I first met Jing when she was a first-year medical student at the orientation session for new members of the Paul Hom Asian Clinic in Sacramento, California. She was enthusiastic about becoming a doctor and very passionate about learning how to take care of patients.
She studied hard and volunteered many of her weekends during her four-year medical student training to provide excellent care for underserved patients in our city. Unlike most of her peers, Jing continued to attend the clinic during her third and fourth years even after this was no longer required by the university. She cared about equity in health care and wanted to do her part to make sure that all patients were looked after well – even those who could not afford health care insurance.
I was shocked to learn this week that Jing recently died from suicide during her internship in Oakland. She had been full of life and excited to return to her hometown to work as a doctor. Her death was entirely unexpected and its mechanism a complete surprise to anybody who knew her.
Since learning of her death, I have been trying to recall all my interactions with her to identify anything that could have alerted me to her struggle with depression. As a senior physician with a lot of experience in healthcare I feel that I should have somehow been able to recognize a warning sign that could have led Jing to get some help with her mental struggles and avoid her untimely death.
Unfortunately, there is still significant stigma around mental health, and individuals are reluctant to seek help for fear of reprisal and discrimination in the job market. As a profession, we must make a strong stand against the stigma associated with mental illness so that individuals can feel safe to come forward and seek help.
As physicians we are particularly at risk for depression and suicide because we work long hours and are often sleep deprived. We also tend to put the well-being of our patients above our own welfare. At times we may be too perfectionistic and have unreasonable expectations of ourselves and of those around us. We must avoid developing a mental construct where we perceive that nothing we do is ever good enough. Instead, we must learn to appreciate the positive effect that our actions have on those around us.
Traditional forms of medical education that used to involve denigrating and ridiculing trainees in front of their peers during morning rounds need to be abolished. Criticism should always be constructive and considerate. We need to learn to appreciate the skill and effort of our colleagues, irrespective of their seniority. The quest for perfection should not lead us to become overly critical of our colleagues. After all, who can claim that they have never made a mistake when working under time pressure, or while tired at the end of a long shift? To err is human and to forgive is divine.
The moral support of a colleague becomes particularly important after an unexpected death under anesthesia. In many cases of anaphylaxis or myocardial infarction, it is impossible to save the patient’s life. Any feelings of guilt on the part of the anesthesiologist therefore need to be immediately dispelled by colleagues. The input of senior anesthesiologists is especially important in this situation to support a junior colleague, because less experienced anesthesiologists may lack the background to put the event into perspective.
Anesthesiologists are more likely to be successful with a suicide attempt than others because of our advanced understanding of physiology and pharmacology. This makes it even more important that we look out for signs of depression among our colleagues so that we can get help for them before it is too late.
The Coronavirus pandemic, the lockdown measures, and financial hardship due to inflation have only added to the mental anguish in our communities. Many anesthesia groups are short-staffed, and many anesthesiologists are forced to work longer hours than they would like. Therefore, we need to be particularly vigilant to look out for signs of depression not only in our patients but also in our colleagues. A kind and genuinely heartfelt conversation can go a long way to improve the mental state of a colleague and to improve the morale of the staff in your operating rooms.
We need to understand the positive effect of all of our efforts on the life of our patients. Recognizing the true humanitarian benefit of our work will help us to avoid depression and treat ourselves and our colleagues more humanely. The satisfaction derived from helping others can be a great source of energy and contentment that often exceeds the gratification derived from financial compensation alone.
It is too late for Jing now and we cannot turn back the wheels of time. I do however hope that her death will help us understand the importance of taking better care of ourselves and our colleagues.