In my two decades of emergency medicine practice, I have encountered many patients who have attempted suicide by medication overdose. Most attempts seemed impulsive, with a poor understanding of the lethality of the drugs taken. When my own suicidal thoughts got out of control, I found myself relying on my medical training to calculate a lethal dose.
During residency, I was proud of being able to manage stress. But when newly hired into a large teaching hospital, I found myself struggling to keep up with the intense work and plagued by self-doubt regarding my knowledge base and skills compared with my colleagues. A lack of ability to cope with these feelings was the first inkling of a long, steady decline that would deeply affect my life and those around me.
My dad calls this post-residency career stage "the busy time." I have come to understand that many physicians feel as I did during this period that is characterized by a growing list of work-related responsibilities (more shifts, research and teaching), family pressures (more children, a spouse's career), and a drive to excel. The demands of the clinical academic-industrial complex are insatiable. I found myself in the throes of these pressures, trying to solidify my clinical skills while pursuing an administrative interest in health informatics, supporting my wife's developing academic career and dealing with an intractable repetitive strain injury from typing a thesis and carrying around chunky infants.
Almost none of my training time in the late 1990s was spent on the wellness and resilience skills that are now commonly taught. None of my colleagues or mentors --and I had some great ones--mentioned self-care. The only skill I mastered to deal with the increasing stress was denial. By my late thirties, things had gradually deteriorated and I experienced progressive burnout, with symptoms such as sleep disruption, irritability, poor concentration and lack of empathy for my patients.
My residency project topic concerned how to care for families of those experiencing critical illness in the emergency department but, gradually, I found that I was doing everything in my power to avoid emotional conversations. On one occasion, I broke into tears while disclosing that three family members had died in an accident. I think showing some emotion can be appropriate in that situation, but increasingly, my overwrought emotions interfered with my...