Editor’s note: This is the first installment of a new column focused on physician wellness. Articles will run quarterly and be authored by Jennifer Villwock, MD, and Julie Wei, MD.
Beliefs are strong. Once, when I was about 4 years old and riding the waves of nausea that came with the flu, my dad told me, “Just lie down on your right side. You will feel better.” As I rode those waves, I clung to those words—repeating them like a sacred mantra—and internalized their message as absolute truth. So completely did I believe that I would lie on my right side in any unwell situation, from stomach bugs to sinus infections to, later in life, heartache. I continue to do so to this day.
When I was in my twenties, I encountered something that not even lying on my right side could fix: severe and debilitating depression. For six months, I slept on a friend’s couch because I was terrified to be alone. Up to that point, I had only been aware of people not successfully recovering from mental illness. No one was openly sharing their experiences, and my internet sleuthing was indicating that one severe episode of depression meant lifelong medication and disability. My internal dialogue told me I would never be OK again. My friend told me I would be, and that she would tell me that every day, over and over, until it was true.
Eventually, the therapy and antidepressants started working. I smiled. Breathing once again resulted in the exchange of oxygen for carbon dioxide instead of sadness for sorrow. I not only survived but began to thrive. When I applied to medical school, I had already been tapered off my medication without incident. My primary reservation about becoming a doctor was the open secret of medicine’s toxicity; I was afraid that I could not survive another bout of depression. I tell people I deferred my admission to medical school to gain life experience, but, really, I needed the year to gather courage before taking the plunge. I eventually matriculated and, luckily, have continued to thrive.
One of my classmates did not. Her name was Jane (name changed for privacy), and she died by suicide when we were medical students. Jane was dynamic and friendly. My last memory of her is a nondescript day during which she was recruiting volunteers for a 5K race to benefit the area’s underserved population. This is not recall bias. This is simply who she was. She displayed none of the usual warning signs, because not everyone does. Her pager had recently fallen in the toilet; she had plans to get a new one that afternoon. The ripples of her life and death continue to be felt by many, including the numerous individuals who received her organs. Even in death, Jane was a healer first.
I believe that many of us surgeons recognize this story or a variation thereof. We trained for many years to be decisive, technically excellent, and resilient. Our beliefs in these ideals are strong. We reject failure and weakness because those things are incongruent with the personas we have carefully cultivated. We are doctors and surgeons first. We see patients at their most vulnerable, yet ignore some of our most human and haunting experiences. We know that burnout, depression, and maladaptive coping mechanisms are prevalent in our community and often appear early in our careers.1-3 However, much to our detriment, we do not openly discuss them. As such, we fail to normalize these experiences. We fail to share our stories of thriving after struggling, allowing negative commentary and outcomes to dominate.4 We fail to show ourselves as safe people to whom our colleagues can confide.
I challenge you to ask a colleague how they are doing and crave an answer other than “good.” Ask a follow-up question. Show yourself to be a safe person. I also challenge you to respond with the truth when asked how you are doing. —Jennifer A. Villwock, MD
Tell Your Story
I once heard an ancient myth about people who were scrambling to the River Styx to be healed. A physician eagerly approached, but was stopped by the deity in charge. She was told, “No. Not you. You need your wounds.” Turns out that, rather than a weakness, our wounds are an opportunity to connect and heal.
Telling our stories and revealing our wounds is critical so that our beliefs about what it means to be good surgeons can include these human struggles. Perhaps it starts in hushed tones over coffee. Maybe after many such coffees, the dialogue opens, and our culture and beliefs slowly shift. Instead of colleagues to impress at conferences, maybe we start seeing people to support us, people who are potentially in need of support themselves.
I challenge you to ask a colleague how they are doing and crave an answer other than “good.” Ask a follow-up question. Show yourself to be a safe person. I also challenge you to respond with the truth when asked how you are doing. Allow someone else to be a safe person for you. Let’s build networks of support to not just be utilized in times of struggle, but to celebrate successes and continually elevate our community. Lastly, thank the people who have been there for you, even if it was just a kind, random word that made a difference. Your kind, random thanks could make a difference to them.
Safe people. May we know them; may we train them; may we be them.
Dr. Villwock is an assistant professor of otolaryngology–head and neck surgery in the division of rhinology and skull base surgery at University of Kansas Medical Center in Kansas City. She is also a member of the ENTtoday editorial advisory board.
- Graham J. Why are doctors plagued by depression and suicide? A crisis comes into focus. Stat. Published July 21, 2016.
- Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314:2373–2383.
- Mazurkiewicz R, Korenstein D, Fallar R, Ripp J. The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychol Health Med. 2012;17:188–195.
- Rottenberg J, Kashdan T. Thriving after depression: why are scientists ignoring good outcomes? The Conversation. Published June 29, 2018.