I’m not sure when it happened, but driving into the parking lot that cold winter day, I knew it had. Tears welled in red eyes, snot dripped out of my nose. I felt so alone and lost. My whole life I’d wanted this — the drive to the hospital and wondering whether I would change a life. But as I sat in my car, engine off, I didn’t want that dream anymore. I didn’t want to be here, but I also didn’t want to be anywhere else. Did I even want to be a doctor anymore?

Regardless of my inward struggle, I was still an overachiever and my shift about to start. I wiped my eyes, blew my nose and stepped out of my car. A truck pulled up next to me, and the window rolled down. A smile and cheerful hello greeted me.

“It’s good to see you back in town — you aren’t looking your usual cheerful self,” Dr. A quipped. I must have passed him on my way in and not noticed because typically I’d wave. I forced a smile, strangely grateful for the greeting and acknowledgment of my mood. I needed that human connection. I needed to know someone cared.

“Sorry,” I said, “I was in my own little world and didn’t see you.”

“It’s OK — you’re just usually always smiling.” I smile forcibly again and apologize. He was right. I am usually smiling. But not today. Today I am … I don’t know … Today I am what? … Today I am crying. Today I don’t want to be a doctor, and I don’t know why.

SIGECAPS

Every medical student learns about SIGECAPS, the pneumonic to diagnose depression. We rely on it for testing, our psychiatry rotation, and often during patient interviews. How often do we ask ourselves the questions?

I never considered myself depressed. Even though the last few months had been challenging, I chalked it up as “just med school.” But then people started mentioning my weight. “You look great,” my best friend said. My mother offhandedly mentioned, “You look skinnier than usual.” And my significant said, “Wow, your legs are really skinny.” At first I was pleased, then I thought, “Why now? Why not last year when I was trying?”

The years of testing kicked in. Like a good student, I picked up the question stem, “Person X under lots of stress has lost weight” … the answer is “Ask SIGECAPS!”

• Sleep? I definitely oscillated between insomnia and hypersomnia.
• Interest? Patients, doctors, the hospital were all becoming commonplace. Throughout medical school, I’d jotted down stories of patients and lessons I’d learned. I thought about the last few months and realized entries had ceased (not because I was busy, but because I was no longer interested in what patients could teach me.)
• Guilt? I was without a role or purpose. I spent months “pretending to be a doctor” without real input on patient care but with constant pressure to perform and make a positive impression. The reality was my presence felt meaningless to patients and staff alike.
• Energy? Gone. Workouts had fallen by the wayside sometime throughout the year. Making it through a shift was all I could ask of myself.
• Concentration? I had always enjoyed studying and research, but it seemed I could not focus on topics that interested me (i.e., anemia) let alone those that didn’t (i.e., electrolyte disorders).
• Appetite? The question which triggered this exercise in self-diagnosis, most definitely gone.
• Psychomotor symptoms? I don’t believe I was manifesting this symptom — of course, I’d always had trouble comprehending exactly what qualifies as psychomotor.
• Suicidal? No, but I wonder, if I was, would people notice?

I was still skeptical, and so double checked my thought process: depressed mood? Yes, especially when alone. SIGECAPS? I met criteria. Duration? At least one month, probably two. If I was a test question, the answer was depression. Me, the student who had loved medical school. The first two years had been academically challenging, but I enjoyed pushing myself. Third year had been one of the best years of my life: I loved the clinical setting, meeting patients, assisting physicians. But fourth year: What happened?

Physician, heal thyself

In the first year of medical school, a lecture was given quoting studies showing 50 percent of medical students experience burnout, around 15 percent moderate to severe depression, and up to 10 percent suicidal ideation. I was blown away by the statistics yet somehow thought they didn’t apply to me. How incredibly arrogant I was.

Medical student burnout has become a hot topic over the past few years. As medical students, we like to intellectualize; it’s a known defense mechanism, and we are great at it. We talk about each other, worrying about who is at risk for suicide. We empathize with each other, understanding why we should be depressed. We discuss the topic ad nausea, and I was an expert at these conversations; I empathized with the most depressed of students, I encouraged my classmates, I argued for school-life balance and stress relieving activities. I never truly thought I would be one of the percentages.

But I am officially a statistic: one of 50 percent experiencing burnout; one of 15 percent with depression; not one of 10 percent contemplating suicide … yet. I don’t know what to do, where to go. I feel alone, yet I know half of my classmates are experiencing similar burnout. I attempted to slyly confide in the faculty at my institution — mentioning simply increased stress — and was met with “hang in there.” I ask myself what support I expect, realizing I don’t know and would say the same thing if roles were reversed. Support from family and my significant other is even harder to ask for. I don’t know how to explain myself, let alone ask for help; so I avoid conversation and rely on impersonal texting to communicate.

A paper was published in 2005 hypothesizing causes of medical student distress and categorized six experiences that contribute to high rates of depression including adjustment to the environment of medical school, ethical conflicts, exposure to death and human suffering, student abuse, personal life events, and educational debt. Additionally, in a NEJM perspectives piece, a professor of psychiatry states distress increases in third and fourth years as students are isolated on rotations and the pressure to match grows. As I read these papers, I found my worries eased as I could relate to stressors legitimized by experts.

The question left is what to do: Do I want an SSRI? Counseling? It would help, but I am switching locations on a monthly basis and cannot imagine finding spare time to make an appointment. So I will cope via intellectualization and hope my story encourages other students that they are not alone.

The author is an anonymous medical student.

Image credit: Shutterstock.com