Blood covered me as my colleague plunged a knife into my chest, my arms outstretched to resist. A friend looked on, and my screams echoed in my brain. My wife gently shook me murmuring, “You had another nightmare.” I lay in bed, my thumping heart and rapid breathing gradually easing, the sheets damp, overwhelmed with despair.
Each night for several weeks sleep was elusive. Apprehensive about the night, I felt a claustrophobic pool of ink spread over my consciousness. This psychic pain was invisible to most, even my wife and family. Desperately unhappy at work, after 32 years I was unable to imagine a life other than as an academic physician.
My symptoms and their origin stories were myriad. Quick to anger, I frequently erupted in a righteous rage on behalf of a perceived slight to one of my patients. Anxiety overcame me as I approached clinic each week: would I miss something and fail my patients? I had feelings of PTSD from the early AIDS era when virtually all of my patients died despite my best efforts. After all the advances since then, frustration arose when patients didn’t take their HIV medications.
With growing grandiosity in what I could accomplish, I had driven myself at work. First in North Carolina then in Africa. Solve AIDS, no problem. Stop mother to child transmission in Malawi. Why not?
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Working harder and harder, I juggled four grants, directed the fellowship program, and took care of patients almost frantically to block the pain. During the Ebola epidemic, in quick succession I dropped my clinic, gave my grants to junior colleagues and created a team of researchers to work in Liberia. When asked by two people about the manic aspects of my behavior, I reassured them that all was well.
Underlying the anger, anxiety, frustration, and grandiosity was depression, hopelessness, and helplessness. I self-medicated in good ways and bad. By working out daily, swimming and running, I kept my pulse up and endorphins flowing, albeit temporarily. Drinking more than two glasses of wine, a known depressant, each night with dinner became a regular habit, exacerbating my symptoms. Tears came easily.
As is often the case for professionals, I kept silent about my thoughts. That and my constant joking kept others at bay and unaware. As I continued feeling helpless, trapped in my job and not seeing a way out, my thoughts turned from occasional suicidal ideation to making concrete plans. At first, I stopped wearing a seatbelt. Then my mind began drifting to taking the elevator to the sixth floor of the hospital and jumping to the plaza below.
An estimated 300 to 400 physicians die by suicide in the U.S. each year, a higher rate than the general population for both males and females. Somehow I avoided joining that number. In my rearview mirror, thinking of my daughters helped me look up and begin the move away from my inner torment. I
told my wife and close friends and sought help. As a medical faculty member, I had excellent insurance, providing coverage for talk therapy and a prescription antidepressant. I had the contacts to find the right psychiatrist for me. I had the money to pay for what the insurance did not cover. Because my angry outbursts affected my workplace, the Department of Medicine paid for an anger management course and an excellent book, “When Anger Hurts.” I was otherwise healthy so did not have to deal with other conditions that can complicate the treatment of depression. And I had a wife, two daughters, and close friends who quickly encircled me with a protective and patient healing love.
By the end of the anger management course and final chapter of the accompanying book, I realized that leaving my job as an academic physician was a key part of my recovery. Although it is easy to write about this decision now, three years ago I could not conceive of it. For me, my work and all it encompassed, research, patient care, and teaching, defined me as a human being. A rather narrow view of self, but it was my reality. Without the crisis of hitting rock bottom, I do not think I would have had the courage to leave.
By participating in talk therapy, taking a daily medication, exercising daily, cutting back on alcohol, restructuring my debt so that I could easily leave work, taking a course on mindfulness to slow down and become more aware of the natural rhythms of the world and yet less driven, my symptoms dissipated. Was I cured? Not by any measure. I still have good days and bad. But I have become less driven to always be busy or happy. I have become comfortable with my uncomfortableness.
Charles van der Horst, M.D., is an emeritus professor of medicine at UNC and a global health consultant. Follow him on Twitter @chasvanderhorst
Resources mentioned in the column
American Foundation for Suicide prevention https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/ Resources for prevention of suicide for physicians and residents.
National Association for Mental Illness NAMI https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Finding-a-Mental-Health-Professional Information on getting help with a crisis hotline as well
How to find a therapist https://www.nytimes.com/2017/07/17/smarter-living/how-to-find-the-right-therapist.html?_r=0
UCSD Anger Management Course for Health Care Professionals http://www.paceprogram.ucsd.edu/CPD/anger.aspx