The nightmare begins like any other. At first, everything seems familiar. But slowly, you realize something is not right — something is out of place. Outside the window, clouds black as night gather, lurching forward like a hurricane. The thunder is so intense you feel the electricity pulsate through your chest. An impending doom consumes your emotions. The room seems to press in on you like some scene from “Alice in Wonderland.” Then the words creep in. Subconsciously, a voice very much like your own echoes over and over: “It’s hopeless. Inescapable. You are a failure!” Your heart is pounding and your body is trembling, adrenaline racing into your bloodstream. All attempts to breath seem futile. Your head throbs, and suddenly, you realize you’ve been rubbing your temples raw for over 20 minutes. When will I wake up? Wake up. Wake up!
The clouds eventually subside, the thunder calms and then you realize it’s two in the afternoon. This was no nightmare. It was an “attack of the bends.” In doctor speak, it was an anxiety attack. However, just as someone having a heart attack finds the physician’s use of “chest pain” an oblivious understatement to their recent experience with mortality, “anxiety attack” does not truly capture the experience. Anxiety is on a spectrum of course, but most would agree that it “bends” your sense of reality and distorts your perception of events. The word “attack” denotes a brief incident; however, these can last days, even weeks. After an attack, you are frightened, concerned with your loss of rational intelligence. The repercussions leave you physically broken and depressed, literally bent out of shape.
Medical students are particularly vulnerable to anxiety. Anxiety is a survival mechanism, sympathetically warning us of impending dangers. For some of us, the wires get crossed and anxiety becomes too frequent, spurred on by any stressful situation. Students have unrealistic expectations dumped on them everyday, predisposing them to this condition. We are pressed to master information that has been accumulating for over a century, all conveniently condensed into a four-year curriculum. We are expected to compete with our peers, learn medicine, become near proficient in Latin and Greek, complete scholarly research, treat patients, deal with death and redefine sleep as “optional.” On top of that, we are told to somehow physically take care of ourselves and have a life. All the while, our debt is teetering over us and competition for residencies is overwhelming. Our families do not know what we look like anymore and wonder if we have abandoned them to join some strange new religion called medicine. When you step back, it is all a bit ridiculous.
Anxiety is real and the solution is not simple. Historically, medical professionals do not seek the help they need because of the associated negative stereotypes, even though they experience greater stress than most in society. This behavior has to stop. We of all people should understand the human condition. This is why we wanted to be doctors in the first place, remember? Give yourself some credit and join the human race. If you struggle with anxiety, never feel reluctant to seek medical therapy or counseling. It does not make you weak, but rather reveals courage and strength. It shows that you have the intelligence and the integrity to take care of yourself so you can effectively take care of others. And repeat after me “I’m not broken; I’m human.”
As for those of you walking around like stoic statues, steadfast to the torrents of medical school stress, you have a responsibility too. An understanding person can solve more problems than most prescriptions, and so it is important to take care of one another. Medical students are known for their competitive natures, callused and blinded to the suffering of our neighboring opponents…I mean colleagues. Funny thing is, however, our entire careers will be focused on taking care of people, including our fellow physicians, nurses and staff. When you see a colleague bent out of shape, take a moment out of your narcotic medical student life, bend down to their level and try helping them straighten out. Who knows, you might find a new perspective and maybe cure a few nightmares.