A simple, innocent question that, for most, would warrant a one or two sentence response. It is well known that medical school is unbelievably rigorous. Diseases run rampant. Students spend a significant amount of time in a hospital or in a clinic, constantly surrounded by sick patients and children that sometimes forget to cover their mouth when they sneeze. The inevitable flu that accompanies the pediatric rotation is well documented. However, the most common diseases that run in medical schools are not those that are not seen on an X-ray, those that cannot be cultured on an agar plate, or labeled with an immunofluorescent antibody.
The diseases that I speak of are taboo. Because the career we have chosen as medical students does not allow them. Doctors do not suffer from “silly mental diseases.” We are given a vaccine upon matriculation that prevents us from suffering from depression, even after telling an expecting mother that her baby will not make it. We will not ever suffer from PTSD after watching a routine appendectomy take a turn for the worst as we watch a 12-year bleed out in the OR.
If you have not caught onto my sarcasm, I would like to clarify, physicians are human. As such, physicians are just as equally susceptible to the many diseases that they diagnosis and treat; this, of course, includes their mental health.
So what is it like? Dealing with your own mental health as a doctor? That I cannot tell you. But what I can tell you is what is it like dealing with your mental health as a doctor-in-training, as a medical student.
My name is Zach and I am in recovery from anorexia nervosa. Additionally, I was diagnosed with general anxiety at age 10. These are things that I am not supposed to say because I want to be a doctor. And who wants to see a doctor that is “mentally unstable”? But this is me and this is my story.
I wake up every day at 6 and briefly review my slides that I prepared the night before. This week, we are discussing metabolism. We begin with a cyclic, six-carbon compound known to even the layman, glucose. As an undergraduate, this material was presented to us over several weeks. As a medical student, this information was given to us in a 2-hour period. In two hours, metabolic pathway after pathway flashed before my eyes.
Enzymes phosphorylated this and dephosphorylated that, this one over here is allosterically inhibited by this one up here, and so on and so forth.
As if the 100 mile/hour pace at which the slides were being shuffled through were not enough to drive an ordinary student crazy, as a recovering anorexia, I could hear ED, my eating disorder, becoming louder and louder. I am taught how easy it is to starve. How simple it is to deprive my body the nutrients it so desperately needs without directly killing it. We discuss glycogenolysis and ED begins to have his fun. By the time we make it to ketogenesis and ketone bodies, ED is yelling at me.
Yelling so loud that I gloss over diabetic ketoacidosis and the many other risk-factors of hypoglycemia. After lecture finishes, I skip a meal. No big deal, I think. My liver will shift into gluconeogenesis in roughly 8 hours anyways and my body will be fine.
But that’s not true. By hour 3, my stomach begins to rumble and I can “feel” the ghrelin creeping its way up to my hippocampus, begging me to eat. I do not move and push on, meticulously scanning the material for a third time now. By hour 6, I begin to fatigue and my body begins to shiver. I run to my locker and grab my blanket, “it’s just a little cold” I tell myself despite my iPhone telling me that the high for today is 90.
On my way back to my study room, I run into my roommate. He asks if I have eaten, if I want to take a short break. ED wants to tell a lie, but noises from my stomach will not allow it as it lets out a cry. I give in and run to the cafeteria to eat.
Despite reviewing hundreds of slides and mastering intricate pathways I feel like a failure as I slowly begin to feel my stomach fill. But I take another bite. And another. And another. And eventually it becomes easier to finish the meal.
I remind myself that my body needs fuel, that I am not a type I diabetic and DKA is not cool. I remind myself that it is okay I wasn’t able to go to the gym today because I’m training to be a doctor, not a gymnast anymore. I remind myself that an eight-pack or a PR back squat will not help the girl that I am scheduled to meet with at JayDoc, a free health clinic that I volunteer with, but me studying and focusing on my education will. I remind myself that ED lies, he manipulates, and he is no longer in control here. I continue on with my studies.
I try to head home before it gets too dark out, but it’s normally 10 before I make it home. At night, I review my material one last time before I must forfeit myself to my bed. I set my alarm for 6AM. And I repeat.
This is what it is like to be in recovery during medical school. This is my story.