Physician Suicide and Depression

Recently, another doctor committed suicide.  One of many in a culture that I feel is callous, cold, and rather indifferent.

My first exposure to suicide in the medical field was during med school.  One student a year below me, and one two years ahead of me committed suicide.

We never heard details and I'm glad they weren't really discussed, because it decays into gossip.

I'm not sure why those students killed themselves and I never will.  I just know there is so much pressure to succeed, stress from exams, the collateral damage our friends, families, and outside interests take once we decide to pursue a career in medicine in particular.

I personally struggled with depression when I was younger. I think the freedom of college helped.  Something just changed. My social circle expanded and I met so many intelligent, fun loving people. I think the warmth of new friendship helped me.

Throughout college, though, I did struggle with a direction in life. I eventually settled on medicine because I had a deep desire to help others, others who suffered in many different ways.  Medicine made sense to me as a career, even though I constantly worried about how many credit hours a semester would look acceptable to admissions committees, what GPA was good enough, and if I was just good enough.  Anxiety ate at me. Everyone around me was pre pharmacy or pre med and they all talked about what questions they may have missed after the exam. We all calculated how many questions we could miss and still make an A.

Despite that, in college, I was active and fit. I had time for hobbies. I didn't drink very much at all and I ate healthy for the most part.  Many days were sunny, and the cold days in winter were invigorating.  I was young and surrounded by young people with dreams and desires.

Everyone was proud of me for following my dreams of becoming a doctor. I wonder of they imagined me standing tall and confident with a necktie and white coat, muttering intelligent things and making the sick and dying muster a smile or laugh.

I studied hard for the MCAT, did well, graduated with good grades and started med school.

Just keeping up with the sheer course load was exhausting.  My weekends were spent catching up and memorizing. I was dumbfounded by the students who had so much memorized so quickly.  My anxiety and stress was at least double that of college. I knew people who dropped out permanently, and some who remediated and went on to do well.

I would wake up at 5am on weekends and study until 11pm at my wooden dining room table in my small apartment.  There was no glory in being a med student, just work and stress.  I did have a few friends with dreams and desires like in college, and that helped.  I didn't have a best friend in med school. I was envious in a soft, melancholy way of the people who grew really close.

I was chronically tired and started developing physical symptoms like hyperreflexia and psychological symptoms of burnout my second year of medical school.

Once a friend from college visited me and brought me gifts for morale. It was so kind of them and I still remember how much of a difference it made.

Then I started the clinical aspect of medical school. It was much more exhausting and  demanding than basic sciences.  People demanded so much of me as far as knowledge and performance, but I mattered so little much of the time because I couldn't put orders in or really have a say in patient management.

Some upperclassmen had been dismissed from the medical school after they were discovered to have cheated at some point in medical school.  Medicine wasn't a perfect world with perfect people in it.

I performed above average as a med student.  I never hurt anyone or made a mistake that harmed someone, which I always felt good about.  Someone on Facebook in my class wrote a post vaguely implying they had harmed someone, and they seemed so haunted by it when I talked to them.

Medicine was starting to affect us all physically and psychologically.  It was starting to harm us.  We were shouted at, disregarded, ignored, made to carry out necessary tasks that didn't necessarily need to be done by a doctor.  Patients didn't always get better (I started med school knowing this, and started a bit cynical), we became less idealistic, some of us felt defeated, and some didn't feel anything but complete focus on that one competitive residency.

The worst anxiety, stress, apprehension, and depression began intern year. It dwarfed any negative feelings I had in the past, they were jokes.  It wasn't a learning curve, but I scaled a vertical cliffside instead.  I constantly second guessed myself and kept asking questions to my upper levels if I was doing the correct thing because I was just starting out, thrown into complicated patient care.  I thought about all the possible side effects and derangements in physiology my treatments could cause. I worried about the old attendings humiliating me or expressing disappointment in me for not knowing a certain medical fact, or presenting a patient in supposedly the wrong format.

ICU rotations were draining, but I learned a lot. I was guided by good upper levels, the occasional disrespectful, as well as sarcastic and nearly cruel fellows.  I was hyperaware because patients were very unstable and constantly needed medical and procedural intervention over the course of 20+ hour work days.  There was so much death and dying. The was so much futility in providing care for patients who never got off a ventilator.  I had so many family meetings, comforting the crushed families, and being diplomatic and understanding with family members who were furious that their loved one was beyond saving.  Everyone tries to cope differently. I had goals of care talks about twice a week and up to 3 times a week in a certain ICU.  The families and patients who opted for comfort care were probably less than 5 in all of residency so far.  Dozens of patients were coded over and over until they were even further from ever making a recovery. 

My depression grew in size then. That was in addition to working under expert physicians with years of experience who would make me feel inadequate despite being a beginner.  There was little to no mentorship and none of us were elevated or coached. We were mainly workers with limited experience, expected to perform and know as much as these physicians with years and years of experience as attendings.  I lost much of my self esteem and impostor syndrome surfaced nearly daily.  I kept working hard, carrying teams, and still continue to work hard, pushing my body to its limits in stressful situations.

I feel lonely and very tired.  Tired physically and psychologically, sad and drained.  Everyday I'm anxious about what the day holds and if someone will say something to make me feel small and like a failure.

I'm at the top of my class in residency as far as scores. My evaluations are good and I pose no problems to the program.  I even have a publication in a peer reviewed medic journal.  I check on my fellow residents and make sure they're doing okay. I offer to listen to them.

But the hours are long, longer than attending hours and there's constant, eroding criticism that isn't needed.  I have no meaningful life outside of medicine because of my long hours and demands with exams and expectations of knowledge and performance level.  I feel like I'm not the perfect resident and I struggle with that.

I feel lonely and constantly stressed and anxious and not appreciated. No one asks me how I am or what I want to learn each day.   I'm depressed. I feel lost.

I sometimes think I could be a body on the pavement outside and what kind of dark string of events would make me end up there.  But I tell myself it won't be me because I'm future oriented and that's one good prognostic factor I learned about depression in medical school. I see myself moving through this even though it seems like there's no end in sight. I just know I'll emerge on the other side although I feel trapped and that there are only dark tunnels to keep traveling through.

Many of us are sad, spent, and alone in a culture that labels people with our qualities as liabilities, problems, and poor fits.   Many of us leave medicine by dying, for many reasons. A major factor is how much medicine changes and damages you.  It sometimes feels like you're drowning, with someone pouring more water on you, and sometimes draining some away. 

I really am struggling these months and just need to make it to the warmth of springtime.