Recently I changed jobs.  As a result,  I lost my group disability policy at my old job and was required to jump through all the fun hoops to get a new one independently.  My cholesterol is great by the way.

The application is very detailed.  And I am a horrible liar.  The application asked If I had ever seen a counselor or something to that affect.  Well as a matter of fact I had.  So I answered yes to that question.  I also answered yes to having taken a SSRI, but no longer being on the medication.  I had to write an explanation and sign a release for them to have my records.  I call the therapist that I saw and asked what exactly would be released.  She has a generic statement that she gives in situations like this, keeping personal details personal.  But even she warned me not to check “yes” on the application indicating I had seen her.  It wasn’t on my insurance, I was good to go now, and it wasn’t their business.

But it kinda is their business, right?  Mental illness is well hidden for many years, particularly by physicians.   But it is disabling.  And this is disability insurance we are talking about. After my experience with addressing and improving my own mental health, I have learned that maybe disability insurance application should read a little differently.  Maybe they should ask if you have seen a psychiatrist or therapist, because if you haven’t, you probably should.  Otherwise, your chances of becoming disabled due to anxiety, depression, PTSD, addiction or suicide attempts go through the roof.  For physicians anyway.

(While the reported rates of depression and other mental illness are similar to the general population, the suicide rate for physicians is higher.  400+ physicians a year are lost to suicide.  Beautiful, amazing people with big hearts, altruism, intelligence out the wazoo, and phenomenal potential are gone.  Perspective: my med school class was 150 people.) That’s more than double my class every year in so much pain that they end their lives.)

So here’s a piece of my story, and what I learned along the way.  Background:  I’m maternal fetal medicine (MFM).  I am privileged to be a part of beauty, life, luck, and miracles.  But I am also a part of serious, traumatic sadness and loss.  The majority of physicians are.  It comes with the territory.  Not everyone gets a good outcome.  Bad things happen, and sometimes we can’t stop them.  On the worst days, we are unwitting characters in a play, a tragedy.

After residency, fellowship, and 2 years as an attending, it seems I had seen enough of the bad.  One morning, I was walking along the hall on L&D to attend to some (relatively) mundane matter.  I passed  the room of a mother who had just lost her term baby.  Unexplained. Unexpected.  Gut wrenching.  And she was wailing that primal wail of a mother who has lost her child.  Have you heard it?  It’s awful.  Those in my specialty will hear it more times than we will choose to count. This time it stopped me in my tracks.  I couldn’t move forward.  I just listened.  Then I shut down.  A resident saw me in the hallway and hugged me.  I teared up, (definite no-no if you are the attending, right?) clutched her and started repeating “I can’t do this, I can’t do this.”  I hurried back to my call room, shut the door and locked it.  I started hyperventilating.  My lips went numb.  My fingers tingled.  I thought if I talked to someone, I would regulate my breathing.  I called my husband, no answer.  I called my L&D back up partner.  I definitely needed back up.  She answered, and rather than finishing her son’s first day of preschool drop off, talked to me and came to take over for me.  I will be forever grateful for her kindness toward me.

Later I came to realize what I had experienced was a manifestation of post-traumatic stress disorder (PTSD).  I experienced a physical reaction to an emotional stimuli.  It also explained the anxiety I had been experiencing (though I didn’t know or acknowledge that’s what I had been feeling until much later).

My colleague encouraged me to see the “work-life connections” psychiatrist at my job.  The psychiatrist told me I needed to see someone who could help me process all of bad outcomes I had seen.  She said my box was full.  (Y’all know I’m OB right?  That’s so inappropriately funny.  But I didn’t giggle, because she was serious and I was trying to appear professional).  ANYWAY, the box in my psyche where I could place all the bad outcomes, the sad and traumatic stories, was apparently not going to handle anymore.  So I asked how I could go about creating one with more capacity.

Psychiatrist: “You don’t get a bigger box.”

ME: “Yes I do, I’m a doctor!”

Psychiatrist: Straight-lipped stare back at me.  “I’m a doctor too.  You don’t get a bigger box.”

ME: “Oh.”

It wasn’t until much later that I realized I had insulted my physician colleague in that interaction, but luckily, her training as a psychiatrist seemed to have helped her use that to give me more empathy and support, not less.

She also told me I had anxiety.

“No I don’t,” I countered.  “I have a high stress job.  I don’t have a problem.  My job does.”

Then I asked if there was a book or something I could read.  Because if I could just read about it, I could fix it myself.  I really said that.  If the psychiatrist rolled her eyes, I didn’t see.  But seriously her restraint was phenomenal.

Psychiatrist:  “Now who does that sound like?”

ME:  “A two year old?  I do it myself!”

She didn’t answer.  My emotional maturity had apparently slipped back to a two year old demanding independence and refusing help.

It took several visits for her to convince me that my anxiety was an actual, real- live organic problem that needed medicine, not just gritted teeth, nose to grindstone, pulled-up bootstraps.  She explained that I had been through trauma, and stress and other factors had created a temporary reaction in my brain that unbalanced my serotonin, etc levels.  When the nanny quit, I caved and took the meds.   Shockingly, the psychiatrist was right, with therapy and after altering life stressors, I was able to stop the medication.

So back to the box. (The psychological one).  The psychiatrist sent me to a local therapist to try Eye Movement Desensitization and Reprocessing (EMDR) therapy.  A colleague told me she had tried it, but it was too hokey for her to work.  The therapist actually said something similar.  She suggested we try it on a “small” trauma to see how I felt about it.  You have to have a lot of “buy-in”  to move forward in this type of thing.  I had buy-in.  I had resigned my job and was moving my whole family across the country soon.  I had to start healing.  I couldn’t go into my next job “broken.”  I didn’t want any one to know about this whole incident.

She explained that EMDR helps folks finish processing “unprocessed” memories, particularly traumatic ones.  Sometimes, when something is very traumatic, our minds don’t fully process the event and tuck it away as a memory.  Instead it keeps replaying in our heads, disturbing our sleep, our lives, creating anxiety, waiting for a trigger to send us running for cover… like me that day on L&D.

She had me close my eyes and list recent traumatic events.  Then she picked one with a good outcome, and had me focus on it.  She asked, could I see myself in the memory (in 3rd person), like watching a movie?  Or could I not see myself because I was actually still in the memory (1st person), acting out my part like it was happening right then?  We picked my son’s recent near drowning, because a) it was definitely traumatic, b) he didn’t die, and c) it was an unprocessed memory where I was still in the 1st person when I replayed it in my head.  I put on these headphones where a tone alternated from one ear to the other and closed my eyes.  (Different EMDR therapists do different techniques along with or instead of the headphone thing).  She talked me through the memory and did her (very skilled) thing.  At the end of the session, the memory played in my head as a memory, completely processed with me in the 3rd person.  She deemed me a good candidate and I made an appointment for the next week.

Over the next 3 months or so, we worked through some of the traumatic work experiences I had replaying in my head.  It took several sessions for some.  I released a lot of stored up emotion and guilt. I said things I had never let myself say out loud.  It’s a lot easier to cry around a stranger when your eyes are closed and there is this goofy tone going back and forth between your ears, by the way.  As I talked through things, she helped me finish my reasoning out loud.  She helped me walk down all the potential paths of outcomes had different choices been made by all players.  She helped me understand the true unpredictability of outcomes linked to choices, and how there could have been potentially even worse outcomes had a different path been taken.  She helped me see how I can do my best to control a situation and direct an outcome, but some days, I’m just an actor with an assigned script in the tragedy as well, and I can weep with everyone else.  It was really amazing.  We took that box of bad stuff and found a place on the shelf for each memory.

Then she repeated the process, but with anticipatory guidance.  She had me imagine the worst scenarios, the worst outcomes.  I can’t remember everything she said in that session, but it definitely built my resilience further.  I had been using a lot of my energy to protect my heart/mind while handling the hard clinical stuff coming at me every time I was on call.  Processing those memories freed me from this and allowed me to redirect that energy purposefully; I could be fully present.

Previous to this, the anxiety from the unprocessed memories felt like an invisible person stalking me, waiting to hit me over the head at anytime. Now I was ready to face the clinical challenge without fear or anxiety about what may happen. Rather, I went in confident in my skills, my training and experience; and humble in my ability to call for help when it was needed.  Months later, in my new job, I remember racing to the hospital to meet a patient being flown in.  I honestly wasn’t sure if she was going to survive the flight.  But I wasn’t anxious, I wasn’t preoccupied with the “what if” of a bad outcome.  I strode into that OR and did my thing.  And it felt soooo good to be back.  (She lived).

So back to the disability application.  I received my disability insurance policy (without increased premium), but with stipulation that for the next two years I could not receive benefits from a disability due to anxiety.  But post-treatment, I wasn’t worried about that.  Now, if I hadn’t done the therapy?  If I hadn’t taken the meds?  Yes, maybe then I would be riddled with disabling anxiety.  Or worse, what we physicians do best, failing to acknowledge my anxiety, and instead degrading my husband and marriage, being hateful to my kids, drinking too much, suicide?  Yes, I get the insurance company has to hedge their bets in order to take safe, financially beneficial risks. But I would argue that they are taking more risk with participating in the stigmatization of mental illness in physicians (and all people).  If we can’t acknowledge the negative psychological effect that practicing medicine and really caring for our patients has on us all at times, then we can’t get help.  If we don’t get help, we stop caring as much about our patients, we damage our closest relationships and the support we truly need, we become disabled (labeled as such or not), and we lose ourselves.

Earlier I said I didn’t want anyone to know that I saw a psychiatrist, that I took a SSRI, and that I saw a therapist.  But doing all that (and my interaction with the insurance company), helped me realize I actually wanted just the opposite.  So friends, especially my physician friends, please know that you are not alone if you are struggling with trauma, anxiety, depression, guilt. Knowing you don’t have be isolated is a game changer.  You can get help.  You are not beyond help.  In the end, I am so thankful for my experience and that moment of decompensation that forced me to call for help.  I am forever grateful to my colleagues who came to my rescue clinically, and personally, and pointed me toward help.

So, get your disability policy all squared away, then go see a counselor, then tell some folks about it and encourage them to do the same.