Dear colleagues, I know you have seen these questions:
Do you currently have any physical or mental impairment that could limit your clinical practice?
Are you currently taking any medication?
Have you ever been hospitalized for any reason?
Have you ever been hospitalized for, or diagnosed with, a psychiatric disorder to include substance abuse?
Ugh! I hate, hate, HATE these questions! “It is none of their business,” or at least that is what I told myself over the years. Am I a good doctor or a bad doctor? Am I a fraud or a hero? These are the questions I ask myself. These are the questions that play in a loop in my head as I carry the hidden shame of depression for the majority of my career.
I guess I didn’t see myself as having a psychiatric disorder, even though I was suicidal. At least this is what I told myself. Denial is powerful. I resisted adequate treatment because it was an embarrassment at best, and, in my mind, humiliating. I had to admit I was just as human as everyone else (lay people, civilians, the non-doctors, that is). I always considered myself a “normal control” when studying disease and chronic illness in medical training. “I was so normal,” I told myself. “What happened to me?”
These were my thoughts, as I drove through the mountains. Driving away from my life, literally. I kept telling myself, “How can this be happening?” “Why can’t I keep it together?” I drove, speeding around slick and icy mountain curves, trying my best not to give in to the strong urge to drive off the road. It would be so easy. It would be such a relief. I looked straight ahead, as I shook, my knuckles white as I held the steering wheel steady. There was a mesmerizing pull of the sharp mountain curves. Each curve beckoned me to end it all.
I survived that drive, but it was not a relief. Days later, I was still overworked, stressed, crispy-fried, and isolated in my own thoughts. I found myself sitting in the middle of the countryside. It was dark. It was cold. I had a sterile scalpel (like if I was going to end it, I would need a sterile instrument). Feeling my pulse at my left wrist, “1, 2, 3 stab!” Pause. “Wow, that really hurt!” I was actually surprised that it hurt because I had been feeling so numb, detached, shut down. Maybe I was alive? The relief of physical pain diminished the emotional pain for a second; a brief second to change my mind. That jolt of pain brought me to the realization that it was cognitive distortion telling me I was a horrible mother and horrible doctor; that I was a burden; not worthy of living. “This is f**cked up thinking, not my real thoughts,” Finally, out of my numbness and fog, I chose to live.
The realities of getting the rest and help I needed came with consequences. Forevermore in my medical career, I had to make a decision when answering those dreaded questions. Should I lie? I decided to lie. I lied. Please insert more shame here. Oh, and here for every time I had to answer those questions thereafter.
In preparing to write this piece, I asked a lawyer if I would be at legal risk. “That is a risk you will have to decide,” he answered. Well, that is reassuring! In the end, I decided that I have had enough of hiding this part of myself. I’ve had enough of worrying myself sick with past and present thoughts like, “What if I have a bad outcome, or get sued, and it comes out that I was hospitalized and treated for depression in the past? Will I be discovered if a patient or coworker files a complaint? Will the hospitals want me if they knew the truth? What if they sue? What if the malpractice insurance company refuses to cover me?” The “what ifs” are endless.
If I didn’t lie on the applications, I would not have been able to return, to be hired – or gone on to become a better physician for having admitted I was a mere human. The alternative was disclosing a complicated and painful story and having to carry it around everywhere I went – like Sisyphus and his boulder, constantly having to push it uphill. The alternative was release of my personal medical history to boards, administration, and physicians I worked with every day. The alternative was monitoring by a physician health program (who report directly to the board involved, and make money by recommending the treatment that they conveniently provide).
How humiliating that would have been – to have to tell my whole medical and psycho-social history everywhere I went. Really? Why? Is it really necessary in the name of patient safety? Do we really have to be super-human and perfect? I proved that you just have to look that way with your colleagues, administrators, and state boards. This is the best kept open secret that we couch in “burnout,” “moral injury,” “compassion fatigue.” How can we prevent the increasing number of physician suicides if we don’t start telling the truth?
I am at a place, in my happy and healthy life, where I can share freely – perhaps others will follow. You are not alone. Through Dr. Pamela Wible, I have met many competent, capable, formerly suicidal physicians. This is for them. This is for those that may be feeling shame, or isolating themselves while pretending all is well.
Fraud? Hero? Funny, I don’t even care. Writing this is a risk, but I do it for all the doctors struggling today, and in memory of the thousands of doctors who have died by suicide. There but for the grace of God, go I.
One last note: The American Disabilities Act agrees that unless there is current impairment, to paraphrase … “It is none of their business!”
Robyn Alley-Hay is an obstetrician-gynecologist and can be reached at her self-titled site, Dr. Robyn Alley-Hay.