone weekly and in his office every two weeks. Dan attempted to do everything in his power to save himself. He followed his doctor’s instructions to a “t”. I provided and he ate three balanced meals a day along with three snacks, he cut out caffeine and we ran together regularly. In the evenings we developed a bedtime routine to make falling asleep a little easier. He asked that I not tell anyone about his struggle including our families. He was embarrassed and did not want his struggle to change other’s perception of him. I wanted to respect his request because he was seeing his doctor, following his treatment plan, and making every effort to take care of himself. It is common for an antidepressant to take six weeks to reach its full effectiveness. I wanted to give him those six weeks of privacy as he requested and did with two exceptions.

I reached out to one of his partners letting her know I was worried and I had never seen him like this. I informed Dan that I spoke with her and she and Dan communicated with each other almost daily.

The intense schedule of caring for him, the kids, and working began to take a toll on me. I called my Mom in New Orleans and asked if she could come help me take care of the kids. She surprised Dan with her arrival on April 3, 2014, our tenth wedding anniversary. To my surprise Dan shared great details of his illness with her within minutes of her arrival.

Over the course of the next two and a half weeks Dan’s status appeared to make small steps forward with a few steps backwards. Ultimately, in the days preceding his death, he began to exercise without me, sleep more soundly, and more fully engage with the kids. It appeared we were making progress. That year Easter fell on April 20, 2014. It was a really good weekend. I remember parts of it feeling so “normal.” I was seeing glimpses of my happy and energetic husband. I told him I was excited to see the progress. He told me it was taking a tremendous amount of effort, which I sincerely believed.

Dan died of suicide just two days later, April 22, 2014.

I cannot stress enough that my husband was a different man when he arrived in Arizona from his conference in March. I cannot make sense of it, but it was our reality. In the blink of an eye he developed rapid onset of depression and anxiety. Dan was a “strong” man. He had no prior history of mental illness, he did not abuse drugs or alcohol, he was not facing any medical malpractice claims, and he was not having an extramarital affair. Dan had a stable career, he was financially stable, and he did not live outside of his means. He was in a loving marriage, had three beautiful children, and was surrounded by supportive family, friends and colleagues.

According to the CDC suicide is the tenth leading cause of death. It is the third leading cause of death in teenagers. Suicide rates are on the rise. Over 90% of individuals that die of suicide have clinical depression or another diagnosable mental disorder.

Do the stigmas that surround mental illness and suicide exist because we do not understand it and fear it?

Thank you again for reading this blog through the end. The feedback I have received and number of visits to the website have reinforced my belief that sharing our story and struggle is the right thing to do.

Connie DeMerell