Friday, April 7, is World Health Day. This year's theme is depression, the leading cause of illness and disability worldwide. In observance of World Health Day, WHO is encouraging people to speak openly about depression and suicide through their #LetsTalk hashtag. In that spirit, today on the blog, a medical student speaks openly about her ongoing battle with depression and suicidal thoughts. She encourages others to speak out as well.By Rebecca Powell
There are two versions of me.
On the wards, I am the student who shows up early, the enthusiastic learner, the integrated helpful teammate, and a friend to patients. I am known for my big smile, even among strangers who do not know my name.
At home, I am a dark cloud, crying in bed with the covers over my head so that my roommate will not overhear. I sleep too much, eat too little, and struggle to find interest in any non-medical activities. I know the criteria for major depressive disorder. Since starting medical school, I have full-blown, rip-roaring, unrelenting clinical depression.
This little dark cloud has called the suicide crisis line three times in the past school year. Twice while working the long hours that are the norm during a third-year surgery clerkship and once, ironically enough, while working on the inpatient psychiatry unit with suicidal teenagers. I have a positive family history for major depressive disorder, and had several episodes of depression during stressful times in high school and college. During college, I thought I had found the depths of my depression, but I was wrong. It was medical school that pushed me beyond the point of passive suicidal ideation to active suicidal planning, which is a huge, dangerous leap that, as I interviewed psychiatric inpatients, made me feel I should be sitting in their seat.
What got me here? Why the change for the worse and why, when I was studying the very disease I was suffering from, could I not receive the help I needed?
It wasn’t until after my second call to the crisis line that I recognized I needed to be more proactive about my depression. I was working long hours and under constant stress to perform. I had very little autonomy, and was worried that I had made the wrong career choice. In addition, the transition from the first two years of medical school, which took place in an academic lecture hall where I could be a passive learner, to the third year of medical school, where I was now standing shoulder-to-shoulder with the medical team, was not easy. I made an active effort every day to get up in the morning, shower and look presentable, pay attention on rounds and be alert to any “pimp” questions thrown my way. Like a ritual hazing, “pimping” students is a key component of teaching on the wards. It’s when, as Dr. Druv Khular described in the New York Times
, doctors ask students “a rapid series of questions, from thought-provoking and relevant to esoteric and unanswerable[, which continue] until teachers run out of questions or doctors-in-training run out of answers.”
Introverted, shy, and depressed, I did not appreciate the sudden expectation to be an active member of a team and sometimes the center of attention. It took all the mental and emotional energy I had to be present all day with the medical team and our patients. Afterwards, I felt exhausted and defeated. I would go home and go straight to bed. Then I’d get up and do it again. It was a vicious cycle with no place for self-care. When I only had a few days to impress a preceptor, any time away from studying or the patient wards, I feared, would be detrimental to my grade.
So logistically it was difficult to seek help. I did not know my schedule more than a week or two ahead, so scheduling an appointment with a doctor was nearly impossible. Primary care providers and psychiatrists usually work 9 to 5, but I usually worked 6 to 6. I had gone into medical school wanting to help others in their greatest time of need, and now I couldn’t even help myself. And it was literally killing me to keep trying.
I waited to see a physician until I was scheduled to work the night shift several weeks after my second call to the crisis line. Instead of leaving the hospital after my shift ended at 6 am, I stayed on campus until later that morning when the clinic could fit me in. That way I did not have to ask my preceptor, who was grading me, to excuse me early or allow me to come to work late.
Even if missing work to see a doctor wouldn’t hurt my standing, medical training puts a lot of pressure on students not to appear weak. I felt that I was under constant surveillance, both by my classmates and my superiors. A budding physician needs to be impervious to psychological conditions, otherwise she will not be worthy of the profession. I worked hard to appear worthy.
Depression cannot always be seen on the outside, but I know I am not be the only medical student or medical professional who has felt this way. Statistics about health care providers and their mental health are thrown around all the time, including higher suicide rates among physicians. Some of my own classmates are fighting this mental illness. I don’t have the answers. I am still struggling with this myself. But I am writing so that others won’t feel stigmatized or alone and might have the courage to advocate for themselves. I encourage students and preceptors to build an atmosphere of wellness within their sphere of influence, to be examples of self-advocacy, and to be sympathetic of others who may need support. Admitting you need help and seeking it is not a sign of weakness. It is a sign of strength, and it will serve you and your patients for the better. Rebecca Powell is a third-year medical student who will be pursuing triple board specialty programs in the fall. If accepted, she will be working towards becoming board certified in pediatrics, child and adolescent psychiatry, and adult psychiatry. Read more about depression on the blog.