A panic attack brought on by the stress of medical school [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“As I leaned against the pristine wall, my vision suddenly dimmed. Everything turned gray. I gulped for air. My arms and legs went numb. I felt that drowning sensation I’d had in third grade when a nun pushed my head between my legs to keep me from fainting in church on a brutally hot June day. Or like the time when I was eight months pregnant, took a hot shower at the university gym, and almost belly-flopped onto the concrete floor. I prayed that I wouldn’t pass out on my first day of medical school classes. I didn’t want those MDs-to-be, all smarter and younger than I, to know I couldn’t handle this, that I didn’t belong.”

Anne McTiernan is an internal medicine physician and epidemiologist. She is the author of Cured: A Doctor’s Journey from Panic to Peace.

She shares her story and discusses her KevinMD article, “A panic attack brought on by the stress of medical school.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Anne McTiernan. She’s an internal medicine physician and epidemiologist. She’s also the author of the book Cured: A Doctor’s Journey from Panic to Peace, and there’s an excerpt from that book on KevinMD, and that’s titled “A panic attack brought on by the stress of medical school.” And welcome to the show.

Anne McTiernan: Thanks for having me.

Kevin Pho: So we’ll get into your book and article in a little bit, but first off, can you share your story and journey to where you are today?

Anne McTiernan: Sure. Well, I was an unusual physician, because I didn’t come from a physician family background. I grew up in working-class Boston, the daughter of a single mother, and I went into medicine on the later side. I had already been married and had two small children when I decided I wanted to go into medicine. So the stresses that other medical students experienced were really exaggerated manyfold for me, because I had things to do besides just study. So that was one of my major challenges during medical school, and then during training as well, during residency.

After residency, I was looking for a job where I could combine with family more easily, and so that’s how I ended up in research. So I did some clinical medicine at the beginning as well as doing research, and then changed over to being purely a research physician.

Kevin Pho: Now, tell me what your life is like as a research physician, and also tell me how the pandemic has affected your research over the past year.

Anne McTiernan: Well, research physicians, there are very different types. I like to do clinical trials that use my clinical skills as well as my epidemiology skills. And so, doing clinical trials, because you’re working with participants, sometimes healthy participants, sometimes people with a pre-existing disease, you really have to make sure that their safety is preeminent. And so it’s not just doing experiments; it’s working with people. In order to do these clinical trials, we also have to get funding, which is not easy, and so we spend quite a bit of time writing grants and getting grants and then administering grants.

I do very different types of trials. Some have been quite large. I was a project director for the Women’s Health Initiative when that first started in ’92, and did that for quite a while, and then I moved into doing more independent and smaller trials. Sometimes we’re asking people to do something that could be simple, like taking a pill. Sometimes we’re asking them to make major lifestyle changes. So clinical trials can have very different types of interventions, and then we’re also often following people long term. The Women’s Health Initiative followed people for decades, and in my studies, we tend to follow people for one or two years. So we really keep a close eye on how people are doing and what the intervention effect is.

And the other thing we do is we have to write scientific papers. We have to write up our results. We have a responsibility to those participants and patients, and to the public who’s funding these studies, so we write up these results. Usually we would have several trials going, maybe a trial or several observational studies where we’re collecting data but not doing an intervention. It’s almost like having a portfolio. You have to have several things going at once to keep yourself going and keep your team funded.

Kevin Pho: And the past year, during the pandemic, how has that affected your research?

Anne McTiernan: It’s been very challenging on some levels. Now, I’m lucky I can work from home, and I was required to work from home, but our clinical trials often require participants to come into our clinic, our facility, and we had to put that on hold several times because of safety for the participants, because our institution had closed some parts of it down. And so it really extended the amount of time it’s been taking us. It’s not been a safety issue for the patients that are going through clinical trials. It’s definitely a safety issue, and those trials were allowed to continue, but they still had problems.

Kevin Pho: So let’s transition now into your KevinMD article. You talk a little bit about your medical journey through training, and your book is titled Cured: A Doctor’s Journey from Panic to Peace, and the excerpt on KevinMD from that book is titled “A panic attack brought on by the stress of medical school.” Now, for those who didn’t get a chance to read that excerpt, can you just walk my audience through it and share the story of why you decided to share it?

Anne McTiernan: Yeah, so the excerpt is the prologue from the book. What I wanted to do in the book was to describe, with creative nonfiction, so it reads like a novel, what it was like for me as a young mother struggling to do medicine, to learn this enormous amount of material, to go through training, and then also at the same time to be mothering two children. And I had a husband, but that doesn’t take away the responsibility of the mom. So it was a great strain, and I ended up becoming quite anxious and ended up having panic attacks. I didn’t know at first what they were, and finally, when I realized that I needed help, then I asked for help. The book describes that process of asking for help and getting help.

But the excerpt in KevinMD is the prologue, and it describes the first day in anatomy lab, and most people who have been through medical school remember that vividly. The idea there was to bring in all the senses, so that somebody reading it can understand all the feelings and experiences I was having just on that first day.

Kevin Pho: If you could paint a picture for us about some of those competing challenges while you’re in medical school with a young family, give us a story specifically of how those competing challenges affected you during that time.

Anne McTiernan: Well, I think that would build up. For example, anybody that has a family or caregiving responsibilities understands the time that that takes. On a typical day in the first couple of years of medical school, my children would be at school, so I’d take them to school, and my husband would drop them off, and then I’d pick them up after school. After school, there would be things for them to do, maybe homework, getting supper ready, feeding them, getting them ready for bed, and that all takes time. I wouldn’t get to start studying until about eight or nine o’clock at night.

And for my peers, other medical students, there were no other mothers in the class of about 150 people. They could start studying at three o’clock in the afternoon and go to midnight if they needed to. And so that pressure just kept building up and up, because I had other responsibilities. I couldn’t just study. It just became overwhelming.

Kevin Pho: And you mentioned that you had symptoms then that you now know were panic attacks. What kind of symptoms specifically did you have back then?

Anne McTiernan: The panic attacks that I had, I would feel like I couldn’t breathe, and I would get pins-and-needles sorts of feelings just about everywhere. And then, of course, I couldn’t sleep. These would usually be at night, so I wasn’t having them when my children were up, luckily. And it just kept building up. They didn’t go away. I kept thinking, “Well, they’re going to go away,” but they really didn’t.

I talked to my family doctor at first and then realized there was something else going on. And I remembered that when we went through our medical school orientation, there was a psychiatrist from the psychiatry department who stood at the front of the room and put some, not his, phone number on the board. Back then, there were no electronics; he had to write in chalk, and these were three-foot-high digits that he wrote. Like good medical students, we all wrote the number down, and I’m thinking to myself, “I’d never use this.” But I remembered having it, so I went looking for that number and I called it, and through him, I got a referral to a psychiatrist, and I started the process of psychotherapy.

For me, that worked. Back then, in the ’80s, there weren’t medications available for people with anxiety or panic attacks, or they weren’t, they didn’t work very well, or they would have too many side effects. And so I chose not to go that way, although for many people that works quite well. I chose to go to therapy, and through that process, which I described in the book, I actually bring the reader into the therapeutic room so they can see what happened. Then, through that process, I was able to reduce my anxiety and reduce the panic attacks significantly.

Kevin Pho: Now that you have time to reflect on your medical training, what are some of the lessons that you’ve learned from this whole experience, and perhaps lessons that you could share with my audience who may be going through similar experiences?

Anne McTiernan: Well, I think there needs to be a lot more concentration on and attention to mental health for people going into medical training and for physicians. It’s shocking how, for example, the state licensing boards often will ask, “Have you ever had a problem with mental illness? Have you ever been treated for mental illness?” And sometimes then people have problems with getting their license or getting their license renewed.

The reason this is so shocking is that, well, there may be some conditions that would make patient care difficult. It’s also the truth that these things that medical students, trainees, and physicians go through are just being human. And so humans will react with grief often if they’re under a great deal of stress. They’ll get depression, they’ll get anxiety, and these are the sorts of things that can be prevented or treated early on. And to encourage medical students, residents, and physicians that they can seek help, and that they should seek help, and that whatever their conditions are, they’re treatable.

Kevin Pho: Now, how do you propose that they reach out? Because during medical school and residency, physicians are taught to be stoic, and there’s a certain stigma that’s attached to mental health issues, although during my podcast and my blog, that’s less now than it was back then. But nonetheless, what kind of advice can you give to medical students and residents in terms of how they can seek that help?

Anne McTiernan: Well, first, I think it needs to come from the medical schools. They need to open this up so that they’re talking openly about this, and make it acceptable to the medical school for the students and residents to seek help, to make it possible for them to get treatments if they need it. And then for the students to realize that it’s not a sign of weakness to avoid getting help; it’s a sign of strength, and that in order for them to be the best possible physicians, they’re going to keep their whole body healthy.

There’s a lot of stress and distress that comes just from the process. For me, the worst part was the first couple of years, when there was such an enormous amount of material. For some residents and medical students, the problems come with the severe sleep deprivation and stress of residency. And paying some more attention to those problems, to try to prevent those, to help prevent the mental distress that can happen later, I think is really important for medical training programs.

Kevin Pho: We’re talking to Anne McTiernan. She’s an internal medicine physician and epidemiologist. She’s the author of the book Cured: A Doctor’s Journey from Panic to Peace, and there’s an excerpt on KevinMD titled “A panic attack brought on by the stress of medical school.” And tell me, what are some of the other main messages that you want my audience to take home from your book?

Anne McTiernan: Well, from the book, I would like people to understand that physicians are human, that we have various aspects to our lives, and that it’s a struggle. This struggle is going to be experienced especially by women with children, but also men with children that want to be involved with their families’ lives. That balance is always going to be there, and sometimes it will be worse than others.

One takeaway is to realize you don’t have to be perfect in everything. There’s a concept of good enough, and most physicians just can’t deal with that. But there are probably some aspects of every physician’s life that way, where they can just say, “OK, I can be good enough in this. Then I can focus more on something else.” So I think that’s important, and then to realize there may be periods of your life when you need to pull back on something to focus more on something else. But we don’t have to be perfect. We don’t have to do it all exactly to such intensity as many of us try to do.

Kevin Pho: Now, after reflecting back, and now that you’re a successful physician researcher, is that medical school journey something that you would do all over again?

Anne McTiernan: I think I would be better prepared next time, but I certainly have no regrets about doing it. Medicine is a wonderful field, a wonderful profession, and I’m honored and privileged to have gone through that and to be a physician. So I would never change what I did. I might have tried to do it earlier, before I had kids, but then that would have changed the trajectory of all of our lives, so I’m not sure I’d really go that route.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Anne McTiernan: Well, I’m hoping that if people read this book, they’ll come away with a sense of resilience and hope, and even though I write about some sad things in the book, that they’ll understand and appreciate there’s a happy ending. I think during this pandemic, we all need a happy ending.

Kevin Pho: And how can people reach you?

Anne McTiernan: I have a website, annemctiernan.com, so it’s A-N-N-E-M-C-T-I-E-R-N-A-N.com.

Kevin Pho: And thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Anne McTiernan: Thank you so much.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes