PERSPECTIVES IN MEDICINE
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On February 6th, 2019 I went to a one hour review class. The cardiology/nephrology exam was a few days away. People had been checking in with me all week because they knew I was struggling. I told them I was doing fine. I was lying.

I had spent the past week sitting at my desk staring down at my notes. Not understanding, not progressing: basically treading water. All the time telling people I was fine.

It took everything I had to try and pay attention to the lecturer. But the content of the questions wasn’t just things I didn’t know. It was things I would swear I’d never heard of before. The tears were welling up in my eyes but I managed to keep them in and stare down at my desk pretending to work. At least my back row seat afforded me some privacy from people noticing me turning redder with every question. I stuck out the hour. Just barely. Then I went upstairs.

It was one of those moments where you can remember your thoughts, but can’t remember at all how you got somewhere. But I found myself standing in the Student Affairs offices. Thankfully they knew what was going on with me and the decision I was weighing, because I was not in any state to be explaining myself. I sat down and said what I’d been practicing in my head for the past hour. “I‘ve decided. I can’t do this right now”. And my tears broke free.

* * * * * * * * * * * * *

In my second year of medical school I was diagnosed with anxiety and depression, a diagnosis that, had I been really honest with myself, I would have received several years earlier.

But I can’t be depressed, I’m not nearly as bad as other people I know.

But I can’t be depressed, I just have a stressful job that I’m not capable of doing well.

But I can’t be depressed, I’m just in a stressful situation. Once I finally get into medical school, it will get better.

But I can’t be depressed, I’m just a lazy procrastinator who’s too stupid for medical school.

There was always a reason. A reason to dismiss my feelings as less than depression. A reason to deem myself unworthy of help. A reason to blame myself for everything I was experiencing.

It took the combination of a very kind counsellor, concerned parents, the staff of the student affairs department and a family doctor who remembered the medical school experience all too well, for me to realize that I was in trouble. I tried to work on my mental health and continue with my studies but I began failing exams and receiving subpar evaluations. I was on the verge of academic trouble. I had never been on the verge of academic trouble in my life.

When it was first suggested to me to take a leave of absence I felt like a complete failure. My parents wanted me to “just be okay”, my family doctor told me “it might be worth considering some time off” and student affairs told me that it was probably for the best that I take a leave and come back thriving. None of that could convince me that I didn’t have failure stamped on my forehead. So I tried to stay in school, and everyday was like hanging onto the bumper of a speeding car by my fingernails. Gradually I started to accept that I was not a failure, I was sick. And on February 6th, 2019 I finally let go.

* * * * * * * * * * * * *

My leave of absence was all of these things, in no particular order:
-Exhausting
-Boring
-Embarrassing
-Challenging
-Lonely
-Adventurous
-Uncomfortable
-Unpredictable
-Expensive
-Awkward
-Exactly what I needed

After about a month I learned how to handle people asking me about school. Most people were just being polite so I kept it short and to the point: “I actually took a leave of absence for my health, but I’m going back in the fall.” People responded very kindly to that.

These days when people find out I’m not in my third year yet I give them the positive highlight version of my leave: I went to Europe with my mother, I rented a bizarre musical instrument that I always wanted to try, I finally played the Legend of Zelda: Ocarina of Time, and I taught my dog some new tricks.

All of these things are true, but it was also a lot more than that. Something that I think we don’t give our patients enough credit for: getting better is hard work. When I first went on my leave and people asked me what I was up to, I told them “nothing.” Compared to the rigorous schedule of medical school it seemed like nothing. But I was certainly not doing nothing. I was working, very hard, to get better. I was getting out of bed everyday. I was eating healthy meals. I was paying my bills on time. Most of all, I was spending a lot of time and energy trying to make myself believe that I wasn’t worthless. I spent my leave working with my healthcare supports on the neglected areas of my wellness and that helped me build a better foundation to go back to school happier, and a whole lot healthier.

Having been back at school for over 6 months now I can see the dramatic change in myself from this point last year. Besides the improvements in my memory, mood and academic abilities, I have regained a part of me I didn’t even realize I had lost along the way. I started to care again. I have started to find joy and meaning again in the simple act of supporting another human in their most vulnerable moments. Regaining this piece of myself gives me direction as I get back on this crazy, complicated, arduous journey that medical students take.

* * * * * * * * * * * * *

Coming back to school meant confronting the issues that had caused me to hesitate about taking the leave in the first place: it felt like I had broken all the rules. Medical school, at least mine, seems obsessed with categorizing you in classes. As a member of the class of 2021 I was in two group photos on the very first day (the obligatory white coat photo, and the one that was hung up and signed by us all). I also signed the Class of 2021 banner in my first year and I received my class of 2021 colour coded knapsack. But I’m not in the class of 2021, I’m in the class of 2022 now. I’m not in the white coat photo. I’m not in the group photo, nor did I sign it. My name is on the wrong banner, my knapsack is the wrong colour and my transcript will be 5 years long. I feel like I stand out in a way that I had hoped to never stand out and I can see why this might prevent someone from taking a needed leave of absence.

​On this whole journey I have felt like I was the first person this had ever happened to. That’s the main reason I decided to speak up today. Because I definitely wasn’t the first. It only seemed like it because we don’t talk about these things in our circles enough. I wasn’t the first. There was someone before me, and there will be someone after me, and someone after them. Because no matter how hard we work towards becoming doctors, we never escape being humans.

This is Margaret Stephenson's perspective, a second year medical student at Dalhousie Medicine New Brunswick. Visit www.PerspectivesInMedicine.ca to read all the other amazing stories and to submit your own.
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