Like millions of other viewers, I tuned in to the 14th episode of “The Pitt” on HBO, ready to immerse myself in the popular show, which has consistently delivered shockingly accurate portrayals of medical care in this country. As a double-boarded trauma surgeon in general surgery and surgical critical care, I spent a great deal of my time working alongside emergency department personnel, and like many other health care providers, agree that The Pitt gives a true to life look at many of the story lines it seeks to depict, from end of life care, to mass shootings, to inadequate health care coverage and its effects on patients. While many of these story lines have been dissected and discussed in the press, it is the slowly devolving mental health of Noah Wyle’s Dr. Michael Robinavitch this season, and in Episode 14, that has brought tears to my own eyes. I have watched on screen the portrayal of a 20-year experienced emergency medicine physician, who finally faced his depression, stating to his friend: “I don’t know if I want to be here anymore. That’s the only place I can be (the emergency department), I have purpose in there, I can be distracted in there. I don’t know that I want to be anywhere anymore.”
I sat stunned, tears streaming down my face. Because these feelings spoken aloud reflect feelings I am all too familiar with, having seen them in my colleagues, my friends, and even myself. In residency, a friend found a medical resident who had slit his wrists in our resident lounge, an attempt which, fortunately, was unsuccessful. Five years later, that same friend, now a brilliant and accomplished surgeon in her own right, took her own life. In the United States, 300-400 physicians die by suicide each year. Female physicians have a higher rate of suicide than men; while male physicians have rates of suicide reported at 40 percent above the general population, for female physicians, that rate dramatically increases to 130 percent. Surgeons have some of the highest known rates of suicide among physicians. Until very recently, we did not discuss our mental health. However, as many as 50 percent of surgeons experience anxiety, depression, and other mental health challenges at some point in their careers, according to the American College of Surgeons. Discussing personal struggles with mental health was viewed as a sign of weakness by many.
The culture, as demonstrated by the writing in “The Pitt,” is changing. Wellness and resilience courses are being incorporated more and more into surgical training to help prevent burnout and promote the normalization of mental health discussions. Open conversations about struggles with depression and other mental health issues are no longer seen as signs of weakness, and our students and trainees are being supported in ways previously unheard of by practicing surgeons, too many of whom suffered in silence for years. Mental health is health care, and this is critical in an era that will see a decrease in the number of practicing surgeons; of the predicted 13,500 to 86,000 physician shortage by 2036, 74 percent would be surgeons.
For those of us who trained in the era of mental and physical “toughness” above all else, learning to recognize the signs of depression in ourselves and in others remains vital. Looking back, the signs of my friend’s depression were there- we just didn’t know what to look for or how to get her help.
