I treated a service member for an anxiety disorder in the outpatient mental health clinic during my residency training. He responded to an antidepressant, and his symptoms were in remission for several months before receiving a deployment tasking. He was able to complete his job duties without problems. At our last appointment, he thanked me for helping him and told me that he would call me after completing his tour to make a follow-up appointment.

True to his word, he called me after returning home. He said that he was doing well and would schedule a follow-up appointment after his two week post-deployment leave. Two days later, my training director called me into his office to tell me that this patient had died by suicide via carbon monoxide poisoning.

    That was the first time I had a patient die by suicide. I was flooded with shock, sadness, guilt, loss of confidence, anger, and self blame. I thought that I had a good rapport with him. He had responded to treatment. He had no history of suicide attempts. He told me that he was doing well. How did I fail? That last notion stuck in my mind for a long time.

    However, I slowly accepted that, no matter what I did, the outcome would not have changed. Patient suicide is an unfortunate occupational hazard. If patients truly want to die by suicide, they will and they won’t bring their immediate distress to our attention. We should not automatically take that to mean we are incompetent, we missed something, or we failed.

Kaustubh G Joshi, associate professor of clinical psychiatry

University of South Carolina School of Medicine, Department of Neuropsychiatry and Behavioral Science, Columbia, South Carolina, USA

[email protected]

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.