This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
Persistence is a big, fancy word for “never giving up.”
Determination is just another way of saying “no ifs, ands, or buts.”
Courage is about having the guts to do what needs to be done.
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“Soumya, I’ve been having excruciating back pain. It’s really bothering me, so I’m going to the Emergency Department.”
I received this voicemail from one of our respected division faculty members as I started my weekly visit to the nursing home as a Geriatric Medicine fellow. Five months earlier, we had learned that the young daughter of two other faculty members had an inoperable brain tumor. Six weeks earlier, the night of November 8, 2016, I was glued to the television, white as a sheet. A first-generation immigrant woman from India, I watched as a man who boasted about sexually assaulting women, and who started his political career calling non-white immigrants rapists and criminals, became president-elect of the United States.
Nearly nine weeks to the day after that voicemail, I found myself presenting a patient case at a grand rounds to our entire Internal Medicine Department, the day before the funeral and wake for the faculty member who sent me that voicemail. At age 60, she had been diagnosed with, and had died of, metastatic melanoma.
I had prided myself on “going it alone” my whole life. I graduated high school near the top of my class, in three years, starting college as a cocky 17-year-old girl with the world at my feet. After some initial struggles, I excelled in my field of political science and attended a top graduate school in public policy. I graduated, as many millennials did, into the 2008 financial crisis. I returned home, and inspired by the physician leaders I worked with, I decided to enter medical school, intending to combine a medical career with one in policy and leadership.
I thus started an eight-year cycle of medical school, residency and fellowship, punctuated with bouts of isolation, imposter syndrome and undiagnosed clinical depression. I felt I was alone in my struggles, but I was wrong. I have had friends diagnosed with serious mental health conditions in medical school, requiring years-long titration of psychiatric medications, and those who suffered through substance abuse as trainees. They were empowered to seek help, and have rebuilt their lives in different specialties, or in fulfilling careers entirely outside of clinical medicine.
Studies from major medical journals have shown that 28 percent of medical students exhibit symptoms of depression, but only 12.9 percent of depressed students seek treatment. Amongst resident physicians (those who have graduated medical school but are not yet ready for independent practice), the statistics are even more dire. Over 40 percent of medical residents across the country screened positive for depression with the two-item PRIME-MD screening test (During the past month, have you [a] often been bothered by feeling down, depressed or hopeless? [b] often been bothered by little interest or pleasure in doing things?).
However, consequent to fear of negative implications for being able to obtain a medical license or for their future careers, many students and residents do not seek help until it is too late. Until, as happened at my training program, an anesthesiology resident barricaded himself in an operating room with a gun and gave himself a lethal overdose of fentanyl. Until, as in my current hospital, a neurology resident was found dead by suicide in his home.
What I learned during my last year of medical training—the most difficult year of my life—is that “going it alone” did not make me stronger. It made me weak and vulnerable. I was vulnerable in internalizing the tragedies of my patients and my peers, bottling my emotions until I could no longer take the pressure. This affected my ability to be a competent, compassionate physician. This realization came as I neared the light at the end of this long, often dark tunnel: when I was seeking jobs as a full-fledged attending physician.
The initial quotes in this article were from a greeting card my division gave me on my last day of fellowship. Those words confirmed that my colleagues had recognized my struggles, and that simple gesture meant everything to me. Sixteen months later, I have returned home to my family to build a career as a physician and leader at an elite medical center. I am leading an interdisciplinary team in the acute hospital care of vulnerable elders. Most of all, I have developed as a person and have committed myself to ensuring that no other strong, intelligent, capable young physicians ever have to “go it alone.”
For additional statistics on depression in medical students, refer to this 2016 JAMA study.