We learn about it in school as a formula. There is a checklist that we are given, and we ask our patients these eight questions and then calculate whether or not they have depression. It’s so simple. Anyone can do it! I never once thought that I would be calculating my own score at the prime of my education.

I entered medical school full of hope after years of failures and thinking that I could never become a doctor. Having the opportunity to become one was the best thing that ever happened to me! I finally had a purpose, and my parents were so proud of me. I had the support of my entire family and friends, but they were all back home in Vancouver. I was alone in the middle of nowhere.

I was always good at making friends and finding a good group of people to help and support me wherever I was. Then, it was end of the second year; I could actually start going to hospitals, where all the action happens. Before that, I had to take Step 1.

This was where everything that I had worked up to so far was going to fall down the drain. I am a very hard worker, and I have a Type A personality. I am extremely hard on myself. And if I am unable to achieve the goals that I set out for myself, I fall down a deep spiral of catastrophic thinking. I had a goal for Step 1; I had a target specialty and set all of these plans in motion when I began studying for Step 1. This was the most difficult exam I had ever taken, and I studied the hardest I have ever studied in my life. I had given it my all. All of this made the eventual outcome, which was 18 points below all my practice exams, all the more disappointing for me.

The day I got my score was the day I felt, at the time, that my life had ended. I couldn’t recall any happy memories that came before that moment; the only thing that I ever thought about when I woke up and went to sleep every day was my score. I felt that I would never amount to anything and that I was worthless. How can you give your all to one lousy exam and still fail at that?

I started clinical rotations and all the excitement and hopes that I had riding on my third year vanished. I had no confidence going into my third year, and I saw myself feeling envious of everyone that I met, wondering what their lives were like, wishing I could be like them.

I remember having these fleeting thoughts about what it would be like to disappear and cease to exist. I remember that these thoughts were the only thing that would give me solace. Waking up every morning was so painful for me because I didn’t see the point in it. I would get ready reluctantly every day wondering what would happen if I just stopped.

When I learned about depression in school, they taught us that a lot of the time, there is a reluctance to continue daily activities and individuals would just stop performing regular life activities. I still got up every day, got ready and went into the hospital. So obviously, I wasn’t depressed.

I had these recurring thoughts about flying home, driving to Kitsilano Beach, leaving the car keys in the sand and walking into the water. Deeper and deeper until the water was up to my neck and just letting my feet go. I would imagine the waves in the water, carrying my body further into the ocean. I don’t know how to swim. Every time I imagined this scenario, it would bring me calm.

I was really good at faking a smile. No one apart around me knew how I truly felt. I had always had a very cynical outlook on life, and when I made comments about suicide, my friends would think of them as jokes.

I can understand how to an outsider these thoughts can seem dramatic. All of these feelings about a test score? But for medical students around the world, board scores can be the end-all and be-all of our lives. Sometimes it means the difference between practicing as a doctor and never being able to find a residency position. A lot of us have so much riding on this and spend so much of our lives working towards this that when we aren’t able to achieve our goals, life itself seems futile.

Going through my depression, I never sought out help. I cried myself to sleep every night and woke up, then cried again in the shower. I accepted this as my new routine, just a part of my life. I have a very supportive family that noticed my behavior, and they made me feel loved. Whenever I had these fleeting moments of disappearing I thought of them and how hurt they would be if I decided to do that. My thoughts of walking into the water forever were so selfish, it brought me calm. But it would only bring pain and suffering to the ones that loved me. Knowing this is what got me through these dark times.

I was lucky to have a support system that kept me sane. Not everyone has this. It’s really important to take a moment and consider your own mental health along with those around you. Take a moment to offer support to the ones that may be suffering in silence beside you and check up on them. A lot of us are going through things. And sometimes all it takes is one friend stopping to ask if you are OK to know that there are people that care about you and support you.

I will never forget this period of depression that I went through, and it will always stay with me. But I am proud and happy that I was able to work through it and have come out so much stronger.

This journey is not easy and as medical students, residents, and physicians, we have to remind ourselves that there is more to life than exams, board scores, and our jobs.

The author is an anonymous medical student.

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