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ER Goddess

ER Goddess

Suffering in Silence No More

Simons, Sandra Scott MD

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doi: 10.1097/01.EEM.0000473164.60570.6b

    Begrudgingly, I emerged from the covers, kicked aside the incriminating cupcake wrappers, pulled a clump of frosting out of my hair, and looked for the nearest baseball cap to hide my haggard face.

    Just pulling myself out of bed was a small victory. Truth be told, I wouldn't have overcome the inertia were it not for my sons waiting for me. They were the only lights in my life, and they most definitely did not deserve a hot mess of a mom who spent a disproportionate amount of time on the couch, took all day to complete a to-do list that normally should have taken 20 minutes, and went to Fresh Market wearing the same taco-stained dress she wore the day before.

    But this was the best I could do in the midst of my maelstrom of a divorce, new stressful job, financial turmoil, and lack of a support system. I was the mental health equivalent of a little old lady with no physiologic reserve who would die from a hip fracture because if one more thing went wrong, I thought it would kill me.

    But I'm an EP, and we always find a way to handle whatever comes through the door, no matter what. I put my baseball cap over my frosting-tangled hair, and headed out to face the day, resolving just to try harder.

    Overdue Epiphany

    My suspicion is many doctors hit lows like this, perhaps minus the frosting-topped tresses. Yet societal expectations and the expectations we put on ourselves make us feel like we always need to be up, on, and capable, so we don't admit it. We focus on diagnosing what others need while the pressure to be unstoppable limits our willingness to acknowledge our own issues.

    Like most physicians, I wasn't comfortable asking anyone to help me with my funk. Every night I would drive to the ED, take a deep breath, and leave my personal issues at the door because I wasn't supposed to be sad. I would tell suicidal patients they needed a better coping strategy than trying to hurt themselves, and then go home and drown my sorrows in a bottle of wine. I put on 40 pounds of stress weight, but I kept telling myself, “Just diet. Just exercise.” I let bills and responsibilities pile up, but kept telling myself, “Just put one foot in front of the other.” I was in such denial that when my pep talks to myself didn't work, I went to have blood work done, totally convinced that my ever-fattening behind and anhedonia were due to a thyroid issue.

    They weren't.

    The long-overdue epiphany that I was not OK finally came when I lost my ability to run. I had signed up to run my 13th marathon for my 40th birthday, both just months away, but I was usually too apathetic to even lace up my running shoes. When I did make it out to run, I frequently walked home in defeat. I tried my 16-mile training run on a glorious spring day with my favorite azaleas flourishing everywhere along my route. I should have been flourishing, too, but I couldn't do it. Distance running is about mental fortitude, which in my eyes is a barometer of mental health. And it became poignantly clear to me during what should have been a blissful run through the azaleas and sunshine that my funk was depression.


    It had imparted such an inability to cope with anything outside basic mothering and doctoring that it took me more than a week after my epiphany to overcome the paralyzing inertia and pick up the phone. I feared what reaching out would mean for my career. What would a diagnosis of depression and an antidepressant prescription mean the next time I had to answer screening questions for my medical license? Would my colleagues judge me? I was embarrassed because of the stigma. It's very telling that I, someone who is so outspoken and educated on psychiatric disorders, was afraid to say anything. If I cannot be open about my own struggles, how many others must be out there suffering silently? The psychiatrist, when I finally saw her, met my reluctance with some stern advice that I suspect a lot of us need to hear: “You need support. You have to let someone in. You can't do everything alone.” She was right.

    Overcoming Stigmas

    I started an antidepressant that day, and I've been a better mother and doctor since then. Ancient demented crusty GOMERs have returned to being cute little old ladies. My couch and I are seeing a lot less of each other. I feel like I can breathe again, and I feel silly for having stubbornly clung for so long to the pull-yourself-up-by-your-bootstraps approach to mental health. “Be stronger” and “pull yourself up” are not acceptable answers for depression. No amount of grit can overcome brain chemistry.

    Just as I was starting to get better, I learned that a 40-something EP in town killed himself. Another doctor my age had been trying to pull himself up by his bootstraps, too, but hadn't received the help he needed. His suicide hit too close to home and was a sobering warning that physicians are hurting. They are hurting without resources to cope and without the ability to speak up free of stigma.

    I decided to put my natural outspokenness to good use, stigma or not. I began to talk, and everyone seemed to have something painful kept below the surface. People were thankful for my openness and grateful to know they were not the only ones struggling. I even inspired a few people to get help themselves.

    I encourage other physicians to reach out to inspire the medical community and to place an emphasis on our own mental health. It's worth it. Judge me if you want, but there shouldn't be such a stigma. As long as someone is good at her job, who cares if she takes antihypertensives, antibiotics, or antidepressants? We all need to have the courage to talk about it.

    Pretending to be OK is all too easy for doctors. Sometimes the braver thing is revealing when you're not. Remember, nobody's infallible, it's normal not to feel OK, and we should be able to open up and reach out without fear. I hope my story serves as an example and gets more people talking about physician mental health. If we're not well, we can't make patients well.

    Read about how emergency physicians cope with depression in our Special Report on p. 22.

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