Depression, Anxiety and a virus named for a crown

If there’s one thing they don’t cover in medical school but that every doctor learns it’s navigating your own mental health.

Obviously, they teach you about how to recognize it and manage it in your patients, they teach you about biopsychosocial models, they teach you how to ask questions indirectly and how to check if someone is a danger to themselves. What they don’t teach you is how to be ok with not being ok yourself. They don’t teach you how to protect yourself. I remember a lecture in 5^th year about how to look after my finances but I never remember a lecture about how to look after my heart and mind. No one gives you the coping skills about dealing with human destruction and death that is inevitably part of the career. I think they thought we would get desensitized to it. Starting in second year standing over a cadaver with a scalpel and ending with being called to certify death in the ward at 2am in your internship years.

I realize that my medical training occurred in a grey zone where my teachers had been born in the years following a world war, a great depression and a giant holocaust. They were perhaps more sensitized to suffering than we were as a generation. They were also part of an era where mental health was stigmatized. People were trying to conquer visible disease like polio, syphilis and HIV. If you were struggling as a medical professional, you certainly didn’t talk about it. You just didn’t become the best you could be. Instead of being a gregarious surgeon you resigned to an everyday reliable GP practice. You didn’t push yourself harder you accepted who you were and made life livable. Or you didn’t. You suffered and probably caused immense suffering in your wake. In your patients, in your family, in your colleagues and trainees, in yourself. We didn’t have mentors in this area. People taught us how to suture, put up drips and defibrillate but they could never teach us how to deal with our hearts.

Now, as a new generation of teachers, we find ourselves lost in a sea of uncertainty. We, long before an invisible monster started running rampant across borders and fences, were floundering under an epidemic of sadness and anxiety in the profession. Sadness at at the inequality in our health care systems, the poverty and suffering that lives beyond the borders of suburbia, out past the airport and even further, deeper into the smaller pockets of our country. We have been overwhelmed by the volume of need for healthcare, nutrition, education and employment in our society. We have been struggling to stretch resources, apply equal rights in a deeply unequal system and do this all with posts unfilled and budgets cut.

We were anxious before all of this started. We were reading articles and listening at academic meetings about being resilient. We were rolling our eyes as they told us to sleep more, socialize more, eat healthier when we knew that no 24-hour shift one or two times a week, two sometimes three weekends a month at work, would ever encourage those behaviours. We watched helplessly as the economy slipped and the patient numbers increased but the capacity to employ more staff never came. We watched as our colleagues melted in front of us or hardened to stone. We watched some walk away broken. We buried some who simply couldn’t identify with life outside of work anymore. In all of this, those of us, not necessarily stronger but maybe more stubborn or persistent, have mentored ourselves through our mental health crises. Some crises have been short moments, some have been catastrophic. Some people have managed it on their own, some have done it with trained professionals, drugs and therapy. We haven risen, or at the very least stayed standing, taking one step forward at a time. Though we have not felt it we have been resilient even if we are not sleeping enough, talking enough or exercising enough.

Then out of the east a terrible wind began to blow. It carried with it an invisible uncertainty, something with the capacity to escalate the sadness logarithmically. The wind grew stronger and stretched its fingers further west, carrying microscopic particles of fear and panic in a steady swell. It has stopped countries, economies, governments and freedom. It has taken from mankind the one thing that is our strongest weapon – community. This virus that wears a crown has for now defeated us.

Yet, as low as we sink under the weight of what is around us – somehow, we must teach ourselves again to rise, to be tougher, stronger. We must keep standing. One foot forward at a time. We must carry each other. Carry our patients. Carry our nurses. It’s true – we have no mentors again, but we are shaping ourselves still to be mentors to the next generation.