Contributing Writer Emeritus
Cleveland Clinic Lerner College of Medicine
Alicia Stallings is a fourth year medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve. Her research interests include medical resource allocation, health outcomes and medical education.
As a medical student nearing the end of my studies, I have come to understand many of the challenges and rewards inherent to caring for people at every stage, and every walk of life. I can understand the pain and joy that define the experience of being a physician because I am a member of this group.
There is little doubt that many in the world lack access to adequate public health systems, and we know that good global health work can help these individuals. Fortunately, institutions and individuals are becoming increasingly interested in contributing to the field of global health. In fact, global health has become increasingly integrated into medical schools, so even tertiary care centers with little-to-no public health offerings afford their students opportunities to go abroad.
When I started medical school last August, I arrived on campus excited to fulfill my childhood dream of becoming a doctor, eager to learn more about the body and its mysteries, and more than a bit nervous. “Medical school,” the physicians in my life told me, “is no joke.” But “everyone survives” they assured me. While I clung to this promise as I made my way through the year, I did so perhaps for different reasons than I first imagined.
On March 4, 2015, JAMA Psychiatry published an article entitled “Depression and Suicide Among Physician Trainees: Recommendations for a National Response” calling for “[a] national commitment to support residents and fellows throughout the challenges of medical training.” However, we believe that the term “physician trainees” should also be inclusive of medical students.
I am a medical student, yes. I am also a survivor of sexual violence. With the recent Columbia University commencement, the surge of articles surrounding the narratives of Emma Sulkowickz and Paul Nungesser prompted me to reflect on this latter identity. When histories of sexual harassment at my school emerged last November, my survivor status edged its way into my path toward doctorhood. I know I will always carry the mark of my trauma with me, and I am learning how I will better empathize with patients because of it.
As medical students we’re told over and over to treat the whole patient, emphasizing unity of body, mind and spirit, recognizing the things that make us unique: upbringing, culture, values and beliefs. But on the way to achieving this holistic view of our patients, we often lose ourselves in the process. Barraged with metabolic pathways, pathological markers and exams, medical school tends to become a zero sum emotional game.
There is another reason wellness is now stressed so heavily in medical schools, and it is one that is not often talked about — physician suicides. As many as 400 physicians commit suicide each year. That is equivalent to four medical school classes who take their lives every single year.
Have you ever spent a night curled up in a ball of blankets rocking yourself, tears streaming down your cheeks, just wishing you could go to sleep and wake up a couple of months later? As a teenager, I had more of these nights than I did nights of restful sleep. There was no particular trigger. I had an idyllic childhood, growing up in a quiet suburb with a loving, supportive family.
It has been a little over two years since Kaitlyn Elkins, a second-year medical student at Wake Forest, took her own life. Her death stunned friends and family, who had been largely unaware of her protracted struggle with depression that was ultimately revealed in her suicide note. Kaitlyn’s mother, Rhonda Elkins, dedicated herself relentlessly to advocating for mental health awareness before succumbing to her own grief, committing suicide one year later.
Yet when nine black individuals were horrifically slaughtered in an historic black church in South Carolina by a white male (Dylann Storm Roof) who said, “You rape our women and you’re taking over our country — and you have to go,” all of a sudden psychiatry and mental illness become the legitimate explanation. Of course, Roof later confessed that he hoped his actions would start a “race war” and he was seen in pictures wearing a jacket with flags of apartheid South Africa, as well has sporting a license plate with the Confederate flag.
“Race is a social construct.” This is a statement that we hear frequently but don’t fully believe or understand. In the United States, we may superficially state that race is a social construct, but in reality, we understand it as genetic underpinnings. In medicine especially, race and genetics are often understood as interchangeable.
Today, there are more people in jail for drug offenses then there were prisoners for all crimes in 1980. People of color comprise more than 60 percent of those incarcerated, yet represent only a third of the country’s population. While the issues leading to the disproportionate incarceration of people of color are many, I wish to focus on a single contributor which is the most important cause of America’s dramatic increase in incarceration — the structural racism readily apparent in our country’s approach to drug offense convictions.
Writer-in-Training and in-Training Staff Member
Warren Alpert Medical School of Brown University
The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.
I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!
