Severe depression and anxiety and considering quitting

[neurodo2020]

Hey guys,

I really need some sound advice. I'm currently a PGY2 and recently transferred back home to a new program to start a neurology residency. I have been absolutely miserable since I have been here. I've tried to deal with the anxiety of being on call and under constant stress but I had to start seeing a mental health specialist and even start SSRI to help with it. Right now I feel like quitting every single minute of every single day. I haven't had any bad things happen at work and the attendings said I've been doing pretty well compared to my peers; same goes for my seniors but I feel so disconnected and feel like my mind is very distracted. I have not been sleeping much and def not enjoying the things I used to.

My point is when does one say enough is enough and try to move onto something more tolerable? I've begin to apply to residency again and thinking of doing PM/Occ med but I feel like there is not way I can finish the year if this continues any longer. I know that quitting looks very bad but at this point I value my mental health more. I know it will be a huge struggle going forward but honestly being out of this situation feels like the only solution at this time. I had no issues during intern year outside the normal stress of being an intern. No mental or work performance issues at all and every attending is willing to write me a letter if I need it.

What is the right move right now? Can being in this situation be a legitimate reason for leaving a residency?

Thanks

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[Trauma Surgeon]

Sorry to hear what you are going through… Unfortunately I don't have any good advice, but I'm sure that you will get some good advice from other SDNers.
But since some of your peers will read this post, I guess this study is something that would be of interest for preventing these problems among residents,

http://archsurg.jamanetwork.com/article.aspx?articleid=2293073

 

[Doctor Bagel]

So basic mental health advice generally includes telling people not to make major life decisions (quitting jobs, leaving spouses) when in the midst of depression. So with that in mind, I'd continue to work with your MH providers -- antidepressants can take weeks to kick in, and might need to be adjusted -- and to work on other self care, finding ways to survive even in this miserable work environment. I wouldn't make any rash decisions about quitting or switching specialties until you start feeling a little better.

And just curious, what about this new program is different from your internship? Why is it so much more stressful?

 

[Deep Sea]

Deleted.

 

[Crayola227]

Please read some of my post history about chronic pain, depression, suicide, etc.

The best post of mine is in thread "Resident friend joked about suicide"

PM me with any questions

 

[neurodo2020]

Thanks for the replies. I guess my main concern is that this place is quite different from where I came from and there is no sense of organization. A lot of this has to do with the turmoil within my program and the hospital itself. And I cannot control these things. Fundamentally though I do not enjoy what I'm doing daily and I feel absolutely no empathy towards any of the people in treating. I almost fell as if each person and each patient is more of a burden that task rather than a learning experience. Fundamentally though I do not enjoy what I'm doing daily and I feel absolutely no empathy towards any of the people in treating. I almost feel as if each person and each patient is more of a burden the task rather than a learning experience. This is a terrible thing to admit considering that I got into this profession because I wanted to help each one of these people in anyway that I could.

 

[Crayola227]

Thanks for the replies. I guess my main concern is that this place is quite different from where I came from and there is no sense of organization. A lot of this has to do with the turmoil within my program and the hospital itself. And I cannot control these things. Fundamentally though I do not enjoy what I'm doing daily and I feel absolutely no empathy towards any of the people in treating. I almost fell as if each person and each patient is more of a burden that task rather than a learning experience. Fundamentally though I do not enjoy what I'm doing daily and I feel absolutely no empathy towards any of the people in treating. I almost feel as if each person and each patient is more of a burden the task rather than a learning experience. This is a terrible thing to admit considering that I got into this profession because I wanted to help each one of these people in anyway that I could.

This is a terribly common admission. You are not alone. Most providers experience burn out at some point, and that's one of the key symptoms, feeling a lack of sympathy/empathy for others (where once there was, not including my baseline sociopaths here)

You are both in your second year and somewhere new. I imagine that the only thing harder than going from intern year to second year is then starting second year at a new hospital. You're being given more responsibility than before AND going through some of the same stress at the beginning of PGY1 which is learning the system.

It's hard for me to say how much of this is change, the program, the specialty, or just build up of burn out.

Seriously, use my tips in the Resident friend joked about suicide thread to find a discreet way to get plugged in to some help with these issues.

I would say reach out to your program for help with burn out, but I want you to get confidential help, so tread with care about seeking help through employee wellness, etc whatever other things are in place for resident burn out. The last thing you need is the microscope.

 

[neurodo2020]

I read your previous posts and I was also thinking the same thing about trying to be as discreet as possible as to not raise any red flags from my program and going forward if I decide to switch. I don't think I'm in any type of situation that was describing that post but I never want to get to that stage. I currently have a lot of support especially at home and even amongst my co-residents but fundamentally I absolutely hate going to work and doing what I do on a daily basis. Even though internship was really tough and the schedule was rough and I was away from family I never felt like this on a daily basis. Don't getme wrong there were days when you just felt like quitting but I never ever voiced to anybody or follow through on it because the next day was fine and I was able to handle it without any issues. I can't really figure out what the source exactly is but I know that I am absolutely miserable and the current situation I am in and I need to find a way out

 

[Crayola227]

I hope you are not in danger of hirting yourself.

As poster above said, try to stabilize any depression or burn out going on before any big decisions.

Previous threads on switching can be helpful for how to approach PD.

I would highly encourage you to be certain about what field you want to switch to.

If that means going through match again, you can start putting together ERAS ASAP w/o being fully decided yet, but should talk to your PD before actually applying elsewhere.

If you would be applying for more advanced position elsewhere, sounds like an ERAS thing, I dunno.

It's best to finish the year even at great cost to yourself, as long as it's not putting you or patients at serious risk of harm, unless what you want to transfer too you can do mid-year with PD support (I have no idea how feasible that is, usually your PD would rather walk over hot coals than try to deal with mid-yr gap)

Maybe resident swap website can help?

Know too once you go to PD director about this, you have no idea what will be the reaction. You may see the flames of Dr. Kelso in their eyes. Once you have talked to your PD you have shat the bed.

They will either be supportive and help you figure this out, or you will be punished in some way whether or not you ultimately stay for the year, the whole residency, and if you do get out I pray to God they help.

You're in a tough spot because if ERAS is the road you're going on you need to get on that boat soon, whereas on the other hand playing it cool for now to see how tthings develop might be best, but missing the ERAS boat sucks, and obviously finishing this year given how you feel blows.

Only you know how much you truly hate the specialty and need out.

Good luck.

 

[neurodo2020]

No I am not in any danger to myself and I don't think I'll ever get to the point without seeking help.

I've already mentioned things to my PD a couple weeks ago but it was dismissed pretty quickly and I was told to just keep going in hopes that I would start to enjoy it. There isn't a lot of support at the top from our program and that's why there's a lot of change occurring. I even went to the chairman who is also very dismissive.

I have already started to gather my applications and focused in on one or two specialties that I would like to apply to that I don't have experience in the past before I know that I would be able to do.

I thank you for your advice and will heed the warnings and make an informed decision after taking into account all things that was said above.

 

[Crayola227]

Definitely if it seems like the program is "turning" on you over this (sometimes knowing that you've committed to jumping ship they will push you out before you have something else lined up), putting you under the microscope to can you, general abuse, promises of a letter and support that never materialize, from this point forth I suggest you consider them the enemy and follow the CYA protocols mentioned re: documenting stuff, playing the game, and already having the number of a good attorney

 

[neurodo2020]

I don't think it's quite to that level yet but I am actively working on way to get out if I can. I've been keeping things to myself in regards to my plans and stuff so nobody really suspects a thing yet. Plus I have been doing my work just fine and actually better than my peers according to the attendings.

 

[neurodo2020]

I have begun applying through ERAS and started using resident swap but there's nothing available right now. I have also got in contact with everyone I know in the area and there is is not a single position open anywhere this time that would be feasible for me. I know that I want to apply to occupational medicine and I am moving towards that goal but it's just so painful mentally on a daily basis.

I just feel so miserable every day that I have to go in to work and being in this situation. Seeking help and talking to people about it is appearing to be a temporary fix but it still doesn't remove me from the situation that's causing all this since I never had any of these issues prior to starting this program this year. I've also been on an SSRI and I know has been enough time since that's kicked in but honestly it all goes back to the concept of not having these issues prior to me starting the second year.

 

[Crayola227]

Hmm.

Tough one.

Well the SSRIs can take longer than advertised to help, but frankly I think even someone on Ecstasy could find residency able to overpower its effects. So prolly too soon for med change.

You know the typical depression drill.

I don't know how long you've been a 2nd yr now, but going to a new hospital I have to imagine this is almost like Start of Intern Yr: Part 2: Return to the Beginning.

I'm sorry you're in this place.

If I can be any help let me know