Doctor suicide ‘inconveniences’ patients →

PamelaWibleMD-JonAzkueMDSuicide

Jon Azkue, a Chicago-area doctor, died by suicide just before completing his training. I first reported his death a few years ago. This is a follow-up story on his suicide. What really happened to Dr. Azkue? And why? In this podcast I break the silence on one doctor’s suicide.

Two years ago, on April 20, 2015, I first read the headline: Police: Doctor found dead near hospital in Berwyn. Immediately, I published an article on Dr. Azkue’s suicide. The next day, ABC news changed the title of the story to “Man found dead near hospital in Berwyn.” How does a dead doctor get demoted to a “man” found dead?

Here are the facts: On April 16, a maintenance worker calls police for a well-being check on a tenant, Dr. Jon Azkue, a 54-year-old physician employed at MacNeal Hospital. Police discover a suicide note and his decomposed body surrounded by helium tanks. Thinking they were propane tanks, police call the bomb squad and evacuate the four-story building which houses health professionals and medical businesses. Here’s how his neighbors and colleagues respond:

“I was actually going to get some baby food,” says Jemin George who evacuated the building with his family. “My daughter is in one of the vehicles and it’s been almost three hours since she’s had something to eat.”

“It’s an inconvenience for the patients,” claims Riz Ahmed, an employee at Chicagoland Retinal Consultants, a clinic located in the building. Clinic manager Anna Futya, is also frustrated by the inconvenience. “All the calls that are coming here—whether from patients or doctors—nobody is able to answer . . . 

Wait, I thought this news story was about the doctor. The original headline clearly states: “Doctor found dead near hospital.” So why is the focus now on patient inconvenience? How did Dr. Azkue get scrubbed from his own story?

Dr. Azkue’s death is not only reported as an inconvenience to patients, he is treated as if he is guilty of a crime. There’s no sympathy, no sadness for the loss of a man who spent his life helping others. In the comments—amid jokes about terrorist plots and remarks about the selfishness of suicide—one doctor writes: 

Wow. I’m appalled by the lack of sensitivity for the loss of life here. I myself am in residency and unless you live through it, you cannot begin to imagine the stress and sacrifices that we and our families endure—far greater than missed eye appointments. My condolences to his family and colleagues. The journalist and editor should be ashamed of the slant through which they allowed this ‘news’ to be delivered. 

Jon Azkue memory

I’m compelled to discover the truth. Turns out Jon Azkue is a 1994 foreign medical graduate from Central University of Venezuela who was just a few months from completing his final year of internal medicine residency at MacNeal Hospital. Though he was a physician in Venezuela, his dream was to practice medicine in the Unites States. So what happened? Why would he kill himself just months before fulfilling his dream? 

Physician suicide often leads to more questions than answers. In the U.S. we lose more than 400 physicians each year to suicide. Like most docs, Jon Azkue left a note. Why aren’t we analyzing these suicide notes for common themes to prevent more suicides? Why aren’t these suicides fully investigated? Why does it seem like nobody cares when a doctor dies by suicide?

Nobody cares about doctor suicides

Since the bomb squad left his apartment, we’ve heard nothing more about Dr. Azkue. We’ve heard nothing about lives he saved. This was his five minutes of fame. Nearly two years later and we still have no answers as to why, no investigation of his residency program (where I’ve been told other doctors have attempted and died by suicide). Sadly, my prediction that this doctor would be forgotten by the media and medical profession has come true. Are his years of dedication not even worth a plaque on a wall? Are doctors so disposable?

Since Dr. Azkue’s suicide, I’ve amassed hundreds of cases of doctor suicides. Plus a collection of “suspicious” deaths like the anesthesiologist found on the side of an interstate. “No foul play.” Docs found dead inside hospital call rooms. “No foul play.” Really? That’s it. No follow-up stories. Healthy docs dead. Prime of life. Top of their game. Chief of departments. Case closed. How can we solve a public health crisis by ignoring it?

Jon Azkue Suicide Pamela Wible MD

Here’s the truth: One million Americans lose their doctors to suicide each year. Until we investigate why so many doctors are dying by suicide, we’ll continue to lose more doctors to suicide. Maybe if we took a sincere interest in Dr. Azkue’s death, we could prevent the next one. 

Meanwhile the only public honoring of Dr. Azkue appears to be on my blog where co-workers share: I knew Dr Azkue and worked with him. Shame on the public for their insensitivity to this situation. Unless you know the whole story, people, think before you speak! You never know what someone else has gone through! Who are we to judge? May he rest in peace. I worked with him also and found him to be a kind doctor. He was very nice and very intelligent and it breaks my heart to see that he passed away.

Even Dr. Azkue’s son, Jon Mikel, reached out from Mexico to search for answers about the unusual circumstances surrounding his father’s death. 

He was in fact fired on his third year of the residency (just a few months before graduating). The hospital didn´t tell us why exactly. He lost his visa status as a result and would have had to leave the country. We are from Venezuela, and its bad over there, really bad. That must have devastated him, as his dream, since I have memory, was to live and practice medicine in the states specially because he did his first two years of med school in Boston. He could not finish back then for financial reasons, so he went on to finish med school in Venezuela and was a doctor over there several years. After Chavez though, he committed himself to his dream of practicing medicine in the states. It took him years. We thought he had finally made it… By the way, my family went through his stuff, they found two job offers for when he finished in August as well as few good letters of recommendation. A relative spoke to the program director. We still don’t understand why he was fired. They told us it was a decision taken by a board, nothing that could be done there. But wouldn’t give us the why. 

Now it’s 2017 and we still don’t know why. I do know of several residency programs that have a habit of firing final year residents just months form graduation. I’ve seen the victims vilified and careers destroyed. Any investigation into these programs? Not that I’m aware of.

In summary, a physician is sacrificed by his profession and the media chooses a patient inconvenience angle. Why? Wendy Eidman explains the unusual and callous reporting of this story: 

So I used to be in television news (both an anchor and reporter); I can tell you exactly why this story was written the way it was. When the reporter got to the scene, she was not doing a human interest piece, which is the kind of story that you want to listen to. She covered a breaking news story, a situation that was unfolding — a possible explosive device in the building, the disruption of the residents’ lives, the consequences to the businesses involved, and the discovery of a victim in an apartment that had been rented to a physician, cause of death undetermined at the time of broadcast. It was appropriately done with the information that the reporter had at the time she had to go live. When I was in TV, it was station policy to not cover suicides in general unless the suicide had some consequence to the public — a person stepping in front of a train, causing the system to shut down for a time during rush hour, for example; in those cases, the story itself was the disruption of service to customers during rush hour. Management for my station felt that if they did allow coverage for suicides, the publicity might encourage suicidal people to go through with their plans. Since the reporter in this particular story had already gone live, it would have been good to follow up with the kind of story that you are envisioning once the coroner released the report that the doctor had indeed completed suicide. It would have been an awesome opportunity to do a series on the issue of physician suicide and the general state of medical care in America. I am going to hashtag the TV station so that they can read this comment and perhaps follow through during May ratings. 

Physician suicide is a public health crisis, yet there has still been no follow-up story. No major media investigation. So I’ll continue to report on these suicides myself—and I will continue to honor our fallen physicians. 

If you are a doctor, medical student, or health professional who is suffering, click here for help. If you want to know why so many doctors are dying by suicide, listen to this award-winning NPR interview

Pamela Wible, M.D., reports on human rights violations in medicine. She is the author of Physician Suicide Letters—Answered

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Doctor revived after suicide. Here’s what he says. →

In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life.

Dear Pamela, I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted the police. Sheriff deputies were upset when I did not pull over to talk to them after overdosing. After boxing me in, they threw me from my truck into the slushy street and tased me. After charging me with a felony and two misdemeanors, they nearly provided the perfect assist to my suicide. Through a series of miracles I was brought back. I am missing four days of my life including three on life support, but I am alive. I have to repair almost every relationship I treasure from the betrayal of my weakness, a chore I will perform with as much love and patience as I can muster. I may never practice my specialty again, but I am alive. My family has a husband, father, son, and brother.

My wife once asked how we do it in the ER, to be there for everybody’s worst day and also for their best. My worst day was almost my last. Funny thing is I was as happy as I had ever been in my personal life. My decision to end it all was 100% work-related.

Pamela Wible MD Suicide Quote ED Doc

I had just lost a young girl in the ER a few weeks before. Influenza. I followed proper protocol, gave her a couple of treatments and she felt better so I discharged her home with appropriate warnings. Thirty hours later she came back, in respiratory arrest. She ended up on life support with family refusing to withdraw care. They, of course, blamed me. And, of course, complained.

My review was days later. While my employers were very sorry about the case and stated support for me, the result would likely lead to termination due to this incident and a few other cases that were trivial. I thanked them for their honesty. At first my wife and I talked about it, and I was fine. I could likely go back full time where I used to work. I returned to work that night sad, but comfortable with my likely outcome. When I got home in the early morning hours I was just sad. I cried for the girl and her family. I cried myself to sleep and woke up still sad.

There’s a saying we have in the emergency room when we witness trauma and death among the innocent: “A little piece of my soul died.” We’re never offered counseling and in the end you get the jaded emergency doctor who struggles to care. My psychologist says it wasn’t just the last girl. It was trauma after trauma after trauma.

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Pretty sure I have PTSD from the Haiti rescue and recovery trip. From bloated bodies liquifying in the heat to starving kids begging in the street. Years later, walking into a Mexican hotel with similar tiles and stucco walls, I was overwhelmed by the smell of rotting flesh. Other times when opening a large perirectal abscess, I could smell dead bodies.

Tip of the iceberg. Horrible cases. A drug-related killing where a kid was bludgeoned to death with a baseball bat. Barely alive when his druggy friends dropped him in the ambulance bay. Child shot through the head when crack addict mom didn’t pay up. I had to assist taking clothes off siblings to obtain as evidence since they were covered in blood and brains. Shootings. Stabbings. We do this every day.

Yet I’ve never been depressed per se and never suicidal. I just snapped.

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Sitting alone with my grief, I grabbed what I needed and drove up to the mountains. I thought my wife would be better off without me. I texted: “I’m so sorry. You deserve better. I have tried to be strong. I can’t take it any more. To have that girl die was too much. To have to face being terminated for it? I can’t go on. I’m sorry. I love you to the end of the world and back but after one final hurt, I can finally stop hurting you. You have your family and church to help you and you have your finances taken care of.”

I took a handful of pills with the final thoughts that my student loan debt would not pass on to my wife and at least she has my life insurance to take care of her. Then came the police cars. I don’t know why, except not wanting to talk to them or face my wife, I continued driving. I obeyed all traffic laws, never exceeded 22 mph and in no way endangered pedestrians or other motorists. At one point I pulled to the side, and multiple officers took cover and aimed guns at me. They wanted to know if I had guns, and I told them that they were in the vehicle and they could have them. I kept my hands visible as directed but refused to exit the truck because I did not want to talk to them. Ultimately, I was thrown from the truck, tasered, cuffed, and put in the back of a police car.

I requested to go to the hospital. I was surprised that they took me to jail. Seemed weird because I thought all suicidal people came to the hospital first. I started to get sick from the overdose. Sweating and nauseated and a little unstable on my feet. They had me sit in a holding cell in the booking area, and that’s the last I remember.

Of the next four days I have almost no memory. I am told I went into respiratory then cardiac arrest in the jail and they started CPR. I was finally transported to the hospital, where they got a pulse back. I was critically ill on ventilator support. My family was told I was going to die. Then my sweet daughter found what I took, and the appropriate meds were given. I improved. Couple days later I was off the vent and out of the ICU.

Almost every day, since that worst day, my wife just looks at me and repeats “I can’t believe it even happened!” The people I’ve told about this are utterly shocked. I have spoken with a few residents I used to teach and they can’t believe it. I can’t either. Could happen to any doctor. Seemingly without warning.

Nobody would have ever guessed this would happen to me.

I, however, have the residual aches and pains to prove it happened. As we try to heal, I spend my time reading scriptures, praying, and trying to get some level of fitness back (you might be surprised how hard a few days on life support can be on your body, not to mention chest compressions).

I am not sure of my return to the ER. Those few shifts worked after the girl died were awful. I was very unsure about everything. I could not make a decision on patients. If you can’t discharge a young patient with the flu, who can you discharge? Even though I did everything right, I still have trouble sleeping. I mourn for that family. Emergency medicine once defined me. I loved going to work every day. I think at one point I was a good doc who cared about his patients. Now I am just very anxious even thinking about going back to work.

Still, I’m trying to make sense of this. I’m certain of one thing—the Lord saved me for a reason! I am just horrified as I read through my chart of how very close I came (pH of 7.1, lactic acid of 15, heart failure, renal failure, elevated cardiac enzymes, and rhabdomyolysis).

Thank you again for all you do to educate and advocate for those that did not make it, and for helping to prevent even more suicides. Of course you can do anything you want with the story. I don’t want the attention drawn to me specifically, but I hope it can reach someone before it is too late. ~ Michael

PamelaWibleMD-SuicideQuote

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Pamela Wible, M.D., reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered. Need help? Contact Dr. Wible. Want to love medicine again? Join our teleseminar

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A doctor’s love letter to a doctor →

Doctor's Love Letter

My Dearest Love, Fiancé, Partner, and Best Friend,

I want you to know just how much I love you. I genuinely love you with every ounce of my body and soul.  🙂

But I worry about you. You’ve been beaten down. Your residency program doesn’t set you up to succeed. Every day, you’re overwhelmed by another ridiculous list of tasks. Constantly, relentlessly someone is seeking your attention. Then you get rushed, thrown out of a rhythm. Your superiors find fault in you, quick to criticize you for their own failure to demonstrate the path to success.

This evening, a phone call intended to bring you fresh optimism, renewal, hope…brought exactly the opposite. This doctor, whom you never met, shot down your dream clinic with a disturbing level of confidence. You tried to be polite, but I know the real you. I could FEEL your disappointment. Hoping to finally step off the treadmill, you were told that it’s impossible—an immature and idealistic dream—get over it!

It crushed me and made me cry for you. 

I sit here knowing how much I love what I do as an infectious disease doc. I love the patients, the pathology, everything. It makes me happy and genuinely content with my life and career. And I know how much you love family medicine. How happy and excited you get when you talk about your country farmhouse clinic with the big garden. I imagine the wood stove crackling as a couple of cinnamon candles flicker beside you and your patient, each of you sitting on a love seat. You’re both sipping tea and just talking away like long-time friends.

Bimbo is curled up beside you while Puffy is lounging on your patient’s lap, licking a hand hoping to get a scratch on his head. Your patients love all the doggy kisses. Even the rough, gruff old men seem to soften a bit. They adore those dogs just as they do you, your kids, and me.

Now you hear the loud steps of your next patient, the diabetic contractor wearing his Timberland work boots. Remember? The one who never saw a doctor before you. You got his A1c down from 12.1 to 7.9. As always, he’s 15 minutes early so he plunks himself down into one of the wooden rocking chairs on our wrap-around, enclosed front porch with the potted flowers and gentle wind chimes. And he just rocks away until it’s his turn, as he does every time, rain or shine

This is your dream clinic. Do you see it in your mind’s eye? Do you hear the sounds? Smell the cinnamon candles? Can you feel the warmth of the stove and soft fabric of your love seat?

I so miss seeing that sparkle in your eyes. You are beyond exhausted. Lord KNOWS you have a good reason for it too. From my perspective, there’s not a damn thing you can do about it. Still you always give 100% each day so you can be the best physician, mother, fiancé, sister, and daughter.

Please…don’t let this broken system and poorly constructed program steal your dream. Don’t let physicians who are stuck in the mold, complacent, or afraid to challenge the norm discourage you. Forget them! Keep going, Every day you are one step closer to your dream.

I’m here for you. I’ll support you in every way I can. Please don’t forget that. Don’t pull away into your despair. If we have to build a shed out of donated scrap wood and furniture, plop it on the corner of the yard, with a kerosene lantern and a hand-painted sign that reads, “Your Family Doctor” then that’s what we’ll do.

I love you and can’t wait to see you in just one more day now that it’s past midnight!

Your fiancé, best friend, and colleague,

John

For expanded commentary on the love letter, download MP3 or listen in . . . 

Pamela Wible, M.D., is a family physician who pioneered the first ideal clinic designed entirely by patients. She loves helping doctors open ideal clinics and live their dreams in medicine. Join our upcoming teleseminar to learn more.

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A Valentine’s plea for doctors →

Love yourself first

For all of you hard-core docs who put everyone’s needs ahead of your own.

For all the docs forgetting to eat or drink all day then fainting in operating rooms.

For all my sisters working through miscarriages without taking time off to grieve.

For all the doctors working with strep throat so severe they can hardly swallow.

For all the dehydrated docs hooked up to IV poles that they keep dragging from room to room.

For all the resident physicians working through severe asthma attacks.

For the doctor who told me she was so sleep deprived she fell asleep on her patient’s leg.

For my friend who had brain surgery during medical school and powered through so she could still graduate on time.

For all the female physicians back at work just a few days after delivering their babies.

For all the depressed and suicidal doctors caring for others until they can’t go on one more day.

Please stop the self-abuse.

Love yourself first.

 

 

~ Pamela

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The ugly truth about Caribbean medical schools →

Caribbean Medical Schools

Dear Dr. Wible,

I want to fill you in on what really goes on behind the scenes at my medical school and maybe you can help inform other students about what happens here before they make a huge mistake. If students slip between the cracks of a US med school, then international med schools in the Caribbean may be the next choice. Some have better residency match rates than others so beware. Mind you, your choice of residency is skewed a bit coming down here, but again there are ways to work your way through internal medicine and find a fellowship of your choice, it is just a tougher and longer road. 

My school allows 1000 students a year in on average at the start of each August class. They let in about 700 for the January starting class which are on different schedules and have a smaller lecture hall to accommodate a smaller class. My starting class began with 1100 students, we are down to 650, meaning 59 percent of my class that I started the first day here with are still here to finish off our second year. The class of 700, starting in January, finished with around 450, meaning about 64 percent of their class made it from day 1 to the last day of year 2. US med schools have about a 1-2% attrition rate, we have on average a 40% attrition rate. The problem I have with this is that our school allows students to take on 40K per semester of debt just to dismiss them after 4 or 5 semesters if they fall below an overall GPA below a 75% or having a final grade of below 70% in any one class. If a student does fall below either mark students may or may not be allowed to decel, which means repeating the failed class; however, this looks bad on a residency app and if one fails again they are almost certainly dismissed (rare exceptions). 

So, why are so many students failing or dropping out? 

1) Students are literally mashed into a lecture hall which seats 900 and there are over 1000 students that must click in for mandatory lecture which is 80% of all lectures. If one falls below 80% attendance they are automatically failed in the course. The stress of clicking in, finding a seat, and waiting in lines on a campus that can’t accommodate this many people is a reason for the students who drop out in the first few weeks, which my school has statistics on and they know this will happen after years of practicing the purposeful overcrowding. This is a business for profit medical school and profit definitely comes before the well being of any student.

2) The mandatory lectures are nearly pathetic. There are usually so many mistakes made by the inexperienced professors, the lecture becomes confusing and muddled. Students are used to having brilliant or at least decent professors. When they see the quality of tutelage and mix that with the stress and workload, the second round of students drop out by midterms.

3) There are not enough dorms on campus to house this many students. Our school placed a random selection of students in a motel 5 miles from campus. There were no laundry services, no ovens, and a shared floor bathroom. Some were disappointed about only having a hotplate and microwave to cook with. This added with the intense work load and adaptation into the pace of medical school is the third round of students to drop out.

After about a month the class will be down to 900 or so. These are the students who started something and are going to finish, even if it means living in a box.

With 900 students how did we get down to 650? They turn the heat up in term 2/3/4 and have a system of questions and statistics for each question they put on their tests so that they fall within the number of students they need to remain to hit their margins. If they need to cut down class size numbers, the heads of the departments are told to use a more difficult test bank by the Dean. Mind you, I’m very close with the head of several departments and we have discussed this for hours, and our disapproval of the methods they use to keep within their budget. We only have 600 positions open for clinical rotations so 50 more students will have to go this term in order to make the numbers right. The school has to have this 40 percent attrition rate to fund the paid positions for our clinical rotations in the US. 

4) IMG’s [International Medical Graduates] have to score an avg. of 10 points higher on the step than a US med grad for an equal position in the US residency match. The avg. US step score is 224. We have to get a 230 usually just to get looked at. Another fact they purposely kept from us until our term 4. Why can’t anybody find the true numbers of this school online? They do not post them. If they did they wouldn’t have the demand they do now because if we were given all of the facts, some us would have chosen a field within health care that doesn’t require this amount of chance, debt, stress, and moral compromise. 

5) Students who can not self study and teach themselves the material fail. Students at my school must teach themselves what they need to know. We are given a vague outline and need to get through the tests and STEP with high scores. We actively search for resources to help fill in the gaps our school leaves. About 30% of the class has headphones on during lecture listening to an outside source and just click in for the attendance question. 

6) Emotional distress/burnout/sickness… This is the area that caught me off guard. I had a medical condition that required hospitalization. The staff is disconnected and said either repeat the term after you seek medical attention or just quit. My advisor told me to “just quit, it isn’t for everybody and it only gets harder.” (thank gawd I didn’t listen to her.) I was in shock and started crying like I never had before. All of that work for someone to tell you to “just quit.” I then went into a depression and felt numb. I luckily met you, Dr. Wible, and found out there were options for these feelings and that I was not alone in this process, med school can be hard…. The others that leave really do just get sick of the abuse and the stress and just zone out. The toughest part about them leaving after a few terms is that the debt has mounted and they have to start repaying their loans 6 months after they quit. It is kind of a vicious circle.

In my opinion I wouldn’t “recommend” my school to any of my friends or family. Im against what they stand for and do not believe in my school. They throw us all against the wall and whoever sticks gets to stay, whoever falls they leave behind. This is for money and I don’t believe it is good for humans to go through this type of abuse while in training to help others. The negative attitude predominates on campus, so I chose to live off campus with success driven students to escape it.  

So why come here? TO BECOME A FREAKIN’ DOCTOR, THAT IS WHY!!!!!!!!! I remember studying homeless in the park for the MCAT with a head flashlight on. Now that Im in my last semester it seems all worth it. Every bit of it. There are waterfalls, beaches all over, fruit stands, rum shops, paddle boarding, night clubs, beautiful views at the campus, good people, and lots of fun to keep you sane while you’re putting in what is most likely the toughest two years of life. It is stressful but it is ALL ABOUT WHAT YOU PUT INTO IT!!!! If you want a 250 STEP 1 score you work for it. If you want to be a surgeon you work for it, if you want to serve the underserved, you guessed it, YOU WORK FOR IT!! I worked my tail off to get to this point and I feel accomplished now. 

I feel like I can do the most good from this position. I could be a nurse, PA, NP, EMT, or any other health care provider but I want to make some changes in this world and this puts you in the driver seat to do so. My school is now helping out this term and they want to see the students who made it though their process succeed. They are smiling now and so are most students. It is sad to see friends that didn’t make it, but most of the ones that I know failed because they held onto a negative attitude, expected others to do the work for them, got into substance abuse and night life, or simply just didn’t want it bad enough to sacrifice everything for this dream.

The reason I don’t “recommend” it is because I believe students, friends, family should explore and exhaust every option before coming here. I rushed into it and wanted to get started ASAP and paid the price. But if this were my last option to becoming a physician I would still probably do it out of determination. So it can be done, there WILL be hardships, difficulties, confusion, fear, and stress. But if you work as hard as you can and make it through the process. If students do choose this route, they must prepare an emotional support team, an exercise plan for keeping body and mind healthy, and perhaps a mentor to help get adapted to the school.

Please publish my letter if you feel it will help others. And keep doing everything you do for medical students. Please. We need you.

Sincerely

~ David

Pamela Wible, M.D., reports on human rights violations in medicine and what really goes on behind the scenes in medical training and culture. View her TEDMED talk Why doctors kill themselves. Need help? Contact Dr. Wible.

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