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 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
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
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