Clinical, Emergency Medicine, Featured, Housestaff Wellness
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The Health Provider Paradox: Depression as a Resident Physician

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.

“You need to just take care of yourself” — a phrase I’ve heard often over the past few years. What does this even mean? I thought it was silly and laughable. As a surgery resident, I was working over 80 hours a week with four days off each month. I “literally” had no time to take care of myself. I barely had time to prepare for my surgical cases the next day.

As an intern, my goal was to not be on anyone’s radar. I simply wanted to do my job and not make any mistakes that would put a target on my back. The fear of making a potentially deadly mistake in patient care kept me afloat during that year. The constant ups and downs of stress and anxiety provided enough dopamine and adrenaline to keep me going.

“It gets better. Every year it gets better and better. Just be patient. You’ll get there.” These were the words too often expressed to me by senior residents and peers.   I certainly understood delayed gratification as I watched my college friends start building families and homes while I went further into debt with each year of medical school.

As I was knee-deep in my surgery residency, I would often reflect on whether I was cut out for it. I never accepted failure because I always figured out a way to get myself back on track or at least through the immediate hurdle. Then I realized I had encountered an obstacle unlike any other I had before; this was intangible. It was not like receiving a bad grade on a quiz that I could simply study harder for the next time.

The reality of my situation is that I was minimizing and compartmentalizing a lot of self-doubt and shame that had shaped me. As a surgery resident, to ask for help and to display any signs of weakness was essentially professional suicide. We were expected to be emotionless and stern in the face of crisis, personal struggles included.

I went through three years of surgical residency when suddenly I had enough. I had lost touch with all my close friends and even my immediate family who lived just two hours away. I became a bitter person. I had lost interest in hobbies that I used to enjoy. I knew that the specialty I had chosen was just not the right fit for me. I dreaded going to work. Most days, I just wanted to stay home in my place of isolation, hiding under the blanket in bed, unable to face the reasons behind my shame and lack of self-worth.

I was marching through a dark tunnel with no foreseeable light at the end of it. It was at this time that I finally got help. A sentinel event resulted in me having to take some time off from residency. With the support of my program director and residency leadership, I finally “took care of myself.” I am still grateful to have been given the opportunity to determine the root-cause of my behavior and transgressions. Underlying it all was untreated depression and a generalized anxiety disorder.

These were diseases that I saw in patients during my medical training, but I had no clue that I was also afflicted with the same diseases. As doctors, we know “SIG E CAPS” — lack of sleep, lack of interest, feelings of guilt, lack of energy, lack of concentration, decreased appetite, suicidality. I had all of these symptoms … for years. It pains me to write about this, but if this article can help just one person, then opening those cobwebs will be worth it.

Depression felt so taboo to me, especially as a resident. Unfortunately, it is a highly prevalent disorder. In 2013, an estimated 15.7 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year. For those in medical training, rates of depression are higher in medical students and residents than in the general population. A recent survey of American surgeons revealed that although 1 in 16 had experienced suicidal ideation in the past 12 months, only 26 percent had sought psychiatric or psychological help. 

The latest alarming statistic says that over 400 physicians commit suicide each year. Suicides also account for 26 percent of deaths among physicians ages 25 to 39. I thought I was the only one suffering from depression. What I have realized from this process is two things: it is okay to be assertive and ask for help, and depression can be treated.

For many depressed persons, such as myself, antidepressant medications are an essential part of treatment and have proven to be effective. However, it is not a quick fix. It is not just a “happy drug” that will boost your “cerebral joy juice” as my psychiatrist would say. Often, the popular stereotype is that depression is an acute illness, like the flu, from which you should recover relatively quickly. The odds of recovering from a major depressive episode are fortunately quite good, but the median time to recover can be up to six months.

I write about my perspective of the disease because everyone will encounter someone in his or her lifetime who has suffered, or is suffering, from depression. Having been on both sides, I want to emphasize that recovering from depression is very much a “Catch 22.” That is, all the things you need to do to recover are made difficult because of the symptoms of depression.

For example, if you’re depressed, someone with underlying good intentions might say, “Snap out of it. Cheer up, go out and have some fun!” Yet depression often involves an erosion of your capacity for pleasure. You ought to get proper nutrition to maintain physical health, but you may have little appetite. Ideally, you should exercise since studies show that regular aerobic exercise yields strong positive effects on depression and anxiety. But depression robs you of every ounce of energy. You are chronically fatigued so how could you possibly muster the will to hit the gym. These are just a few examples of these “Catch 22’s.” Having this perspective will allow you to better empathize with those suffering from this disease.

Studies about depression during residency training are sparse. We as health professionals have to be resilient. We must have the capacity to withstand stress and catastrophe. However, being resilient does not mean going through life without experiencing stress and pain. The road to resilience lies in working through the emotions and effects of stress and painful events. Resilience is also not something that you’re either born with or not. It is developed by having close relationships with family and friends, a positive view of yourself, confidence in your strengths and abilities, and most importantly the ability to seek help and resources.

Fast forward two years later; I was now an emergency medicine intern. I realized that surgery just wasn’t the right fit for me. In addition to seeking treatment and overcoming depression, I found a specialty that better suited me and what I wanted to accomplish in medicine. For example, in a typical shift, I must have the knowledge to resuscitate a cardiac arrest, the assertive but composed attitude to stabilize a patient with a gunshot wound, the cultural competency skills to contend with a suicidal patient, and also the patience to delicately remove an ear foreign body in a pediatric patient at 2 a.m. No other field of medicine offers such variety and excitement, and this is what I look forward to as my life’s work. I never smiled more than I have in the past five years. I loved being at work so much that there were days when I’d rather stay and work a few extra hours than go home.

Even today I go into work everyday with a card listing positive affirmations I have for myself that I read before my shift. “I am blessed; and sometimes I am the blessing. I am enough. Being isolated does not make me safer.” I am sure there are stories like mine out there. Everyone has a story, and we all have a voice. It empowers me to write about what I experienced. I have become a more compassionate and emphatic physician through all this. I now believe that I deserve good things, even great things. And so do you.

Image creditGreenwich Tunnel by Photographing London licensed under CC BY 2.0.

Henry Wong, MD Henry Wong, MD (1 Posts)

Resident Physician Contributing Writer

Virginia Commonwealth University School of Medicine

Dr. Henry Wong is a PGY-3 emergency medicine resident at VCU Health in Richmond, VA. He earned his medical degree from VCU/MCV and his undergraduate from the University of Virginia. His clinical interests include difficult airway management and critical care. In his spare time, he enjoys tennis, kayaking, napping, and playing with his wiener dog.