The alarm on my phone screeches, jolting me awake to another day of hating my patients and my work. I try to get up to get ready for clinic, but my body is nailed to the bed. I cannot even lift my head without a dizzying blur knocking me back down. I am a resident physician with depression and anxiety. I was in a top ten residency in my field. I was chief resident. I was happily engaged planning my life. A year later, none of these things are true. This is a look at my price of asking for help.
My program said they wanted to support me, and I believed them. However, there is no room for support at the administration level in residency. There is patient safety at stake, along with clinics and hospital teams that need to be staffed. What is the use of cheap labor of residency if the labor needs a mental health day? Unreliable labor means other physicians need to be called in for coverage, and residents are generally overworked and short-staffed as it is.
There is no room for the normal trajectory of recovery, because there is no room for bad days in residency. If I was late during a freak snowstorm, I was asked to be evaluated for safety again, because it might be the beginning of another downward spiral. My notes took longer because my preceptors told me to include every possible point of discussion in my documentation, given the possible legal risks of my treating patients. My visits took longer because I was no longer sure of my clinical decision making. I didn’t trust anything I did because my supervisors didn’t trust anything I did, not when they were responsible for managing the risk I posed. My education no longer had any priority when I was only seen as a liability.
My peers abandoned me. They may not have meant to; residency is busy enough to simply lose touch with friends. But they may very well have meant it. They may have taken my self-isolation as being ungrateful of their friendship. They may not have understood that hearing about work and patient care starts my hyperventilating and cold sweats. They may not have had the time or energy after taking care of patients all day to take care of me too. They may have seen me when I was trying to stay positive, faking it until I made it, and thought I was not really as depressed as I said I was. Too many residents have no clue what high-functioning depression looks like. They may have resented me for the extra coverage I piled onto them. I will never not believe this last statement, because of the overwhelming guilt my depression has given me.
I realized the person I loved became only my platonic roommate. I had been overworked and fighting my depression for so long; I lost any concept of working on my relationship. We didn’t talk anymore; we never saw each other. When we did, we were both doing the work we had to bring home every night: the documentation, the in-baskets, the studying. My heart broke over how empty my relationship had become. I watched my biggest support drift away and felt more alone than I ever had in my whole life. I wondered if I would ever be put back together again.
The truth is, if you’re not at 100 percent of your capabilities, you are not welcome in residency. Even if you are at the top of your game, you will never be trusted once you’ve shown “weakness.” You’ve already proven to be a liability, and your administration will spend every day watching you under the microscope, wondering the next time you’re going to crack. You will feel uncomfortable around your friends, wondering if they’re just waiting for your next meltdown, for the next time they have to pick up extra shifts. You will never feel good enough again, because no one will give you the room to be good enough again. You will want to leave medicine; you will tell yourself that this kind of work is making you unhealthy and you need to take care of yourself. You will look at your $250,000 in student loans, and realize that you are trapped. The only way out is through, but you’re not sure you’ll make it through this time.
The system we currently have takes some of our brightest, most caring, most motivated students and breaks them down. They begin to resent their patients. They lose track of their physical health. They hate themselves. Some think of ending it, and some of those people will attempt or die by suicide. And the system of residency only furthers that self-hatred with this demand for perfectionism. It has long been known that these impossible standards on top of unhealthy work habits set residents up to fail, creating a widespread mentality of feeling unworthy.
Why then, has medicine ignored teaching residents self-compassion for so long? I learned about this concept in intensive outpatient treatment, but who among residents has not had thoughts of inadequacy or failure? Dr. Kristen Neff has extensive research on self-compassion exercises, which force the individual to face their suffering with kindness and connectedness, and “as such, it transforms suffering in a way that enhances well-being, resilience, and coping with difficult thoughts and emotions.” As it is impossible to avoid painful experiences in residency and in life, self-compassion instead allows the individual to face their pain and difficulties and transform them into sources of strength and identity. Research has also shown that practicing self-compassion can be performed and enhanced in short time intervals, and can improve motivation and interpersonal relationships. Why do residencies continue to ignore such a simple first step toward changing this damaging culture?
The epidemic of physician burnout, mental illness, and suicide cannot be fixed overnight. There is a widespread systemic failure pushing young doctors out of medicine and worse, over the edge. Though residencies acknowledge this fact and warn residents about burnout, not enough is being done to implement actionable steps to help residents and give them all the tools they need. Instead of demanding perfection, we need to take our first steps toward resident health by showing them how to care for themselves the way we teach them to care for others.
Michelle Hofmeister is a family physician who blogs at Sutured With Gold.
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