The following manuscript was submitted to the May 2017 Mental Health Themed Writing Contest.
If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.
It’s been about three years since Jacob* committed suicide. In the high turnover microcosm of general surgery residency, there aren’t many who remember him. I guess that can be expected. Time waits for no one. Memories of those long gone eventually fade. In Jacob’s case, memories of the man were replaced by an annual memorial lecture in his name. Each year, I look towards this lecture with a mix of anxiety and guilt.
The anxiety stems from the well-intentioned but misdirected efforts of the lecture organizers. The day is meant to have an emotional appeal and to be an opportunity for trainees and faculty to reflect on wellness and mental health. But in an auditorium full of workaholic, matter-of-fact surgeons, few disclose their struggles and vulnerabilities. The memorial lecture is followed by a “wellness retreat,” during which we listen to more lectures about the importance of time management and sleep, of which we do not get enough as there is not enough time despite all the time management we do.
This disconnect makes me anxious. And I can’t afford to be anxious because an anxious surgeon will hurt patients — at least, that is what I am taught. For those who only have minutes to repair a ruptured aorta before the patient dies, anxiety is a privilege that cannot be afforded. Through residency, I’ve learned that emotional wellness is for those who are not responsible for the lives of others.
Guilt — the other emotion I am not supposed to feel — weighs heaviest. Despite the name of the lecture, we never actually talk about Jacob. Maybe if I had been a better colleague, a better friend … maybe he would not have killed himself.
Those of us who knew Jacob agree that he was a very nice person, but not a good resident. In our environment of team-dependent work, niceness does not compensate for the extra work others have to do when a team member is inefficient or incompetent. In fact, the niceness just breeds contempt. I was angry with him. I was angry that I had to do his work. I was angry that he was so damn kind-hearted. Anger, I knew, was an emotion I was allowed to feel.
After he committed suicide, the program director said there were no signs of depression. One moment, he was fine. The next moment, he was dead.
Jacob was objectively one of the smartest people in the entire program, consistently outscoring everyone on the yearly in-service exam. And he had a very successful career in the medical industry prior to joining the residency program. But Jacob constantly showed up to work late and disappeared during the workday. He made mistakes he shouldn’t have. Things didn’t add up. We ignored the inconsistencies. Instead of investigating further, we labeled him “lazy.” Once labeled, that was the end of any extended collegiality he would receive. No one wanted to work with him because it meant a larger workload for everyone. He was, to a degree, ostracized by faculty and house staff.
The only person who will talk about Jacob with me is Dr. P,* a retired surgeon. He once sat on the resident review committee that evaluated house staff performance for promotion. Jacob was a frequent topic of conservation and Dr. P had recommended that Jacob seek professional psychiatric help. But there was no clear process to seek help. The resources were not readily apparent. Jacob was gone shortly after the committee concluded he would not be promoted to the next post-graduate year.
Resident wellness and mental health has become a greater priority since Jacob’s death. In addition to a change of administration, an associate program director has been dedicated to running a wellness curriculum. The program adopted the ACGME’s initiative on physician well-being with a focused approach on five areas: education, resources, influence, research and collaboration. There is an annual wellness retreat and designated ombudsman to resolve interpersonal conflicts. But there is still much to do. It will be no small task to promote well-being and combat burnout while maintaining a rigorous training environment. The effort will have to continue long after those who worked with Jacob leave following their training.
But his memory will live on in more than just the annual memorial lecture. It will live on in the way we treat each other. Since Jacob’s passing, we have simply been nicer to each other. I am careful about labeling my colleagues as “lazy.” I treat them as I would want to be treated — as a person first and as a surgeon second.
And most importantly, I now allow myself to feel emotions. I acknowledge my anxiety, guilt, anger and sadness when I think about Jacob, and recognize these feelings as an important part of my experience as a resident and a human being. In doing so, I am preparing myself to acknowledge love, hope and fulfillment — feelings that I wish would have prevented Jacob from taking his life.
Author’s note: * Names have been changed to protect identities.