On Suicide and Survival

United States of America

When my depressive symptoms began in early medical school, I noticed them more as a disconnect or distancing. As my energy drained, I found myself sleeping in, avoiding class, and catching up on the video recordings of lectures from my bed. When class attendance was required, I created an optimal route through my medical school building to get to a seat in the back of the lecture hall with the least chance of having to cross paths with my friends or acquaintances. I did seek out help from one of the school counselors, but I think I also hid the depth of my depression enough to not trigger any further treatment at the time. "It's not that bad," I'd tell myself. It's not like I needed to see a psychiatrist, or even worse, needed to go to the hospital. "I can get through this on my own," I tried to believe.

One and a half years later, during my clinical rotations, I finally hit a wall that showed me I couldn't do this on my own anymore. I can remember the day more clearly than most days during that period of time. It was my first day on the obstetrics and gynecology rotation. There was only one delivery by Caesarean section scheduled and the OB warned me, the fetus had died in the womb, so the delivery could be emotionally traumatic. He offered the opportunity to sit the procedure out given the sensitive nature of it, but I felt that I had a responsibility to learn no matter how sad the circumstances. After all, medicine isn't without loss and grief, so why not deal with it now? I helped retract during the surgery and remember feeling surprised by the warmth of the blood that spilled out over my gloved hands. The warmth jolted me into realizing this patient, this woman on the OR table, was a living human being, even if her baby wasn't anymore. But instead of feeling the overwhelming sadness for her loss that I imagined I should feel, I felt nothing. I just felt numb. That's the moment I really realized something was terribly wrong in my brain. I went home and went to bed. The next morning, my body felt like lead and I literally could not summon the energy or motivation to get myself out of bed. I called my medical school and asked to take a medical leave of absence. I called my primary care physician and asked for a referral to a psychiatrist. I knew it had gotten bad, but I couldn't have imagined it would take me two full years to get back to my life as a medical student.

Ten months later, after multiple failed medication trials, I found myself fighting against thoughts of suicide. For many months now, I had had intrusive thoughts of wanting to be dead. I had methodically gone over ways to end my life, ruling out different options for different reasons. I remember one day clearly thinking about cutting my wrists, but not having the energy to walk down the stairs to the kitchen to get a knife. The thought of using a gun was the most pervasive. Thankfully, I was protected from that, given the lack of access or knowledge about using a firearm. Then, after months of struggling with these persistent and violent thoughts of suicide, I found myself counting out tablets of painkillers to see if I had enough to kill myself. I thought I was not just ending my own pain of existing, but felt I would benefit my friends and family by freeing them of having to deal with my depressed self. Thankfully, some part of my survival instinct told me to tell my then-fiancé before I actually took the overdose. As he drove me to the hospital, the main feeling I experienced was a sense of shame that I had let the depression get this bad. Admitting that I needed psychiatric hospitalization felt like I had hit rock bottom. I cried not because I was so depressed, but...