The medical record of another young man in our practice went into the office basement Friday after being stamped “DECEASED” across the front of the manila folder.
In all my years of practice in this community I cannot remember a single young male patient of mine who died from a disease like cancer or AIDS, but I have known over a dozen who shot themselves, jumped off the bridge, took a deliberate or accidental overdose, or died as a result of a motor vehicle accident.
This time it was a self-inflicted gunshot wound in the context of a failed marriage and a troubled new relationship that ended a young life. Several staff members knew Thursday morning what had happened to the young man I only met once about a year ago. Someone had even heard it from an eyewitness, but the “DECEASED” stamp didn’t go on the record until the obituary appeared in Friday’s newspaper.
When adolescent or preadolescent males come in for physicals, we don’t often find new diseases. We’re certainly on the lookout for boys who might be developing hypertrophic cardiomyopathy and are at risk for collapsing during vigorous exercise. We also preach the importance of testicular self-examination. This is extremely important, since the majority of testicular cancers are discovered this way. I still remember the last case I saw, probably four years ago now. The young man felt a lump I wasn’t sure I could feel. I ordered an ultrasound, which identified the cancer and confirmed his self-diagnosis.
The most important part of the adolescent male physical is talking about the things that most often threaten or end the lives of young men. I have no illusions that we as physicians can stop suicides or deaths from risk-taking behaviors or accidents in even a fraction of cases, but what if some of us can do that even once? We don’t know when we might indirectly save a life by nudging someone toward better conflict resolution skills or away from situations like getting in a car with an impaired driver behind the wheel.
The young man who ended his own life Wednesday seemed like a decent fellow. I’ll probably never know what made him do what he did, but it does sensitize me to my role as a fiftysomething physician who has the privilege and responsibility of sometimes, however briefly, being in the position of elder or mentor for young men making their way into a complicated adult existence. Am I open and aware enough to offer my ear or my hand when it is wanted?
A Country Doctor Writes: 
This is a very sad story. It is something I think about often. I have two 30 something boys and in my extended family we have had 2 thirty something young men (two different cousins sons) who committed suicide in the last 2 years. My sons seem very well adjusted and both have happy marriages, and this is something I never dreamed I would be worrying about, but it seems to be happening way to much with young men. One cousins son was having a lot of personal problems but the other was a complete shock. He had just landed a great job and was engaged to be married. No one seems to know what caused him to do such a thing.
I’m very sorry for this young mans family.
I often have similar questions as to whether or not I leave enough of an open door for my patients during course of a busy day trying to keeps the doors open in general. There is so much that we are “supposed to” discuss at each brief appointment at some point I fear that all of this becomes diluted and the patient’s agenda never is addressed.
Last week I had a patient die before her time as well. I’m not sure on the details, but my suspicion is domestic violence. Was I available enough for her to see how she was doing and to discuss a safe plan?
Doc this is a heart breaker. Like you, I am always on the look-out for a dadburn pheochromocytoma, but the time is better spent on the lass academic ways to save lives.
Dr. B