Medical students tirelessly work towards the goal of becoming physicians. And the overwhelming joy and responsibility that comes with the journey is nothing short of elation.
We have vowed to absorb the avalanche of knowledge and have committed to lifelong learning. We are guided to appreciate the beauty of the human body and mind that makes us all equal yet unique. We are taught the plethora of vulnerabilities within each complex being and how we can strive to prevent or alleviate them. We have dreamed of the chance to wear the white coat of honor and have pledged to serve our fellow human beings.
Among this joy, gratitude, honor and responsibility, I stand up, and I cry, “We are not prepared for our patient zero!”
In a profession where we are trained to fight death around any corner, any day, students need to not only understand how to handle death in a medical setting but also how to cope with the weight we bring upon ourselves in end-of-life situations. No matter our past experiences, no matter our clinical training or how academically prepared we think we may be, it can be traumatic to feel the burden of responsibility for the loss of a life.
I lost my “patient zero” when I was 14. My grandmother — my childhood best friend and the only adult in our home growing up — passed away from a heart attack in my arms with no healthcare resources nearby to help.
Had I known basic life support at the time, had I access to aspirin, had I woken up a few minutes earlier, had I ran in search of help sooner…
These self-imposed unbridled thoughts as well as critical inquiries from frustrated, grieving relatives rattled through my mind for years, muddling my self-worth and diminishing my confidence. It led to learned helplessness in many challenges that came thereafter, and it has been an ongoing battle to learn how to forgive myself for this loss that placed me in the eye of the blame hurricane.
While we all advertise the glorified experiences and breathtaking discoveries of medicine, this eye of the hurricane that we all eventually reside in remains silent amongst trainees and physicians. When we step into the shoes of a physician, we are all putting our mental health at risk: the unprepared role we play in patient death is our shared vulnerability.
As a medical student, I realize that the questions clouding my mind following my grandmother’s passing are quite similar to the questions physicians may find themselves asking after a failed case: Had I tried something different, had I consulted for a second opinion, had I done more research, had I not been so tired … While hypotheticals can become consuming and pauses are a rarity in the busy life of medicine, protected time to reflect is crucial after every case. Whether the outcome is successful or not, reflection is a necessity in pursuing understanding and improvement.
Nonetheless, it only takes one unchecked reflection upon a failed case to diminish a physician’s self-worth and push them over the line.
For example, in an NPR interview about doctors struggling with suicide, Dr. Wible says, “You don’t focus on the 99 you save. You end up focusing on the one you lose.” As a result, doctors are at a higher risk of suicide than the average person. Furthermore, despite being taught how to handle cases of suicide in the general and at-risk population, physicians are ironically less likely to seek help themselves. In comparison to age-matched peers of the general population, trainees and physicians are less likely to seek routine medical care, with over 25% of physicians lacking a primary care provider to provide routine depression screenings and early interventions for suicide prevention.
This tendency begins in medical school, where over 27% of medical students suffer from depressive symptoms, yet only 15.7% sought treatment. This trend is then translated into residency performance, where residents with depression compared to non-depressed residents are over six times more likely to commit medication errors. Among a plethora of other barriers, including busy work schedules and affordability, physicians may fear compromising confidentiality and hindered career advancement, and rightfully so: 37% of state medical boards indicated that diagnosis of mental illness by itself was sufficient for sanctioning a physician.
Meanwhile, for years, the pressure for perfection builds. Day in and day out, we have been warned about the battle we are taking on at the front line against the innumerable threats to the human body and mind. We are taught that even the simplest mistake is a mistake too big that can harm our patient, a fellow being who has put their life and faith in our hands. We are told that what we inhale during our four years of lectures and clinical training can — in one instance — be called upon years later to be perfectly exhaled. Our true capabilities in that moment can define the difference between life and death.
As doctors, we will be held responsible for our inevitable mistakes and vulnerability. And at our worst, we will find blame coming not just from the loved ones of the patient but also from within.
Despite this truth, we are not taught about what lies on the other side when we inevitably come up short. We, as medical students, need to be taught to embrace our vulnerability. After all, by understanding our vulnerabilities, we can attempt to effectively address them and use our experiences to become a better version of ourselves in service to others.
As an aspiring female physician-scientist, I am especially at a much higher risk for suicide than the average physician. So I write this cautionary notice to my fellow aspiring physicians and myself before it may be too late. I ask aspiring physicians, practicing physicians and my fellow human beings to be kind to each other, be kind to yourself and repeat:
I am vulnerable. I will fail. I will forgive. I will learn. I will grow. I will serve on.