4 Dark Truths Behind The Suicide Epidemic In Med Schools

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.

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.

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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