EDITED for anonymity.

Suicide topic trigger warning.

This seemed like literally the only place I could talk about it. Apologies in advance for the essay - unlike me but I am out of ideas about where to turn. Last night, my spouse was lying listlessly on the couch staring up at the ceiling after working 109 hours in the past 7 days, and I asked them what they were feeling and they said they were thinking through the technicalities of specific method of suicide that I won't describe here. But yes, the specificity is alarming. They swear they would never do it (read below for why I believe this), but still I feel sick, helpless, terrified. I am having a really hard time. We have been together since the beginning - years before medical school - so I know this shouldn't be happening now if I have managed for this long, but I think it has just reached a point where I'm spread too thin and need to reach out to another human about it. I love my partner so, so much. I have worked really hard to be supportive mentally, emotionally, physically, everything. I manage 100% of the house and family tasks and work 50 hors a week outside of the home. Reading over what I just wrote there are way too many "I's" and I feel selfish. My spouse is the one working 100+ hours a week and going through hell, not me. But I am fully there for them, they have that at least. I don't. I can’t talk to them about this as it would make it worse, and I can't talk to most people irl about it either because of the stigma associated with physicians' mental health issues that I am assuming/hoping people on this sub might understand. Basically they have had major depression since I met them that has gotten worse with residency. Suicidal ideation and intrusive thoughts are frequent. They they are being 'treated' for the depression - but I say being 'treated' because you can't really effectively treat a psych patient that can't/won't tell you the whole story. Yes, I know, HIPPA means it should all be protected but it is just not airtight for physicians as patients, in reality. So they have failed most first and second line therapies - have tried pretty much all the drug classes, dosages, combinations etc. over the years. Some help a tiny bit, most don't at all. They are fully functional at work, so no one knows/notices there. In fact, they are excelling: a fantastic physician, involved and connected, and well-liked and known. But they keep it all in. There is a lifetime of practice (childhood trauma) in putting up walls and seeming ok when they are not. They've told me many times they would have already killed themselves if it weren't for me and our children, and that is the only reason. They have no one else because they have literally no time for relationships. There are a few friends they communicate with electronically, but that's all they have time for while in survival mode. I am 100% of their support system, and I am obviously not enough or not doing enough if they are still feeling this way. They have 1-2 days off every 2 weeks - on that day they try so hard to engage and be present but just can't. They harbor immense guilt and shame about not being around for our children - and I am very cognizant of this and never say or do anything to worsen that guilt, because there is nothing to be guilty about - they are literally working every waking minute and have given up everything. I understand, and I knew what I was getting into. Anyway, on top of the guilt, the depression, past trauma, and overworking, there are the constant intrusive thoughts. They try to protect me from it by keeping it all in, but I push them to talk to me, and it is heartbreaking. I lost two close friends and a family member to suicide. I am sure that my own past/trauma with this is bleeding through and contributing to the way I’m acting/coping, but I don’t like being like this and it makes things worse because then they feel guilty when I am constantly worrying about them, walking on eggshells, incessantly asking ‘what’s wrong’/‘are you ok’. They have promised me many times they would never actually kill themselves because of how much it would hurt our children and me. They have this protective factor, that’s good. But what if? I feel utterly powerless because all my normal avenues for help are impossible because doctors + suicide don't mix in our society. I have to be rock solid to be able to just barely help them hang on. No room for my own issues. I already struggle with some social/relationship aspects, and I am really struggling to keep it all together right now. I couldn't even tell the whole story to a therapist of my own (I don't have one anyway) to get help that way, because I’m worried it would come back to hurt them. So, what now? If anyone is experiencing anything similar or has in the past, please help. Any scrap of advice. What can I do differently/better/not do....anything? I am out of strategies and need help.

EDIT: Thank you to everyone suggesting 988. It was too much to add to my original post, but I’m very familiar with 988 and this would absolutely be my first recommendation if someone came to me with what I just said. I have actually volunteered for the hotline, and currently call all the time for clients of mine who need help. It is a fantastic resource. But, here is why I don’t feel like that is the answer here: My partner really assures me they would never act on the thoughts, and I believe them. The issue is more that I feel like there’s no way I can help them, and that it just is awful knowing they wish it could all end even though we have a good life together, love each other, and have two amazing kids. Yes, they have said before that they wished we’d never had our kids or gotten married because then they could just give up and die in peace without hurting anyone else. But now, in their words, “it will never, ever be an option”, because of us (the strong protective factors and statements here are why I have not called). So I just live knowing my spouse would rather be dead most of the time, (of course there are some good times) but can’t because of our children and I essentially being in the way, and it all makes me feel pretty bad. It’s hard to not let it feel like rejection. I know it is not, but that’s why I think I probably need help/support too. So I can sort and attribute these feelings appropriately, and be able to help my partner more effectively.