Remembering Sonal

By Melissa Sparrow

On Thursday, Jan. 8, 2003, a friend from my pediatric residency program called to tell me that one of our fellow classmates had committed suicide the day before. Sonal (not her real name) had taken an overdose of multiple medications and was found dead in her bed by her roommate. The day she killed herself was unusual for all of us recent graduates from residency programs. We had learned the results of the pediatric board exams taken three months earlier—a grueling two-day exam that qualifies physicians as pediatric specialists. I knew Sonal, and her particular fragility, and I immediately thought she must have failed the exam.

The prior year, Sonal and I had spent a month together as supervising residents on a very busy inpatient team. We spoke often and confided in each other about our goals and insecurities. About two weeks into the month, one of our interns became forgetful and inefficient. She seemed distracted, spacey and sad. My first thought was that she was depressed. Anyone with a physiologic predisposition for depression (and that is quite a few of us) is bound to become depressed during residency. The hours, the suffering we witness, the lack of positive feedback all gather together like a tidal wave, pulling back, pulling back, until a rolling shelf swells toward us. Residents fall hard and deep into a breathless darkness that only those with depression can understand.

Sonal and I decided we would talk to the new intern together. I did most of the talking. But Sonal often took the back seat in group conversations. She would place her words in pockets of silence only when she had something important to say. When she spoke, she showed a lucid mind and a majestic dignity.

The intern’s eyes welled with tears as we talked. She hadn’t realized her mood was affecting her work. She’d been under a lot of stress, some from outside her new job. We told her we understood how she felt and suggested how she might reach out for help. She dried her eyes and blew her nose. Later, I remember Sonal remarking to me, “It is good the way you can talk about depression.”

“It’s taken me a long time,” I answered.

“I have problems also with depression,” she said. “But I’m not supposed to talk about it. In my culture it’s taboo. We’re very closed about our emotions. It’s been very hard for me.”

I looked at Sonal then, her stunning, tea brown eyes, the quiet leaking of sadness I had not seen before. I knew she was hard on herself and that she had insecurities about being a resident at Hopkins (didn’t we all?). But I hadn’t known she had depression—or that she had such a marvelous capacity to hide it. I had also never considered what it meant to belong to a culture that didn’t allow conversation about this pervasive frailty.

Sonal and I never talked again about depression. We finished residency, and though we stayed in touch, we followed different paths. The last time I saw her was at the pediatric boards exams. We had lunch together, although she didn’t eat. She said it made her stomach hurt to eat during exams. I wolfed down a chicken sandwich.

I remember thinking how exotically beautiful she was with her thick black hair and full lips darkened a shiny brick. We talked about our jobs, my new Victorian fixer-upper, her excitement about her fellowship in New York. Then, we returned to the test. She coralled her long hair in and out of an elastic as she filled the ovals of the booklets with number two lead. Three months later she killed herself.

I think all of us recent grads walked out of the exam feeling like we’d failed. Did those infuriating ovals trigger Sonal’s despair? Is the combination of brutal perfectionism, depression and failure inherently deadly? Everything I could say about Sonal now, about what happened and why, is conjecture—a sad, empty-handed friend trying to make sense of an insensible world.

Was she being treated for her depression? Where did she get ahold of that much medication? What was the emotional context into which the news of her test failure fell like a bomb? Is there anything any of us could have done? Did I, as a friend, fail Sonal?

I know that people left behind in suicide are haunted by anger and guilt. It’s not the first time I’ve lost a friend to this final act. But it’s the first time I’ve lost a friend on the cusp of quiet greatness, a woman who knew the meaning of a perfect heart and bountiful lungs, having watched children without them die.

Sonal, I wish I’d known, I wish I could have made a safety net for you. But is that even possible if we doctors cannot recognize the severity of depression in our friends, are blind to their vulnerability? And are doctors perhaps even more vulnerable because within us a predisposition for depression forges with a self-punishing perfectionism.