February 15, 2021

Two years ago today, my son Thomas killed himself. He was four weeks short of his 30th birthday.

To all who knew him, Thomas seemed a promising young man.

He graduated with honors from the demanding Pre-Med program at Washington University in St. Louis . Rather than enrolling immediately in medical school, Thomas joined Epic , a company that provides software to hospitals and clinics.?

He liked the work so much that he abandoned a medical career and embraced the software business.

By February 2021, Thomas had served the company for seven and a half years. His performance reviews were consistently positive. He had established himself as an expert in downtime prevention – a critical hospital area. By all measures, he was an outstanding technical consultant.

Customers loved him. They said he was brilliant and well respected. One customer described Thomas as "the most knowledgeable consultant I have ever worked with."

People liked him. Colleagues said he was helpful, caring, patient, kind, and poised.?

Privately, Thomas was unhappy.

We don't know exactly when he started feeling miserable. COVID lockdowns devastated his social life. Epic halted business travel and implemented voluntary work at home. Most workers stayed home; Thomas went to the office every day. Restaurants, bars, and movie theaters closed.

COVID severely affected the hospitals he supported, adding to his stress.

By late July 2020, his anguish was so intense that he called the crisis hotline of his HMO, Group Health Cooperative of South Central Wisconsin (GHC).

GHC had shut down office visits for mental health treatment "due to COVID." They were under no government mandate to do this. Wisconsin's emergency lockdown order expressly exempted healthcare facilities. Nationally, the CDC Centers for Medicare & Medicaid Services (CMS) recommended office treatment for initial assessments, telemedicine for follow-up care.

Madison, Wisconsin, had a low COVID case count in July 2020. But even in places with high case rates like Massachusetts and New Jersey, restaurants and gymnasiums had opened up by then. Hospitals resumed elective surgery. Businesses provided services like manicures and haircuts. Remember masks, social distancing, and plexiglass screens??

But GHC could not figure out how to treat crisis mental health patients in the office. They treated Thomas exclusively with "telemedicine" – phone calls and Zoom conferences.?

I asked GHC for evidence that telemedicine is as effective as an office visit for crisis mental health. They didn't provide any.

When GHC leaders shut down office visits, they did not do so to comply with orders from the government. They did not "follow the science." They simply caved to a panic.

In Zoom sessions, Thomas expressed a sense of failure. He said he felt hopeless and worthless.

He spoke about killing himself.

The Physician Assistant treating Thomas rated his risk of suicide as "low to none."?

Oops.

After Thomas died, I asked why GHC lowballed his suicide risk. The response: Thomas was "nicely dressed" and "seemed rational."

According to the Medical Examiner's report, when Thomas shot himself he wore two brown socks, Calvin Klein briefs, "Dockers" shorts, a Tommy Hilfiger long-sleeved polo, and an LL Bean coat. I’m just noting this detail in case there are mental health workers reading this who believe "nicely dressed" people don't kill themselves.

The Physician Assistant also noted that Thomas had no history of self-harm.

It's true: people with a history of self-harm are more likely to harm themselves again.?But more than half of all suicides succeed on the first attempt.?

Thomas had no history of self-harm until he pulled the trigger.

The Physician Assistant did not think it essential to refer Thomas to a medical doctor for evaluation. In the six months he was in treatment, no psychiatrist or medical doctor examined Thomas or reviewed his case. GHC never took his vital signs or performed routine tests – even though he complained of physical ailments.

From July through November 2020, a GHC social worker met with Thomas four times in Zoom sessions. This "talk therapy" seems to have helped him a little. By November, he wasn't talking about killing himself.

But things weren't going well at work. According to a close colleague, Thomas was inattentive and forgetful. He would commit to tasks, then fail to deliver. This pattern started around July 2020, when Thomas first sought help from GHC, and worsened over time. The situation was intolerable – Thomas was making mistakes that were visible to the customer.?

Epic says they did not know he was in treatment for his mental health at this time. It’s curious that his manager had no idea that he was struggling. In quarterly performance reports, Thomas complained about his workload.

It makes you wonder: Is there something about Epic’s culture that prevents employees from seeking help?

On February 3, 2021, Thomas met with his manager. In the meeting – which the manager describes as "contentious" – Thomas resigned abruptly.

We know that he did not plan his resignation. Forensics on his personal computer showed no job search activity before he resigned. He hired a resume service the day after he quit.

Epic declines discussion of the circumstances leading to Thomas's resignation.?

The colleague tells me that Epic removed Thomas from a significant project. Epic denies this. The colleague is in a position to know the truth and has no reason to lie. I do not trust Epic to tell the truth.?

Twelve days after he resigned, Thomas killed himself.

We buried Thomas in Holy Cross Cemetery, near his grandparents.

The conventional wisdom says people kill themselves to avoid pain or anguish. As I review Thomas's records, I see boredom, frustration, and lack of challenge. He feels trapped in his job. He feels tied to Epic by the company's employment practices. He sees little opportunity for growth.

He is sick of living in Madison, Wisconsin, a city whose culture consists of Butter Burgers and fried cheese curds.

He misses Boston and its art museums.

He has yet to succeed in forming a serious relationship. He has no "real" friends.?

He regrets his life choices.?

He remembers playing the sax in a high school jazz band.?

He misses his family.

He seems tired of living in a world run by clowns.

If Thomas had picked up the phone and called me, I would have said Thomas, you're right. Clowns are in charge. Our leaders are incompetent grifters. Everyone hates your employer, especially those forced to use its software. Your HMO is lame. You live in a hick town run by bolsheviks.?

But you don't have to choose the off-ramp. You can find a place for yourself in Clown World. Not everyone is corrupt. You can go placidly amidst the noise and haste.

You have money in the bank. You have no debts. You have no dependents. Quit your job. Travel. Live at the beach. Pick up your saxophone. Come home. Do whatever you want. Take care of yourself. We love you.

He did not call.?

He took the off-ramp.

Thomas valued his independence. Maybe he didn't want to come home. Perhaps Thomas thought he would be a burden, or we wouldn't respect him if he took time off. Maybe he felt that quitting his job and changing his career would destroy his self-image.

Maybe, maybe, maybe.

He didn't leave clues about his thinking.

Neither Epic Systems nor Group Health Cooperative has shown any interest in understanding why Thomas killed himself.

Sixteen months after his death, GHC still had not reviewed his case. That’s odd, isn’t it? A patient dies while in treatment, and the provider does not investigate as a matter of course.

When I prodded them, GHC claimed, without evidence, that its treatment was "appropriate."?

The treatment was appropriate, but the patient died.

Epic is equally uninterested. Total mystery why he quit. Sometimes people just kill themselves. Shrug.?

Losing a child is like losing a leg. You don't recover; you adapt. You learn how to walk again with a prosthesis. But your leg isn't coming back.?

And there are scars.

Thomas isn't coming home for Christmas. Ever.

We hang his stocking over the fireplace anyway.

We count our blessings.?

Time heals.

A friend quotes St. Augustine: Thomas "is not lost, only called earlier…to the country whither we shall follow him.”

I take some satisfaction knowing that Thomas is free from clowns.

February 15, 2023