My pager beeped again. I grabbed it, scribbled the number onto the back of a handout about pancreatitis, and stuffed it into my white coat pocket.
“I’ll call them in a minute,” I told myself, one of the many tasks I had to do that day during my month-long obstetrics and gynecology rotation at Magee Women’s Hospital in Pittsburgh.
I sat down on a teal chair in the hospital’s conference room and took a different handout from my pocket. This one was a questionnaire about depression. It asked:
Over the last two weeks, how often have you been bothered by the following problems?
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
Check, check, check …
- Moving or speaking so slowly that other people could have noticed
- Thoughts that you would be better off dead or of hurting yourself in some way
I was annoyed that the instructions wouldn’t let me answer the questions accurately. The highest score possible for each answer was “Nearly Every Day.” But these symptoms weren’t “nearly” for me—I had them every day.
When I was a whippersnapper applying to medical school, I had a picture of my future life: Me as a beautiful woman strolling from patient room to patient room in a pressed white coat. Sparkling hair and teeth, genuine peaceful smile, brain brimming with every needed detail to provide perfect patient care.
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Even though I was warned by physicians that the reality was much different than that, I couldn’t absorb what awaited me.
As a resident, I would be pushed to my breaking point over and over for three years. I would be disheveled, hiding stains on my smelly scrubs from blood and other body fluids. I was often fraught with fear to keep up my knowledge base to take good care of my patients and to appear competent in front of my peers. And I was perpetually exhausted.
“I would be pushed to my breaking point over and over for three years.”
My colleagues and I didn’t discuss our difficulties. We all were trying to keep up the painful façade of strength under pressure. My family didn’t help much, either. When I called my father to say I was struggling, his advice was the same as the physicians I trusted:
“Don’t let ’em see you sweat.”
Depression slowed down my work. I made more than the usual number of dumb errors and it took me longer to catch on to key concepts. I couldn’t teach medical students as effectively. I would find myself staring off into space while typing up notes about my patients. Somehow I did all the work I was supposed to do. I never missed a day of work because of depression, though I probably should have.
A sensitive faculty member noticed my mood and started me on an antidepressant. Although the medication initially gave me suicidal thoughts, and I nearly jumped off Pittsburgh’s 40th Street bridge, it eventually may have helped. Although my depression continued, it wasn’t as severe.
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Talking to more experienced residents was helpful, especially when they were honest about their own difficulties. Weekly sessions with a Balint group — a supportive and collaborative medical organization of clinicians and teachers — guided me to put things in perspective. My wife Judith’s support was what really got me through.
“We all aged about 15 years in our three-year residency.”
As I muddled through my residency, I wrote whenever I had a chance. Sometimes I wrote to keep myself company. Other times, I wrote to document my journey and that of my colleagues as we worked to overcome the difficulties of residency. We all aged about 15 years in our three-year residency, something several of our faculty members remarked on while comparing a photo of our class taken just after we had started the program in 2010 with how we looked near its end in 2013.
Eventually, I gathered, mashed, and distilled my writing into “Prognosis: Poor,” a book about the medical training process. It offers ideas about improving medical education and rescuing drowning trainees like me.
Admitting that depression is a common problem among residents is step one. It’s a reason I’ve gone public with my experiences, and I am delighted to see others doing the same thing. But we still have a long way to go to implement solutions and interventions that will reduce depression among medical residents, or at least detect and treat it early.