Millard Salter’s Last Day

Psychiatric TimesVol 35, Issue 7
Volume 35
Issue 7

In this novel, we join New York consultation-liaison psychiatrist Dr Millard Salter for what he intends to be his final day on earth.

Millard Salter's Last Day


by Jacob M. Appel
New York: Simon & Schuster; 2017
245 pages • $16.00 (softcover)

In this novel by psychiatrist Jacob M. Appel, we join New York consultation-liaison psychiatrist Dr Millard Salter for what he intends to be his final day on earth. He has plans to hang himself at the end of the day (his 75th birthday), so that he doesn’t end up growing old and dependent. He has had one loving marriage and had fallen in love again in his widowhood. Three of his 4 children are successful, and he has had a productive career. As a psychiatrist, he will have, like the rest of us, spent much of his working life doing suicide risk assessments and envisioning risk reduction plans. “Had he been one of his own patients, he’d have phoned 911 immediately.”1p9 Yet Dr Salter is not depressed; rather he has rationally planned out his suicide at length.

While the topic sounds like it could be nothing but morose, Appel tells Millard’s story with warmth and wit. Millard’s swansong of a day is not as expected. It is filled with a medical student who needs a letter of recommendation, VIP patients, and a hilarious malingerer (who rents his NYC apartment out on Airbnb and thus requires a hospital bed), departmental reports that need to be filed, a narcissistic colleague, and of course trying to make sure his family is sorted. The protagonist psychiatrist is someone we as psychiatrists see parts of ourselves in. I loved that Millard had his own private jokes-even in his last day of life-eg, promising that he has no plans for a vacation the next day when asked about work tomorrow, and making up inappropriate names for his wayward son’s dogs when his annoying neighbor asks. One can imagine oneself at 75 when, like Millard experiences, none of the trainees we are teaching know our pop culture references. (It happens to some of us long before 75.)

In addition to the mundane occurrences of the day, Millard is attacked by a lynx cub loose in the hospital. Presented with wicked humor, this still gives one pause. Why put disinfectant on his wounds if he is only going to kill himself in a few hours?

Appel is a New York City psychiatrist, lawyer, and bioethicist who has written on rational suicide and euthanasia. He holds 7 Masters’ degrees and was featured in an AOL story as potentially being “America’s most overqualified, overachieving worker.”2 He is also a prolific novelist, short story writer, and playwright. He has written for the Huffington Post and the New York Times.

Millard Salter’s Last Day was awarded the William Faulkner-William Wisdom Prize. The book is a thought-provoking novel by a psychiatrist, about a psychiatrist, grappling with suicide, which is usually considered a psychiatric issue. In sum, the book makes even the psychiatrist reader ponder rational suicide in advancing age and close to home, all the while injecting humor. Whatever one’s views on rational suicide, this book pushes the reader to explore them further. I highly recommend Jacob Appel’s Millard Salter’s Last Day.


Susan Hatters Friedman, MD is a forensic and perinatal psychiatrist, at the University of Auckland and Mason Clinic Forensic Services.


Dr Hatters-Friedman is Associate Professor, University of Auckland, New Zealand.


1. Appel J. Millard Salter’s Last Day. New York: Simon and Shuster; 2017.

2. Fastenberg D. Is this America’s most overqualified, overachieving worker? March 22, 2012. Accessed June 18, 2018.

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