16 After a Suicide | A Toolkit for Physician Residency/Fellowship Programs Helping Residents Cope In the aftermath of a suicide, residents may feel emotionally overwhelmed, and this can disrupt patient care as well as learning and overall performance. Most residents have mastered basic skills to control their emotions, but these skills can be challenged in the setting of a suicide. For some residents it will be their first experience of death of an individual they personally know, let alone by suicide. As physicians, however, the residents are likely to recognize complex feelings and physical indicators of distress, such as stomach upset, restlessness, and insomnia. Some may experience a suicide death as a psychological trauma, and will have symptoms related to that (hypervigilance, avoidant responses, intrusive memories, numbness, sleep disruption, or negative changes in mood). These symptoms should lessen in intensity over time; if they do not lessen or if they are at a level of severity that interrupts the resident’s functioning, the resident should be encouraged to seek out mental health care. It may be helpful to reach out to residents to help them deliberately process their emotions, and to better identify those who may need additional support. Counselors can meet with small groups of residents to help express feelings and discuss safe coping strategies. Residents can be encouraged to use relaxation or mindfulness skills as a way to cope with intense emotions related to the event. Residents may need to hear permission from the PD that they should engage in activities that will help them feel better and to take their mind off the stressful situation, as well as permission to seek help. Participating in rituals, such as attending a funeral or memorial service, may help the resident resume their daily lives and responsibilities. Pay attention to residents who are having particular difficulty, including those who may have struggled previously, or who begin to show signs of deteriorating health/wellbeing, e.g., tardiness, sick days, short temper, trouble managing workload, or any persistent changes from baseline behavior patterns. Encourage them to talk with counselors, Chaplain, and other appropriate personnel. The loss of a resident also has practical consequences on schedules and work flow, particularly in the residency class which has lost their colleague. Consider solutions such as providing increased physician extender coverage for that year. The one-year anniversary of the death, or other significant dates such as the deceased’s birthday, may stir up emotions and can be an upsetting time for residents. Residents may also be desensitized to death in general, and may react to patient death differently. While physicians can become desensitized to patient death, the death of a peer, particularly by suicide, can evoke strong emotions. It is helpful to anticipate this, particularly for those residents who were close to the deceased resident or who are exposed to other deaths or challenges soon after the loss.