The last 24-hours has been rife
with reflection. I learned recently of
the suicide of one of my friends from medical school as she was completing her
residency and preparing for her board examination. Guilt fills me thinking that I was less than
two hours away, and lost track once residency started. Could I have changed the outcome if I had
been there for her? Would it have even
made a difference? How many other people
are feeling lost, hopeless, and helpless to change their situation? Is there something we can do as a medical
community to care for each other the way we care for our patients each
day? The facts, at present, are staggering (from the American Foundation for Suicide Prevention):
- Each year in the U.S., roughly 300–400 physicians die by suicide, and this is an underestimate.
- In the U.S., suicide deaths are 250–400 percent higher among female physicians when compared to females in other profession.
- In the general population, males complete suicide four times more often than females. However, female physicians have a rate equal to male physicians.
- Medical students have rates of depression 15 to 30 percent higher than the general population. Depression is a major risk factor in physician suicide. Other factors include bipolar disorder and alcohol and substance abuse.
- Women physicians have a higher rate of major depression than age-matched women with doctorate degrees.
- Contributing to the higher suicide rate among physicians is their higher completion to attempt ratio, which may result from greater knowledge of lethality of drugs and easy access to means.
How did we get to this point? Fear of ridicule for appearing weak,
jeopardizing patient trust, and lack of understanding from hospital
administration seems to rank among the top reasons why doctors let their pain
fester inside until the only salvation seems to be death.
I had a terrible start to intern
year of residency. Hours were long, the number of notes I had to complete was
seemingly insurmountable, I lost sight of the beauty in caring for other people
and became a cog in the never-ending machine of a hospital. I was abused and belittled by consultants and
transferring physicians alike, left to feel like I was causing more trouble by
being there. After a particularly
difficult week of nights (my second week as an intern), I came home to sit on
my living room floor and sob. As sad as
it may sound to some, if it had not been for my two cats, I probably would have
given up on a career that I now love so dearly.
Their unconditional love in that moment steeled me from putting on paper
the letter of resignation I had been planning in my head the entire night I was
awake. While not a suicide note, it
would have been the end of who I had become up to that point, and I would never
have had the opportunity to be the person I am today.
The following week, I had my first
day of clinic with my preceptor. He was
incredibly caring toward the residents he worked with and his patients. Unfortunately, he is now no longer practicing as a clinical
physician due to his own burnout in the medical field. However,
on that day, he took the time to ask how I was doing. I told him about the events of the week
before, and the resignation letter I had almost written. He told me a story of how one of my favorite
residents from the class above me, my preceptor himself, and several of the
other physicians I viewed as role models had all been in the same place I was
the week prior. They had all penned
letters of resignation, and then for one reason or another, never submitted
them. Some had preceptors, like mine,
who made them feel heard; others had interventions from chief
residents. Regardless, though,
he said that all residents have that moment of complete
hopelessness. At the time, this
solidarity in misery was a relief.
Now, in looking back, I realize
that despite our better attempts, we are all feeding into a system that fosters
toxicity. Why should I feel relieved to
know that others have suffered the way I have?
Why do I still tell other residents the story above to show them even
the most "nauseatingly positive" resident has had moments of
self-loathing? Is this part of the
reason we have the highest rate of suicide?
Is it because even those of us who make it through wear our darkest
moments like purple hearts? We prove
ourselves by pulling out stories of self deprecation, burnout, hopelessness,
and loss of faith in our abilities. We
are not improving the broken system by sharing these stories like they are a
right of passage. Instead, we should
share these stories as an opening to accepting the vulnerabilities of our
fellow physicians. We can only heal our
system by first working together to heal ourselves. This culture of destruction will get us
nowhere.
Strength comes in opening up,
allowing ourselves to be vulnerable such that other physicians feel they can
also come forward and speak the unspoken.
What would happen if, as a fellow physician, I was present for one of my
own who was in need? What if I took the
time to hear the pain one of my colleagues is currently going through? Would it make a difference? Even if I don't have the expertise to do more
than hear them and sit with them in that pain, would that be enough? Could I open the door to obtaining necessary
mental health care that would be able to provide that person the support they
need to continue in a career they were so excited to become part of in medical
school?
Is there more we can do at the
medical school level to provide students with the tools they need to speak up
when they are hurting? Can we be present
for them to share their darkest thoughts and feelings? Would other female physicians-in-training
benefit from knowing that imposter syndrome is real and likely a huge driver
for female physician suicide? What can
we do to improve their self esteem, to let them know that while the feeling of
being an imposter never fully goes away, it can be dampened so we can continue
to be huge advocates in the field of medicine and for our patients? How can we create an interdisciplinary team
for ourselves like we do for our patients?
Medicine as a career is isolating
in and of itself, but we become even more isolated by turning our backs on each
other. In general, the only other people
who can fully understand the suffering and pain medical professionals see and
care for are other medical professionals.
If we ridicule each other for succumbing to the normal physical and
emotional reactions to repeated trauma, then we only do a disservice to our
community. When our comrades have no one
to turn to, drowning and numbing the pain because the first alternative. When that is no longer enough, then death can
become the most appealing outlet for the deluge we cannot hold back on our
own. Our hope is always that someone
will first hear our cries for help, and grab hold until the storm passes, the
current slows, and we are able to pull ourselves out of the mire and to the
safety of shore. When this all too often
doesn't happen, the easiest course is to give in to the pull of darkness, and
quit fighting. Let's start building
rafts and lifeboats for each other instead of reacting only to the shock of
watching another physician's lifeless body go over the waterfall and disappear
from sight.
