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Fighting Physician Suicide Takes a Tribe

Compared to the general population, female physicians are 2.3 times more likely to die by suicide, making it the second most common cause of death in women ages 24 to 35. That statistic sits on my chest like a death threat.

This time last year, I found myself in a big bed with soft sheets, tucked between my friends Caitlin and Victoria. On this night, we are surrounded by empty ice cream containers, faces plastered in the sticky sweet syrup of cheap face masks. I remember us asking each other, how did we get here? How did we end up counting all the people around us — including us — who are depressed?

Victoria is applying to be a trauma surgeon. That’s nine years of training to learn how to pull bullets out of bodies. Caitlin wants to spend the next decade teaching her hands how to dissect seeded studs of cancer from the abdomen. Me? I’m taking a little break, trying to figure out what I want out of this life.

Together, the three of us are united in a text group known as Pu$$ySlayer69 (yes, pussy is spelled with dollar signs) — an ode to a male acquaintance’s WiFi password that we’re hoping to get emblazoned in glitter across team jackets. On this night, we are here in this bed because amidst the food porn and single girl memes, our text thread has slowly become darker and more desperate. It is filled with texts that say, “Today I feel so worthless.” Messages like, “I am crying in the bathroom between surgeries I don’t know why I just can’t do anything right.” Updates like “Another one of my patients just died. I’m so tired and sad I can’t even drive home to cry in my own bed.”

In this moment, with our arms wrapped around each other like curling vines, we check on each other by rattling off the diagnostic criteria for depression. SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor Agitation, Suicidal Ideation. We recite the words just like we learned in medical school. We laugh, because when you say it fast it sounds a bit like a song. Psychomotor agitation, suicidal ideation. We laugh, so it sounds like more of a joke.

When I applied for medical school, I knew I was signing up for hard work. I knew I would have to spend countless hours studying, that my sleep cycle might never be the same. But I had not expected this.

Perhaps I shouldn’t have been so naïve. Other trainees are aware of this risk from early on. In 2016, just two days after my best friend started medical school at Mt. Sinai, a woman in her fourth year jumped from the 33rd floor of the school’s dormitories. Her body was found by one of her classmates.

And bodies, when they fall, they fall heavy. I know, because one day during my surgery clerkship they dropped the stump of a 45-year-old man’s leg into my waiting arms and my first thought wasn’t oh my god I am holding somebody’s leg — it was oh my god this is heavy. I thought, someone help me.

By the time physicians reach residency, rates of depression are four times the national average. One of every three nascent physicians will experience an episode of major depression during their training, and nearly four hundred doctors commit suicide each year. More than one per day. Added together, that’s almost my entire medical school.

On this night, we take turns saving one other. We save each other at times we cannot save ourselves, share victories when we forgot we had any. I tell them about Mr. T. How he stopped eating the day they told him he had pancreatic cancer. But on my watch? We shared wedges of key lime pie in his hospital bed. Victoria’s eyes light up when she tells us she was invited to a traditional Ramadan meal with her patient’s family. Caitlin slaps her hands gleefully to each cheek like a cartoon character, revels in how good babies smell, especially when you deliver them with your own hands. We wield memory and sugared ice cream spoons, embrace fear and each other, do our best to slay insecurity and doubt.

We turn this night into a midwife; a way to be reborn.

Following greater recognition of physician burnout and depression, I have seen an increase in wellness programming at my and many other medical schools. Students now have sessions devoted to yoga and art, the opportunity to go horseback riding or participate in a modern dance class. I don’t want to diminish these efforts, but they’re speckled interpolations, not solutions. They exist once or twice a semester, on afternoons most medical students would prefer to spend studying for the next test. (There’s always a next test.) And while these attempts to dedicate more resources to personal resilience may be well-intentioned, they target individual behavior without seeking to address the stressful conditions that drive suffering in the first place.

The world is dying of loneliness and doctors — who are worked from dusk to dawn, steeped in expectations and challenged with grief on a daily basis — need more than grit to heal. It’s not just about self-care. If depression is so much about isolation, the antidote cannot be found alone.

Just a few days ago, I stood in an atrium filled with balloons and familial fanfare and watched as Caitlin and Victoria opened their Match Day envelopes. At noon, these two women — along with a hundred other dear classmates and 30,000 eager students — discovered where they are spending the next several years of their lives as medical trainees.

I hope — oh, do I hope — that the programs listed in their envelopes will recognize the ferocity of their care and the value of their hard work. I hope that they will fly to a place that treats them with kindness, one that reminds them how powerful they are on the days they feel small, and unworthy, and alone.

I am hopeful that this time next year, I will call my friends and find them wedged between a new tribe of people who support their breath. Hopeful they will find new communities and supports, new allies — new ‘Slayers.

Because that’s the point. We give each other hope.

Editor’s note: A version of this essay was originally published in Scientific American.

Jennifer Tsai Jennifer Tsai (14 Posts)

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!