On Easter, April 20, 2014, I had hope. We had a good day with family and friends, and the effort and work that Dan was putting into managing his depression and anxiety seemed to be paying off. Throughout the day I continued to catch tiny glimpses of the well Dan, a man who loved life and treasured each moment with his children and family.

Monday, April 21st, hope began to diminish. Dan began to worry about Tuesday. To Dan, Tuesday was going to be a difficult day. In addition to a full patient schedule, Dan also had a monthly partner meeting scheduled that evening. And Grace, nine months old, had her well visit scheduled. It had been cancelled two times prior so that I could be with Dan. Grace’s development had been on track but her speech seemed a little delayed. We felt it was best that I work from home so that I could take her to her doctor’s visit. Dan felt torn. He wanted her to be evaluated but wanted me with him in clinic that day.

In addition to not having me at his side, Dan knew that it would be a long day due to the evening meeting. He usually got home from these meetings between 10:00pm and 10:30pm. As I mentioned in a previous post had developed a bedtime routine to help him fall asleep and stay asleep. Coming home at 10:30pm would interrupt our routine. The fear of not sleeping was frightening to him. He was also concerned that if he looked and felt tired, his partners would identify his struggle with anxiety and depression. On Monday night we made a plan as to how we would handle Tuesday.

We had a plan. A bedtime plan I naively took comfort in, not once considering that Dan had his own suicide plan.

On Tuesday he was working in his Hillsboro clinic. It was a full patient schedule as usual. We spoke throughout the day. He sounded stressed about getting his dictations done in time for the 6:30pm meeting and was particularly concerned about staffing as some changes to the daily processes were soon to be implemented. I tried to reassure him that I would do anything he needed. He called me again from the car while driving to his downtown office for the partner meeting. During that phone call I cried. It was the first time I expressed feeling overwhelmed by working a full schedule, taking care of the kids and taking care of him. I was fully committed to taking care of him; I loved him.

I tried to reassure Dan that I was ok and was just feeling overwhelmed in that moment. I believe that the outcome would have been the same, but I will always remember that phone call and wish I had not cried. I wish I could have been stronger for him. I have considered myself a failure in that phone call. I wish I had called a friend instead.

Once at the meeting, he sat next to his physician business partners. I believe there were five other physicians present that night. Dan had known some of these physicians for 10 years; they were colleagues and friends. The group ate together and discussed the usual. Dan did not eat much and did not drink alcohol but did engage in discussions regarding the future in the usual manner. According to a colleague, he looked tired as if he had caught the same cold I was recovering from, but there were no other significant signs. I share this because it is unbelievable how someone who is hours away from succumbing to depression, anxiety and suicide can hide the extent of his disease from his colleagues and his wife. We are all health care professionals, yet we didn’t know. This is something that will follow me for the rest of my life.

He called me at 10:00pm. He told me he had to stay a few extra minutes to sign a check. He seemed calmer than in our earlier conversation. He asked me how Grace’s appointment went. I told him fine and started a conversation on a different subject. He interrupted me wanting more details about her visit. I reassured him that the pediatrician was pleased with her development, was not concerned about her speech at this time, and would reevaluate her at a later date. Then he said he had to get off the phone and would be home soon.

After the phone call I brushed my teeth and got in bed as usual. I layed quietly in bed and could have fallen asleep. I had no idea that would be my last conversation with him. Did he know that would be our last conversation? I replay it in my mind often. His last words to me were regarding the health of our daughter. It brings me to tears thinking about that moment. Did he need to be sure she was going to be ok before he could carry out his suicide plan?

It seems like as his wife and a nurse I would know. But I didn’t know. His physician friends and colleagues didn’t know. Dan dying of suicide was not a consideration in my mind that night until 30 minutes passed and he still was not home.

In retrospect I consider his increase in energy level over Easter weekend was because he had a suicide plan. He could gather the strength to have a “normal” weekend of family activities so when we would reflect on our final time together the memories would be fond. On Friday, he went to the gym where he exercised and engaged a friend in normal conversation. We watched a movie with the kids and then filled Easter eggs after we put our children to bed. Saturday we enjoyed the sunshine with the kids and played dodge ball with the boys. Saturday night we hid eggs at our home and he, in keeping with tradition, drove around to leave eggs on the front lawns for a couple of our very dear friends. Easter morning we celebrated with the children as normal. He went for a run in the afternoon before we joined our friends for a later Easter lunch. Over the weekend we even made love.

I have accepted that I could not have changed the outcome. I could not have known the depth of his silent suffering if he would not tell me. Those seven weeks were filled with unimaginable struggle, but I am grateful that he shared with me as much as he did. I will always cherish those weeks when he let me love and take care of him, the tender conversations where he revealed what he could of his struggle, and the nights he would fall asleep in my arms. We were together in sickness and health. We were together till death do us part. He was a wonderful man. We had a wonderful love.

Dan does not possess many of the risk factors for suicide and in fact he possesses many protective factors. However, Dan did not feel that he could talk openly about his illness or ask for help. He inaccurately felt he would be judged, and in his words he believed he had become a “failure”. Dan believed that people would think less of him as a person if he publicly acknowledged that he suffered from depression and anxiety. Due to a fear that people wouldn’t understand, or that his colleagues would think him weak, or that his patients would no longer trust him, Dan remained isolated and afraid.

This fact that Dan felt he had to suffer in silence is one of the aspects of his death that I continue to struggle with the most. I can’t help but believe that if Dan felt he could have asked for help without fear that people would question his ability to provide for his family, the outcome may have been different. Depression and anxiety consumes lives. We must create an environment where sharing fears and struggles more openly with friends, family, co-workers and health care providers doesn’t carry a stigma. Someone in his or her deepest despair should not feel like a “failure”.

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Connie DeMerell