'How Are You?' Doctors & Mental Health

Like three weeks or so ago, someone asked me how I take care of my mental health while working in Surgery, given how demanding surgical training is. This question had come from the point of concern stemming from the news of a female Kenyan resident who committed suicide. I have never had suicidal thoughts but believe me, my mental health has been tried and tested in many ways than I can ever describe. His question left me wondering because it is true that in our setting, junior doctors hardly ever talk about our mental health struggles or get the support we need to deal with them.

I like to believe that doctors are a hardworking and resilient bunch. Surviving medical school alone is enough proof of that! We are taught to show up every single day, regardless. It's like an unspoken medical school rule. We are so desperate to prove ourselves that we often forget to take care of our mental health, and eventually, it shows. There is so much depression, burnout, and a creeping sense of demotivation and disillusionment amongst us. But we have unconsciously inherited the habit of not telling our stories because of the fear of being judged. So we bottle everything up and keep moving. How dare we struggle?

When I was asked about how I took care of my mental health, I wanted to talk about all the days that I cry or scream into my pillows because I've had a really tough day. I wanted to tell him how I sometimes have difficulty regulating my emotions and how feeling tired can seem like a default setting. But then, I didn't want to be considered fragile. Just by being a woman in surgery, I have to deal with daily microaggressions and people assuming I am an eggshell and not as capable as my male colleagues. How could I then talk about these feelings without seeming even weaker? But it shouldn't be like that. I shouldn't be afraid of talking about how I deal with my pain and struggles. My feelings are valid. Imagine how much we could learn from and support each other if we genuinely talked about our mental health struggles.

The things we see and the battles we fight at work every day, can be overwhelming and be physically and mentally exhausting. Watching patients die from causes that can be prevented or managed better had it been a different setting is exhausting. We suffer compassion fatigue from seeing some much suffering daily. Working in a semi (or non) functioning hospital system is exhausting. There are days when I experience a tsunami of emotions that I can't begin to explain... anxiety, anger, fear, sleep deprivation, burnout.. all of them. The fear of making mistakes, working long hours, missing significant events with family and friends, dealing with accidents like unintentional fluid splash and needle stick injuries can affect your mind in ways you don't even realize. Your mind can be in constant overdrive.

Our society is toxic and often classifies mental health issues as spiritual or just downright trivializes them. Most people don't understand things that they cannot see. Mental illnesses are not diagnosed with routine lab tests or investigations like othen a doctor says they are tired, overwhelmed, or depressed, they should have the support they need. When we admit to being mentally unwell, our credibility as physicians is brought to question so instead of getting the help and support we need, we brave it up, firm it, and show up. We treat our symptoms as just 'another day in the hospital.' We are scared to be labeled, tagged, judged, and stigmatized. So we never let our guard down.

We need to start talking about our mental health. We have to break the silence and give an opportunity for growth and evolution of the medical culture towards openness, understanding and support. Hospital systems should be a more nurturing place for junior doctors. We must unlearn 'mental resilience'. So many times, when someone says 'how are you', the reflex response is 'I'm fine.' It's like a random greeting. Instead, we should feel okay to say 'I am not fine' or 'I've had a rough day.' Imagine how comforting it will be to know that you are not alone in your struggle, that you are loved and supported. Imagine how relieving it would be to not just have to plod through each day pretending to be okay!

I am really blessed to be supported and surrounded by amazing friends and family who look out for me and carry me through the tough days but I am aware that not everyone has a support system like that. It is not a blessing that I take for granted. They are my therapists. One of my best friends has a sixth sense for when things are not right with me. When I give a reflex I'm fine response, she'll say 'No, I mean, really how are you?' Because of my support system, I get to let out my emotions in a healthy way. And those days when I feel totally overwhelmed, and I cannot say out how I really feel, I write. Writing and journaling have got me through some very dark times!

Dear Junior Doctors,

We owe it to ourselves to take care of our mental health. Take a break, ask for help, look after yourselves. Talk, write, workout- find an outlet and let out your emotions in a healthy way. Be mentally aware! It's okay to not be okay. In the end, we'll be better doctors for our patients, better friends and better family.

Happy new month! I hope this month fills your life with positivity, sunshine, peace of mind and happiness!