Hello everyone,
We lost a medical student last week in New York City. Another senseless death, added to too many other losses that accumulate year by year. I’m no suicide expert, and it wouldn’t be right for me to comment on the circumstances surrounding these tragedies, but I’ve spent my whole career working with young physicians, so let me make some observations.
Progress, But Not Enough.
We’ve made progress de-stigmatizing mental illness, but there’s still work to do. We encourage people to get help and we post numbers to call, but too many physician still believe that asking for help is a sign of weakness. Then, because we don’t discuss mental illness, we underestimate how many trainees suffer with depression, anxiety, PTSD, OCD, bipolar illness, and other disorders. In turn, we unwittingly make those who need help feel like outliers. The same goes for the many others without diagnoses who need counseling.
Would it surprise you to learn that I saw a psychiatrist in medical school? Actually it was two. Sequentially. One had an office in a basement on campus, which I entered through a side door so patients couldn’t see one another. The other was downtown, off Central Park, far from school. I have no idea how many of my classmates saw therapists, although I assumed at the time that it was few. None of my classmates seemed particularly anxious or depressed or phased by medical school. Looking back, I’m sure I was wrong. Therapy would have helped a lot of them and I hope they got it.
Nowadays, I’m glad when I learn that trainees are getting help, and I know many of them are. I worry more about the ones who elude our attention, the ones suffering in silence. We still have work to do to de-stigmatize mental illness and encourage people to get the help they need.
The Shaky Relationship Between Work Hours and Wellness
Work hours are more humane than they used to be. Twenty-eight-hour calls are better than the 36-hours ones I had, and an 80-hour work week sure beats the 120-hour ones of my internship. When I was a resident, we had no days off during July and August, because “the interns were new,” and we had no days off during ICU rotations, where we were on call every third night, because “the patients needed us.” But resident wellness hasn’t improved in line with work hours. Moreover, long hours can’t explain suicides in fourth year medical students, or among trainees in programs with shorter days. So, yes, let’s continue to improve our schedules, but let’s not delude ourselves into believing that shorter work days will end this problem.
Finding Meaning at Work
What can be more depleting than time spent on meaningless tasks (those forms!)? But even as we try to minimize their number, there will always be tedious activities that we can’t escape. I worry sometimes that we perpetuate our own unhappiness by avoiding activities that sustain us. We spend so much time writing needlessly long notes. We need to remember and preserve the most meaningful parts of our work. What’s more satisfying than making a diagnosis? Or learning to place a central line? Or teaching a student to read an EKG? Or helping a patient recover? Or comforting those who don’t?
I don’t believe that time pressures alone keep us from engaging in meaningful activities, but we need to look carefully at the obstacles—both internal and external—that get in our way.
Attending to our Needs
Embedded in our collective unconscious is the odd notion that it’s more important to care for our patients than ourselves, as if we physicians don’t have basic needs. We convince ourselves that we can go without sleep, nutrition, exercise, or hobbies. We can go it alone, without friends and families. We may have grown up attending a temple, a mosque, a church, or a synagogue, but suddenly we don’t need to go anymore. How many of you have shelved your basic needs? How many of you have postponed peeing just to get through rounds? I have. Sometimes we do have to make temporary sacrifices to address our patients’ needs; we’re not going to drop into the cafeteria as we scamper to a code. But we must not let self-sacrifice become self-defeating.
We Need to Support One Another
When any of our colleagues suffer, we all suffer, and when everyone thrives, we all thrive. We should ask our co-interns and co-residents how they are doing every day, and we should listen to the answer. We should support each other with encouraging words and kindness. We can climb mountains together.
We Need to Discuss the Stresses of Work. It’s hard to lose a patient, especially when you’re new at this job. We tend to blame ourselves when things goes wrong. We’re perfectionists, and we tend to crucify ourselves when we make mistakes, as if we don’t all make them, as if they wouldn’t have happened if we just tried harder. It’s hard not to feel crushed when patients get angry at us, especially after we’ve invested so much energy trying to help them. It’s hard not to feel inadequate when we’re surrounded by such bright, talented colleagues, even though we know the comparison is ridiculous, even though we know they feel just as inadequate themselves. We need to open up about our stresses. We need to share our experiences so we can build resilience together.
Seek Perspective
Clouds are just temporary veils that block the sun. On cloudy days, we can forget that the sun floats just behind the gray. On gloomy days especially, we need to set time aside to remember how fortunate we are to be here, to be alive, to be in a position to serve others, to belong to a community dedicated to learning, curing, and healing. The sun will return. We need to breathe. And if you’re like me this early May weekend, you need to take Allegra.
Take Control
Helplessness fuels hopelessness. When something is wrong, speak up. When something is broken, let’s figure out how to fix it. Don’t let yourself be controlled by dark imaginings. Don’t underestimate our collective ability to make things better. Don’t be a victim. Take control.
Some Final Thoughts I should say this every day, but it’s crucial to say now. I adore each and every one of you. It’s not because you are uniquely talented, though you are. It’s not because of your many accomplishments, though you amaze me every day. It’s not even because you have the potential to transform medicine, though many of you probably will. It’s not about any of that. I adore you because each of you is a cherished member of our residency family.
So when you’re crabby, it’s easy for me to conclude it’s just a passing phase. And when you doubt yourselves, I maintain my faith. When you ask if you’ve made the right choices in life, I know the answers are coming. When your car gets a flat tire, or runs out of gas, or gets stuck in a ditch, I know you’ll be back on the road soon enough.
So let’s acknowledge the deep importance of a good night’s sleep, a day off, and spending time with the people you love. Let’s get help when we need it and support each other so everyone has the strength to do so.
I still can’t come close to making sense of the senseless, but I understand the value of openness and how important it is to look out for one another. That’s what keeps us well, forward looking, optimistic, hopeful, and ready to embrace the days ahead.
Enjoy your Sunday, everyone. I’m going out for a long bike ride.
Mark
Employee and Family Resource Program – Brochure attached. There are two onsite counselors that work here at 836 Howard Avenue across from the Adult ED and many licensed counselors are available throughout CT. Most people choose face-to-face counseling but there is also phone and video counseling available. 1-877-275-6226
Chaplain Services Office (8 AM – 4 PM) 203-688-2151; if no answer or off hours, use Chaplain on call pager: 187 then 12651 – also available through Smartweb
Paul Desan (Dr. Desan is a psychiatrist who is available to support our trainees)
National Suicide Prevention Lifeline 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.