Wednesday, January 24, 2018

Physician Suicide and Depression II

I'm going through a hard time.  Hard enough that I told myself today I would write in this blog daily and just talk, maybe even have discussions with some readers.  I want to be a voice for those in similar places as me.  Maybe some of the things I write are what physicians who couldn't continue anymore thought or felt but just could never tell anyone.  Maybe other doctors will feel less alone.  I apologize for my lack of master editing skills, but on days I'm not on call, I'm awake a bit past 4am and come home in the evening or early night.

I go home daily and right away start thinking about tomorrow's anxieties like I have previously described. I drink alcohol to relax, and the same amounts I used to drink have no effect on me.  I decide whether I should keep drinking or not.  I wonder how close I am to self-harm from drinking.  I think of alternatives like tea or water, or novel meals, maybe just laying in bed in the comfort of blankets with my dogs.     

Am I going to be criticized for doing something reasonable and safe but just not the way my attending wants?  Am I going to have tools or equipment taken from out of my hand because someone is impatient?

Am I going to be talked down to loudly in front of everyone because I'm too slow at a procedure I barely have enough experience with?

Am I going to hear others talking about me in a negative way when they think I'm not around?

Am I going to disappoint people because I don't know this medical fact because as much as I study, I'm so stressed and anxious and depressed I can hardly retain anything?

Are they going to think less of me and say it to my face again?

Is it going to be another day of being the first to show up and last to leave, working hard without anyone saying hello to me?

Like I said, I do well on exams, but no one freaking cares.  I'm really about to say something to someone in the program, but everyone before me already has and there hasn't been any change.  I also worry about coming forth and getting labeled as a "problem resident," or be seen as someone who needs to be closely monitored.  I don't want people to build a case against me just because I disagree with the way things are around here and they think me being gone would be easier for the program.

There are so many stories of residents being let go or suspended for various reasons, just look it up or ask what happened to resident X from the year Y.

A problem with medicine is how hard residents work and how the sword of Damocles hangs above us all and how many of our superiors forget what that was like.  I literally haven't seen or used some types of equipment before and I'm spoken to like I'm an insult to people's existence.  It's disheartening to say the least.

My second encounter with the topic of suicide in medicine was in early residency.  I've known of people not in my class, but in my residency program who committed suicide.

Maybe once a year we'll sit in on a talk about depression, burnout, and "wellness," and someone will mention those we lost, but then it's another 364 days of no one listening, no one caring, of doctors with problems suffering in the darkness.  

No one talks about what problems those doctors who killed themselves had.  They only talk about the night they found Dr. X dead in a room after trying to find out why they wouldn't answer their pager.

I never hear people voicing regrets and saying "I really wish I listened.  I really wish I were there for them."  

It's like the death of a colleague is just a passing shadow.  Just transient darkness if their life they forget about.

Today I was talked down to in front of others, I was stressed, I was anxious.  I had cold sweat on my brow for the second time this week.  I kept on making good clinical decisions, I harmed no one, and didn't cause any problems.  But still, I'm treated like less of a person.

Where I am, I think that there are only a handful of physicians who I call "true humans."  As in, people who ask how you are, people who help build you up in skills and confidence, and people who will just listen and understand.  I don't even want to start talking about the personalities in medicine.  Not all doctors are kind.

Only once in residency has someone said it was a good thing I was cautious during a procedure, as an aside.

I'm sad everyday.  And during moments I think I can be happy, I think that I should probably continue being sad. 

I have a friend who I talk to who knows about my situation.  A good number of friends.  One of them tells me to go out, and that it'll help.  I don't see how it's going to make my work environment any less suffocating or less of a slow poison.

I've told people before I think about whether or not I'll make it through residency.  They don't really say much back, they're co-residents and come off as depleted as I am.  Last year I worked with people who made me question my worth as a human being, and made me question my decision to become a doctor.

Everyone around me complains, is unhappy, and shows how stressed they are.  The advice I get from people who have since graduated is always along the vein of just taking it a day at a time.  If only the people who have the power to affect our days listened and did something about it.

I feel like less of a person and almost embarrassed to be who I am because I work with people who are experts and have years of experience and they talk down to me or treat me differently, someone with barely a fraction of their knowledge and experience.

So whenever I see posts from overly excited medical students or people applying to medical school, or med students bragging about their achievements and how they're "destined for greatness," I just can't continue with them.  Medical training either breaks people completely or they emerge whittled down and diminished and may or may not recover.

I have thought about ending my life before, more than once.  I've thought about leaving medicine and finding a way to manage of my debt.  But then I thought that would mean "they'll have won," "they" being everyone who has been so terrible to me.  I'm not perfect, but I show kindness and patience others, and I listen when so many around me show me their impatience, and their insults.

I can't let the cruel people win.  I can't become a conversation topic that surfaces once a year.  My life is worth living, as sad and eroded I feel everyday.  I think it'll get better someday, I truly do.  At least I want it so badly I think it really will happen.

I get through everyday by sheer will I find somewhere in my spirit, and a mantra I repeat over and over: "I've made it this far.  I can go further."

19 comments:

  1. Hey, are you in Dallas? Probably Parkland, huh? Bless your heart.

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  2. It was on ICU nights my intern year that I had my break down. I was probably working with one of the smartest upper years, which made me feel all the more stupid. It wasn't even that bad of a night. But it was enough to break me. I was afraid I was going to kill someone, with how numb and terrified and stupid and incompetent I felt all night long. I did not feel personally healthy enough to care for anyone, since I could barely keep my own head above water. I was drowning. It only took 6 weeks of residency to turn me from a happy-go-lucky person, into someone who was willing to throw everything away just to not have to go back to work the next night.

    So that's what I did. I didn't go back to work the next night. Or the night after that. In fact I ended up not going to work for almost a week. Instead, I laid on my bedroom floor, staring at the walls and ceilings for hours. I laid there, contemplating whether it would be worse to call my chief resident and tell him that I was quitting for real, or to tell my friends and family and husband that all that money and education was now wasted. I also considered if just killing myself would be easier than either of those options.

    However, my program encouraged me not to quit, and instead referred me to a psychiatrist. I only met with the psychiatrist a couple times, but she started me on an SSRI and briefly Xanax for the severe panic attacks. I also had a few sessions with a counselor, who actually ended up teaching me quite a lot of useful coping strategies and things about myself that I guess I already knew but didn't know how to put into words (i.e., I'm a catastrophizer, I believe that the worst will happen and people think the worst of me and are judging as such).

    It took a couple months for things to truly get better, but they did eventually.

    I'm not going to say everything is perfect now, and I do intermittently need to get back on the SSRI. But now I know that getting on it earlier is better than later, because taking just one small pill a day is nothing compared to the misery I felt for those few months. I guess you could say, my threshold for starting it again is much lower, because I know how much it helps, and I really believe if it didn't save my life, it certainly saved my career.

    I'm pgy4 now, also doing my training in Texas. I don't know how far along you are in your training, but I really do recommend reaching out even if it's just someone outside of your program, getting help, trying the medications, and seeing what happens. Literally the worst that could happen is that nothing changes. But it's much more likely that something good will come of it.

    I felt entirely alone during that period of my life, and it's only been over the last three years that I've realized many of my co-residents felt the same way or worse than me. Not everyone reached out, but everyone wishes they had or were grateful when they did.

    You Are Not Alone.

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  3. Depression is real.
    Please seek help.
    Residency training is brutal but it sounds like you are in a very malignant program. Seek support from “better” upper levels and I sincerely hope you realize that in the big scheme of things, it’s just a job. Do not let that alone define you. Please seek professional assistance.

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  4. I could have written this post during my residency. I just want to let you know that you are not alone in your feelings and that it DOES get better after graduation. During residency I sometimes felt that I would die of anxiety. I often wished that I would get in a car accident on the way to work so I wouldn’t have to face another day of being treated as a subhuman. I felt very isolated, as even some of the other residents in my class would ignore me if I said hello to them in the hallway, and the ones that were friendly didn’t seem to be struggling the way I was. My program director had a very low opinion of me and called me in to tell me what a bad job I was doing. I constantly felt that I was on the verge of being fired. The attendings gossiped about the mistakes residents made, and so any time I was chastised by one of them I knew everyone else would hear about it within a few hours. I could go on and on about how horrible those years were.

    A couple of realizations turned things around for me toward the end. One was that I was being bullied. And I was being bullied because I made myself an easy target. My shoulders were slumped, I hung my head, I was acting like a victim. I had come to believe that I was less than, and that I deserved the way I was being treated. Slowly I came to realize that I did NOT deserve that kind of treatment. I realized that I had value as a human being regardless of my performance as a resident. I learned that the way others treated me said far more about them than it did about me. And I started to believe that I was a good physician. I worked hard, I took good care of my patients, and I treated them with kindness and dignity. When I started to believe that, I started to take unkind treatment less to heart. I started to stand up straighter, look people in the eye, and stand up for myself (in respectful ways that wouldn’t get me fired, of course). One thing I found oddly empowering was to start addressing my superiors, especially those who were rude to me, as “sir” or “ma’am.” It was kind of a way of saying, “You can’t take away my dignity and I won’t stoop to your level.”

    Anyway, I took it one day at a time, and before I knew it residency was over. I now have a job where colleagues value my expertise and seek out my opinion. I work with helpful, friendly people and am treated with respect. I know I have saved lives and that is one of the best feelings in the world.

    So hang in there. Believe in yourself. You know you are a good doctor. There will always be those who will try to tear you down because they are miserable. Do not let them! You will get through this and one day you will even be grateful for this experience and the things you learned from it. But in the meantime, don’t isolate yourself. Find people to talk to who will build you up. If there is a way to contact you outside this blog, I would love to be a listening ear or shoulder to cry on.

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    1. This. You are better than the people treating you this way. Pity them, and stand up for yourself to some degree. I have had depression- did not notice if I had it during residency which wasn't so bad for me- and you (OP BUrnt Orange Scrubs) definitely need evaluation for it in case treatment will help. BUt I feel I rose (mostly) above the harassment by laughing at it when it was the most ludicrous. I noticed gender harassment more, and didn't feel bullying was wrong then, but I recall telling one surgery attending "You can mock me for being Int Med, for being from Kansas City, or for being a chess player. But you can't mock me for being Black, female, or Catholic because that is illegal."

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  5. Just discovering your blog. THANKS so much for this courageous post! Although I'm really sad that training still sucks after over a decade. I did Med/peds residency circa 2001-5 and still marvel at the horrific lack of guidance. I mean, hello, residents are trainees. They're doctors in training. It seems like some programs expect residents to just magically know stuff. I suspect it's just that some programs aren't well-equipped to teach. Please know that it's not you, it's them. You sound amazingly resilient and you will get through. Hand in there and keep blogging about it. Love your work! As a matter of fact, I'm so impressed by this post (as well as having flashbacks to my own residency) that it may inspire a post on my own blog. I'll let you know.

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  6. I don't know who you are;but this too, shall pass. Everyone has to deal with shitty people. Residency is temporary;but the system is fucked for now. You can make a good difference. Learning curves are different for everyone. If you are bullied: assert yourself, don't take discourteous remarks personal. Make clear how people may approach you, and what you will tolerate when it comes to corrections and unfriendly behaviors. You are not alone.Talk it out, this will pass. Change is coming to medicine-it has to, and you are apart of that difference. Talk it out, people are listening. Don't give up. Medicine is rewarding, but it needs integrity, honesty, care, fairness,fortitude,
    and more doctors and see the long game. Stay strong, talk it out, this struggle will pass, resilience will be built, and you will learn, you will manage, and you will be effective in your duties. You are in my thoughts. I wish all the best.

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  7. Hi there. I’m a fellow physician. I had a really tough time in my fellowship program. For two years, I felt like I was in the twilight zone. And I’m a psychiatrist! It was so hard to believe that experts in Behavioral Health could be so unkind and cruel. Thankfully, my experience was limited to that program, and I haven’t looked back since graduating. What I’m trying to say is, sometimes, we can feel trapped in an environment and it feels like there are no options. But there are. One option is to seek out a professional to talk to. It sounds like you’re in a toxic environment and having someone to be a sounding board who can listen without judgment can be tremendously helpful. Of course, I’m Psych, so I am biased. However if sounds like you’re suffering from depression and I hope you will consider getting help. I wish you all the best and I’m sending positive energy your way : )

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    1. Hi psychdoc, sorry to learn of your difficulties, but pleased hou sought help, im a psych fellow too having struggles in a different light. Email me jun2668@yahoo.com
      @

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  8. I’m so sorry. You sound like a very decent caring person. I’d be lucky to find a doctor like you and so would so many other people. I have blocked the miseries of residency from my mind, a few years out. I try to connect with patients with great honesty. That’s what we can really offer that makes a huge difference,

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  9. Hey I don’t know who you are but I am also a resident and if you wanna have a anonymous pen pal I can just be a listening board that won’t judge you because I’m in the same boat. Thinking of you and keep pushing. You are not alone
    Drtiffys@gmail.com

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  10. I hear your struggle....residency also felt to me like one long hazing ritual. You can get through this....with your humanity intact. And then be one of the “humans” to residents and medical students coming after you.

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  11. Hope you are feeling better after your brilliant idea to blog about it. I relate. Your conditions would get anyone down - some would talk about it and others are not so strong.
    I was a medical student who was especially abused by a surgical resident. I was on a senior rotation and figured they'd not kick me out so I told the resident that he couldn't talk to me like that, and I was not going to take it. The turd tried to flunk me on the rotation. I appealed to the director, who already knew about the resident's abusive behavior and he backed me up. State boards are now taking action against people who throw trays of instruments against the wall, etc. I'm nearing retirement now and have seen things improving tremendously over what it once was. Remember, you are 6 foot person standing in a 7 foot deep cesspool, and it is hard to see the expanse of blue sky just above your head. Your program's culture is behind the times. It is no longer considered OK to abuse those whom we are teaching. So, - you might enjoy this - as a staff person with equal if not better command of subject material, when I see someone getting "pimped" (we used to call it that), I intrude into the discussion to rescue the victim, and start pimping the pimper, to expose what ignorant asses they really are. There is always something even the smartest person won't know!! I must say I feel a little guilty for enjoying it, but at least I limit it to higher level staff who are being abusive and deserve it. My point was, though, that over the years I have gotten less and less opportunities to practice this blood sport. Even while we are under duress from above, we can still comfort the sick, and love our patients, and encourage, reassure, and comfort our students. We love them, and they will love us, too. If you are early in your training, maybe you could change programs, or even change specialties. If you are almost done, hang in there. This is the worst it will get, and things will improve in the future. The abuse in medical education is just like child abuse. We'd rather think it is right, than to think our parents were bad, so we pass it on... thinking it is the right way to parent. But, please don't give up. Consider seeing a psychiatrist - I do.. getting through the door was the hardest part, and while I'm sure I could get by without it, I've been happier with it. If you stick it out, you can do wonderful things for your future patients, your humanity being a great asset.

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  12. So sad reading this but im happybyou gotbtge courage to document ur struggles. I recently completed residency and started a fellowship program, i got caught up with visa issues and immigration problems and here i am unemployed.!!
    I wake up every day feeling so useless. I hate loking at my bookshelf seeing all my books.
    I am a firm believer in prayer, residency was not ad bad as urs thank god, in fact i was one of 2 chief residenrs. Life is life my dear. Im waiting for mifacles right now. I wish you the very best i am a christian and believe i prayer, pray for me and i for you.

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  13. Sorry to hear of your hardship, life is such ,my dear. Mine was not an easy task too but i spent 4 yrs and recently completed,worked hard became one of 2 chief residents, now im faced with immigration issues, started a fellowship and became unemployed due to immig. Mattrrs. Im a christian and will never give up hope. I hope u are a beleiver too, .hope and pray for the best!

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  14. Thank you for having the courage to write this; I believe many of us have had some (if not several) of these experiences, probably more than we would like to admit.

    I have been a surgery attending for several years, very much involved with our residency program, and physician wellness is a huge interest of mine. It has become more obvious the older I get how impactful this is to our ability to function at our best as a physician, but also personally. There are many challenges in medicine we do not have control over (attorneys, hospital administrators, insurance companies, etc) but I believe the onus is on us to learn to treat one another better as trainees, mentors, and colleagues. We can hold ourselves to high standards, yet be respectful about it and not allow abuse to be a tactic.

    Wellness is becoming of increasing interest at a national level, and I am hopeful that mental abuse, belittling, and humiliation will eventually not be tolerated. Whether you are 15 or 50, bullying/ lessening others is NOT cool, and I have no problem people here that I feel this way. I have had serious thoughts of walking away due to things similar to what you described several times as a trainee as well as out in practice, but still would like to think there are enough people out there that see things similarly that want to make the situation better.

    I believe that one of the best things we can do is behave in a way you would like to be treated- if you don't already, you will have juniors watching your behavior, and they are more likely to want to emulate you when they are treated with respect. There is truth to the old quote "be the change you want to see in others"- it works :) I would also highly encourage you to seek out opportunities to get involved in resident wellness initiatives at your institution; even if you don't know of any within your department, people with the GME likely could point you in the right direction.

    A healthy activity outside of work is also huge, whether it be a sport, place you like to visit, community activity, religious, animals, or personal hobby (arts/crafts/music)- find one you like and have it be the thing you reward yourself to after a long day. If you ever want to chat, please reply, as I'd be happy to help in any way I can :)

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  15. Sounds like you are surgical, which can be very rough. Despite no time or energy, you have to keep up your connections with the outside world, talk to your family, old friends, go sit at a coffee shop, bookstore, or just somewhere with normal people. I can tell you that it does get better with experience. Someone once said that being a young resident is hard because you haven't ever done these things before, which is uncomfortable, and going around almost 24 hours a day being uncomfortable is hard. This somehow made me feel better that it was okay to be uncomfortable, I didn't have to pretend every minute that I knew what was going on. Find ways to center yourself, 15 minute meditations worked for me some. Overall, just try to remember that this too will pass, no one can stop the clock.

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  16. To the kind hearted resident who so bravely shared your struggle, please know that you are not alone.

    I know what you are going through, as I am also a resident physician. Another commenter wrote that realizing you are being bullied and helped one regain the sense of human dignity - I too am coming to that realization with outside help. I know how prevalent toxic MedEd environments is, and how complacent those in power and authority could be, but just in case your institution has mechanism to assist you in dealing with these unprofessional behaviours, it may be worth checking.

    I hope you have a physician who can look after you. We can all benefit from professional treatments for depression, anxiety and/or panic attacks. More importantly, we need to give ourself a chance to heal from the toxic emotion stressors hijacking our frontal lobes. Even doctors get sick and need time off to get well. Don't be afraid to take a break for your own wellbeing. Pushing through it won't make it any better. You deserve to be healthy and well. Your family and loved ones deserve it. Your future patients deserve it. Your future self will thank you for it.

    In solidarity.

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  17. I am still broken-part of my soul, my spirit, my core ripped out, and, 4 years later, I still have flashbacks. I am filled with regret that I suffered that long for nothing. I am still a good doctor, because I care and worry. But I could have been a good doctor without demoralization, without fear, without abuse. We do not need this nor is it teaching a 'life lesson' to help us later on. You are not alone. We deserve better.

    Things that helped get me through training (for better and worse): alcoholism, pneumonia (got me 2 days off at an emotionally critical time after I collapsed in clinic), promiscuity, the gym, studying for board exams and going to medical conferences(focusing on a side of medicine that made sense), cutting behaviors, friends who are not in medicine, and eventually an independent psychologist (help provided by the program was also malignant)

    I am healthier now because medicine no longer defines my self worth. At least, that's what I tell myself over and over, and I continue to make strides to prove my mantra true. It helps. Transitioning out of medicine, however, will help me more- and that is exactly what I am going to do. Not out of duress, but out of self love. Not out of fear, but out of strength.

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