Today I am hit with a wave of sadness. It’s been six years since I graduated from residency at Oregon Health & Science University, and in those six short years, four of us are dead. Among the internal medicine-psychiatry-neurology cohort that I completed residency with, four people are no longer with us. At least two of these deaths were by their own hand. In what should have been the prime of their lives, they departed, leaving behind the grief of their loved ones.
When I first arrived as a new student at Harvard Medical School, I was surprised to find there was a metal detector at the entrance of the library. It seemed odd that there would be a metal detector here but nowhere else on campus. Then I learned that in the year above me, a woman had brought a gun with her into the library and shot herself after finding out that she had failed her anatomy course. The metal detector was to protect us from ourselves.
For my MPH thesis, I researched mental health disparities among Asian Americans. One of the things I learned was that there often were no warning signs before Asian American teens took their lives. When analyzing suicides among adolescents of other ethnic groups, there were often classic signs preceding the suicide, such as worsening grades or dropping out of activities. In contrast, Asian Americans teens continued aceing their classes, continued showing up to soccer practice - until the day they died.
The culture of being a healthcare professional has a lot in common with Asian American culture. In the indoctrination of each medical student into the culture of medicine, we hear the implicit message that it does not matter how a person feels on the inside, only how they perform and appear on the outside. Or put in other words: Just keep your head down and keep going. Keep plowing through. But what happens when the day comes when you can no longer keep plowing through?
The implicit message that how you feel is not as important as what you achieve is one which has been fed to Asian Americans since we were children. Perhaps this is why Asians make up only 5% of the US population but comprise 20% of the healthcare workforce. When we encounter the culture of healthcare, we already feel at home with the overwhelming burden of perfectionism and never being good enough.
The suicide rate among doctors in the US is around 35 per 100,000, or approximately double that of the general US population. Why would a profession that is well respected and well paid have people killing themselves at twice the normal rate? I believe it lies in the implicit messages within healthcare that we need to be perfect, that it’s not okay to make mistakes. Perfectionism and a judgmental environment create the perfect storm to fuel shame and secrecy, leading people to feel alone and unreachable.
I truly wish that I could go back in time. I wish that I could speak to that woman who had killed herself. I would tell her that she is so much more than a medical student or a doctor. That whatever she was troubled by, whether it’s failing a class, making an error, losing one’s job, or even one’s license - none of this is worth losing your life or your mental health. Each of us has an intrinsic value that goes beyond our work or our academics. Each of us has a value that is intrinsic to being human.
I have been lucky in that I was able to break out of the cycle of secrecy and self shame. I still struggle with anxiety, and the task of becoming “worthy” is one that I constantly wrestle with. But I am lucky that I started doing therapy when I was 24. I have also been blessed to discover meditation and yoga at a young age, which has helped me to find solid ground in an intense and competitive environment.
If you are struggling as well, please know that your worth goes so much beyond your work or academics. And there are resources to help. The Medical Society of Metro Portland offers free confidential counseling to physicians, which is not billed to insurance or documented in a person's health record. For those of you who live in other states, please check your state medical board. Most states offer a similar program, as does Kaiser Permanente for all employed physicians.
Your wellbeing does matter.