A doctor turned Hollywood actor on physicians who struggle with suicidal ideation [PODCAST]

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“Thanks for gathering today in this anonymous detached space. Since it’s unlikely that we’ll ever publicly convene in a circle on metal folding chairs, I’m reaching out through this letter. You can peruse this in private and perhaps see a piece of yourself here.

As a non-practicing physician who speaks openly about my decades of suicidal ideations, I know there’s a thirst for connection on this topic. Colleagues pull me aside to whisper that they, too, have felt “that way.” See this letter as my way of firing a flare into the dark cavernous topic of physician suicide in order to faintly shed light and, above all, signal that you are not alone.”

Eliza Shin is an actor and former radiologist.

She shares her story and discusses her KevinMD article, “To my fellow physicians who are struggling with suicidal ideation.”

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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, 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, KevinMD. Today in the show we have Eliza Shin. She is an actor and a former radiologist, and she wrote the KevinMD article “To my fellow physicians who are struggling with suicidal ideation.” Eliza, welcome to the show.

Eliza Shin: Hello, thank you for having me.

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

Eliza Shin: All right. It’s a long, complicated one, but most lives by this point are. I am a working actor in Los Angeles, and by that I like to tell people I pay my bills; I can put a little away for retirement. So that is where I am. My journey into physicianhood and out of it to here is all about mental health, emotional health, and trying to find inner peace.

So just briefly, I was a child of immigrants. My mother passed when I was young. We had a blended family then, and I took on the idea of becoming a doctor as a way to sort of get into a world that was unfamiliar to me and where I felt extremely insecure. But then as I went into medicine more and more, I could feel that there was an emotional mismatch, although there was an intellectual match of sorts. I could do it, but it didn’t quite feel right.

So I started therapy in my first semester of medical school, and it was this geriatric psychiatrist who was giving a lecture who said that most senior citizens and elderly were undertreated in terms of their depression, because people thought it was natural that an old person would be angry and depressed. Who wouldn’t be? But he wanted to point out that someone who was old, angry, and depressed would have been young, angry, and depressed, and someone who was old, happy, and well-adjusted was that way when they were young. Like a bolt of lightning in the lecture hall, I could feel that I was on a direct path to being old, extremely angry, and extremely depressed.

So I found a therapist at a time when people weren’t going to therapy, and especially from a culture that didn’t support therapy. My father is just a product of his world and was very threatened by it, as are many family members even today, I’d like to point out. But I am now a person who is really proud of who I am, of where I’ve been, and what I’ve come through. I have such professional satisfaction. I’m at personal peace with myself, and I wake up pleased and, I think, quote, unquote, normal, versus waking up just so upset that I’m alive and feeling that life is unfair and how could I have been given health and education and money only to be so unhappy at my deepest core, which is how I felt as a physician making plenty of money. So that’s kind of a nutshell of a very complicated journey.

Kevin Pho: So you are a radiologist, and of course a lot of physicians take a pretty linear path to get there. They go to undergraduate training, pre-medical courses, medical school, residency, and now they’re an attending. And you left the field and are now a professional actor. Tell me about some of the challenges that you face in making that non-traditional transition.

Eliza Shin: So I’ll first talk about my segment during training, because I could feel that there were certain physicians around me who thrived. No matter how hard their days had been, no matter how many hours they had been on call, you could tell they were deriving vitality from their work. And there were so many other physicians who were just, I mean, profoundly bitter and angry. I could tell that there’s a life out there that’s worth having, and maybe it’s in the shape of being a physician, but maybe it’s not. But whatever those people have, I wanted. So that was the beginning of thinking, OK, life at peace is a real thing, because I can see it with my own eyes. It’s worth pursuing.

I had always been musical, and I think coming from an immigrant, bicultural, bilingual family, that made sense, because we weren’t verbally or culturally facile in my house with the white American culture. But music is simply an art of execution. I mean, not to denigrate musicians, but classical music is. So I thought I would go into music, and that hobby had carried me through medical school and residency. So if people want to say that I had had a dream of sorts, it was that I would be a musician.

I never thought I would end up in acting, and I think I point that out because my relationship with acting came out of a series of very small steps, where I found myself being hired for it. I found myself not very good at it but willing to do more, and it gradually came to the surface, versus something like medicine, where you declare it at a very young age and you just hang on to that tightrope, come hell or high water.

And to get there, I had to let go. I had to be very honest when I got to my limits as a musician and saw that although I was musical, I’m not cut out to be a musician. I had to be very honest about whether or not I wanted to live with a lot of money, because I’ve spent many years with an income not commensurate with my educational level, but that was fine for me too.

I mean, at my lowest, when I first moved out to California, and I moved to California without getting a license on purpose, I was combing lice out of the hair of private school students, because they all huddle around their devices and lice just jumps from one student to another. And people would ask me periodically, “Do you miss medicine?” I never said yes to that. I always said, “I miss my sense of mastery,” because I was a good radiologist, and I know what it’s like to be a master of one’s craft. I knew I wasn’t at that level, and I’m still not at that level as an actor. But I knew somewhere in my bones that medicine was a decision that I needed to make at that age to help get me through my 20s and early 30s, but it wasn’t going to serve me in the long run.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “To my fellow physicians who are struggling with suicidal ideation.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Eliza Shin: So it’s about how I view suicidal ideation as a natural outgrowth of people’s experiences through life, including young experiences, because I’d had suicidal thoughts and ideas even as a youngster, since my mother had passed. So the idea of death was very familiar to me. And then I had had suicidal ideations all through my years in medicine, but I had to keep them silent for many, many reasons. Over the years I’ve come to realize that I believe that there are different kinds of suicidal ideations, but because we’re ensconced in silence, we don’t even know how to interpret them for ourselves. Although therapists are helpful, sometimes there is wisdom to be gathered when there are more voices in the room.

So as I read more and more articles of other people writing about their suicidal ideations, I could see how there were true times where I actually wanted to end this physical life. But there were other times where my suicidal ideations were more conditional, that I just wanted this series of events or this path to end. And then there are other suicidal ideations, just because I’ve lived with them so long, where it’s actually sort of my stress response. I haven’t had these for a while, but in these past few years, that’s just when I have a flicker of, like, “Oh,” I can feel them coming. I can just pull myself back and be like, “All right, sort of, what’s going on? Why am I stressed out?” Maybe the way some people have, like, plaque psoriasis that flares up when they’re stressed out, or it’s just an indicator.

And I also wanted to write it because with the pandemic, there’s been so much discussion about burnout. Although there are physicians out there who probably just need some therapy of whatever sort, I know I’m not so unique that there aren’t other physicians for whom this is not where they should end their professional days. I wanted them to know that it is possible to completely leave this career and find a way to sustain yourself in life that is thoroughly fulfilling, because by and large, physicians are gifted people. And it is an utter privilege to say that. I completely understand, because so many people in the world are simply struggling to put a roof over their heads, and it’s true we should be grateful if we make it to a certain extent in life. But I think a truly fulfilling life is when you are wholeheartedly engaged to the fullness of your capacity, and to do that with dignity, and that it’s possible to do so as a former physician.

Kevin Pho: How difficult was it for you to manage your thoughts of suicidal ideation while training and practicing medicine?

Eliza Shin: So it’s a wonderful question. I had to take a leave of absence during my third year of radiology residency, which was thoroughly frowned upon, because I trained at an institution that even puts people on call, at least they used to put people on call, the day they’ve had chemo. It was a brutal institution. So I got screamed at by my fellow classmates, because they of course had to cover my call during that time when I was out. But I was waking up and obsessed with ending my life.

And the most effective way I found to clear my head space: I made a deal with myself that year, because it was just so much chatter. As a physician, we clearly know how to end our lives. There’s no sort of, like, non-fatal suicide gesture. So I said, “OK, you’re allowed to do it, because otherwise we’re just going to keep asking the question. The only caveat is you have to spend an entire year truly looking for the answer to the question: Is life worth living? Because you know this is a final answer. If you do it, you have to give the full weight of yourself into that question: Is life worth living?” And I gave myself a year, and I mean, even by like nine months, the kind of rage of ideations had faded.

When I was out of practice, at least, I always worked part-time, and I never had the financial struggles that I had had while I was in training, so it was less. But there were a couple of times I went through a couple of bouts of medication, and then I would come off. There were also a couple of times, I learned gradually, where I just walked myself to an ER, because I knew that that was the best thing I could do. I’d already answered for myself the question, is life worth living, but I found myself in a place where I needed extra help, and I didn’t know what to do, and I knew I needed to be around professionals.

Kevin Pho: Did you get a sense that you were going through these behavioral health issues by yourself? Did your residency mates or classmates also struggle with behavioral health issues?

Eliza Shin: They were all struggling. Not all of them; there were a couple of my classmates and fellow residents who I could tell were happy people. But so many people were trying to talk me into an unhappy life and compromises, and so many people would sit me down because they could tell I was struggling, and physicians by and large are attuned to pain, otherwise we wouldn’t be in the profession. Well-meaning people would say, “Eliza, it’s worth it. Look, I have a practice lined up, I’ve got a real estate agent looking at this house, my wife wants to have a baby.” But I could hear the strain in their voices.

And the black humor that we used to get through residency, although funny and incredibly witty, I could also feel was just poisoning us. By now I’ve connected with a few sort of former classmates, and it just corrodes a life. Some of these people, like, you can’t talk about the co-parent of your child that way every day at work and not think that it’s going to manifest itself in some way. So there are so many acceptable ways to be a brutally unhappy physician, and it’s killing us.

Kevin Pho: We’re talking to Eliza Shin. She is an actor and former radiologist, and she wrote the KevinMD article “To my fellow physicians who are struggling with suicidal ideation.” Eliza, if you were to do this journey all over again, is there anything that you would do differently?

Eliza Shin: I mean, I hate to give this stock answer, like, at this point I’m so at peace with who I am. I can look at everything and see how it contributed, how it got me here, and I guess, you know, that’s the hope for everybody. I mean, the world was the way it was. My parents were who they are, even now. My classmates, we were so young. I mean, society has changed so much for me as a woman of color in the United States, for the better. So I mean, I can look back at that struggling version of myself, and if anything, I would whisper, “Keep following your instincts. You’re strong enough to get through this.” But gosh, if I took away any piece, I don’t know if I’d be where I am now. And I’ll be honest, I made some terrible mistakes. I hurt so many people. I didn’t behave in the best ways at many junctures. But I really was always somebody doing the best that she could.

Kevin Pho: Now, for those other physicians who are also struggling within the profession, what kind of advice do you have for them?

Eliza Shin: You know, we live in a time where people have access to so much, and especially as a physician, most people have the financial ability to get help. Help is individual when it comes to this form of help. So, you know, try things, even if it’s not talk therapy. There’s group therapy, which is not a cheap form of talk therapy; it helps to sit around other peers and see people who are living through what you’re living through. But nowadays there is microdosing with psilocybin. I’ve gone through two ayahuasca journeys, acupuncture, Reiki, tarot card readings, full-on psychotherapy five days a week, just reading articles alone by yourself, electroshock therapy. There is so much out there. There’s going to be something for each person.

I would also say the form of help that helps you may stop helping you as you move through various phases of emotional health. So, you know, be open to letting things go and letting something else in.

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

Eliza Shin: That this sort of kind of cynical, skeptical, “Ha ha ha, aren’t we so great for white-knuckling it through the tough profession that we have,” this idea of, “Oh, they can hurt me, but they can’t stop the clock,” is a terrible [expletive] way to make it through life. There’s no honor in that anymore, and we live too long to chain ourselves to that sort of outdated, unhealthy view of ourselves.

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

Eliza Shin: Thank you so much.

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