I've written before about how medical training does very little to help people in the midst of depression, despite how prevalent it is. This is a story about a personal experience during training, and how my attending basically got pissed off at me for showing signs of depression. I've changed several details, but the idea remains the same.
Right before the end of my PGY3 year, a close relative died and another one was diagnosed with cancer. On the tail end of these tragedies, maybe because I wasn't taking great care of myself, I injured my back pretty badly lifting my daughter. I'd hurt my back a few times before, but usually it resolved within a day. This time it wasn't getting better. I had daily, severe pain, and it was keeping me from being able to sleep or stand or do anything.
At that time, I was on an inpatient rehab rotation with an attending who I will call Dr. Comp (short for compassion). Dr. Comp was kind of used to PGY4s blowing off her rotation, so I can't blame her for thinking the worst of me. But I was very honest with her about what I was going through. I told her about my pain and I even cried in front of her once. I don't think I was behaving like a slacker resident.
Throughout this, I was managing my patients adequately. They were chronic patients who required a very low level of care... some had been on the unit for months, one for a year. I never felt like I dropped the ball and even remotely put anyone in danger. In fact, I had to put together my own signout sheet for my census, since the last resident had graduated and left me with no information on any of the patients. I spent hours digging through all notes to give myself a full picture of every patient.
Meanwhile, I was quite depressed. I was having pain with prolonged standing/sitting, lifting my baby, and difficulty sleeping. I did see a doctor, but Dr. Comp was a little passive aggressive about letting me go to appointments. Finally, she told me that she had "reported" me to the program director for my behavior.
The program director, at least, was very kind. He told me he knew I was a good resident and that I had been through a lot recently. He told me that if I needed to take a short leave, I could do that, but I said I wanted to try to get through it. He even did acupuncture on me, which didn't work. (Surprise, surprise.)
On one morning when Dr. Comp and I were alone together (about two weeks into the rotation), she asked me how I was doing and that's when I started to cry. She told me to get myself together and call the mental health services. I did. For the first and only time in my life, I tried going on an anti-depressant, and had a severe reaction to it that finally necessitated my having to take a few sick days from work.
When I got back to work, Dr. Comp told me that she wasn't going to allow me to take call anymore because she had to change the call schedule for my illness, and she didn't want to do it again (on this particular service, the attendings generally took call alone so putting me on the schedule just meant the attending would be a second back-up). I asked her how I could make it up and she said simply, "You can't." I felt really burned by this. On my last rotation, the attending had told me I was the best resident he'd ever had. It didn't seem fair that in two weeks, I could go from that to feeling completely untrustworthy.
I did eventually start to feel better and pulled myself together again maybe three weeks into the rotation (it was a two-month rotation). But the way Dr. Comp treated me always seemed to drag me down again. Every interaction I had with her brought me nearly to tears. I remember there was a patient on our unit who was going for a colonoscopy, and she had somehow expected me to know to start the patient on IV fluids the night before (still unsure why). When she saw I hadn't done this, she said to me, "It's clear that I can't trust you at all. You are completely scattered and have no idea what's going on."
Admittedly, Dr. Comp was not the queen of psychosocial skills. She would routinely fight with patients during rounds, sometimes loud screaming fights. She was also quite "scattered" herself and would often claim she told me things when I was fairly sure she didn't. But other residents in the past said she was nice enough.
The second month was better. I still had issues with pain, but I had gotten to the point where I could deal with it, and it didn't affect my work. When we sat down for my evaluation at the end, she said, "I got the impression in the beginning that didn't want to do any work, but then I realized that wasn't the case."
You know, I could see how a depressed, tearful resident might make you think they were incompetent or unstable. But I'm baffled that the impression she formed of me was that I was a slacker. Half the reason I was so depressed was because I couldn't do my job well.