A Resident Log: Depression

A Resident Log: Depression

By: Dr. Amanda Kore Schilling, DO – of Sisters and Scrubs.com

Residency is a life-encompassing journey that demands growth, expects stoicism, teaches empathy, and ultimately creates a different version of you.

The strenuous hours differentiated by patient encounters, securing impossible airways, responding to codes, transfusing pack after pack of blood products, and looking into the eyes of a screaming trauma victim only to leave him behind in the operating room…pulse-less; those hours blur into seconds as you desperately try to articulate your shift to someone…anyone. How do you explain your sense of helplessness as you place an epidural on a mother who is about to labor over her stillborn baby, knowing your local anesthesia will do nothing to numb the true pain?

And within a blink of an eye, your alarm shrieks and exhausted, your body finds its way into a pair of scrubs to start the day all over again. We quickly rationalize the events, analyze pathophysiology, recall our pharmacology, and debrief with our mentors. With the pager back on our waist, we smile, and reassure our terrified patient that we will be with them as the syringe empties into their veins and their eyes close to a comatose state, with every beat and breath completely dependent on you.

Our chosen field of Anesthesiology is demanding— more so than most of us ever dreamed. We are stoic yet empathetic. Our anesthetic algorithms are theoretically programmed yet our execution is intellectually and emotionally complex. That is the definition and the art of anesthesia; yet, we find ourselves struggling with the emotions behind medicine, and scramble for methods to cope.

Many are unaware of my struggles throughout the last few years of residency. Sleep deprivation and insomnia lead to depression and ultimately resulted in a suicidal shell of a human. My personal life had been drastically shaken and my educational/professional journey proved more difficult than I was emotionally grounded to handle.

There was a disconnect— I robotically motioned through daily rituals in the operating room where I found comfort in the structure and routine, but it failed to parallel other, more important, aspects of my life. Outside the operating room doors, the world had lost its color and when the cyclical thoughts paused, it was only a recess for hours of tears. I questioned everything: my decision to pursue medicine, my purpose, my choice of specialty, current and past relationships, my future, my faith, God, and myself.

These questions had one common theme. They were all answered with silence. There was a sense of hollowness, and with every passing day, the void only grew.  I was falling, and the idea that there would be no one to catch me slowly etched itself into my psyche. In utter desperation, I reached out, and by grace, the person who caught me started a chain of events that eventually saved my life.

Depression is a transient memory to some, and to others, it is a constant force that ebbs and insidiously seeds itself as the underlying tone in their life. Depression has a voice and yet it is never given a podium or an audience; instead, it is silenced by shame and fear.  It is more present then we care to acknowledge and it is so desperate to be heard.

Is residency a friend or foe to depression? Residency holds the building blocks of success but from first-hand experience, it can also hide the heavy anvil of depression. Is the olden, hierarchal approach of teaching medicine the optimum feeding ground where harsh reprimand starts a spiral toward self-deprecation? As physicians we observe, diagnose, counsel, treat, and follow depression in the lives of our patients; but what happens when reflected in your patient’s eyes you catch sight of what your white coat has so successfully hidden within?

As physicians, we must understand the depth of pathologic states, educate the diseased, and carrying the weight of the decisions we make. The responsibility and accountability alone can bear heavy.  We find ourselves deeply integrated into the most fragile aspects of patients’ lives, events that less than 1% of the world will ever even know of.  Very few of us have the ability to pursue the gift of providing medical care to those who need it and that rarity, although it can be isolating, has the potential to unite and create a bond between us.

The months of September and October are focused on suicide prevention and depression awareness. Very little emphasis is placed on the risks and the predisposition that our occupation as physicians, plays in depression.  So I encourage you to put medicine aside for a few moments and focus on the person: truly see the Resident wearing the stethoscope, smile at the Intern writing notes, hug the Fellow who stays late to place one more central line, support the Medical Student struggling through their case presentation, and thank the Attending who took time to educate and reiterate.

We know, better than most, that life is never static, stable, or promised.  Please pause and appreciate the individual inside the white coat, realizing that there are days where they feel defeated and overwhelmed. Depression is so easily hidden inside a white coat and the daily demands of medicine and its accompanying lifestyle.  Over the next few months, we will not eradicate depression and the ideations that may accompany it but, acknowledgment and awareness might create a force large enough to change lives; a change towards wellness that might be the hope so many of us long for.

Author Bio:

My name is Amanda Kore Schilling and I am an anesthesiologist and intensivist.  I have many passions and they all involve helping the individuals wearing the white coats. No one teaches young physicians how to handle the extracurricular pressures surrounding medicine:  depression, finances, balance, suicide prevention, wellness, fatigue, family, death, and more.

My sisters and I are doctors and we started Sisters & Scrubs as a blog aimed to shed light on some of the aspects of medical training that alienate trainees, doctors, physicians, and dentists.  We wanted to ensure that no one felt alone.  Our blog quickly progressed into a website with tools, advice, and more posts regarding topics like medicine and the military, empowerment, and female physicians.  We even published our “Ready to Match” Guide focused on helping students, residents, and fellows become successful young professionals, excel in interviewing, perfect their CV, and reach their specific specialty goals. 

On our new website, we openly tackle topics that people are afraid to speak about because of fear of reprimand or stigma.  We love sharing our stories through creative writing and hope that through our viewpoint of medicine and dentistry, doctor-hood and training, that we will be able to help others feel that inspired and empowered and never alone.

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