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 were unfazed by bomb threats. Rival gangs shooting at each other in the ER. Prisoner patients cuffed to hospital beds. 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.
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.
- Porn everywhere
- Roaches
- Scabies outbreak
- Close proximity to the patient room with the inmates cuffed to their beds. I did not fully trust the cuffs.
- 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:
- We finished the left femur.
- We are setting up for the right femur.
- The anesthesiology resident is dead.
- There is another broken man in the ER drunk post gunshot wound to arm and motorcycle accident.
Me: Shane, back up. 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. 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 that we have lost to mental health issues. For all of these reasons I will wear crazy socks on June 1. 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.
Jennifer,
Profound post, but I recognized the story, as I had similar experiences in my training (1981-86), way long before shift time limits. I do not recall anyone committing suicide. I wonder if it’s that hospital and training environment that drives docs to this end! Very sad and frightening.
I am seeing more and more docs retiring before the traditional age of retirement. Even back in the late 80s, doctors in training knew that the hay day for physicians was over. We were more frugal with our earnings. We didn’t buy fancy cars. We didn’t invest carelessly. We saved, because we knew we wouldn’t work into our late 60s and 70s like our predecessors did. It was a different time. And now, many docs have positioned themselves to be able to retire early if they burn out. And they are burning out. It’s unfortunate, because we live in times when we are truly needed. There will be a shortage of adequately trained docs in this country. We’re training longer and quitting sooner. We’re taking off more time. This can’t help but have an affect on the distribution of medical care in this country.
Barbara, I wish we were making progress in the correct trajectory. At least there is a conversation in 2018… So much work to do.
Really well written, Jen. Thank you for speaking up for us. It’s all true and all the “small stuff” like our patients not trusting us adequately, being called “provider” not doctor, EMR, paperwork, add up to BIG burnout and physicians needing support and recognition of this risk. Well done.
Jen, Thanks so much for this comment. We have to make a change or the next generation will never take care of us!!
I usually wear crazy socks, but tomorrow will have a REAL purpose.
Reid Nichols you always have a REAL purpose!! wear crazy socks and fix those kids 🙂
I fortunately trained at the beginning of the 80 hr work week so there was a semblance of 80 work hours. Couldn’t imagine what it was like for you but I could see the exact places you describe. The call rooms, the pts, the trauma that came in didn’t change. Your stories were legends when I trained. We heard about the anesthesia resident but never got details.
I never even thought about how much harder and lack of what the future may bring it was for the prelims.
Thanks for sharing. I will wear my crazy socks with you on June 1.
Selina Poon, I wish we had done more to pave a better road for you and the others who followed us. I am proud to wear the badge of honor from Ben Taub with you.
I would wear them but don’t have any. Just my conservative but comfortable work clothes. Great story. Maybe next year, if still working. We should give ourselves a day of recognition. Have you noticed how nobody seems to know Doctor’s Day anymore. My own staff has no clue. I’d rather have a “secret socks” day anyway.
Alice, I conservative and comfortable is awesome too. Even if you aren’t still working next year, would love to see your crazy socks! my kids are embracing this, and they would be happy to take you shopping?! 🙂
Great post, Jennifer. I’m fortunate to not have had any suicides of people I knew while I was a resident, but one of our Pediatric Surgeons died of suicide about 20 years ago. In retrospect we all should have seen it coming. We all need work together to support all of our colleagues. On a lighter note, I wear Stance “crazy” socks everyday so June 1st wouldn’t have been a “special” day for me.
Hank, I am so sorry to hear about your loss. I am grateful to work alongside you in this realm of physician well being.