I'm lucky enough to not have lost any colleagues to suicide...yet. In the US, physicians are the profession with the highest rate of suicide. Pamela Wible has described three scenarios that I know have at least flitted past my consciousness. The idea that we are supposed to take on as much responsibility as we do and not be allowed to address our own distress is appalling. We shouldn't be afraid to ask for help for fear of losing malpractice insurance.
I know I've blathered on about the stress associated with residency, but honestly feel that I just can't do it enough justice. The words to describe the emotional roller coaster just don't exist. Instead, I'll give you a list of events that I have experienced, usually many in the same day.
Received lab results back that confirm invasive breast cancer in my neighbour.
Been so overwhelmed at work I haven't cleaned my poor kitty's box in well over a week.
Delivered a beautiful baby girl to a mom and dad who couldn't stop kissing each other or the baby to let me congratulate them.
Delivered a beautiful baby boy to a mom who because of her own brain injury will not be allowed to keep him.
Revive a patient during a code blue and have him go on to living a healthy happy life.
Help a young woman suffering from a painful cancer sleep away her last week of life. And then help her parents cope with their daughter's decision.
Lost track of so many emails and Facebook messages from friends I'm surprised they still answer me when I do send a note.
Been told that I'm an incompetent physician who needs to do at least 6 months of remedial training.
Been told I'm a brilliant physician and that my preceptor is excited to have me as a future colleague.
Had patients hug me for telling them about their cancer, their lack of cancer, that I'm leaving a practice, that their mom just died.
Newborn baby exams. Smelling newborn babies.
Helping moms learn to breast feed when they've given up hope.
Missed my nephews special events for work.
Finding my own worrisome lumps.
Had my vacation time continually denied until I just gave up and have weeks of vacation at the end of each residency year left over.
The ups and downs never end. It can be absolutely exhausting. My blog has provided me with some outlet for what I'm doing. I also have a fabulous partner who is extra supportive and a BFF who is going through the same crap. But even with all of the help, residency is incredibly isolating.
This doesn't make sense to me.
Residency is supposed to be preparing us for practice. We should be learning the coping mechanisms now that will keep us from planning a 03:00 dive off a bridge.
Which I suppose leads to the question, what prevents us from becoming hopeless? How do we keep our light shining when we barely have the energy to wash our hair?
Zakari Tatasuggests monthly counselling sessions for residents to address the extra stress that residency incurs. She also says "The idea is not to find a perfect solution but to openly discuss and accept that physicians are vulnerable. The current culture that presents physicians as always being in control of their psychological health should be discarded."
I know an attempt was made in my med school to encourage self care, but it wasn't given as much attention as the importance of knowing how to write a clinical note or avoiding embarrassing the school. Lip service from the chosen few lovey dovey types that isn't also reflected in regular practice is soon lost.
Next week is resident wellness day at my institute. Events will be held in a city I try to visit and will include a speech and yoga. One day a year doing something I could do at home by watching a Ted talk while stretching.
As with most other behaviours, I argue that we need to learn and be taught by example. After breaking bad news, do a debrief and check in on one another. A preceptor who is willing to admit to difficulty dealing with everything on their plate and going through the options of dealing with said overflowing plate teaches a valuable lesson. We are trained to recognize depression and anxiety in our patients but rarely ask our colleagues about it. I've seen a doc whom all his colleagues stated was burned out but none were willing to talk to him or ask how to help him slow down and recharge. The lesson I learned is that my own mental health doesn't matter in my profession.
That can't be right.
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