I'm sure many medical students and doctors would tell you the exact same thing...
For me it was personal.
I'd always wanted to study medicine. What better job was there? You could save lives and live in relative comfort your entire life. I'd get to emulate my childhood hero growing up, Captain Hawkeye Pierce from M.A.S.H.
But after leukaemia struck my life... it became personal.
I wanted to help people as I'd been helped. It was my doctor's words; that "The Good News Is You're 17 and You Have Leukaemia, but the Bad News is You're 17, And You Have Leukaemia..." and his actions that got me to believe that I actually had a chance in this... It was another patients' words the day before my transplant that really sunk in, and changed my life. Imagine being in a position to do that for people everyday!
My first day in medicine was one of the most joyful of my life.
I was so excited to finally be in a position to give back, and so delighted to be alongside so many other people who cared just as me.
But as time went on... things changed.
For me, and for many of my classmates too.
As I progressed through the course, I got more and more burdened with work, and more and more dissatisfied, and indoctrinated (pardon the pun) into the collective Group-Think of modern medicine. One which emphasised speed over accuracy, marks over competence. One which measured success through KPIs such as reduced wait times and greater efficiency rather than reduced morbility and morbidity, and higher patient satisfaction and involvement. As I feel many in this profession feel at some point.
Doctors have the highest rates of depression of any profession.
1/4 medical students are majorly depressed, and more than 1/10 will think about suicide in any given year.
Why is this happening though?
Aren't these people being paid heaps?
Don't they know the risks of the disease, and how altered biochemistry can alter your very mental state - your very person?
Well, there are many reasons why.
Various personality traits and attitudes make doctors more likely to suffer from depression.
Perfectionism, hints of narcissism in some, compulsiveness in others, martyrism in most, and disparaging views of vulnerability are all commonplace. Facing death, watching good people suffer, and losing the battle over and over again also burdens doctors. Burnout from stress affects 45% of doctors, ladies and senior physicians in particular. And as this article puts so poignantly, Osler, the founder of the first American residency program, advocating for equanimity in physicians, was perhaps the largest contributor to all this...
Junior doctors and medical students have similarly sky-high rates of depression and suicide ideation (the 10% figure is a conservative estimate; studies in my nation show , but have the added pressure of exams and the weight of expectations on their shoulders too.
Very recently, in my country, Australia, 3 junior doctors took their lives within one week.
I'd always wanted to help people. It was just the right thing to do, it seemed. It's why I'd wanted to do medicine. Cancer just cemented that. But I realised that it also is the best thing you can do, not just for others, but also yourself.
Because that feeling of putting a smile on someone's face, or easing someone's struggles... unlike things like fame, money, power, men or women - all those things we seem to desire most in life, that can never be taken away from you. That will never seem meaningless. That's something you can always do.
And I want to share 1 unwaverable truth to all the doctors, medical staff, and regular people out there reading this...
No matter how dire things seem, no matter how much you feel like you're just a cog in this machine which keeps churning out pain and death, no matter how much you feel hope, and powerless - YOU CAN, and DO, ALWAYS MAKE A DIFFERENCE.
No matter what the outcome.
Because what made my doctors special wasn't the medical calls they made or their knowledge and prowess, what made my doctors REALLY special to me was the times they'd talk about my biking progress or my basketball before an appointment (that alone mitigated the 1 - 2 hour wait to see them)... the time one doctor walked alongside me and chatted on the way to a lung plural biopsy which I knew was gonna hurt. It was the time my doctor decided to write in to the medical entrance board and allow me to sit the exams that would allow me to become a med student. THAT'S WHAT MADE THEM SPECIAL... to ME.
I've sat down with men who were dying's families and held their hands as they knew they were about to go, and been told by their family that that night we played snakes and ladders a few days before he passed was something he remembered on his deathbed itself. That the barbecue one friend had on father's day, when a companion of mine in hospital had finally gotten gate-leave on Father's day was the best barbecue and one of the best meals he'd had in his life. But to those reading this, I also want you to know also that you don't have to go this far to create change. Because the little things are Huge. They not only give fleeting happiness to your patients, your small gestures, and make you feel HUGELY cared for too as a patient... something that I realised I hadn't felt when I had severe, suicidal depression for a year until I visited my old doctor, who'd treated me first (thank God I didn't take that jump on that day.)... They also make you realise, at a doctor, that YOU ARE making a difference.That YOU DO matter... Those little acts of kindness reinvigorate you.
And if you take that opportunity to be the light in peoples' darkest day, instead of going into work everyday thinking "Oh here we go, another 12 hour shift where I'm looking after people I can't even listen to me, yet alone help or save", "you'll be thinking, "whose day can I make... whose pain can I ease... whose LIFE can I change?" And that's huge. It's the difference between this being a job and a profession. It's the difference between being run down or turning to alcohol or drugs to get by, and feeling fulfilled. It's the difference between life and death. So go out there and take every opportunity you can to do it. When you have a spare few minutes, take a few moments to see what allied health services around you can do to help improve quality of life for your patients and refer people to social workers to see how you can improve their lifestyles. They've made huge changes to my life, and so many others. It takes a median of 15 years for people to go see a pain clinic, for instance. Let's fix that.
But I still couldn't outthink depression. I still was miserable, despite my fighting against it and willing myself on, again and again. I still went into that deep dark place of wondering what's my point in my mind when the pain I face struck. If others think are thinking you're weak... then they'd better have done more than me. Otherwise, whoever is or would, is someone who doesn't understand something that should be basic knowledge. Someone judgemental and incapable of thinking outside the tiny little box that guides their life experience. Someone beneath your concern, someone who you wouldn't want to befriend anyway. Someone you shouldn't worry about, or let get into your way to becoming the most content version of yourself - something you do deserve, no matter what depression makes you feel otherwise. I say this because one of the other biggest reasons we don't get help is because we're embarrassed.
Sometimes that person is yourself. Most of us are strong people. We power on. We've gotten through gruelling pre-med studies, then through medical schools and internship and everything that comes with the job, or in the struggle to get there. We can beat this. Or we can't be one of those losers or sadsacks or whiners who suffers. We just get on with it. Scraping by, as some of us always have. But getting help isn't the "weak" option. You don't get anything out of beating it. Why risk proving it to yourself, or put it off, or dismiss it as unnecessary, or just chinning up, and putting on a facade when you can get help to get you through it. And I can tell you that when I got help, this all changed. Instead of walking in front of a train that day, I decided to walk across the street from the lab I worked in to see my old doctor, tired, cramping and feeling so alone. And thankfully, he was there. He just sat there, talked, and acted as any person would for another. He did what any doctor should do. He cared for me. As well as took care of me. He sent me to emergency, something you guys reading on mostly likely wouldn't have to do, and I saw a psychiatrist. When I saw her, she said I wasn't despondent, and didn't need admitting, but would require therapy, for some time. When I asked about an SSRI (I'd noticed something was wrong for weeks), I remembered tbere was a drug I'd looked up for my unexplainable, untreatable cramping called duloxetine. I suggested it instead of the one she'd prescribed... and on day 2 of it... I not only lost this fog that was clouding my brain for a year every single day that I now know was depression, I also stopped feeling the pain. I'd felt as good as I had for years! Since before cancer. But it wasn't just a drug that got me there, and got me to stay there. It was talking to someone about it. My psychiatrist, he mainly does psychotherapy. Indeed, his goal is to minimise drugs (indeed, I've eliminated all of my psychiatric;neurological ones for that depression currently), and I recommend seeing someone who does too - maybe a psychologist, perhaps your nations' doctor - doctor help line or mental health service (something I found out at that national doctors' conference that we did for the first time). It seems confronting to do - open yourself up and admit things that you've never admitted before - to others or yourself - but the very things that make it seem confronting are the very reasons why it's great. What you say, can never leave his or her office. You'll never see them in day to day life, or even have to see them again if you don't want to. They are literally professionals at their jobs. And whatever you say to them, they legally can't disclose to anyone! I encourage you to take that first step of reaching out to one, if you haven't before, and think you may benefit. And finally, I'd like to say thanks. You may not hear it a lot as doctors. It seems we patients are becoming less and less grateful over the years, but you guys really to matter to us. You see 20, 30, some of you, even 50 or 60 (in India, that's common according to my Uncle), but we only see 1. It seems like a huge burden when you put it that way. But it's also a huge opportunity. I hope what I've said convinces you to seize it with all your heart. Nikhil
If you'd like to talk. I'm always here.
Suicide hotlines: 13 11 14 - Lifeline Australia. Add a +61 after your international dialing requirement and punch this number if you don't have an alternative.
UK: Samaritins: 116 123
And I'd like to announce what I'm doing for the first time on this blog. I've started up a social enterprise that'll, as said above, save hundreds of thousands and billions of dollars a year! Check it out at www.gettosleepeasy.org - here's what it is.