4 Dark Truths Behind The Suicide Epidemic In Med Schools
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A doctor's life involves swimming in pools of money, basking in society's approval, and partying with nurses dressed like strippers and strippers dressed like nurses, right? Maybe for Dr. Agracer, but for many, it's one of the most depressing jobs out there. The suicide risk for a doctor is much higher than for the average person (twice as high in the case of female doctors). We lose 300-400 doctors a year in this country to suicide, the equivalent of an entire medical school being killed annually. One doctor we talked to told us that the troubles begin early ...
Residents Suffer From Serious Depression
The first suicide attempt was a third-year resident. One day, she just didn't show up to work. I asked a mutual friend what happened, and was told she tried to kill herself. She ended up in a different hospital in town (for obvious reasons, she didn't want to come to ours). She basically vanished from the residency. There was no attempt to explain what happened, to tell people why she vanished, or to offer counseling. And yet everyone still had to cover for her, so it generated a significant amount of ill will among us. We were extremely resentful, having to cut short, easy rotations to take over her spot on the difficult ones, and that's about the only emotion we had about the situation.
29 percent of physicians in training show signs of depression, but we doctors don't show each other much sympathy in this area. One resident left after suffering what was basically the normal, expected amount of abuse. He became a laughingstock, and his name became a verb that we used to make fun of each other. 80 percent of residents report receiving mistreatment at the hands of their superiors. 10 percent this past year admitted to having suicidal thoughts.
There was a running joke in the surgery residency about how "weak" the anesthesiology residents are, because if a patient died on the table, they were given the rest of the day off. We surgery residents? We got just enough of a break to get a bite to eat, or to round on patients, or to pee (but definitely not all three) before the next case started. In my fourth year of residency, I had three of my patients die in the same day. Next day, back to work.
You Train So Long To Be A Doctor That You Don't Think There's Any Escape
A couple of weeks before I nearly jumped out a window, the patient who had been torturing me for over two months finally died. He was the second patient I operated on in my fellowship. He'd been my patient for eight weeks, and did terribly in post-op -- by that point, he'd had a tracheotomy, a tube in his stomach, a dialysis catheter, mechanical circulatory support, got shocked a few times, was never off vasopressors. Now I didn't have to get any more phone calls about him from the intern in the ICU, and I was going to maybe be able to sleep through the night. I was overjoyed at the death of another person, I suddenly realized, and I had to sit down and evaluate my life.
Not a week after he died, another patient in the same ICU room nearly bled to death post-op. Thankfully, we were able to get him back to the operating room and stop the bleeding. I'm pretty sure my heart rate didn't go below 110 until he woke up two days later. Once again, I felt a rush -- joy? relief? -- and that frightened me, because I wasn't relieved that he was alive. I was relieved that he was up, which meant he was not going to torture me the way the previous patient had.
Then came the night of my suicide attempt. I hadn't slept more than two hours in a row, or six hours in a night, for about three months. I'd been pretty much delirious 24/7. My wife worked more than 100 miles away, so she only spent a day or two a week with me, and this was one of them. I could have gone home at 8:30 p.m., after I'd stabilized my patients, to see my wife for an hour and a half before coming back to the hospital, but I didn't have the energy. Instead I was trying to get a couple of minutes of sleep before my 10:30 p.m. rounds. But a stubborn little blue light from a computer was boring into the back of my skull, keeping me awake, and leaving me with my thoughts -- of how the only satisfaction I ever felt nowadays was when the work stopped.
I had spent my entire life getting to this point. I'd decided I wanted to be a doctor after my grandfather had surgery when I was nine. Literally everything I had done for the past 22 years was to get here -- every extracurricular activity, every research project, every class in college, every rotation in medical school -- and I reached what should have been the light at the end of the tunnel. Instead it felt like a fucking black hole. I couldn't fathom switching careers. There was nothing else I'd even considered wanting to do for all these years. I had a sudden realization that instead of building a mountain for the past 22 years, I had been digging a hole, and when I finally looked up, I could no longer see the sky.
You Start To View Your Own Death With Clinical Detachment
I looked at the window and remembered that after a couple of undergrads in the university where I went to medical school had jumped from the dorm windows, there had been talk about sealing them. Incidentally, one of the medical students in my class killed himself after failing to match where he wanted to. Then I wondered if that was the reason all the call rooms at the hospital were on the first, second, and third floors. This window right here, though, was on the sixth. So I figured, let's put our hands on that window and slide it open.
It was six stories straight down to the asphalt parking lot. I climbed up on the windowsill and put my head and my shoulders out. Then I stopped.
I knew the LD50 -- the height at which 50 percent of people will die -- is four stories. But since I was on the sixth floor and the ground floor was numbered "one," I was really only five stories up. That meant I had probably a 30-40 percent chance of surviving the fall, which was unacceptable. Because that would mean severe trauma, lots of broken bones, probably severe internal injuries, multiple operations -- I did not want to put some other poor surgical resident through all that, and I really didn't want to torture my wife. So I stepped back down off the windowsill -- not because I didn't want to kill myself anymore, but because I was just as likely to survive and wind up stuck in the hospital ... and I really wanted out.
The Culture Of Acceptance Contributes To Severe PTSD
The third suicide attempt I heard about was a resident jumping out of the call room windows. Fortunately she was in a hospital and she survived, though I don't know what happened to her afterward. The response from the program was to bring in a psychiatrist who held one meeting with the whole department and basically said, "You know why I'm here, and if you need anything, call."
That was it.
After you become a doctor, you're in for life -- that's what the hospital thinks. There's a mandatory retirement age for, say, airline pilots, but we let surgeons operate into their 80s. Two of the surgeons in my residency had cardiac arrests (fortunately, people were close enough to start CPR) and then went back to work after getting heart surgery themselves. Two attending surgeons had cardiac arrests, and one had a heart attack (but not an arrest), and every one of them just went back to work as if nothing happened.
When I was a junior resident, I had pneumonia with a fever of 103. I was told that the policy said I was supposed to go home for 48 hours, so as not to infect anyone, but I was on call 36 hours later. I've been stuck with needles -- from an HIV-positive patient, from a Hep-C patient before there was a cure -- and showered in blood, and the biggest concern was figuring out who was going to pay for my own subsequent ER visit. Turns out my health insurance did not.
That's not to establish pity. It's to illustrate the biggest problem doctors face: pure burnout.
The symptoms of burnout are changes in appetite, anger, anxiety, guilt, worthless feelings, isolation, loss of enjoyment, detachment, irritability, and apathy. But "burnout" is not a clinical entity. It's just our word for it. There is a clinical entity that encompasses the same subset of symptoms: PTSD.
When I was a third-year resident, I removed the gallbladder (this procedure is called a "lap chole") of a woman who had a young child. The case went fine, she went home the same day, and three days later she came back with a major complication. For months afterwards, I was afraid to do lap choles.
After every patient complication or death, a resident has to create an M&M ("morbidity and mortality") presentation which they'll broadcast to the whole department of surgery during a weekly session. While writing this, I took a look through all my old M&Ms. There were a couple strokes, pulmonary embolisms, big complications. But I didn't even remember them until I read through the slides. Are there soldiers who have personally killed so many people that they can't even remember them all, or is that just in movies?
For resources on physician and medical student depression and suicide prevention, visit afsp.org. Ryan Menezes is an editor and interviewer here at Cracked. Follow him on Twitter for bits cut from this article.
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