Frank’s suicide does not seem related to his status as a medical student, but when Pearson later presents statistics on the prevalence of depression and suicide among medical students and physicians, the connection is plausible. Male physicians are 1.4 percent more likely than non-physicians to die by suicide. For female physicians, the number is 2.3 percent higher. Pearson writes about the all-consuming nature of medical school and 24-hour trauma shifts as periods that block out the world, including the good things that might bring joy or relieve the pressure of academic of professional expectations.

When Pearson is depressed, it is a profound despair to the point that she doesn't even recognize it as depression. She sees it as an integral part of herself, this lifelong desire to die. She feels “doomed” (93) to be a medical student. Although depression distorts her thinking, she still pushes forward in a field that will require her to be close to death for the entirety of her career. To Pearson, the rigor required for elite medical practice sounds like it must almost exclude other interests, hobbies, and cannot allow for other passions. Her remedy is to encourage physicians to strive to maintain a life outside of work.