Residing in all of us, whether or not we feel it, is an innate zest for life. As a family medicine resident, I live with enthusiasm daily, because I am happy seeing patients, no matter my rotation. From the acute care wards to the family medicine clinic, I enjoy and relish the opportunities to sit with patients. Unfortunately, this zest for life was once lost on me, and at times in residency, it can be challenging to maintain. Given the difficult working conditions and systemic pressures in the culture of medicine, it should come as no surprise that so many physicians, including myself, suffer or have suffered from mental illness. It is well documented that rates of burnout and depression are exceedingly high in our field. This started for me in first year of medical school. I took on an unhealthy amount of extracurricular activities, neglecting my own health, feeling inadequate relative to my peers, and trying to quell the fear of failing by studying endlessly. I crawled to the end of first year, not understanding what was happening to my body and mind. I lost 30 pounds, and progressively distanced myself from everyone. By mid-summer, I was in a full-blown episode of severe depression. My sadness morphed to numbness; the contrast to my former self was stark and perhaps would have been more shocking had I not felt so devoid of emotion. I was in immense pain and even contemplated taking my own life. I blamed medical school for what was transpiring and yet couldn’t bear not to go back for second year. I couldn’t just give up my dream that I had worked so hard for! I went back and lasted less than a month. Luckily I had an army of support behind me. My then girlfriend (now wife), family, psychiatrist, family doctor, counselor and voracious pursuit of self-help were all instrumental in getting me back on my feet. Slowly but surely, I started enjoying life again. Eventually, my spark for medicine grew, and I wanted to go back. I timidly joined a new cohort the following September, afraid of how faculty and students would react to a colleague with mental illness. Would my reputation be tainted? Would future career opportunities be thwarted? I persevered, but some of my misgivings materialized when it came around to interview for residency. I was shocked at the interview advice my medical school gave: “Tell them you took time off for your health but don’t be specific. Tell them how it made you more resilient.” While I felt they wanted me to evade the truth, I don’t blame my school. Overall I was satisfied with the support they gave me, and I believe they were trying to help me match. Others with mental illness already in residency told me what to do verbatim. At least they acknowledged the stigma: the sad need to disguise part of who I am, and what I had been through. Fast forward to Fall 2018. In my call room dazed with fatigue, I was working on hour 88 of 103 for the week, away from family and friends on Thanksgiving weekend. I remember questioning my sanity and that of many other physicians. I felt anxious with my pager by my side, praying that I would get some sleep, even an hour. I remember feeling nauseous, tired, sad, and frustrated by almost everything. I didn’t want to see any more patients. I’d stayed up two nights that week working 24-hour shifts and was on track for another 24+ hours without sleep. It’s hard to feel “well” when you’re working senseless hours that are unheard of in other professions, and questioning the safety for all involved, of working such long hours. Fortunately, this story has a happy ending. For the most part, I am thriving, and I have found my zest again. I enjoy few things more than putting a smile on a patient’s face. I am most happy when I get to help patients with their mental health. I enjoy empathizing with patients, letting them know that I’ve been there, and that I am living proof it can and will get better. My main goal is to give them hope. I try and support patients as best I can with the resources available. I counsel them to make small changes in their lives that will turn into positive habits, aiding both their mental and physical well-being. I counsel on cognitive behavioral therapy and give worksheets, recommend meditation apps, refer to social work, prescribe medication, etc. Perhaps most importantly though, I listen. I listen actively to their stories of hardship, pain, and suffering. I lend a supportive ear when they feel they have no one. While sometimes I struggle as a resident with the long hours, the stresses of being a junior physician, and trying to balance work with life, I am grateful beyond words for where I am today. I am healthy and look forward to going into work and assisting patients as best I can. I would never have gotten here without the help of several others, including physicians. I will continually strive to help others with mental illness throughout my career so that they can find the zest for life that exists within each and every one of us. Alistair MacDonald is a family medicine resident. Source
