June 1, a day of awareness for physician mental well being

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My 8 year old, Coco, risked life and limb to liberate these crazy socks from her big sister's room

The year was 1998. Surgical internship at Ben Taub Hospital. This place was the real deal. Gun detectors soon to be installed. Security so challenged that we residents were unfazed by bomb threats. Rival gangs shooting at each other in the ER. Prisoner patients cuffed to hospital beds with police guards nodding off nearby. Knife and gun club did not begin to describe it. Pre 80 hour work week restrictions for residents. 38 hours on 10 hours off, rinse, repeat.

It was a rare moment of quiet. I was rotating as a surgical resident in the SICU, the surgical intensive care unit. Putting in lines and chest tubes. Managing patients that were sicker than sick. The blind leading the blind, interns helping interns. The nurses helping the interns. Sometimes the patients helping the interns. Sometimes the patients physically threatening the interns. That factor was variable. I looked at my best friend, Marc. Our birthdays were 2 days apart, he just turned 28 and I turned 27. I complained that if I jumped out the window of the SICU and didn’t succeed in killing myself, I would end up right back in the SICU. There was no escape. We were so sleep deprived that this was hilarious to us.

The SICU had an awful smell. Antiseptic and sick all at once. It was steps to the trauma room in the OR. We didn’t leave the floor. I’m not sure if this was a real rule, but we didn’t. But we would go for a “walk” now and then. And the trauma room in the OR was sometimes (not often) empty. For some reason it did not smell bad in there. So this was my grand destination to clear my head in the middle of the night.  The fluorescent lights were so bright that you would never know what time of day it was, though.

There are always a few interns, called preliminaries (prelims), who did not have a plan after internship. Internship is hard enough with a goal in sight. I would become an orthopedic surgery resident after the year of torture. But the prelims were not lucky enough to have matched into a full program. So they spent the year working themselves to the bone to prove to the world that someone should give them a spot to finish training in some sort of surgical field. They were more miserable than the rest of us. A few of the prelims had been surgeons in other countries. To be a doctor in the US they had to redo their training. One of these prelims was from Mexico. He was an experienced surgeon in Mexico. He had a wife. He had children. And he subjected himself to a prelim year of surgery internship to try to reestablish himself to become a surgeon in the US. I can’t remember his name. But I saw him in the empty trauma OR on my “walk” around 4am. I remember his face. And his stumble. And the tourniquet he had applied to his own arm. And the needle and the drugs he was injecting. And the nurse who saw him from across the hall. And the senior anesthesia resident who started his code. He was unsuccessful in his suicide attempt.

The story in 2002 in that same trauma room has a different ending. I was the senior resident on call. The junior resident was operating on a huge man with bilateral (both sides) femur fractures. I was catching a few minutes of sleep in the office. I did not ever go to the call room. Reasons to avoid the call room.

  1. Porn everywhere
  2. Roaches
  3. Scabies outbreak
  4. Close proximity to the patient room with the inmates cuffed to their beds. I did not fully trust the cuffs.
  5. Did I mention the porn everywhere?

Shane, my junior resident, should have been annoyed that I was not helping him fix the broken man. But he was too nice show his annoyance. Shane was a hard worker. His report went as follows:

  1. We finished the left femur.
  2. We are setting up for the right femur.
  3. The anesthesiology resident is dead.
  4. There is another broken man in the ER drunk post gunshot wound to arm and motorcycle accident.

Me: Shane, back up a step. What was #3?

Shane: dead. The anesthesia resident. Overdose.

Me: I will come do the right femur.

We didn’t talk much about the anesthesia resident. We weren’t sure if he overdosed in an attempt at drugs to stay awake, get high, or try to kill himself. Shane said he stumbled out from behind the curtain in the OR (the anesthesiologist is stationed by the head of the patient, with a sterile drape separating them from the operative field) and made it to the bathroom, where he died. The loss of the anesthesiology resident mid case posed a threat to our patient, as the other anesthesiologists were otherwise occupied running codes or in other operating rooms. I think someone may have come in from home to cover. There was no debrief. No check in with the other doctors or the nurses. Noone asked how anyone else was. I’m not even sure who would have checked in on us. It became a tall tale, an urban myth that was actually true.

Now it is 2018. We know 400 plus physicians suicide each year. We know that in my specialty, pediatric orthopedics, 39% of our surgeons are burned out. We are called providers instead of doctors.  We spend more than half of our time with electronic medical records instead of patients.  We answer to patient ratings and scores.  The average person trusts their neighbor as much as their doctor to give medical advice.  We all have friends and colleagues and partners we have lost to mental health issues.  For all of these reasons I wore crazy socks today, on June   Because June 1 is #crazysocks4docs day.  To call awareness to all of this.  Doctors are people, too.  And when doctors fall and break the only ones to fix us and catch us are other doctors.  

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