Life and depression as a medical resident

I started my medical residency a few months after I graduated from medical school.  Residency consists of the first years of training you are given after becoming a doctor.  You are not allowed to just set up shop after graduating from medical school, you must choose your specialty and be trained in it.  Residency is highly supervised and programmed (which is a good thing).  These are the years when you hear about young doctors working 80 hours a week and never having time off.  Rates of depression in residency are high, close to 30%. My journey began in Iowa City, IA, where I matched for my pediatric residency.

Diving in

As a resident, you rotate through the different settings and specialties that a pediatrician may practice in – a pediatric inpatient unit, outpatient clinic, PICU (pediatric intensive care unit), and NICU (neonatal ICU) just to name a few.  You work long hours and often spend every 4^th night in the hospital tending to patients overnight.  You get paid a livable amount, but a pittance if you calculate out your wages per hour.  The goal during these three years is to figure out what field you might like to spend the rest of your career working in.

Being granted a medical degree does not suddenly make you a great doctor overnight.  There is still so much to learn with the added pressure of trying not to make mistakes that could hurt your patients.  You spend a lot of time feeling inadequate and sometimes incompetent, especially in the beginning.  It is very overwhelming.  There is no choice but to dive right in and start learning as much as you can.

In the beginning, I found residency to be all of the above, but also a little exciting.  Everything was so new and moved so fast, I was kept extremely busy just trying to keep up.  It took a while for the novelty and excitement to wear off, but eventually it did.  The more time I spent taking overnight call, the more tired I became.  I didn’t know anyone going into residency, and although I made some great friends, I missed my family and primary support group.  

My depression resurfaces

One day I was in clinic speaking to a teenage patient, and he started to talk with me about his depression.  He was going through the feelings he experienced, and described when he first realized that this was not normal.  I remember thinking “he’s right, it’s not normal to feel like that”.  And then something clicked, because I had also been experiencing all those feelings he described.  Even though I experienced depression in the past, it crept up on me the second time.  It took treating a patient with depression for me to realize that I was suffering too.

This time, I at least knew how to start getting help for my depression.  I made an appointment with a primary doctor and discussed how I was feeling with her.  She referred me to Psychiatry for medication management and counseling.  My insurance in residency required that I get all my care in the hospital that I worked in.  And my hospital was a teaching hospital, meaning that I was seen and treated by residents just like myself.  It was often difficult finding the time to attend these appointments, especially the counseling.  I tried to attend weekly, but my work schedule often derailed these sessions.

getting help

I was started on medication, the same one I had been on in college.  They figured the medicine had worked for me once, it might work again.  And it did, although the effect seemed much slower this time.  I spent countless nights crying myself to sleep and believing I was the worst doctor ever.  Something surprising to me was that this time around, I had more suicidal ideation than the first episode of depression.  I had moments where I would think about killing myself and couldn’t stop it.  The thoughts were intrusive, popping into my head without warning and crowding out everything else there.  It was scary because this was the first time I really thought about suicide.  Your mind lies to you and tells you how much better off the world would be without you.

At work, I like to think I was pretty good at hiding how bad my depression was.  But there were people who noticed that things seemed different with me.  I was more tired than usual and lacked my usual motivation at work.  Only those closest to me really knew what was going on though.  I was afraid of being seen as weak, and unable to handle the pressures of the job.  Mental health was not something that was talked about often in our residency program.  I’m sure that others suffered as well, but no one ever came out and discussed it.  It was just hard to know who might judge you and who might understand.

My depression did start to improve over time.  The counseling and medication worked together to help lift me out of the dark hole.  During this time I started to rely heavily on a coping mechanism I had experience with – eating.  During residency, you work so much that your meals already consist of mostly prepackaged foods.  Well, that and cafeteria food, which is like fried heaven.  I began to rely more heavily on food to make myself feel better and “reward” myself when stressed.  My mood was feeling more stable, but the weight gain made me feel bad about myself again.  This coping strategy would solidify in the coming years until I started to lose control of it.

Unforseen consequences

My depression occupied a significant amount of my free time during residency.  One of the consequences was that I did not devote as much time as needed deciding what I wanted to do next.  If you wanted to continue on with training to subspecialize after residency (in a fellowship), you were expected to apply during your second year.  This still seems ridiculously early to me, even for those not suffering from depression.  I was nowhere near ready for this, so I put it off until my third year.  I had always been interested in pediatric oncology, and I ultimately decided to pursue this field.  But I would now have a gap year in between residency and fellowship because I applied so late.  

I needed to fill this year with some kind of clinical activity.  You are not allowed to just take a year off; you have to account for every month on your CV.  This is when I discovered locum tenens work, which is basically traveling doctoring.  You could take jobs of varying lengths at hospitals and clinics that needed extra help around the country.  All of your living and travel expenses were paid for.  Although it was terrifying to know I would be the doctor in charge in a few short months, it sounded interesting.  I ended up getting two long term jobs during this year, the first in Oregon and the second in New Mexico.  After that I would be heading to Colorado for my Pediatric Hematology/Oncology Fellowship.  Once again, my life was decided for the next few years.