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Episode 12: My First Goodbye — Too Much and Not Enough

MyFirstBigMistake

Too many doctors and medical students are dying by suicide and too few people are talking about it. But talking about it is how we can help. By talking and listening and blogging and reading and sharing, we can do all we can to save these lives that save the lives of others. Until there are changes in medicine supporting the notion that better care begins with the best possible mental and emotional health of doctors and student doctors, we have little more than the clicks of social media to fuel this fight. Retweets and shares, hashtags, forwards and listens, and lots and lots of comments are how we can finally get this conversation started.

Our season finale — featuring Drs. Pamela Wible, Pranay Sinha and Lauren Appell — points to many contradictions and deficits in medical education and asks us to ask ourselves how we can make a difference.

Listen to Episode Twelve

So, where do you start? You can:

• Continue the conversation by sharing this episode or this very blog post (see share buttons below). You can also listen to it on iTunes.

Read and share Dr. Sinha’s brilliant NYT article, Why Do Doctors Commit Suicide?

Watch and share Dr. Wible’s two incredible TED Talks: Why Doctors Kill Themselves and How to Get Naked with your Doctor.

You can join us in funding the documentary, Do No Harm by Robyn Symon, via Kickstarter.

And if you’re feeling suicidal, remember that you are not alone and there are people you can talk to. Please call 1-800-273-TALK (1-800-273-8255).




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This is the transcript of Episode 12 of the medical podcast My First Cadaver. Enjoy! 

FAITH AERYN: Welcome back to My First Cadaver! This is Episode 12: My First Goodbye. I’d like to start things off a little differently today by first introducing you to Dr. Pamela Wible...

What was it that was suddenly the trigger that caused you to be so active about suicide in your Ted Talks and your own blog and your website and all of the articles that you’ve done – like the great one you did for the Washington post? What was the catalyst for you?

DR. PAMELA WIBLE: The catalyst came October 28, 2012 when I was sitting in a memorial service for the third physician that we’d lost in eighteen months in my town and I was in the second row behind his like, five children. He was a top rated pediatrician in our town and he shot himself in the head in the middle of a public park. And I think it was like October 1st, which was two days after I published my book, Pet Goats and Pap Smears, which was all about bringing joy back to medicine and I was just heartbroken for so many different reasons. I was thinking, “Oh wow! Writing a book on how to be a happy doctor probably isn’t going to solve a problem when so many doctors are shooting themselves in the head.” You know what I mean? Like handing them a book on how to be happy might not be the solution, right? So I was a little bit devastated by just the fact that we keep losing so many doctors in my town. And I know eight in my town who have died and I live in a small town in Oregon; but during his memorial service I started counting on my fingers how many doctors that I knew died under suspicious circumstances that I thought might be suicide and I had ten. In a very short period of time that I had counted, every finger on my hand was taken. I guess I could have started counting on my toes, but I just realized – wow, this is a huge issue that is so much more than this one man’s death. Because when you’re at one memorial service of course everyone is asking “Why? Why? Why?” and they’re obsessed with that one person’s suicide. But I knew that the why was so much bigger when I reached number ten on my fingers. And that evening I just happened to have one of my physician retreats because I teach physicians twice a year the business strategies to open their ideal clinics and I just – it wasn’t – my retreats were not about suicide. They were about business strategies. And so I had to leave the memorial service early, drive into the mountains about two and a half hours away for the retreat that I just happened to be teaching that evening. As everyone piled into the room I decided to start by asking them, you know, how many of you have lost a colleague to suicide? And every single hand was raised. And then I asked, well how many of you have considered suicide? And every single hand was raised, including mine – except for one female nurse practitioner. And that’s when I had – that’s all the confirmation that I needed that this was a huge, under-reported and completely covered up crisis – a public health crisis in this country. So I just ended up diving into this topic and I’ve been on it for four years now, non-stop. There is a line that I took out of my TedMed talk because I was told to take it out of my talk because it was too, uh – it was going to provoke the audience, I guess, in a way that they felt wasn’t going to be helpful. But I did have a line that said, “across the country our doctors are jumping from hospital rooftops, overdosing in call rooms, found hanging in hospital chapels. It’s medicine’s dirty secret and it’s covered up by our hospitals, clinics, and medical schools. That’s not science; it’s deception.”

FA: Two years ago, a friend of mine passed away during his intern year. It was awful enough that he had died so suddenly, but when all of the signs pointed to suicide, I just – I feel like I experienced nearly all the stages of grief in the space of a few hundred heartbeats. I went from thinking that it couldn’t actually be him, to actually wondering, “could this really be the only way of dealing with whatever he was going through?” And how could I not have noticed that something this serious was wrong? As time went on, I slowly began to make peace with what had happened but I continued to wrestle with it for more than a year afterward. I kept asking myself, “Why? Why did this happen to him?” He was so kind and so talented, so gregarious and smart and full of promise. I - how did it come to this? I threw myself into research and I found articles by doctors Pranay Sinha and Pamela Wible, which helped me begin to understand the enormous and devastating scale of this crisis. With this greater understanding, my colleagues and I wanted to do something. And it was out of our collective loss that this podcast was born. As such, we thought it was only fitting to dedicate our final episode from season one to physician suicide, to my friend; and to begin with a question that has plagued me for the past few years: why do so many doctors and med students die by suicide?

PW: I believe that this medical student and physician suicide crisis is caused by a flawed medical education model. Our current model is not working and we’re having trouble telling the truth. We keep pretending like we’re going to try harder with a model that’s a failed model. And so our resistance to telling the truth and keeping these secrets is perpetuating more and more deaths and more and more despair among medical students, which carries over into their entire career. So it’s a problem; it’s a huge problem. And furthermore, beyond just the flawed medical education model that we have, we need to actually graduate as human beings, as whole human beings who are well – not struggling with PTSD and depression and suicidal thoughts. You know, obviously something is wrong when so many of us are newly diagnosed with mental health issues during medical school, or are struggling with suicidal thoughts, or are losing our classmates to suicide. But just beyond that, I think we need to have mental health services available as the norm in medical education and in our medical practices. And the big problem is that we have so many wounded people who are not even recognizing their own wounds who are now teaching in medical schools and they’re perpetuating the cycle of abuse. I can say so much more but that kind of probably gets us started.

DR. PRANAY SINHA: So it’s so hard to try to figure out what makes somebody make that decision to stop living. What could make you lose help in the future? You know, if you look at us, we are smart, we are fairly attractive, and we have generally succeeded most of our lives at the things we have done. So what makes this extremely privileged group make that step?

FA: That’s doctor Pranay Sinha, whom I interviewed this time last year, at the beginning of our season.

PS: And I think that this is the question that really bothered me. And last year around this time we had two interns commit suicide. And these two interns were extraordinarily talented people. And there was a great article in the New York Times the other day and I think the writer of that article had some really great ideas. It was sort of this concept of growing up with a future, and then having that future seem unreasonable or impossible at some point. And then it’s just carving out a new future for yourself saying, “oh well, if that is not going to happen that I may as well just stop.”And I think that happens in medical school and I think that happens in residency. And I think residency is particularly hard and I think since I’m close to it I can comment on it. So, I remember when I started intern year I was so stressed. I was constantly doubting myself. And I realized that big deal, that pressure was from myself. You will be your worst critic and you will pretty much never be able to satisfy yourself as a doctor. We tend to be somewhat neurotic people – we tend to sort of keep, you know, doubting ourselves. And in the first couple of months of intern year, you will slow things down for everyone. That is normal. That is so normal because you’re still learning this whereas they’ve been doing this for awhile. But you can’t see that. You see yourself as something defective, you feel like the program has bought a lemon and at any time they’re going to find that out and then kick you out. And I just felt like I was worthless. So those feelings of worthlessness, those feeling that you are worthless and slowing things down and not able to contribute, those are the feelings that I worry can affect people that have other things going on. Because again, and this is something I should specify because I don’t think I did this in my article at all, but I think people who commit suicide, there’s usually more than one thing going on and we potentially will never know what it was.

FA: I mean, hopefully you haven’t had to experience it with any of your peers, but do you have any thoughts on why it’s so present within the medical community?

DR. LAUREN APPELL: I believe that it’s encouraged to discuss mental health now. And I believe that the incidence may not be changing but the awareness is certainly rising. And so maybe things that may have been chalked up to accidents or medication errors and things like that, may actually have been intentional suicide. That’s just my own educated guess.

FA: That’s Dr. Lauren Appell

LA: Doctors are no more immune to mental illness than anyone else. And as being someone that has battled depression in my past, it’s hard to drag yourself up out of bed everyday and take care of messes. All day every day, all we’re doing is putting out fires, it feels like. And it’s hard to take care of yourself when your job is to take care of others first. And I mean, I’m guilty of having packed on several pounds just from ignoring the gym. Because, you know, I work so late and it’s like, “I deserve to eat and I deserve not to work out!” And I’m sitting here not practicing what I preach and I think that’s the main problem is that we don’t practice what we preach. We’re supposed to be these symbols of health and at my medical school there was like a notorious cardiologist who would go after surgery and smoke in the stairwell. Things are absolutely frowned upon and mental health is undeniably one of them. And it is undeniably frowned upon, in whatever field you’re in, to require psychologist visits or psychiatrist visits. And when you deal with the burdens of people very sick, and - that are - you know, these are dying people in whatever field you’re in - it’s hard not to take that home with you at the end of the day. And I don’t think it’s necessary all that but I do think it’s a factor. But it’s also – when you get home at the end of the day – not being able to care for yourself properly. And I think that it’s a feed forward cycle that ultimately ends up being too much for people. Because once you’re a doctor, you can’t just bow out. You can’t just say, “hey guys, this isn’t for me.” Because that isn’t accepted in the field and you would be ridiculed and you know, discussed for years and years and years. And I feel like the desperation that that leaves people is just what drives anyone to commit suicide. And it’s not something that I can ever say that I understand feeling because I’ve never felt that way but I’ve certainly felt desperate before. Especially knowing, like – I need help and I don’t even know where to ask without being made fun of. And it’s not like, a matter of – it’s just your own personal insecurity that’s harbored in this field because we’re supposed to be the ones that have the answers and like, who should you ask if you don’t have the answer, you know?

PW: I’ve had so many people who feel suicidal and feel like they’re defective call me and tell me that they’re burned out and that they just can’t keep up with other people and they really think that there’s something wrong with them. There is nothing wrong with them. I have to keep explaining, “you’re having the normal reaction to a very sick medical education system or to an inhumane work-environment.” You know, that would make anyone terribly upset, depressed, crying, and thinking that there’s something wrong with them if everyone else is pretending that it’s normal. But you have these people who are basically in the top 1% of resilience, compassion, and intelligence when they enter med school and somehow, some way, after graduating, like, over 50% of them are “burned out,” which I just think is total B.S. These people have been abused by a system that has dehumanized them to the point where they don’t even have normal bowel or bladder habits because they had to hold their bowels for all these surgeries and all of these things that they had to do. And they haven’t been able to eat and they haven’t been able to drink and, you know – we just have to understand that this is far more than the “burnout.” This is abuse. And it’s not going to be cured, even though we want everyone to do self care like – they need time to do it. But it won’t be cured by like, a certain yoga position or a breathing techniques. It’s so much deeper and more serious than that.

LA: It’s not even the life or death situations that you bring home. The life or death things are usually very concrete and those are few and far between. Unfortunately it’s like, the ordinary, run of the mill: Did I miss something? Am I thinking of everything on every single person that I see? And that is what can wear you down.

FA: There is a TedTalk – I think the title of the episode was, Doctors Make Mistakes — Can We Talk About That?

LA: That’s great!

FA: Yeah. And it was just such an amazing talk because he talked about how he made his first mistake. And he says what the mistake was. And then the second mistake… And then the third mistake… You know? And it does sound like, you’re right, like the devil is in the details and you’re only human at the end of the day.

LA: Mhm, exactly!

FA: Yeah, that level of assumed perfection or imposed perfection that I think you guys have to deal with is just – oh my gosh – it’s inhumane! It’s inhumane and I think there’s no other word for it in a field that deals with humanity.

PW: A dysfunctional medical system can only be sustained on the backs of a disempowered physician population. The precursor of which is an abused medical student population. It’s abuse – from the day one of medical school, where people decide to do things that would otherwise be considered unethical. Like, in my class, they were killing dogs, you know, in physiology lab. I stood up against it and wouldn’t do it. But I’m just saying it’s like day by day, minute by minute, we are making decisions to do things that we would never do if we were on our own. We would never choose to mistreat a poor patient if we were our bright-eyed, bushy-tailed pre-med selves. Right? But because we’re in an environment in which people are behaving unethically and greedy and doing other things that are highly questionable; and that’s the peer pressure that we’re somehow under is to conform to this very sick, very abusive medical model. We end up chipping away at our own identity to the point where, when we graduate, we’re so far away from the personal statement that we described that propelled us into this profession, that we’re so far away from being the true healer that we ever wanted to be, that it literally will destroy the rest of your life and undermine your marriage, undermine your relationship with your children. When you give up on your dreams, you are undermining yourself and everyone around you. And you are no longer a healer if you’re a victim. That’s the other thing: if you’re going to choose to be victimized and not stand up for yourself and others around you, then you can’t be a healer. It just doesn’t work. You can’t be both; you have to choose one. So I am encouraging medical students from day one of medical school to choose to be healers and to notice things that are not healing that are going on around you and to write them down, if nothing more, in a diary so that you can share it later in an anonymous blog or do something. Do not accept abuse as normal. You are a healer. So you are here to look around and help people who are wounded and there is a high density of wounded people at medical school – including administration and faculty – and they need help. And they don’t even realize they’re wounded, some of them. You know, stockholm syndrome? If you have been victimized yourself and you don’t realize that you’re a victim you are at a high risk of becoming the victimizer. And you’re going to perpetuate this onto future generations. And we’ve had so many generations of physicians who have been so wounded and they’re now in teaching positions and we absolutely must stop the cycle of abuse. And it can easily be stopped and it doesn’t even cost money! It’s not like we need to install a bunch of MRIs or redo our whole medical system. I mean, all we need to do is reach into our hearts and souls and be healers and stand up for things that are right. You know, if you see another medical student getting pimped or abused, I think you could stand up and at least, if nothing more, talk to that medical student later and say, you know, “that was wrong the way that teacher was talking to you and I’m appalled by that and I’m going to write a letter or let’s start a petition.” Or, if you feel strong enough as a group, stand up and call that teacher out or write a letter to the dean with multiple signatures that says, “We don’t appreciate being treated the way Dr. So-and-so treated us,” or you know, whatever it takes, we need to do this together because teaching by terror is not the way to train a doctor.

PS: In medicine there is, the way we teach is through something called pimping. It sounds terrible – it basically means asking juniors questions and it’s supposed to be some sort of Socratic method and people use it to sometimes put people in their place and sort of demonstrate their superiority because in the end, medicine is a fairly hierarchical system. The reason why pimping can get brutal, and the reason I think sometimes seniors freak out at their juniors instead of reaming them out is that they think, “If this guy doesn’t know this piece of information, he is dangerous.” I think the way to think about it really is that you have about three years to figure out how not to kill somebody and how to take care of really sick people. So it’s okay if you don’t know something the first time – you’re far more likely to retain it if you’re taught it! This whole, “I should,” I never – like every time I hear it I cringe: “I should be able to do this. I should know that.” No! You shouldn’t! And especially [given] the way the U.S. medical system is structured, is that we work really hard during years one, two, and three. Year four is party time, you know, for the most part. Because we take light courses, we go for a lot of interviews, get fattened up on interview dinners, um, take a few vacations, enjoy match day, take another vacation. Then we come to intern year having forgotten a lot of the things that we learned in third year. So, how can you at that point – just because you have an md after your name – expect to take care of extremely complicated patients at a level that you’ve never done before and at a quantity that you’ve never done before? You can’t. And the funny thing about it is – I was just marvelling at it the other day – now that I’m a second year resident, I’ve been through a year of this. I have seen these patterns – you know, because patients fall into patterns, I’ve seen these patterns – a couple of times and now I get it. Now I know what to look for and so I can do that a lot faster and I can do that a lot better. And it’s really marvelous how the system works and how suddenly you have abilities that you never had before. But I look back at my interns who are struggling to do the same things and I can see myself in that position and I know that there is no way that I could’ve done then what I do now. And with that comes empathy; with that comes sort of, you know, the acceptance – and I’ve tried to, I mean, I try to tell them that it takes time, but then I’m always met with that sort of, “oh no, I want to be able to do this now.” So I think one piece of advice that, if I could, I wish that I could go back and tell this to myself, is: “Stop comparing yourself to your residents. You will get there.” You know? You don’t need to go to hell and back to become a good doctor. You just need time and you just need experience. And it’s okay to struggle.

PW: We all need to stop the sort of suicide censorship that goes on. I think the people who can really change this are the family members who have lost people – their brothers and sisters or aunts and spouses or whatever – to medical student suicide. When they come forward and speak openly with the media or publish blogs or you know, come forward with the full story, it just frees us all up to tell the truth. Because we lose the equivalent of an entire medical school of physicians every year to suicide, and that’s not even including the medical students that die. And what that equates to in these big-box clinics where, each one of us, at least in primary care have like 2,300 patients in our patient panel on average. We’re, you know, over a million americans are losing their physicians to suicide every year. And, like, it’s not being reported in the news. I did a blog called “Why Physicians Commit Suicide,” which I have since learned is the wrong way to phrase it. We don’t even talk about suicide enough to understand the proper terminology to use to talk about it. But “committed suicide” makes it sound like a crime. And it’s not a crime. It is a medical condition. And, so just like we would say “died by pneumonia,” “died by diabetes,” “died by - whatever” it should be “died by suicide” not “commited suicide.”

FA: Within like your medical training and med school or even just in your residency or wherever you’ve experienced it, have you seen any signs of either the schools trying to muster a kind of support system or encourage people to kind of talk to people for help if they need it or any sort of signs that they’re trying to support doctors?

LA: So, yes. When I was in medical school, we had an office – it was completely free, you could go in anytime. It was completely, 100% outside of the medical school so it was confidential – a place where you could go if you had problems with drugs, if you had problems thinking you know, these thoughts like, “I don’t want to live anymore” or like, “the stress is too much to bear.” And these doctors were available 24/7 essentially, I mean. So that, in medical school, like I said – I knew where to get help. And even coming into residency – it’s the same sort of thing. On day one of orientation, there was an hour long presentation about how to stay healthy in residency and these are numbers to call and these are cards for us. And as a resident you have one hour that is you know, guaranteed yours with a psychologist that you can just talk to at any time. And if you’re not sleeping well like, don’t do these things. And if you need to sleep better, like, do these things. And a huge push toward establishing that you need help when you start it. And I even remember on my intern retreat – this was in about September and you know, we start residence July 1st – so I had had this one hour presentation at my orientation in June and in September they’re telling us like, you’ve made it! You’re here. You don’t need to prove to anyone that you’re worthy. Like, we know you’re worthy. We need you to stay healthy because you are worthy. And hearing the stories of residents who have done very rash things and end up taking their lives because of it – there was a huge push toward making it accepted that we’re human. Like, if you have a drug or alcohol problem, we aren’t going to fire you. We will get you help [and] it will be a program that we all agree upon. It’s not safe for the children and it’s not safe for you, for anyone to be practicing if you’re not in your full, 100% capacitance. I mean, even as we sign a contract, have a clause now that they’ve inserted into our contract, that says like, “you must be physically fit to serve as a resident.” And physically fit implies emotionally fit. And they made that like, very clear. Like, if you, you know – if you are struggling to the point where you can’t even take care of yourself, how are you going to take care of other people?

PS: Making the transition from medical school to intern year is incredibly hard. Especially because your self-expectations are crazy and the expectations of other people are also, you know, unreasonable. And I think the best thing that we can do for that – and I try to do this for all my interns – is say, you know, “Listen, it is hard. This is not easy. You’re not expected to know this.” My program director – my first day in intern year – he said, “Just so you know, my expectation of you in nothing. I don’t have any expectations of you.” And that was the kindest thing he could have ever said to me. Because then, you know, when I didn’t know some of the answers it was like, “Alright well, you know, I guess you know – I’ll learn.” And it wasn’t like, “Oh, no. You’re supposed to be able to handle this and this and this and theses are my expectations.” If he’d said that to me, I would have been devastated. The other thing that he said to me that was really kind – and I try to pass on this to my interns too – he said to me that in intern year he used to be the most disorganize intern ever. And that sort of vulnerability that he shared with me, you know – he told me that there was a time that he was not perfect. And my program director, by the way, is extremely respected. He’s brilliant; I’m in awe of the man. And the fact that he struggled with the same thing that I have – I was incredibly disorganized as an intern, I still probably am – but when he shared that vulnerability to me, it made me feel like it was okay that I was struggling right now because if he could do it, I could do it too. And that doesn’t happen nearly enough in our profession. Going to med school, I acted tough. I acted like House because I was trying to hide my vulnerability. And we all do that in medicine. We all act tough, we all act like we get it. You know, if there’s something we don’t get we try to hide it and like, check it later or something. But… you know, that is precisely what we need to get away from. We need to get to a point where we say, “yeah, I don’t know this” or “I’m struggling with this.” That way, if there’s a forgiving culture where you won’t just get hammered for not being perfect, I think that will be a lot safer for people who are struggling which; by definition, they will struggle. Because becoming a doctor, becoming a competent physician is an incredibly hard thing.

FA: I think it’s really encouraging to hear that in small areas, in small ways, both medical institutions and med schools, you know, are trying to make some changes that will actually better support doctors. And whether or not that’s going to trickle up or flow up and impact the doctors who are, like you were talking about, the dinosaur attendings at the top, whether that will reach them and help them if they need it – that remains to be seen. But for the younger generation, the newer generations, hopefully that will be a source of change and a source of comfort and a source of health! Hopefully, ultimately.

LA: Yeah, I know! Absolutely! And it is definitely a movement and it’s definitely a changing process because, you know, there still is definitely a stigma that, were a resident to suddenly die of a, you know, subarachnoid hemorrhage or you know, like an aneurysm and suddenly drops dead on the floor, it’s perceived differently. It’s no more tragic because the same life was lost and were that person to be found you know, in a closet with a needle in their arm or they didn’t show up to work and they’re found you know, hanging in their bathroom or something like that – that for some reason is taboo. And that’s the problem, is that mental health is perceived you know, as a weakness and not necessarily as the illness that it is. And I remember telling one of these patients of mine who ended up having you know, a personality disorder and she wasn’t taking her medicine and she kept coming in with suicidal ideation and all of these things and I looked at her and I said, “This is like if you were diabetic and you wouldn’t be taking your insulin. You would die!” With diabetes we use insulin; with borderline personality disorder we use antipsychotics. Like, it’s a thing! And it’s just – it’s just a whole nother thing treating the mind than treating the body. The body speaks for the mind and when there’s inner turmoil in the mind there’s turmoil in the body. And you know, if we medically clear the body, there’s nowhere else for it to come from than the places we can’t look and that’s the mind. So, you know, we attack it from both ends. We attack - we attack it from the body standpoint – and I usually will tell my patients, “I’ll do my job if you do yours. And your job is to, you know, get into therapy and talk about how you’re feeling; and experiencing discomfort and knowing how to cope with it as opposed to like, medicating it.”

PW: The very positive message that I have for everyone is that we are going to have a paradigm shift and we are going to enter the 21st century here with medical education and medical practice and it’s just a matter of velocity. How quickly do we want this to happen? Because pandora’s box has been opened; we’re not going to bury these suicide victims again in secrecy. The caskets have been opened. You know, there stories are being told online and this is only gaining steam and gaining more media attention. And the sooner medical students stand up and tell the truth and the sooner patients are aware and outraged by the way their medical students and physicians and residents are being trained to care for them – in such a dehumanizing manner – the sooner the general public knows about this, the sooner this entire paradigm shift will happen. This is like a human rights movement within medicine. Everything looks pretty dismal until people start standing up for the truth and what’s right. Before the bus boycott – you know I’m just using civil rights as an example – before the lunch counter, before women got the right to vote – like it all looked pretty dismal and disastrous and depressing. But then one day it changed and I think now is a good time to change some of these traditions that are not working in medical education. And medical students can do it! And if they don’t do it they are complicit with causing the whole next year of medical students to suffer just like they did. You went into medicine to be a healer, at some level, right? And some people keep it more on the surface, and they’re more like idealistic humanitarians and you can see them coming from five miles away because they’re just, they love people and want to serve people; other people kind of hide it a little bit, you know, but I think all of us – I truly believe that people who go into medicine in 2016, we are somewhere deep inside, if not on the surface, idealistic humanitarians. And I want you to show the world who you really are and be that powerful, beautiful healer who will leave such a legacy on this planet of healing. And you can do that most effectively if you do not let anyone harm you along the way. So you have to stay true to yourself and true to your heart and soul and you cannot do anything unethical. Tell the truth! If you are suffering, if you are crying then say, “I cried for six hours last night into my pillow,” and tell somebody that you feel safe to tell that to. Don’t pretend that it’s okay and that’s going to be the normal way that you live. If you are suicidal, tell somebody that you trust. You know, that’s not sitting next to your transcript. And if you’re scared to tell the truth to somebody else, at least write it in a diary. You know, at least come clean with yourself with the truth. Please be true to yourself; love yourself; care for yourself. Know that you are super powerful and the easiest way to do this is just to be clear and tell the truth. And to be a real scientist, you know – follow the truth.

FA: I’ve always wondered what tools med students and then you know, interns and residents and physicians use to try to achieve some sort of work-life balance. Do you feel that there’s anything that you particularly employ that helps you stay whole?

PS: Oh wow! I think I’m probably the worst person to ask about this sort of thing. My girlfriend and I are both pretty bad at this. But I think it’s just, you know, kind of making a commitment to this other side of you. I think what I could do for you is – instead of telling you how I achieve work-life balance, I could tell you how I try to motivate myself to do it, and if I were a better, stronger and more interesting, more intelligent person I might be able to do it. But, essentially what I tell myself is that, to be able to empathize with my patients and to be able to take care of them as a human being instead of as an automaton, I need to have some sense, you know, some experience of the human condition and not just time spent, you know, writing notes and giving physical exams. I need to be able to live life to understand why life is worth living and life is worth saving.

FA: At this point, I don’t know what more I can contribute to this conversation. All I know is that it needs to continue. I firmly believe that when we’re in the midst of darkness, the most important thing we can do is to add a little light and love to the world – whether it’s by starting a conversation, hugging someone, or just being kind. In the greater scope of this – our human existence – I’ve found that it’s normally the things that we’re more ashamed of – what we perceive as our darkest places and thoughts – that are actually the most universal. Which is why conversations like this are so important. That’s how we shine the light on them.

So if you’re feeling suicidal, remember that you are not alone and there are people that you can talk to. Please call 1-800-273-TALK, that’s 1-800-273-8255 or see our blog for more resources.

My deepest thanks to Drs. Pamela Wible, Pranay Sinha and Lauren Appell. I’d also like to thank all of the doctors and people who contributed to our first season. We literally could not have done this without you. Thank you for going on this journey with us, both today and throughout our first season. We’ll be taking a break to gear up for season two but we’d love to hear from you in the interim – especially about what you’d like us to cover next season. So please get in touch with us via facebook, twitter, or email at info@myfirstcadaver.com. And please stay tuned because we’ll do at least one exclusive follow-up episode with Dr. Wible – as I want you all to hear more about how she escaped being a medical factory worker on a figurative assembly line and launched her ideal medical clinic! Enjoy your summer. We’ll be back soon. The first season of My First Cadaver was sponsored by Med School Tutors – the place to go for top-notch, uber personalized, 1-to-1 tutoring for the USMLEs, COMLEX, medical coursework, residency advisement, and more. Check them out at medschooltutors.com.

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Topics: Physician Suicide, Residency, Med School

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