‘The fallout has been all around me’: How becoming a doctor has taken a mental toll

Practicing medicine is a rare privilege that requires discipline, dedication, and sacrifice.

Yet those traits are often incompatible with our social and emotional needs as human beings, and when we’ve reached our brink, it challenges that decision to heed the call. A few months ago, a friend and fellow resident in another program told me that after a long and stressful day at work she had to pull over on the highway because she couldn’t fight back the overwhelming urge to cry and didn’t want to drive at the same time.

Nearly 400 physicians die by suicide each year. As the medical profession starts to look closely at burnout and depression among its ranks, the signs, the symptoms, the fallout have been all around me. I’ve spent the past few weeks tracing my own path to physicianhood, and diving into its toll on my well-being.

During my residency orientation at the Cambridge Health Alliance, I remember our program director telling us to look out for one another, to make sure that we psychiatry interns, all eight of us, had one another’s backs. Instinctively, I was worried — what did we need to protect one another from?

But I knew.

After successfully matching into the fellowship of her dreams, another friend told me that her terrible residency experience taught her how strong and confident she could be. She’s learned from the adversity and grown as a result of the challenges she faced, but I wonder, what was stolen from her in the process? I wonder how much more she could have blossomed as a physician if this growth was driven by support rather than survival.

While interviewing for residency programs, I was repeatedly asked if I liked medical school — the grueling hours, the vast amounts of information I needed to have at my fingertips, the trial by fire when starting clinical work. My diplomatic answer: I was thankful for the opportunity but was happy I never had to do it again. It belied the dirty little secret that medicine is the best and worst thing that has happened to all of us — that we’ve survived the extremes of loneliness, anger, humiliation, or sadness because, “Hey, it’s OK. I’m going to be a doctor.”

And now, as a first-year resident, I was being warned to keep an eye out for my colleagues — to become my co-intern’s keeper.

This time, I told myself, I would get it right.

Toward the end of my third year of medical school, a classmate tearfully confided her demolition at the hands of a cruel supervising physician. I told her it was OK, that it happened to all of us. I steeled myself against her sadness because it was too hard to think about the harsh realities of training. I’d lost my empathy to a plight that could very well have been my own.

I was one of the young fish David Foster Wallace described in his commencement speech to the graduating class at Kenyon College. When asked by an older fish, “How’s the water?” the young fish wondered, “What the hell is water?”

The young fish can’t see beyond their circumstances to appreciate the bigger picture. When it comes to our training, I was the next in a long line of physicians that would struggle to see what’s normal and healthy, and what is not. We don’t see that we are all in this mess together, and we deny ourselves the chance to see the pain for what it is, because we’ve collectively accepted it as part of being tough, being clinical. Being a doctor.

In chronicling her long battle with brain cancer, the late writer Alison Piepmeier reflected on her experience in hospice care and asked: “How can I exist in this place, where I’m so grateful and so sad?” It’s the perfect articulation of a question I’ve wrestled with in one form or another every day for past 10 years as I progressed from a premedical student to a newly minted MD.

While the medical profession can adopt policies to reduce the incidence of depression, I think, all of us, as members of a community, must take ownership of our collective mental health.

Earlier this year, I wrote about finding joy in medicine. Two doctors facetiously tweeted at me that they looked forward to an update after that first year had crushed me. “Losing joy” is an experience that is not uncommon.

As Wallace said, “It is about simple awareness — awareness of what is so real and essential, so hidden in plain sight all around us, that we have to keep reminding ourselves, over and over: ‘This is water, this is water.’”

This is our water — my profession needs to care for its people. We need to care for ourselves. But mostly, we need to look out for one another, to be there, in empathy and understanding. Support over survival. Be one another’s keeper.