I remember standing outside an exam room, phone vibrating in my breast pocket, when the coroner’s call came through. I hadn’t wanted to believe the neighbor’s frantic text about a body bag removed from my husband’s condo, but the medical examiner’s office on my caller ID was unmistakable. I answered, and sounds fell out of my mouth into the phone: “Hello, this is Dr. Hardison.”

I am an emergency physician living in the U.S., and we had one of the top commercial health insurance plans. When my husband, Randy, became suicidal for the first time in his life, I thought I could find him the best care, our insurance would pay for it, and he would get better. Only one of those three things actually happened.

The coroner confirmed it was suicide by asphyxiation. He asked if I could send a recent photo to help ID the body. “In a few minutes I can — I have a patient waiting.” I put the intrusive visual of Randy’s bloated face into a compartment of my mind that was sealed off from the task at hand.

On the other side of the exam room door was a toddler propped in her mother’s arms, coughing between guppy breaths. My face rearranged into calm, and I greeted the mother and child as my eyes darted to the monitor showing low oxygen and fast pulse — signs of respiratory distress. I put the child on oxygen and ordered a breathing treatment and a chest X-ray. The little girl gripped my index finger as I listened to her lungs, and we looked at each other with wonder. Each rise and fall of her chest seemed a miracle.

I felt safer in that exam room than in the outside world. I knew what to do in that room, and in that room, I could make things better. Outside of that room, all bets were off.

“I’d like to test her for influenza and RSV,” I said to the mother.

“Will our insurance cover that?” She mouthed it to me so her daughter wouldn’t hear.

“I hope so,” I told her. “I don’t know why they wouldn’t.”

As I stepped out of the exam room, I became aware of my veins pulsing and a white noise filling my head. Chest paralyzed, I didn’t scream. Instead, I paced down the hall and out the metal door to sit on the curb, waiting for breath to come.

I had fallen in love with Randy because his optimism was magnetic. When his startup began achieving significant milestones after years of sweat equity, he had even more reason to be optimistic. I still have the photo of Randy and his co-founder posing with their first large check, their faces painted with true bliss.

Months later the success fizzled, but Randy never told me how bad things were until the demise of the business was inevitable. The way he tried to protect me from the truth created an ever-expanding distance between us. Each day he withdrew deeper inside an impenetrable shell, and my attempts to connect were met with anger.

As a doctor I should have seen this behavior as a sign of burgeoning depression, but instead I felt wounded by his abrasive tone. I grew fearful of asking questions because they were met with irritability.

One Friday morning, less than four months before the coroner’s phone call, Randy texted me from our home office: I need help. When I opened the glass French door, I was shocked to find Randy on the daybed in a fetal position.

“You have to hide me,” he stuttered. “The investors … they’re coming for me. You have to get me out of here.”

“Randy, that makes no sense. Just talk to them. What’s happened?”

“I can’t do this anymore. Please kill me. Just put this pillow over my face and suffocate me, please. If you don’t do it, I will!” he threatened, grasping and shaking the pillow with both hands. His knuckles were blanching from the pressure of his grip.

Randy needed immediate psychiatric care, and as an emergency physician I knew the options. We put our trust in the mental health team at a local crisis receiving unit, and they kept Randy overnight in temporary safe housing where he could be observed. By morning they had devised a plan to transfer Randy to a retreat-like inpatient psychiatric facility that was in-network with our insurance. The psychiatrist felt Randy was very high risk, but that he could heal with eight weeks of inpatient treatment. We were told our insurance would cover it.

I remember giving Randy a long hug goodbye outside the brick intake building where family members were not allowed. I remember how we lingered, and how he clung to me. I didn’t know it would be our last embrace. He told me he felt good about this place. It seemed peaceful. He would work hard to heal, for me and for the kids.

I felt good about the program, too. I had researched it heavily and agreed it was the best option.

But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care. Randy had just started to feel hopeful, and he was devastated by the news. I was incredulous. How could they go against the psychiatrist’s recommendations? Couldn’t they see how risky that was?

The facility appealed Randy’s case, providing psychiatrist’s notes that clearly outlined his need, but the outcome did not change. Because Randy had no prior history of mental illness, the insurance company determined he shouldn’t need to be hospitalized and stopped paying for his care. A day later Randy was forcibly discharged.

The ensuing months led to a rotating cycle of failed outpatient treatment programs followed by ER visits, brief admissions, and premature discharges. And Randy kept getting worse. He became so unstable with paranoid delusions and psychosis that he was not safe to be around me or the children. He never came home.

A few days before Randy was found dead, he was supposed to have a video chat with our son. Sitting on my lap in his dinosaur pajamas, little green legs swinging back and forth as I wrapped my arms around him, our son turned to look up at me and asked, “Is Daddy too tired to talk?” I gave him a squeeze and rubbed his back. As the minutes ticked by, Randy didn’t appear on the screen. My son became heavier in my lap, his eyes drifting closed.

When I listen to lungs with my stethoscope, I still feel wonder at the rise and fall of each person’s breath, and my responsibility to secure safe passage to the other side of every crisis weighs heavily. But I can only control what happens inside the exam room.

My love for Randy and my professional experience were not enough to save him. I am a physician, and yet my husband died, proving he was sick enough to deserve care.

Now every time a patient asks me, “will this be covered by my insurance?” the feeling of panic returns.

With Randy in my heart, I keep advocating for what is right. During the day on insurance appeal calls. Late at night, fighting sleep to finish charts and check the right boxes so claims won’t get denied.

Joy Evers (née Hardison), M.D., M.P.H., is a board-certified emergency physician, Mayo Medical School graduate, host of the podcast “Your Doctor Wants to Quit,” and founder of Healthtopia Clinics, an integrative primary care practice serving over 35,000 people in Southern California.

If you or someone you know may be considering suicide, contact the 988 Suicide \& Crisis Lifeline: Call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.