Can we talk about getting the medical blues?
I mean when someone who is normally light and rainbowy starts to see the evil everywhere. When the world that medical peeps are in makes clouds drop over everything good in this world. When the dismal fog makes suicide seem like a legit answer when the question is “why am I getting out of bed for this?”
(skip to the bottom for lessons learned if you want - I get pretty wordy here)
Before I decided to go to med school I worked in a copy shop. One of our regular clients was a family doc who made me laugh. He was awesome. He went above and beyond for his patients, making great learning tools on his own time. He was also a coroner in the area. When his assistant picked up orders, she confessed that she was worried about how much he was working and how much he put into his practice. I began to notice that he often smelled of whiskey at 08:00. He was in a car accident a year after I met him that took his life. I can’t say for sure that it was suicide, but there weren’t any tire marks from brakes. His EtOH level wasn’t released so I can’t comment on that. It’s possible that he just fell asleep, but something in my gut told me it was a purposeful death.
This is my story of fighting against the dark and twisties and almost failing.
Flash forward to me getting into med school. Oh happy day! I cried happy tears all day. I’m an emotional person who feels all her feelings on the outside. This is me. That’s not going to change. When I went to see my family doc to get immunizations all up to date, I told her I was worried about my emotions. She told me to never disclose that I have a mental illness and suggested that I read Iron Doc by Mamta Gautum. She also told me I was going to be a great doc.
I entered med school with eyes wide open. There are dark and twisty places in medicine and I needed to make sure that I was safe from. I read about how to stay sane in medicine from Mamta’s book, but then quickly stopped that practice because who the hell has time for exercise, hanging with family, etc. when you have a firehose of information coming at you? The one thing I did do consistently was blog about my thoughts about medical culture and my place in it. That blog was both a harsh reality for me and a way to express my gratitude for being allowed to be a medical learner, and then a physician.
Residency was hard on me. I was an older than average, fat learner who did not fit the approved ideals of how a learner should look. I was either treated as a moron or as someone who was capable of doing everything without any guidance. There was rarely any in between. I became afraid to ask for help because when I did, well, badness. As a people pleaser, I worked harder and harder trying to get to the point where I would be seen as a good doctor. This was a futile mission, and I would likely see that now, but then, entrenched in those emotions of inadequacy it was impossible to recognize that I was surrounded by idiots. It must be my fault.
I started taking SSRIs to deal with the sometimes crippling anxiety and depression. I had a hard time getting out of bed. My new family doctor suggested a leave of absence to give myself time to recover, but the thought of my previous doc saying to never admit I have mental illness rang in my head. As tempting as a medical leave was I refused to do it. Looking back, I’m not sure it would have helped. I was lying to everyone about how hard things were. I didn’t tell anyone that I was fantasizing about suicide. I was increasing my SSRI dose then telling my doc about it later. I was in hard core denial. I would likely have just spent the time beating myself up for not being strong enough to follow the program, and for letting down my husband who had been footing all my education bills for the past 10 years.
Between residency and practice I took a few months off. I blamed it on my papers not being ready, but the truth was, I wasn’t ready. All I did was watch TV and sleep. I was not recovering my strength at all.
I knew I needed to get a therapist if I was going to be a doc that my patients could rely on. Knowing that 1300 people needed me to be strong is what finally got me to the point of going for help.
I could have been a stronger learner the whole way through, but I had too much to prove as an outsider to medical culture. My discussion about being an outsider to a culture of privilege as well will come another day.
The stress that I was under during my first years of practice was intense. I was diagnosing cancers almost daily. I was working 85 hours a week. Locums that took care of my patients refused to come back because they were too complicated. When I went to my colleagues and supposed mentor for help, I was told this is just how it is. That once I learned to stop being so nice, and stop caring about my patients everything would be better.
I never want to stop caring about my patients. When I am no longer passionate about medicine and about keeping my patients well, it’s time for me to find another job.
I lost a patient my age to malnutrition. Fuck. How the fuck does that even happen in the 2010s??? She had an opioid issue that I frankly hadn’t had time to address. She also had so many social determinant concerns that I was often at a loss at where to begin, but she also wouldn’t let me help. So there’s that. I will work as hard as my patients will to keep them healthy. If they’re not ready to work at it though, I will wait until they are.
Other patients lost their family to suicide or homicide. Children died. I kept diagnosing cancers, many terminal. Patients went back to jail. They cheated on each other. They hit their partners and their children. So many kids were raped. OMG so many…
Stress piled up, so did paper work, and I missed a new cancer in a patient. He’s fine, all’s well, he kicked me in the ass to take a vacation. (btw, when patients are telling you to take a break, take a break.) On this vacation, the thought of having to go back to this practice with those colleagues was too much. I had a plan to kill myself while I was away.
Medical professionals know too much. We can make a plan that will make it seem like an accident, and we know that our colleagues in the coroners office are often implicit in this plan. No one is allowed to know how hard it is to be a doctor sometimes. It was a good plan. Murder mystery of the week quality.
When I got back, I called the physician health program in my province and went to see a psychiatrist. I quit my practice and am somewhere that respects physicians (and nurses, and social workers, and rec therapists - is this heaven???) I am significantly more balanced, but am not even close to being the person I used to be.
1. I am allowed to feel my emotions - they make me into a better doctor who will learn more from her patients.
2. EVERYONE in medical practice needs a therapist. None of us think we do. We have ZERO perspective on this.
3. When your family and docs are telling you to take a break, asking if things are wrong, take a step back. Something is screwy.
4. Things in our personal life are the first to go. I stopped crocheting and making Sunday dinners for friends. It might be running, clubbing, walking the dog.
5. The last thing to go is our capability at the office. This is when alarms had better be flashing in your brain. When you can’t hold your shit together at the office, you need a vacation, you need help. Ask for it. If your colleagues are useless tools, ask outside your group.
6. Lots of med peeps turn to substances for help. Alcohol, morphine, fentanyl. If you NEED a drink when you get home from work, or are considering diverting to enjoy a fix, please get help.
7. There are some fantastic resources available to med peeps if you ask for them.
8. There is a MONSTEROUS stigma around needing mental help in our profession. I am still not allowed to say I suffer from anxiety on my college app in case I get denied. Colleagues act like illness is a weakness (even cancer, that’s another story, not mine, but really eye opening). Find better colleagues. They don’t all suck.
9. I am the hugest proponent for mental health for health professionals, but I am still only confessing this in an anonymous blog. Our culture needs a huge change. My side blog fckya professionalism focuses more on self care since I think that self care should be honoured as professionalism more than not being drunk in public.
10. Even the strongest, most go - to person you know may be suffering. When I told my colleagues I was fantasizing about suicide, they thought I was joking because I was such a strong person.
This was hard to write, but I need to let others who were in similar situations know it gets better. I don’t want to lose more colleagues to suicide.
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