“I have spent years in silence about my career decisions, nervous that my inability to take call and inability to thrive while sleep-deprived could be seen as weaknesses. Being afraid to admit I was advocating for my mental health and my life. That’s a problem. I am experiencing fear for advocating for the health and safety of myself and others for concern that I may sound weak. That’s a big problem.

Silence is not the answer. Avoiding talking about it is not the answer. I cannot avoid call hard enough for prolonged sleep deprivation to be less of a problem for others. So let’s keep talking.

Physicians need sleep. The system needs to change. Many are not OK. I was one of them.

We need to normalize talking about the hard things and creating environments that promote psychological safety and the ability to truly ask for help, not censor our struggles in mental health appointments to save face.

And if you need to hear it: It’s OK to crave basic needs and advocate for them. You’re a human, not a robot; we need to create a system made for humans, not robots.

If you are having dark thoughts, please seek help. While the best time may have been days or months ago, the next best time is now.”

Jillian Rigert is an oral medicine specialist and radiation oncology research fellow.

She shares her story and discusses her KevinMD article, “I risked my career to save my life.”

Did you enjoy today’s episode?

Rate and review the show so more audiences can find The Podcast by KevinMD.

Subscribe on your favorite podcast app to get notified when a new episode comes out.

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

Also available in Category 1 CME bundles.

Powered by CMEfy – a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info

Do you know someone who might enjoy this episode? Share this episode with anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today we welcome back to the show Jillian Rigert. She is an oral medicine specialist and radiation oncology research fellow. Her KevinMD article today is “I risked my career to save my life.” Jillian, great to see you again.

Jillian Rigert: It’s so nice to be here, Kevin. Thank you for having me.

Kevin Pho: So we’ll get into the article in a little bit, but for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Jillian Rigert: Absolutely. My story, in the beginning, and it definitely won’t go all the way back to undergrad, but starting with what pertains to the article we’ll be talking about: I started my career on a fast track into dentistry, and during dental school I learned it wasn’t quite the best fit for me. My dental school had individuals from an Air Force base come and rotate to teach us different specialties, and I really gravitated toward the oral surgery officers. So I held on through dental school thinking, “Maybe I’ll be happier when I become an oral surgeon,” and specifically I was very interested in becoming an Air Force oral surgeon. I was grateful to be selected to go into a six-year, Air Force-sponsored oral surgery program, so that helped me get through dental school.

Upon commissioning and entering the Air Force, I had started to have some doubts that the career I had chosen was the best fit for me. I met with the Air Force oral surgery board and explained that when I’m actively engaged in the oral surgery program (I did a sub-intern year), I’m getting quite depressed, because I feel like it’s not the best fit for me. And they said, “Maybe it’s just your self-confidence.” So again, imagine the arrival fallacy. I’m just holding on: “OK, well, I’ll just stick it out, and hopefully it will be better when.” And that “when” was going to be when I entered my civilian select program. So I went into a great program, a super great fit for me, and that confirmed that oral surgery as a specialty wasn’t the best fit for me.

This revelation, after you’ve put your head down and worked so hard to obtain a career path that you think you’re going to be so happy and enthused about, realizing it wasn’t the best fit for me, started to shake me up inside. I was having some distress, one, because I had committed to the Air Force for a 13-year commitment to be an Air Force oral surgeon, and I had committed to my program. With intern year, mixed with sleep deprivation and the stresses of surgery, and it’s a big jump from dentistry to surgery, I developed pretty severe depression.

At this time, it’s 2014, and I thought I was alone in that. Feeling alone, feeling like I was a failure, that I had committed to something that wasn’t bringing me a sense of peace and purpose for myself, I developed suicidal ideation. And it was at a time when talking about it was very concerning, because of all the things you were concerned you might risk, which for me would be my military career, of course surgery, and then your ego, because you think, “If I leave something I committed to, then I’m an ultimate failure.” So I’m having all these concerns, and I finally voiced my thoughts. We’ll talk a little bit more about those moments when I was reaching a revelation, where I’m no longer hanging on to preserve a career, but I have to make a choice that might affect my life, in terms of actually surviving this decision.

But fast-forward: Ultimately, I end up deciding to take a chance to get help for my mental health, which leads to a medical retirement from the Air Force, which leads to a transfer into a different residency. I did oral medicine, and in oral medicine we often focus a lot on head and neck cancer. So my current role is research fellow in radiation oncology, which has really great ties with my oral medicine background and also allows me to use more of my medical background than dental school did, beyond that dental focus alone.

Kevin Pho: The KevinMD article that you wrote is titled “I risked my career to save my life.” Jillian, what are some examples that made you realize that this oral surgery program wasn’t the best fit for you?

Jillian Rigert: I think in medicine we say, “If you like anything more than surgery, do it.” What that really highlights is that it’s a strong sacrifice if you’re going to be a surgeon. It’s long hours in the operating room. What really affected me was the sleeplessness when you’re on call and when you’re under high stress. I realized that the combination of those two things, I couldn’t think my way out of. I didn’t have enough coping skills in my brain to protect myself from the suicidal ideation that resulted from that prolonged sleeplessness, and the benefits didn’t outweigh the risks of potentially taking your own life.

Kevin Pho: All right. So tell me, as the story progressed in your KevinMD article, for those of you who get a chance to read it, tell me more about that story.

Jillian Rigert: Yeah, absolutely. My story came about when I had read some feedback from a person who lost her sister to suicide and strongly thought sleep deprivation was most likely a component. And I thought, we do talk a lot about physician suicide, or a lot more, I should say, but when we talk about it, it’s not getting out there. I found that I was struggling to find the details, from a personal story, on why people think that physicians are under so much distress. We can talk about moral injury, and for me, some things that were hitting home were about sleeplessness, like, “I think that person made the decision because they were lacking sleep.” And I was like, “That was exactly right.” When I was not sleeping, my thoughts felt like they were not my own, and that felt like such a strong component of what was contributing to my own suicidal ideation that I really wanted to get that out there.

Because that’s something that we can focus on as an outcome to improve: How can we help create an environment where residents, physicians, and everybody who is starting to have some burnout and suicidal ideation can get very well rested? How can we focus on that as a top priority?

Kevin Pho: So you went from a point where you realized that oral surgery wasn’t the right fit for you to leaving the program. Now, I’m sure there were steps in between those two points, so tell me about some of the steps in between.

Jillian Rigert: Yeah, absolutely. This was so interesting for me, because when I developed suicidal ideation, I felt like it wasn’t an obvious solution for me to leave my program. I thought that I would rather take my own life than feel the sense of failure and of letting people down by leaving. So I was having these thoughts of taking my own life, and I finally got to a point where I asked an upper-level resident, “Is this normal? Do other people feel this way?” That led me to getting a conversation going with my program director. I’m thankful for that person, because I hadn’t yet developed the courage to overtly ask, “Hi, I’m feeling like I might take my own life. Do other people do this, or what should I do about this?” I said it in a more subtle fashion, and that led me to getting help from a psychologist, who framed it for me. I was thinking out loud, “How can I stay in this program?” He said, “What if you don’t have to? What would it mean to leave?” And I said, “That’s not even an option I’ve considered.”

So I ended up taking a medical leave to gain some clarity, and the whole medical leave, I was still convincing myself that I needed to finish the program. I didn’t really allow myself to rest or consider an alternative option. So I went back into my residency, and that time period was medical school, which I really enjoyed. However, it also showed me I really enjoyed rotations that weren’t surgical, and it highlighted, “Oh, my ultimate goal is really not in alignment with what I find most interesting, where I find I create the most value.” So I appreciated that medical school really helped me to navigate those feelings and thoughts, while my program director was holistically supporting me: “Please just keep diving in, keep diving in, and we’ll try to figure this out together.”

So I get to the end of my medical school rotations, and this is the third year of my surgical residency. At this point, I had lost the love of my life. He had died unexpectedly. We weren’t dating at the time, but I was still very much in love with this person. This is a pivotal point in my decision-making, because he had called me on a Wednesday night to check on me, and I was on call, so I was overtired. It was the first time I looked at my phone and decided not to accept his phone call. That Sunday, the next text message I got was from his sister, about his passing. This was such a profound moment in my life, where I paused and felt, “Oh my gosh, my priorities are so screwed up.” That started the decision to say, “What in life really, truly matters? What am I even doing? Life is so fragile.”

Then, when I got to the point where I finished my rotations, my co-resident passed away the day before our medical school graduation. I just thought, “Did I miss something?” I don’t know the details, and I was just like, “I can’t believe, again, my priorities are not right.”

And one thing I write about in some articles is my journey with anorexia, and I was very undernourished and medically compromised at this point with anorexia. So the Air Force had considered me for discharge based on the development of suicidal ideation and where I was with anorexia. And I still wasn’t ready to give up, right? I still wasn’t ready to give up this identity that I had created for myself as an Air Force oral surgeon. So in order to try to get my mind to a place where I could make decisions that were going to impact the rest of my life, I accepted my treatment providers’ recommendations to admit myself inpatient for anorexia, and for what that was going to do for me mentally. I wasn’t ready to recover from anorexia, but I was ready to think clearer, in order to fight for my military career and to gain clarity on what I might want to do long term.

So I go inpatient, and while I’m inpatient, because I still don’t know if the Air Force is going to discharge me or not, I’m getting interviews for another career, just in case. I’m already planning my next steps in another residency, just in case. I’m just highlighting that I wasn’t resting. I wasn’t truly in the moment, resting and saying, “What’s best for me?” I’m thinking, “I’m a single individual who’s dependent on myself. What am I going to do if this doesn’t work out? What if, what if?”

So when I’m inpatient, I get an idea for the next residency I might go into. Right after I got discharged from inpatient, I was in San Antonio, appealing the decision the Air Force had made to medically discharge me. I went to the appeal trying to stay in, and at that point, the person who was my lawyer, and I’m forgetting the military term that we used for that, but he was my lawyer, was there to help me decide what would be best for me. We just presented all the facts, and I ended up not fighting for it. I just presented the facts and said, “I’ll trust you to make the decision.” Because at that point I had realized: If I fight to stay in, can I confidently say that I can be mentally well enough to do what they need from me? I was so depressed at that point. We use that term burnout, and I was grieving the loss of the identities and the loss of everything I just mentioned.

So I did end up getting medically discharged, and the day after I resigned from oral surgery, I had already signed and started a residency. I never really gave myself the opportunity to grieve and process. So it was a lot of moving parts that ultimately led me to why I speak out now, which is because I’ve learned a lot about things I would have done differently, and things that I would love people to hear now who may be in the thick of where I was in 2014, saying, “I don’t think I’m on the right path for me, and how dare I consider changing it?”

Kevin Pho: So during this journey, which was marked by several episodes of tragedy, did you feel that you had people in your corner? Did you feel that you had people who were on your side, or did you feel alone?

Jillian Rigert: Yeah, I absolutely think that having supportive people on my side is what saved my life. One of the people who stands out the most was my program director in oral surgery, because I went to him pretty vulnerable, and he just held me until we made these decisions together. I speak to him now. He championed me. He never made me feel guilty; I was making myself feel so guilty for considering leaving. And he just said, “What is best for you?” And I thought, “Wow, if I was in a different program, with a different person, with different circumstances around me, would I still be here?” It just makes me express gratitude all the time for his gestures.

Kevin Pho: We’re talking to Jillian Rigert. She’s an oral medicine specialist and radiation oncology research fellow. She wrote the KevinMD article “I risked my career to save my life.” Jillian, you mentioned that you learned so much during this difficult journey that you want to pass on to others who may be on a similar path. So what are some of the main things that you want to pass on to those who may be undergoing something similar?

Jillian Rigert: Yeah, absolutely. Well, one thing is the impact of sleep deprivation. When I really was not rested and was having thoughts that I cannot believe I ever had, that was such a significant factor. So I would really say: How can I prioritize rest? Another thing: It was very hard to make very concrete decisions, not only when sleep-deprived and very depressed, but while in the depths, in the trenches, per se. So removing myself from the environment helped me to gain clarity. And also just having that self-compassion to say, “I made the decision to enter Air Force oral surgery with the information I had at that time, and I’m now making the decision to leave with the information I have gained ever since.”

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Jillian Rigert: I think it’s so important. When I made my initial career decisions, I was strongly impacted by external cues and that constant need for external validation, and I never found it. With the degrees I have, nothing ever helped me define value, and it wasn’t until I turned within that I started to really cultivate a sense of worth. It’s something I’m still working on. But just know that if you’re seeking external validation and credentials in order to feel that you’re worth something, it’s so important to pause and to realize that’s not the place to look. The place is to really say, “Hey, I am intrinsically worthy. What does that mean?” and to look within.

Kevin Pho: Jillian, thank you so much for coming back on the show and sharing your story, time, and insight.

Jillian Rigert: Thank you so much for having me.