I have lived for some time with depression. Most of the time, it is nagging in the background, helped by exercise, family and friends. But a few times, despite my best efforts, it has gotten out of control.

At the middle of my chief year in November, it came to a head. I was under tremendous pressure to apply for fellowship when I didn’t think it was what was best for me, while simultaneously trying to save a failing relationship and manage hours and responsibilities that only increased throughout my training. At one point all I could do was wake up, make it to the hospital 10-minutes late, work a 14-hour day and return home to collapse. I felt exhausted and lonely from taking care of other people all day when there was no one around to take care of me. I was in constant physical pain from the chemical imbalance in my brain. It felt like I was walking around with weights hanging off my entire body. Eventually, people noticed I was missing things. I was puffy-eyed from excusing myself to cry multiple times a day, arriving late and showering well maybe once a week — all these things extremely out of character for me. So I, more or less, was convinced to take some time off.

The first few weeks were excruciating. A therapist told me, “You use work as a distraction from life. We are here to help you with that.” So what if I do? All I could think about was the workload that was shifted to other people. I hated that I wasn’t there. How stressful it must be for them, and what are they saying? Another resident once took time off after losing her mother. She was considered “lazy” for it. One resident even said, “(So-and-so’s) dad died and she only took one week off! (This other) resident is so lazy.”

I attended a partial hospitalization psychiatric program, which ended up being extremely helpful. We did mostly intensive dialectical behavioral therapy, which focuses on emotional regulation skills particularly for people with suicidal ideation. Some skills helped me not give a sh*t about the kind of people that would say the insensitive quote I just mentioned above. Some skills ultimately helped me be a better resident at work and handle the ups and downs of life.

And what I greeting I had on my return! Some people were very warm and welcoming. I will always be thankful to those people. And then there were others.

“Hey, Kris, where have you been? Home watching Netflix, huh? That sounds nice.”‘

Seriously? I have spent the last four months fighting my brain from destroying myself, and you think I was just chilling on my couch binge watching shows. “Ha! Yeah. Loved Black Mirror.”

“Wow, Kris … you missed so many cases. Are you even going to graduate?”

You know, I don’t really know. I probably won’t graduate on time. At this point, I’m surprised I’m still alive. So I guess I’ll figure the rest out now that I am. “Yeah you know, I missed work. I am excited to get back into it and pick up from where I left off.”

“You know we all had to work really hard when you were gone.”

Guilt and pain again. Why couldn’t I just be normal and not have depression, so I wouldn’t be such a burden to everyone around me?This is the first time it has ever gotten to this, I hope it is the last.

“Thanks for covering for me. I appreciate it.”

And then there were the people, who were so receptive to me before (as someone with a reputation for being a very dependable, hard-working resident) who would just look right through me now as if I wasn’t there. That was cool!

People who take time off work for cancer are greeted with hugs on their return. People throw parties for them in remission. They call them things like “strong” and say, “You beat it!”

When you suffer from a mental illness, people don’t do that. They don’t see it as a disease. Although your colleagues all learned about the pathophysiology of neurotransmitters in medical school, they will say things like “Snap out of it!” and “Cheer up!” and “Focus on work.” All of these things, although well intended, are universally unhelpful to someone suffering from major depression.

And even if you work extremely hard in treatment, spend whatever pennies are leftover after rent from your resident salary on therapy and antidepressants and you eventually get better — nobody is throwing you any parties. As a matter of fact, they are pretty annoyed you were gone so long for some nonsense in the first place. The same people you have seen be so kind and empathetic to sick patients.

It astounds me to this day how the pervasive issue of depression and suicide in the medical community is swept under the rug. How uncomfortable it makes people when it is a simple disease process that frankly, we’ve all learned before. How medical professionals are discouraged from seeking treatment for mental illness due to stigma. Doctors are expected to maintain a facade of being superhuman when we are all just imperfect people. The reason I am sharing this is that, although I am obviously biased, I want to petition that we, as physicians, start treating each other how we treat our patients. We can give kindness and empathy to our colleagues as well. I know that we all have it in us.

The author is an anonymous physician.

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