Year 25 at the Bedside or the Blackboard, and Running on Empty : The American Centinel

She has charted through double shifts and graded essays at the kitchen table at midnight. She remembers the names of patients and students from years ago. Now, a quarter century into a career built on caring for others, a nurse or teacher in her late forties may find that the well has gone dry.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.

Burnout is a word people use a lot in these professions, and it is real. But sometimes what looks like burnout is depression, and sometimes it includes thoughts of suicide. Caring professionals are often the last to say so out loud, because they are used to being the ones who help.

Why year 25 can be a breaking point

By midlife, many nurses and teachers have absorbed years of hard moments: patients they could not save, students in crisis, short staffing, angry families, policies that change faster than anyone can keep up. Each was manageable at the time. Together they can leave a deep residue of grief and moral strain.

Home life often adds more. A woman at this stage may have teenagers at home and parents who need rides to appointments. She may be in the middle of perimenopause, with night sweats that wreck sleep before a twelve hour shift or a full day of classes. Retirement can feel far away and too close at the same time.

What coworkers and family might see

Colleagues are often the first to notice, because they share the same hallways. Signs that deserve a closer look include:

A nurse or teacher who used to be warm becomes flat, short or detached
Calling in sick more, or never taking a day off and refusing breaks
Comments like I cannot do this anymore or nobody would notice if I disappeared
Pulling away from the break room, team lunches or long friendships
Feeling like a burden to her family or her team
Talking about death more than usual, or seeming to say goodbye

Anyone who hears talk about wanting to die should treat it as serious, even if it comes out sounding like a joke.

Asking the question caregivers rarely get asked

Nurses and teachers spend their days asking others how they are doing. They rarely get asked in return. If you are worried about a colleague, sister or wife, ask her directly. Are you thinking about suicide? Crisis counselors are clear on this point: asking does not plant the idea, and it gives the person permission to tell the truth.

If she says yes, stay with her. Tell her you are glad she said it. Help her call or text 988 together, or help her get to her own doctor or a mental health clinician soon. If she is in immediate danger, call 911. During a rough stretch, it is wise for families to store medications and firearms safely or out of the home, without making a scene about it.

Care for the people who give care

Many hospitals and school districts offer employee assistance programs with free, confidential counseling sessions. Those can be a good first step. So can a frank appointment with a primary care doctor about mood, sleep and perimenopause symptoms. A woman who has always put herself last may need someone else to help her make that call.

Depression is treatable. Caregivers recover, and many go on to keep doing work they love once they have support of their own. Help works, even after years of running on empty.

Another option a clinician may raise

For a nurse or teacher whose depression has come with suicidal thoughts, a clinician may describe this newer treatment. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.

Many clinics that offer this treatment begin with a free first consultation where she can ask questions and find out whether a full evaluation makes sense. She is welcome to bring a colleague, partner or friend, the same way she has shown up for so many others.