Perspective
A Mother's Story
By Jeanette P. Dippo, R.N., M.S.
A mother pulls back the curtain on her physician-daughter’s life and death.
On Monday, March 20, 2006, the world, as my husband and I knew it, came to an abrupt, tragic end. After giving a lecture on community health education at a local university near our home in McGraw, New York, I rushed home at 10 p.m. to call my daughter, a family physician at the University of Minnesota’s Boynton Health Service in Minneapolis.
Since Kim’s first suicide attempt on March 1, almost three weeks earlier, we had made such daily calls. We had wanted her to come home and recuperate, but she said she had a new life in Minneapolis and that with therapy, AA, and a gracious employer, she would be OK. In retrospect, the phone calls had given us a false sense of assurance. But at the time, they seemed a way to track her progress when we were miles apart. So, after arriving home from teaching that Monday night, the day we later figured Kim died, we rationalized that perhaps she was not answering her phone because she was out for coffee with newfound friends. Still, I was uneasy.
I called her sister, Julie, in Albany. She and Kim had talked that afternoon. Julie said the conversation had been upbeat, except that Kim complained about the side effects of the medications she had been taking since her hospitalization. She had said she would stick it out with the medications until her follow-up appointment with her psychiatrist in about three weeks. If her psychiatrist couldn’t help her resolve the issues, she had decided she was not going to take the medications any longer. They proceeded to make plans for Julie and her family to visit Kim in Minneapolis the following summer. Julie felt Kim was optimistic about her anticipated return to work the following Monday, and Kim stated that she just wanted to “get back to normal.”
Not yet completely frantic after hearing about this conversation, I told Julie I’d call Kim in the morning.
The next day, our repeated calls and voice messages to Kim went unanswered and unreturned. We called the manager of Kim’s apartment building and requested that she check on Kim. She didn’t. Finally, around 11 p.m. our time on Tuesday, we called the Minneapolis Police Department, which, after much pleading and delay, sent a squad car to her apartment. Unable to get in the building, the officers returned to the station.
We kept calling. By Wednesday morning, Kim’s father and I were literally sick to our stomachs. We again called the police, who informed us that we had to wait at least 48 hours before we could report her as missing. We assured them that we had not spoken to her since Sunday and that it had been 48 hours for us. We didn’t mention that Julie had spoken to her Monday afternoon. Finally, after being transferred several times, we were connected to an officer who took down information about Kim. I offered to email him a digital picture of her, but he said that wouldn’t be necessary. I remember thinking, How many 130-pound, 5-foot-3-inch, brown-haired, green-eyed Caucasian females were there in Minneapolis? How would they know Kim?
I asked the officer if he would contact the hospitals and the coroners’ offices to see if there was anyone matching her description at those locations. “No ma’am,” he answered, to which I responded, “So what will you do with this information?” “It’s in our system,” he replied, “and if we run into her, we will contact you.”
Incredulous, I said, “So am I to assume that if the hospitals and morgues are to be checked, we have to call all of these places ourselves?” “Yes,” he replied.
I promptly Googled “hospitals and coroners in Minneapolis and St. Paul,” and Kim’s father and I proceeded to call every one listed. Repeatedly, we were told that no one by that name or description was there. By this point, we were terrified.
My husband booked a flight to Minneapolis for Thursday morning. But I was afraid to leave our home lest Kim attempt to call us. Yet I didn’t want him to go by himself, not having anyone to meet him, having only the first names of a few of Kim’s friends, not having allies, not having anyone to talk to. Most of all, I was afraid of what he might find.
Then it occurred to me to hire a private investigator. I found two online. The first one I called was not encouraging. “I have to tell you up front, you may well be wasting your $250,” he said. (This was his retainer fee.) “I can’t promise that I will be able to help you at all.” We explained that we had no one in Minneapolis to help us, and he agreed to take our case. Within a few minutes, I emailed him three digital pictures of Kim, and he said he would begin working on the case that afternoon.
We waited—one hour became two, four, six. We were panicky. Certainly, if he had gone to Kim’s apartment, he would know something by now, we thought. We were in repeated contact with Kim’s sister. Like us, she had been leaving messages for Kim. We had the gut-wrenching feeling that the worst had happened, but we couldn’t utter what we most feared.
The phone finally rang at 7:31 Wednesday evening. “Mrs. Dippo?” It was the investigator.
“I have a real moral dilemma,” he said, explaining that he had been cautioned by both the police and the coroner’s office that it was not his duty to inform us about anything.
“Let me help you with your moral dilemma,” I said. “You found her, didn’t you?” He answered truthfully, telling us that he had found her lying below her patio.
Since her college days at Bucknell University, Kim had dealt with serious depression and anxiety. Yet she double-majored in biology and economics, minored in chemistry, and graduated summa cum laude and Phi Beta Kappa. She went on to medical school at New York University, where she again graduated near the top of her class, then did a residency and established herself as a family physician. We were proud of her and her accomplishments. Yet a cloud of depression frequently plagued her. During medical school, following the break up of a relationship that began at Bucknell, she self-medicated with alcohol until another counselor helped her begin to successfully address the issue. She would have been sober for eight years on March 23, 2006.
Still, Kim was troubled. During one of our many phone conversations after her release from the hospital following her first suicide attempt, she made a comment that had startled me: “If you really knew me, you wouldn’t like me,” she said.
“What could be so bad that you would think that we wouldn’t love you?” I asked.
Following a long, uneasy pause, she said she couldn’t tell me. Then, after another long pause, she asked, “Can you guess what it is?”
Now, it was I who paused. Kim was so sensitive. Did I say what passed through my mind or hold the thought for fear of offending her? I finally said, “Kim, I can only imagine what it might be that is so troubling to you, but I have a guess. I want you to know that it won’t make any difference if this is it or not. I am still going to love you.”
And then with trepidation, I told her that I wondered if she was contemplating sex-reassignment surgery, adding, “And if that is what you want, I happen to know a nurse who would be happy to come out and take care of you through the procedures—and she comes cheap.”
“Mom, you’d do that for me?” she said. “How long have you known?”
She sounded relieved as we discussed how she had felt trapped in the wrong body since she was 6 years old. She confided that this had been the reason for the recent break-up of her relationship of almost eight years; her partner had not been able to support her in this.
Kim had found a wonderful physician at the University of Minnesota’s Program in Human Sexuality. In fact, he called me after her death to offer his condolences and to say that Kim had seen him the very morning of her death and that he wanted us to know that she was in high spirits and seemed happy that I was willing to be her nurse through her procedures. We imagine that she must have had some trepidation about the surgeries, but she seemed pleased finally to be moving forward. Despite the prospects of eventually being in the right body for her, the medications she was taking for her depression were causing problems in and of their own accord.
Physicians and Suicide
Each year, more than 30,000 people in the United States die by suicide, according to the American Foundation for Suicide Prevention. Physician suicide rates have been reported in several studies to be higher than those for the general population or members of other professions. Results of a meta-analysis of 25 studies published during the last 47 years found the aggregate suicide ratio for male physicians compared with the general population was 1.41 and the ratio for female physicians 2.27. The authors of the study, published in the American Journal of Psychiatry in 2004, called the ratio for male physicians “modestly higher” and for female physicians “highly elevated” compared with the overall population.
To learn more about physician suicide, visit the American Foundation for Suicide Prevention’s website (www.afsp.org) and read about the foundation’s physician depression and suicide prevention project.
The following sites are also good resources on suicide:
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In a phone conversation after her first suicide attempt, I asked her if she really wanted to die. “No mom,” she replied, “but I needed to get their attention. No one is listening to me. I am hurting so much. I am sooooo sad.” I presumed that she was talking about her psychiatrist and counselor. Kim told me that she had called her counselor to make an appointment but was told she was packing for a vacation and would talk to her when she got back. My heart ached that my precious, once-happy child would go to such an extreme to get someone to listen to her long enough to truly understand how badly she felt.
Like all family members who are survivors of suicide, we wonder what we could have said or done differently. What others could have done. What someone could learn from our loss.
We wish, for example, that we or someone had better understood the severity of the side effects of the medications Kim was taking for her depression. Kim described them as incapacitating. They made her uncoordinated and unable to focus, and her hands trembled. When she told us the medications were bothering her, we encouraged her to have them adjusted, even suggesting that she sit in her psychiatrist’s office to see if she might be able to get squeezed in between appointments. She did this. But after waiting hours, she said she asked the receptionist for a pad and pen and wrote a two-page letter describing the side effects and pleading for an appointment.
After her death, her car provided evidence of the degree of her loss of coordination and focus, which we assume was caused by the medications. The morning of her death, after seeing her “gender doctor,” as she fondly called him, she had driven to a local garage to get an estimate for repairs for accident damage to her car. Later that evening, when we figured she was heading out to a group counseling session, the camera in her apartment building’s garage captured her backing into the wall, shattering the glass in the rear window of her Honda CRV. The camera subsequently recorded her return within just a few minutes. At some point, she also perforated the radiator, causing a slow leak that made her vehicle impossible to drive when we arrived in Minneapolis two weeks after her death to clean out her apartment. She obviously should not have been driving.
Kim likely was concerned that the medications would affect her ability to practice medicine. In separate phone conversations the day before her death, she had asked both her sister and me, “Do you think I’m a good doctor?”
Looking back, we wish we had insisted, rather than suggested, that Kim come home after her hospital discharge and take a break for as long as she wished or that she let us stay with her for more than the week that she allowed after her first suicide attempt. We realize now that she had been discharged from the hospital without an adequate, sustainable support network. Family and friends need to be part of any depressed person’s care even when that person insists that they are not needed. This, we learned, was especially true in Kim’s case. She had moved to Minneapolis in 2003 to take a job. When the clinic downsized, she found a new position at the University of Minnesota’s Boynton Health Service. But she had only worked there for about nine months before her death. Kim didn’t just feel alone, she really was alone—so alone that no one except her family 1,200 miles away missed her for the two days that she lay dead outside of her apartment building.
It has taken our daughter’s death at age 33 to help us more thoroughly understand that suicide almost always results from a combination of protracted suffering, underlying psychiatric illness, and a sense of desperate hopelessness that outstrips one’s coping mechanisms. Kim’s life was extremely complicated. As a person struggling with her own gender and sexuality, she was a member of one of society’s most misunderstood and feared groups.
We wonder if we could have been more supportive.We also wonder what difference it would have made if her health care providers had invited her to talk about this issue, especially early in her depression—if it could have been made to seem a more normal part of medical care. What difference would it have made if she had seen some sign in her doctor’s office that indicated that she could safely bring up this very difficult topic?
In sharing our story, I worry that it may make readers think that suicide somehow is a logical, expected, or acceptable consequence of a complex set of life circumstances. To set the story straight, it is not. Suicide is never an answer or a solution. It is, rather, a sign that loved ones have been fooled into thinking that things were better than they actually were and that appropriate medical treatment or adequate support were not provided. It is a sign, quite frankly, that someone could have been kinder to someone else, that a cry for help may not have been taken seriously enough.
I don’t want to sensationalize suicide but rather to draw attention to issues in Kim’s life that led to her death. My hope is that this can reduce the stigma around these issues and prevent future lost lives. As I said at Kim’s memorial service at Boynton on June 14, 2006, just shy of three months after her death, we survivors are left behind to speak for those who cannot. Kim left us with one very clear instruction: “Please walk in this world for me until we meet again.” MM
Jeanette Dippo is the mother of former Minneapolis physician Kim Dippo. For 38 years, Jeanette was the district health education and wellness coordinator for Cortland City Schools in New York. She is now an adjunct instructor in the master’s program in health education at State University College in Cortland.