“Everyday I walk past this bay of windows on the 11th floor. It’s the only part of the hospital where you get really good natural light so I always stop there for a minute. And every day, as I look out, I have to convince myself not to jump out of the window.”
As she spoke my chest became heavy, a pain stuck in my throat as I fought back tears.
“She’s going to be okay,” I tried to convince myself.
I exited the exam room and made my way to my computer. I stared at the screen, the blue light scratching at my eyes. I didn’t have the energy to type in the access code just yet.
I knew what was waiting for me – another patient, already roomed, urine dip positive. Two more in the waiting room. But all that would need to keep waiting.
I was overwhelmed with the million thoughts that had flooded my mind during the visit and I couldn’t process anything else just yet. I slowed my breathing and sat at my desk reflecting on our conversation. Managing depression and anxiety is something I do on a daily basis. But this patient was different. She was a physician.
The fight against burnout is an abstract until your patient is a suicidal doctor.
I had asked her the same question I have posed too many times before, “have you ever had thoughts of ending your life?”
I had wanted so badly for her answer to be anything other than what it was. I selfishly wanted her to say “of course not” or “I’ve never had that thought”.
Instead what she told me was that she was both depressed and feeling guilty for being depressed.
“I look at my patients, sitting in bed with COVID or with cancer, with horrible prognoses, and I think, why should I be depressed? There’s nothing wrong enough with my life for me to feel this way.”
“No one ever needs justification for the way they feel,” I answered. “Your feelings are factual, they don’t need to be evidence based.”
She sat there, tall and poised, hair tied back in a neat ponytail, a hint of sadness in her eyes but only because I was looking for it. She nodded silently but I could tell I had not swayed her.
The mounting body of evidence regarding physician and medical student burnout in recent years has been appalling to all paying attention. If you Google “physician burnout” you will find countless articles and studies, summarizing the grim reality. This past year, the Harvard School of Public Health declared physician burnout a public health crisis.
At every stage of training, physicians have higher rates of burnout and depressive symptoms when compared to age matched peers and female practitioners are leaving medicine at an alarming rate. And I guess since medicine is an evidence based field, a study was needed to prove that depressed doctors are more prone to err.
“Everyone else is working just as hard as I am too – it’s not like I’m the only one who has this intense, exhausting career,” she told me, rolling her eyes at the words as she spoke them.
She was right. There are countless other nameless physicians fighting every day. Fighting and enduring. What we hear about are the statistics. What’s missing from the national dialogue are the narratives.
We see the data and the numbers but not the faces behind those numbers. We hear that students are dying but we don’t know their names, their faces or their histories. We fight against an abstract beast, lurking behind every corner, waiting to pounce on any one of us who is overworked or overstretched. But we never see the face of this beast.
Here she was, sitting in my office, and I could never have envisioned her. The face of burnout had no face for me – just numbers and emotions. When she first walked in, I saw what I am sure her patients see in her – professionalism and decisiveness.
I didn’t see depression. I didn’t see suicidal ideation.
Much like the current pandemic, the pathway to fixing the crisis of physician burnout is not an easy one. There are no shortcuts. But we must move past the statistics.
Teaching wellness to my medical students and being a doctor to many health practitioners struggling with depression, the harsh reality I have confronted is one where mental health disorders are not only stigmatized, but also seen as personal failings.
I have seen more than several postings online during this pandemic, perpetuating this stigma:
“I don’t get why doctors complain, they get paid more than the rest of us.”
“Doctors should suck it up – this is their job.”
“Didn’t doctors and nurses sign up for this?”
We have to do better. We have to push for systemic changes that can only be realized by putting more doctors in leadership positions. We have to change the structure of our healthcare system so that patients come before profits. We have to allow our doctors and nurses time to grieve when they need it, and space to reflect when they ask for it.
But most importantly, we need to be heard. People who go into medicine, who decide to pursue this calling, are among the smartest, most resilient human beings in society. They are screened and vetted and challenged every step of the way, to ensure they are up for the task of caring for humanity.
Their strife should never be seen as a personal failing, but rather a giant red-flag that the system is broken.