Sunday, April 25, 2010

A journal entry: a physician with depression

This is a guest post from an anonymous disabled physician who wishes to share a journal entry:

October 12 2009

Today I went to the dermatologist to have a recurrence of the basal cell carcinoma removed from my arm. Dr. C is a wonderful, kind, a brilliant devoutly Christian dermatologist who is also beautiful tall long and lean. In the past I honestly have felt slightly jealous of her. Her beauty, her thinness, her ability to have excelled in medical school and her residency enough to get her a place in a highly competitive dermatological residency.

I am kept 45 minutes longer in the waiting room than in previous visits. The nurse finally comes to place me in a room. She asks me about any new medications changes. I shamefully tell her about the three new medications I am on for depression. Interestingly the nurse does not look at me with a sort of thinly veiled disgust when I mention these new meds. I show the nurse my new cancer and then tell her that my hair has been falling out in clumps and my nails are thin splitting and frail. She leaves the room.

In comes Dr. C, I am shocked. Is this the same person I have seen on so many visits before? She is a shadow of herself, cachexic looking with her face, chest and abdomen sunken in. Her clothing seems baggy. Her hair is dull, she is pale haggard looking, no smile today just a face made old by the look of some sort of existential pain. She seems slightly confused. The nurse gently guides her. She asks for my complaints. She looks at my arm and then my hair and nails. She then asks if I am on a diet or have started new meds. She looks on the medication list. She says “all these medications for depression? There are so many”. There is a sense of panic in her voice. I tell her this is my fourth distinct episode of depression and it is being much harder to control. I tell her I have been this ill for awhile now. She looks at me and says "I am very depressed too". She tells me that her husband and she are in therapy after 19 years of marriage. She says it is helping her husband more than her. She looks away at the floor and seems slowed down. The sadness in the room is palpable. Her nurse returns and redirects her. She goes to work shaving off and cauterizing the cancer from my arm. This she does well like her usual self.


The nurse has returned to the room and Dr. C starts to give her directions on the labs she wants and why. But she is confused. She sort of messes up the labs she wants to order. Her nurse gently tells Dr. C which labs she needs. Dr. C tries then tries to come up with the ICD-9 codes for the labs but fumbles the nurse corrects her. Dr. C. has not previously been like that. She has always spoken in confidence knowing her ICD-9 codes as if they were the basic alphabet we learnt as children. She seems rattled scared. I see myself in her.

The nurse walks out of the room to get the directions for the local Quest lab. Dr. C and I talk about depression without looking at each other. I mention how I feel that I should not be practicing medicine right now. I talk about how I really need to be in the hospital but am not sure how to do that. She echo’s my thoughts in her words. She feels the same way; she is scared, not sure whether she should be practicing medicine right now either. But how is it possible to just stop and disappear from work expecting others to do our jobs? Especially with this shameful diagnosis. She looks as trapped as I feel. I say did you know studies show depressed female physicians are 4 times as likely to successfully complete suicide then their depressed male colleagues. She laughs and says “because we are smarter”. I say I think it is because men blame their depressions on others while women blame their depressions on themselves. She looks sadder. I hope I have not sparked in her a need to die.

The nurse returns with directions to the lab. She tells me how to go and hands me a map. Dr. C listens to her and says “where”? The nurse repeats herself several times but Dr. C looks confused. The nurse finally says to Dr C. “you know the place you go to every morning to get your iced tea”. Now Dr. C seems to understand where it is I am going. The nurse leaves herself looking saddened.
Dr. C says “I will pray for you”. I tear up; I say “I think God has lost me”. My faith which used to be so strong has sort of been lost somewhere. It has always been there before but now it is gone. My cross seems to burn on my chest as if I do not deserve to be wearing it. Dr. C quickly reassures me that God has not forgotten me and I know she is right. We squeeze each other’s hands and agree to pray for each other.

For some reason I leave the office feeling somewhat stronger knowing I am not the only female physician who is struggling in this way. Not the only one who needs a nurse to guide me. I am not the only physician who can no longer think even the most basic of thoughts? I wish there was some sort of support group for people like us. They have AA and NA groups specifically for addicted physicians. But there are no support groups for those who have major depression. It is as if somehow it is better to be an alcoholic or drug addict then to be ill with a severe affective disorder. I will pray for Dr. C, for restoration of her marriage, for the return of her buoyant personality, for a lifting of the depression and for the restoration of her soul.

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