The Frail Doctor: Depression and our Oath

A year or so ago while biking on the coastline of the Puget Sound, not long after the death of my grandma, I asked my dad whether his increased exposure to death as a physician eased the pain of his mother’s passing. I recall thinking of the proximity and familiarity with death as an occupational hazard of being a physician. A physician would have a more academic understanding of the subject and therefore might be less susceptible to the messier emotional impact death can have on a person. Maybe, in living such a life, a person would become resistant to the collateral damage the death of a loved one can have. I remember him looking at me like I was a complete idiot. His look expressed one thing clearly: no amount of familiarity with a thing like death can prepare one for the loss of a loved one. Some things don’t get easier.

The oath that we took at my medical school’s white coat ceremony states that “Most especially, I will tread with care in matters of life and death. If it be merely within my abilities to help ease suffering at the end of a life, may I face this awesome responsibility with humility and awareness of my own frailty.” This last clause of the Oath used at my medical school is perhaps the least appreciated component of our oath as future physicians. We are frail. We are all susceptible to same pains that our patients experience, whether they be pains of the body or heart. My father understood this principle when I asked him about the passing of his mother.

As healers, we should be conscious of the awesome responsibility we have to our patients, but we must also tend to our own frailties. Depression represents one problem that many physicians experience at one point or another during the course of their careers. On an intellectual level, you can know that depression is essentially an imbalance of chemicals in the brain. You can even have prior experience with depression. However, just as his clinical exposure and intellectual understanding did not help my father to cope with the passing of his mother, neither exposure nor understanding will make any future experience with depression less crippling. Some things don’t get easier.

We often take for granted the idea that happiness is a choice, that if we could each just choose to perceive of the events that form our lives in a positive light—we would be happy. One of the most salient and debilitating aspects of depression as a mental illness is that a depressed person finds it difficult, if not impossible, to make this choice. In his poem “Desiderata,” Max Ehrmann writes, “With all its shame, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.” I like to think that he used the word strive with intention, recognizing that, though we cannot all choose to be happy, we can all strive for it.

Medical school is challenging in many ways that we can anticipate, but it can also challenge us in ways that we don’t see coming. Rarely are our greatest trials born of the fears we prepare for. According to the article “White Coat, Mood Indigo—Depression in Medical School” in the New England Journal of Medicine (NEJM), “medical students are more prone to depression than their nonmedical peers.” Unfortunately, as this article explains, depression still carries with it a stigma that discourages many people from opening up to their peers and instructors in order to seek help. They worry they will be perceived as somehow less capable, but frailty—as the word is employed in our oath—is not weakness. Rather, it is an acceptance that we are merely human, subject to the same limitations and hardships as all humans. Not all of our frailties imply impairment or deficiency. Indeed, the acceptance of our frailty may suggest resilience and offer the opportunity to truly empathize with all our relations including our future patients.

Regardless of how others may perceive depression, the only way to mend is to involve those around you. Accept that we are all frail, and do not fear that others may see in you this human condition. Strive to be happy. And as Ehrmann entreats, “Be gentle with yourself. You are a child of the universe, no less than the trees and the stars; you have a right to be here.”