Depression, suicide and my friend Rick Perrie
June 02, 2005
Maui Time Weekly: How did each of you first meet Rick? I'd love to hear your stories.
Lepolstat: I joined Maui Medical Group in 1990 and at that time Rick was still working there. I remember the first day on the job. As a new person you are kind of anxious. I remember Rick coming down for a consult, and his smile immediately made me feel at ease. That smile. He was just being himself. We had a chemistry together from the get-go. We became friends thereafter and I've always respected him on a professional level as well as being a great friend. We were able to have fun on a medical level and a social level.
Sands: I met Rick when I moved back to Maui in 1988. I don't remember when I first met him but what I do really remember and appreciate is that Rick hired me to work at the Kihei clinic and paid me the best money to work there. It also made more abundance in my life because after that I started making more money everywhere else I worked. I really felt appreciated by him for the work I did. Like Bruce said, he made me feel like his best friend. He really encouraged me. He often suggested we go into practice together. I was very honored by that. We had lots of good times together. We did a lot of Hana Relays together. Rick even came to a Tantric introductory evening for a group I was a part of! He was very supportive. He lived it big.
Lepolstat: He lived intensely.
MTW: Being doctors, you are responsible for patients all day long. This puts you in the public eye all day as well. I imagine that this could create a great deal of stress and be especially challenging for a physician struggling with depression.
Sands: Suicide and mental illness are higher in physicians.
Lepolstat: Doctors are the worst patients because they deny and self-treat. Maybe because we know the consequences of what we have to go through if something is wrong.
Ehrlich: Time is a factor. I think doctors aren't really aware of how habituated they become with severe time restraints. It's so insidious—with time you become unaware of how much you take on. It's not only the time, it's the intensity of it. It starts in college, actually in high school. You start out in a highly competitive academic environment that trains you to sacrifice a lot of yourself and your lifestyle, your studies and your career. You get used to that kind of lifestyle. Then, years later, one day something shatters in your world and you get a glimpse of what you have lost and how daunting it will be to try to recapture that part of your life. It is so important for healthcare providers to keep sacred some part of their world… a part that does not get sacrificed. It is like your temple that nurtures your own physical, mental and spiritual health.
Davison: That's exactly what I went through and it's why I pulled the plug and took some time off. I was going down that same road. I can see the constraints where you start to organize everything into time slots. The notorious thing is that doctors are always late. You are used to people waiting on you, so you don't manage your time very well, and it's a lot of pressure. I think it comes back to "Physician heal thyself." Doctors are the worst patients. We don't recognize a lot of what's going on for us.
Ehrlich: Rick really did well when he took the time for himself. When he went to Colorado and went skiing, he was so recharged.
Lepolstat: Being a physician and trying to be a good physician—it's a 24-hour-a-day job. You can try to put it behind, but in the back of your mind there are always questions like, "Did I give the right diagnosis?" I would try to put it aside to go biking, but it always came back. Like at 3 a.m., when I'd wake up in a cold sweat. So I was never totally free from my work. I'd be lying on the beach on vacation and be thinking about a case a year ago. It's so hard to get away from. Underlying subliminal stress factor no matter what you do, and as the years go along it gets worse… I saw Rick 10 days prior to him dying and we talked about the possibility of him going to Aspen. I thought he might be thinking about taking a year off. That's why I was so astonished when I heard he took his life that Monday because I thought… His mood swings must have been so up and down.
Sands: I was gone the two weeks before he died, and I wondered if he was just sitting up there in his house by himself. But you guys had really reached out. He wasn't in isolation up there.
Lepolstat: I talked to someone who said if we knew about this, we would have had a team of people going up there, being on his case 24 hours a day. When I heard that I thought, "Why didn't I become more aggressive as far as finding more help for him? Why didn't we call a psychiatrist?" We all knew he had talked about it. Maybe we denied that he wouldn't do it. Maybe there's a lesson to be learned there.
Davison: I remember the first manic phase he had. I said, look we have to do something about this, because it's going to lead somewhere. He needed to be supervised and not treating himself. He pulled out of it after that, then I heard he was seeing a psychiatrist. I talked to him and it seemed like he had it under control. And now I feel like you do.
Lepolstat: This is all in retrospect. We didn't do anything wrong. But what is the point where you say, "I'm going to break that line of friendship and get help."
Ehrlich: In such a small community, it's hard for a healthcare professional to feel confident about reaching out in such a crisis situation.
Davison: And they don't want it spread around the community. Because it does happen, doctor to doctor, or therapist to therapist.
Lepolstat: It does happen. It's a small town.
Ehrlich: This is why we are talking about starting a foundation in his memory that can be a safe haven for someone like a doctor to go to.
MTW: I've gone through this dialogue with myself a million times. Rick wanted all of us to respect his privacy. Where do you draw the line between respecting someone's privacy and breaking it to get help?
Ehrlich: Yes. Rick really wanted his privacy respected.
Lepolstat: He had been planning this for a long time. He had read books and bought equipment. He had thought this out a long time. It wasn't a spur of the moment thing. It was planned.
Sands: The thing about suicide–it's still a moment in time. Seems to be true that if someone wants to kill themselves, they will. But still it's a moment. If he could just have gotten through that moment... If he had spent the night in the hospital... Like Courtney said, where do you respect the person and separate the illness? We are so close to him, so how do you separate those? When people are manic they are hard to reach, they have this huge energy around them. When they come down they are easier to reach, and that's a tough time for them.
Ehrlich: With Rick I always had a good time. He made you feel so okay, like, "Oh man, you are a good guy. You are a bud."
Lepolstat: He could definitely laugh at situations, laugh at himself, get you to laugh at your own self.
Sands: What amazes me is that he did this for so many people. There are four of us here, and so many more out there. Even women had this connection.
Ehrlich: Especially the women!
Sands: But he didn't sleep. I can't imagine the stressors of running that practice: hiring people, the billing, the computer system. But he did it. And he even did the Rocky Horror Picture Show with you, Nathan.
Ehrlich: That's a touchy subject for me! He was the guy throwing the shills in the audience: that role was just cut out for him. He'd be the guy in the audience yelling "Whore!" at Janet. Or "Where do you get your drugs from?" when the actor was about to say "Columbia." He had all these little bits and he just nailed it! His part is a tradition in Rocky Horror. The audience members know what he's going to say. It's written into the dialogue. But by the end he was using poetic license and doing his own ones! That was the zenith of Rick's enjoyment of life, and unless he was going to get up there and be one of those Transylvanians, that was about as good as it was going to get.
Davison: I was sitting next to him at one performance and I had no idea he was supposed to be doing that! When he started yelling I thought, "Oh no, he's losing it!"
Ehrlich: By Halloween he had just started creating his own ones.
Davison: Yeah, he'd throw in a few extra.
Ehrlich: As an actor you are waiting for his beat to throw in your line. And then he'd extend his part out… He stole the show.
MTW: Does anyone remember the story behind his game show streak?
Ehrlich: The game show was called Press Your Luck. He is the all-time money winner for this show. He's like a cult hero!
Lepolstat: You can look him up on the Internet.
Ehrlich: It's that "No more wammies!" show.
Sands: He was in medical school at the time.
Ehrlich: He did a lot of game shows.
Lepolstat: Even Family Feud.
Ehrlich: Family Feud! Now that's a great story. It was down to the last question, "Name something that comes in pairs." His family needed to get one answer right to win. So the family is conferring. His brother Gregg says "a pair of boots." Another one says "a pair of slacks." But Rick is the captain. So the game host goes, "Okay Richard, what has your team decided?" Rick decides he's not going to listen to what anyone else has said, and he answers, "I'm going to go with… a pair of lovebirds!" The game host looks at him in disbelief and pauses. "Okay, well then, let's see a pair of lovebirds!" Needless to say, the Perrie family lost the show.
Sands: He won enough money to buy his house in Los Angeles on Press Your Luck.
Lepolstat: It was a strategy. He was good at strategies.
Ehrlich: Rick was a genius. He'd go in there and just work it.
MTW: Could you tell me more about Rick as a practitioner?
Ehrlich: That's how I first met Rick. I met him on the phone when I needed someone with better diagnostic skills. Lots of times over the years I would call him and ask questions and he was more than happy to help out, under any circumstance. He just made me feel so comfortable. He's a busy doctor, he might not see this patient, but he would overextend himself to make sure that whomever I was treating was taken care of. And, he would take any referrals I would send him. He was always there for a patient.
Davison: An interesting thing about Rick is that he and I would many times see the same patients. I would see things from a more energetic approach, and he'd be looking at it from a disease perspective. But he was generally always willing to consider that other aspect. He could put aside his diagnostic mind, and say, "Yeah, you know I never really thought of it that way." Even though it wasn't his background or his understanding. He was very open like that. And I admired it.
Sands: Since we are both in allopathic medicine we talked a lot about cases. I really valued him and respected him for his intrinsic empathy he had for patients who came to see him. He enjoyed them, he'd stay with them, he talked to them. He was there for them probably more than anyone on the island.
Lepolstat: Suffice it to say he was a very conscientious physician.
Sands: Rick was a dragonslayer.
Lepolstat: He would never take no for an answer.
Sands: He was fearless. That whole fearlessness was remarkable. One of the ways I see his suicide was the courage to take that last step.
Ehrlich: I agree… Still, I hold onto the belief that tribulations and hard times will always resolve. Like a suspended musical chord, there is tension and dissonance, and then it comes back and there's resolution.
Lepolstat: I come back to it being bipolar disease that brought him to this level of suicide. So I think it's courageous, and on the other hand, I think it's an act of desperation, a very selfish act. Because look at how it has affected his friends, his patients and his family.
Davison: Yeah, it's both.
Ehrlich: For a long time he probably hung in there for us. It may have been for years. I wonder if he ever thought, "I wonder if my friends know how long I hung in there to be there for them."
Davison: From one side we can see it as a psychological condition. But then it's also a metaphysical crisis, when one realizes there are two parts that can't come together. These parts can get further and further apart, as in Bipolar Disorder, unless you medicate yourself to dull the two aspects of yourself. We all go through that, where we overindulge in self-criticism. And then you come back to a point of self-referral, and things get lighter and feel brighter. We appreciate the present state of being. I think when you push it, and medicate yourself, and have sleep deprivation, and then an injury, then those two parts of yourself get harder and harder to get back into unity. I don't think any of us have been totally in peace all the time.
Sands: I have moments of it.
Davison: We all have moments of it and want to get closer to that place where we experience integration and become more present more of the time.
Sands: It plays out on many different levels. Both personally with Rick, and I'm also trying to generalize it. He told me that 30 percent of people who are Bipolar commit suicide. He didn't want the diagnosis. He was looking for something else to explain what he was going through. But this time, I think it was a confirmation that he had cycled again, and this was what he was going to be living with, and the implications of that.
Sands: So I was really disappointed when he decided not to follow through with a psychiatrist who he respected and who could monitor his medications.
MTW: That last week he sent me an email about seeing a patient who reminded him a lot of himself, the mood swings and everything that goes along with it.
Sands: I think in many ways physicians become better healers when we've had these experiences. He had the empathy and insight.
MTW: How do you each handle the stresses you mentioned earlier?
Lepolstat: Everyone handles it different, because everyone has different personalities.
Ehrlich: Music. Music does it for me. Music, Capoeira, body disciplines, sports.
Lepolstat: Running and cycling are great for me. I also made a pact with my wife that at age 55 I would retire. I'm the oldest one here. So I was doing it the longest amount of time. It wears you so much. It starts to take its toll on you. At age 55 I decided there are other things I wanted to do. For me, I would handle the stresses purely by sports. And movies. Going to the movies.
Sands: I love to be outdoors. Running, windsurfing, biking, hiking, whatever.
Ehrlich: Sounds like Rick.
Davison: For me it's about getting in the water and being active in the water with surfing, kiting or just swimming. Just being a part of the ocean, that's why I live close to it.
MTW: What might you recommend to any doctors out there who feel they might be struggling like Rick was?
Sands: One thing is to have a physician who you trust and can go see and talk to. Most doctors don't set that up for themselves.
Lepolstat: Have a good support network.
Sands: Rick had men's group, close friends. I just would have liked to see him have a medical professional he was seeing. I'd recommend setting up a relationship with a therapist.
Lepolstat: Find a support group with others with the same disease.
Sands: We all kind of looked around like, "What do you do?" And really there's not a great venue here for that. We hide our vulnerabilities. I think the professional relationship serves a purpose. There's the opportunity to relate. There's the confidentiality. One of the challenges is that it's meeting with one of your peers. I don't mean it has to be a psychiatrist or an M.D. But someone with which to develop a therapeutic relationship. That's a start.
Lepolstat: I'd like to see more education out there so mental illness isn't such a stigma. It's an illness just like heart disease and cancer.
Ehrlich: That's going to take a lot of education.
Lepolstat: That's right.
Sands: I think we as professionals are trying to de-stigmatize mental illness. Still if one of us has it, it feels like a character weakness, so it's hard to cop to it. MTW
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