Black hellebore, a flower of the deepest black and with petals the sinister shape of blunted arrowheads, grows wild in the cool, mountainous regions of the Balkans. Despite its unintimidating label as the “Christmas rose,” the hellebore has a much darker history, one bespoken more by the flower’s ebony hue than by its innocuous nickname.
My struggle began around nine months before my eventual diagnosis. This was on a background of an entire lifetime governed by this haunting feeling that something was different. Or that something was not right. Yet being the overachiever that I was, no one noticed. I was always left to question whether my reactions were just a disproportionate reaction to certain life events. And I was repeatedly told the same thing.
An addict in detox, again. / Chief complaint of “at his wits’ end” / Manipulation, his malicious game.
A Silver Bullet / The tiny guns held by my little action figures / still remind me of that god forsaken trigger.
As physicians, it is our responsibility to understand these serious implications and to help these patients live as fully as possible. A patient is not just his or her numbers — their vitals or their lab values. A patient is not just an MRI reading or a CT scan finding. Every individual has a mind, and we must take into account mental health when treating these patients because if left untreated, they can have dire consequences. More importantly as people — as humans of society — we must not stigmatize these illnesses.
I followed my surgical rotation with my rotation in psychiatry. My experience was in many ways the opposite of surgery — there was more time to care for each patient, and there was more time to care for ourselves. I would show up at 7:45 in the morning, spend the day conducting lengthy interviews with my one or two patients and then rounding on these same patients later with the team, leaving by 5 p.m. It was refreshing to have time to study, time to exercise, time for sleep. But the work itself troubled me.
“Great, six weeks of crazy people!” This is the sort of attitude with which I went into my psychiatry rotation. Couple this with the fact that while most schools only have four required weeks of psychiatry, my school has six weeks. Of course, I would have more free time compared to other rotations — it is called “psychation” for a reason — but at what cost? Mental illness was something that made me uncomfortable.
I don’t look both ways when I cross the street / Sometimes I forget I’m alive / I take a step onto the road
Whenever I hear the word “burnout,” I’m reminded of the ugly, oh-so-dark side of being a medical student, the side that hides in the shadows, away from the prestige and privilege that comes with the noble profession. Maybe it seems like I’m exaggerating; I mean, it’s just me jumping to conclusions when I associate the feelings of being overworked with the days where I can’t seem to find the bright side of anything, right?
A very important topic is that of mental health in medical practitioners, notably medical students. According to a study in the Student British Medical Journal, 30% of medical students report having a mental health condition — with a majority of 80% stating the level of available support was poor or only moderately adequate. This column was born from these alarming statistics and aims to stimulate conversation on mental health in medical students, from providing suggestions on how to maintain one’s mental health to discussing the taboo and stigma surrounding conversations on mental health in practitioners and students, and how to eliminate it.
Like poker, medicine has certain rules — patterns of clinical symptoms and lab findings each correlating with a specific spectrum of prognoses that vary in likelihood, the differential diagnosis. Physicians are like seasoned card players, trained to maintain composure and incorporate numerous variables into logical, calculated decisions at what seems like a “dealer’s table” of outcomes. Sometimes, we hedge our bets that the patient will self-resolve, so we elect not to treat; other times, we act conservatively with a battery of tests and pre-emptive therapy.
A fellow student writer recently wrote that she wondered if depression were “just part of life as a medical student.” One of her professors had given a lecture on depression asking students to “think of how many people we knew with the signs of depression listed on his lecture slide” — excluding medical students of course, “because you’ve all got some of these.” There is something so terribly and inherently wrong with that statement.