It was 4:30 a.m. on a freezing cold winter morning when I dragged myself to my car and started down the street to the hospital. I was working in the ICU for the month, and sleep had become a commodity I no longer enjoyed. I tried to shake my brain out of the dense fog it seemed to always be in lately.
I looked up in time to see my car …
A resident physician’s story of depression
A good friend of mine, B., once told me a few years ago that before her divorce, her husband was verbally and occasionally even physically abusive toward her. Somewhat shocked by this news, I expressed how glad I was that she had gotten out of that situation.
I did not think that B. would be a typical victim of domestic abuse. Coming from an affluent background, we met as co-workers in …
Domestic abuse can affect anyone, even physicians
If you’re not a mental health professional, your exposure to psychosis may come through a variety of channels. You may know someone with a psychotic disorder; you may have a psychotic disorder yourself. You may have taken an introductory class on psychology in high school or college, and you may be aware of psychotic episodes as events in which people lose touch with some element of reality — they may …
He was the go-to sports guy in Washington, DC. A masterful surgeon with countless academic publications, he trained orthopaedic surgeons across the world and was the top physician for professional sports teams and Olympians.
Dr. Benjamin Shaffer had it all.
Yet Ben was more than a stellar surgeon. He was a kind, sweet, brilliant, and sensitive soul who could relate to anyone—from inner-city children …
Why “happy” doctors commit suicide
One of the aspects of depression that’s particularly difficult is the sleep disturbance which accompanies it and often continues after the traditional symptoms of depression have finally gotten better. When studied in the laboratory, the sleep of depressed person is short, shallow (with less deep slow-wave sleep), and frequently interrupted by awakenings. Additionally, there are abnormalities of the timing of rapid eye movement sleep and intensity of eye movements during …
How and why to treat sleep disturbance from depression
Recently, more than 70 people overdosed on K2 in the New Haven Green, a public park near Yale — in one day. In the chaos, multiple municipal staff and emergency services personnel ran frantically to help countless individuals who may or may not have wanted help. The day after, I biked by and saw two ambulances and police sirens. These issues are not solved in a day, and might not …
What the news left out about K2
The upgraded responsibility and authority given to starting residents is both a blessing and a curse. Suddenly, the need for co-signatures vanishes. There is greater autonomy in clinical practice. Residents get paid. However, residency can also be a time of significant stress. Residents are forced to navigate the demands of preceptors, other residents, medical students, nurses, patients, family members, and administrators. Residents have very little control over what they do, …
10 ways to make residency less stressful
Imagine spending days or even weeks in an emergency room without treatment for a broken leg or painful kidney stone.
Patients in psychological crisis across the country are living this exact scenario. Long waits in an ER, hospital room or prison for an inpatient psychiatric bed, otherwise known as psychiatric boarding, are their unfortunate reality.
Rewind to over 50 years ago — as institutionalized patients were gradually integrated into communities, the availability …
Let’s talk about the psychiatric boarding crisis
Darkness covers the sky so that no light can enter the soul. Only a silhouette of life is possible — only a shell devoid of existence, devoid of meaningful experiences. Living is like walking in a dense forest where its canopy envelopes all who dare to enter. The falling rain is black. It covers everything like a shroud. The air is so heavy, breathing is, at times, too much to …
Physicians are at the frontline of depression
Two cars arrive at a stop sign at the same time. Both start into the intersection. One driver speeds through, while the other jams on the brakes, avoiding a collision. This driver feels insulted, offended, diminished. Who the hell does that other driver think he is? He nearly killed me!
This scenario, and countless others involving merge lanes, contested parking spaces, and aggressive rush hour traffic, are set-ups for road rage. …
Road rage: It’s all in your head
We’ve all been through difficult times. It may be the death of someone we love or suffering abuse with no one to help. In life, many events fly at us that are hard to manage. Many of us just suffer silently through the pain, not allowing anyone in. And even while we do that, we also know that is not the healthiest response.
Many patients come to me struggling with anxiety …
How to deal with hardships in life
“Oh, you’re a psychiatrist? I hope you won’t analyze me!”
I never know what people actually mean when they say that upon learning that I work as a psychiatrist.
I think they’re saying, “I hope you’re not going to spend our time together trying to discern my flaws.” Nobody wants people to seek out, highlight, and exploit their vulnerabilities and faults, so I can understand that. Of course, that’s not what psychiatrists do.
Anyway, …
Don’t worry, this psychiatrist won’t analyze you
Gratitude may be more beneficial than we commonly suppose. One recent study asked subjects to write a note of thanks to someone and then estimate how surprised and happy the recipient would feel – an impact that they consistently underestimated. Another study assessed the health benefits of writing thank you notes. The researchers found that writing as few as three weekly thank you notes over the …
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It’s been a gut-punch kind of time for many of us, and I want to say a few things that I think are important.
First of all, I really love working with you guys. It is the best part of my job, hands down. I have taken stock of my career lately, and I keep coming back to that. You are young and optimistic and funny (so, so funny). You are …
To my residents after a suicide
Fortnite Season 5 has officially arrived — bringing new features, a new maps, and new skins. Parents can anticipate battles over the amount of time spent playing the game to “level up” with your teens.
If you are not familiar with this game, then it likely means that you are not the parent of a teenager (I nearly wrote “teenage boy,” but it is important to appreciate the growth of female …
Parents vs. Fortnite: tips from a child psychiatrist
Just recently, New York and Virginia became the first two states to mandate that mental health become incorporated into school curriculums. New York passed a law for educators to teach material on mental health beginning from elementary school continuing on to high school. Virginia’s legislation intertwines mental health education with physical and health education for 9th and 10th graders. While these two states should certainly be …
The new mental health education mandate doesn’t go far enough
We bear the pain in different ways. For me, it feels like you’re a combat medic and you’ve used up all your tourniquets on a wounded soldier that seems to hemorrhaging from everywhere. The blood seeps through the skin, and no matter what you do you cannot stop the soldier from choking to death on their own blood, even as your hands, arms, and legs are applying pressure wherever they …
What is it like to lose a patient to suicide?
Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.
Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without …
Physicians don’t just suffer burnout. They suffer moral injuries.
A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years.
History of Suboxone
Suboxone was first approved by the FDA in 2002 to treat …
I was always worried about doing well on board exams. I didn’t want to simply pass them; I wanted to excel. Before I took exams, rumor had it that a person would have to intentionally fail Step 1, 2, or 3 and that failing Step 2 CS was virtually impossible. The truth, I learned, is that thousands of physicians-to-be fail one of these exams every year.
I know, because I’m one …
The culture of perfection in medicine is a disease
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