2

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.

1

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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