Here's the thing.
One of my med students was sent to the ER by his colleagues due to a nervous breakdown.
He's matched to his #1 spot this year but there's a lot of things going on in his life (ie. single mother losing her business, grandfather diagnosed with bladder cancer, known to have depressions, etc)
He's afraid that his mental health will automatically affect his work at his program and he literally broke down.
Should he apply for a wavier and just sit out this year?
Presumably he has graduated med school and been through orientation, due to start work on Monday? As this is Saturday and residency starts Monday, it is probably now technically impossible for him not to be considered as starting residency on Monday. So whatever happens, he will have an official "start" on his record.
My view: he needs urgent support and counselling from his program. If the med school he has just graduated from can also help, so much the better. He needs someone he can talk things through with, and possibly also a little help through better living with chemistry. Perhaps a week or so of sick leave, if matters are that bad. Although leave right at the beginning of the year is not really desirable, it might be better than losing the whole year.
As to not starting/getting a waiver/delaying for a year, I don't see how not starting residency now is going to make his emotional situation better - he will be sitting around with a lot of debt and no job, which is a recipe for feeling worse not better.
As to the practicalities, his family are going through tough times. But having a son/grandson who completes his training as a doctor is one of the best things that could happen to his mother and grandfather. If his mother is not working, she has time to support the grandfather, so the son not going into residency would not be a significant practical help. The family's money troubles will not be helped by the son not going into residency - he is not going to quickly get a higher-paying job. So the best practical option is for him to carry on residency if he can.
My view: best approach is to hope that this is a temporary blip, to try to help him to see that he has already done extraordinarily well in life, that he has every personal quality he needs to succeed in residency, that times are hard for his family at the moment but that carrying on with his career as a doctor is the best thing that could happen to them, and that there is medical and counselling support on hand from his school/program to help him through his current tough times.
I hope he has a good outcome.
