In late March, on what is known as Match Day, graduating medical students like myself found out where we would continue training as residents. This has always been an exciting but stressful time. This year it is more than that. On top of the countless challenges of starting residency, we are becoming doctors on the front lines of a pandemic.
How well are we prepared for this role? I am not questioning our technical preparedness, which we have proven by passing board exams and securing residency spots. Rather, I am concerned about the psychological impacts of learning the ropes amidst a global health catastrophe. Before COVID-19, mental health was a hot topic among the medical community. According to the Association of American Medical Colleges, almost a third of medical students and residents suffer from depression, and one in ten report suicidal thoughts. The American Medical Student Association found that medical students are three times more likely to die by suicide than age-matched peers.
For trainees, suicide is the first and second most common cause of death among male and female residents, respectively. After training, attending physicians die from suicide at double the rate of the general population.
The statistics are not abstract for me. During my four years as a medical student at Mount Sinai, I mourned the death of a fellow student, a first-year resident, and a first-year attending – all by suicide. Experts point to a wide variety of complex factors that result in such tragedies, which occur at medical centers across this country. A more succinct explanation comes from the dean of my school, Dr. David Muller: “We’re so focused on taking care of patients and providing quality care that absent from our education is how we take care of ourselves.”
How are we taking care of ourselves during COVID-19? As we were conditioned to do throughout our education and training, my colleagues are enduring interminably long hours, routinely missing meals and rest, and expending every ounce of energy to treat patients to the best of their abilities – no matter what personal sacrifice it requires. As hospitals fill up and ventilators run out, we have to accept that our best will often not be good enough.
I believe that COVID-19 will sweep from my home in New York City to many other hotspots, peaking and then gradually diminishing, but inevitably followed by a second curve. This curve will consist of medical students, residents, and attendings who begin experiencing COVID-related anxiety, depression, and post-traumatic stress. Even as the infection curve flattens, we will carry the psychological burdens of the most difficult decisions of our careers. Medical students might feel guilty for not being able to do more to help. New graduates will struggle to come to terms with losing not just their first patient, but realistically, dozens, or even hundreds of patients. Residents and attendings will check in with colleagues to see who was infected, who recovered, and who did not.
And where will I be? I start residency this June at Memorial Sloan Kettering Cancer Center, where the majority of patients are immunocompromised and at high risk of infection. Their fights against cancer must continue alongside the new threat of COVID-19, and I have to imagine that they are terrified. To be candid, so am I.
I am scared that I will be caring for patients in isolation wards where it will not be safe for loved ones to be with them to provide comfort and strength – or even to say goodbye. I am scared for my classmates, residents, and attendings who were already experiencing mental health challenges before COVID-19. I worry that their distress will compound and that colleagues will be too singularly focused on helping patients to realize that these providers need help, too. And my greatest concern is that without interventions, this distress might overcome their abilities to work through this pandemic, to remain in medicine after this pandemic, or worst of all, to continue living.
On April 26, a New York City emergency room doctor was unable to continue living after treating hundreds of COVID-19 patients. She died by suicide, despite having no prior history of mental illness. This doctor is patient zero of COVID-related suicide among U.S. physicians, and I am not aware of any coordinated containment strategies.
We cannot let this happen. If the second curve of mental distress among doctors mirrors the first curve of COVID-19, then our country could start losing its infantry, and we could lose this war. We urgently need collective action – from individual citizens up to our country’s leaders – to save the lives of those who are saving the lives of others.
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