Trauma
TW/CW: suicide, self-harm
Author: Julie Graff, MD
keywords: mental health, suicide
Physicians and patients endure trauma daily in the form of climate change, political uncertainty, pandemic(s), medical staff, and medication shortages. There needs to be a way to talk about mental illness.
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The following is an expert from Dr. Graff’s memoir:
On March 20, 2003, I fell apart in front of my medical school classmates, their families, and my best friend in an auditorium holding 149 graduating medical students and their families. We students were to open the envelopes in unison. I trembled with excitement and put my finger just under the seal of the envelope. Just before noon, Dean Goldberg stood before us and cautioned us that not everyone would get the residency that they desired and that we must show respect for all, but I had never been so certain of my success.
I sat in the auditorium of our medical school clutching the envelope that held my future. The paper inside would tell me where I would spend the next three years of my life. I had carefully ranked all the internal medicine residency programs at which I had interviewed: #1 UC San Francisco, #2 Stanford, #3 Harvard, #4 Columbia, #5 Boston University, #6 NYU, #7 UCLA, #8 OHSU, #9 Cedars Sinai, #10 University of Arizona. I believed that the first six programs offered the best chance of getting into a prime hematology/oncology fellow spot, and they would allow me to climb up the academic ladder. We were asked to include every school that we might possibly be willing to attend because some medical students would not “match” to a training program, and they had to “scramble” to get into one several days before the big reveal. Not a great situation for anyone.
During the application process, Dean Schroth’s words rang in my ears like tinnitus. A wonderfully average medical student. I hated those words. He said that to our class during second year of medical school, and my heart ached ever since. I would show him. Average medical students did not get top tier training programs. I had to meticulously coordinate my application packet for residency. I wrote each letter of recommendation to ensure adequate discussion of my achievements and potential, and then sent them to my letter writers as a skeleton- to take or to leave. During fourth year of medical school, I had traveled to University of Washington to do a pulmonary rotation, Stanford for rheumatology, UCSF for oncology. I had earned honors in all clerkships. I had a fantastic letter of recommendation from my lab mentor. I had a first-author publication from my time in an inorganic chemistry lab at the University of Arizona.
The clock struck noon, and I excitedly opened the envelope.
Oregon Health & Science University, Portland, Oregon
A force stronger than I had ever known settled in my body sending vines of pain and humiliation from my scalp to my toes, and I could not stop the tears that streamed down my face. Such a spectacle it must have been for the others in my class, for the teachers and the families, but my body was overcome with grief. Rejection. Failure. I had gotten my wonderfully average residency, which confirmed that I had been a wonderfully average medical student and that I would go on to do average things. We could be reunited (parents and I) and pick up the average life I had left.
I looked and acted like a grieving mother whose eight-year-old just died in a car crash, something far more tragic than my situation. No one could understand why someone would spiral into depression so quickly.
I pulled a box of medical supplies from my closet. I had a box full of spare intravenous needles, rubber tourniquets, and butterfly needles that were left over from my clerkships. I chose an IV needle and inserted it into a vein on the back of my hand and let the blood run into the bathroom sink staining it red. I learned to tear up my veins by twisting the needle at the end with the goal of heightening the physical pain. I had bruises on both hands and up and down my arms.
I rotated through my ophthalmology clerkship during that time. I spent one hour on one day following the physician around, talking to patients. Then, it changed to me getting up, walking to the clinic, going up one staircase to one end of the ophthalmology clinic, down the hall, and then to the other staircase that I would descend to get back to my studio apartment and back in my bed.
On March 23, I spent the day planning a giant leap from the top of my apartment building. I called the Kaiser suicide hotline and got an appointment the next day. The psychiatrist prescribed fluoxetine and zolpidem and sent me to get counseling from a licensed clinical social worker. The LCSW and I talked through what had happened, and he gave me reading to do, including the book Failing Up, about people who had failed early in life and then succeeded later. I had no energy to read.
No one understood me. People just said, “Julie, you are a beautiful young woman and a doctor!” “What could be the problem?” “Portland, Oregon, is a wonderful place to live.” “You have no reason to be so upset.” But they meant, you have no right to be devastated.
I thought I had spent the past twenty-seven years running to success, but I now see now that I was running from trauma.
About the Author: Julie Graff, MD, is a medical oncologist with a focus in genitourinary cancers at the VA Portland Health Care System and Oregon Health & Science University. She is the first woman in her division to be promoted to full professor. These achievements did not come easily. She spent many years debilitated by depression and post-traumatic stress disorder. Her childhood included episodes of sexual abuse and abandonment. Julie believes that the medical system needs to do more to help physicians with mental illness. She has written a memoir (Confessions of a Traumatized Doctor) based on her experiences, which she hopes to publish soon.
