“Remember, today you could be standing next to someone trying their best not to fall apart. So whatever you do today, do it with kindness in your heart.” – Unknown

Today, I want to talk personally from the perspective of a Black, female, physician. I have a confession, I struggle with setting boundaries. I did not know how detrimental this challenge was until I started studying it more deeply. Did you know that being unable to set boundaries can put you at risk for suicide? Let me explain…

When we don’t have clear boundaries, we often say yes to things out of a feeling of obligation or our own negative perceptions about what people will think of us. This often leads to anxiety and depression as we become overloaded with too many burdens and stressed out. Eventually, if no intervention is had, we find ourselves in a hole too deep to get out of, and our brain capacity to utilize our own agency gets destroyed in the process.

I think as physicians, we often find ourselves working in environments where our self sacrifice is honored and applauded at our expense in a profound way. Let’s be honest, it is worse when you are a female physician who feels the pressure to prove yourself even heavier, as thoughts that intrude your desire to seek self-care are laden with feelings of guilt or fear of what people will think or say about you.

I recently was engaged in a conversation with a physician (Dr. Michelle Chestovich) who shared that her sister who was a radiologist, mother of 3, and wife to a supportive husband committed suicide. She shared pictures of her sister, which included one picture of her sitting in the radiology reading room pregnant a day before she was induced. Little did anyone know how burnt out she was, while seemingly holding it all together. Those long and stressful work hours, endless call shifts, home responsibilities, and family commitments accumulated into a sea she was trying to tread in for too long until her legs got too tired to tread anymore. Funny thing is, she was the beautiful, sporty, intelligent, nurturing, outgoing one quick to defend those she loved. No one had a clue! Her colleagues all loved her, and after the fact said they would have done anything she needed. The problem was that her ability to defend herself was being diminished slowly. She asked to explore alternatives to the way the call was scheduled, which was met by ignorance. She even expressed guilt over not wanting to take her baby on vacation because the thought of vacation itself was no relief or escape worthy enough of living another day internally dying.

This story touched me in many ways. Here are some things I took from that conversation as I reflected. I remember in residency when I returned from an exhausting trip for a medical conference, then attended a family funeral, got a UTI which was likely from my neglect to hydrate from being so busy that I fell ill with a fever of 104. I went to the ER, and they sent me home with oral antibiotics. I returned to clinical rotations the following week and went to use the bathroom, only to realize that I could not urinate. A feeling of impending doom hit me like a ton of bricks as I began to feel sick to my stomach and broke out into a cold sweat. I sent a quick text to my colleague to come to the bathroom because I felt something was deadly wrong. I fell to the floor. My colleague and my attending came to the bathroom to help me get into an exam room so I could lay down. Within a matter of minutes, I developed explosive diarrhea and had to be brought into the ER with sepsis from pyelonephritis! As we know, sepsis can lead to organ failure and death if the source of infection is not treated.

Only my close friends and family know this because the story is quite embarrassing, but I’ve decided to shed guilt and shame because I now realize that our stories can save someone else, literally.

I remember doing patient notes while being induced for labor, working through the grief of countless losses, and almost not taking a personal retreat from the madness I was experiencing in life because I felt guilty about what I was leaving behind. I remember the day I had an epiphany of how disconnected I had become from myself that I could not even cry when I wanted to. This came from years of ignoring my feelings and needs in favor of others.

I’m here to tell you, self care is not selfish. You must show up full, rather than empty, to give your best. Otherwise, you will be fighting to survive. I sought counseling for myself when the anxiety and fading hope started to rise within me, and it helped me to identify the underlying issues that caused me to make decisions that were not in my own best interest. Sometimes, we cannot see this on our own.

I am here today to encourage you that counseling is not beneath you. Your brain is a complex organ that can have neurochemical imbalances that cause things to go awry, and in some cases require pharmaceutical help to bring this imbalance back in order. If you were having a heart attack, you would have no problem seeking help or taking the medication necessary to ensure blood flow was getting to this vital organ that was going through a crisis. Your brain is worthy of the same respect, and when it is in crisis, intervention is necessary. We must fight the stigma of seeking help for our brains when we don’t stigmatize help for your heart or intervention for a broken leg.

If your mental reserve is running low, speak up! I give you permission to take time away for yourself, schedule an appointment with a therapist, and take prescribed medication if you need it. Suicide is a permanent solution to a temporary problem. Your life matters, your story matters, and what you are going through matters. If you feel like it doesn’t seek help!

Call or text the 988 Suicide & Crisis Lifeline at 988 (para ayuda en español, llame al 988). You can also contact the Crisis Text Line (text HELLO to 741741).

Samantha Benjamin-Allen is a physiatrist.