Warning and Disclaimer: Please note that this article contains content regarding mental health and suicide. The information in this article is provided for informational purposes and is not intended to serve as medical advice; readers are urged to seek individual medical assistance if necessary. If you have contemplated suicide, or know of a colleague thinking about suicide, please call 988 - Suicide and Crisis Lifeline.

As trainees, we endure the daily grind, sleepless nights, grueling calls, and complicated eHRs, in the hopes that it gets better once we become attending physicians. We hang on to that goal as a lifeline and our hopes and aspirations keep us in the game. And then it culminates in a graduation ceremony – or not, for those finishing training during the pandemic.  We found a new sense of excitement as we looked forward to our first real job after training. We sign the documents, accepting the "standard" clauses, non-competes, RVUs, no paid maternity leave, etc., because we believe it's got to be worth it. Financial independence, our impact on patient care, or academic achievements, will surely bring us happiness!

We begin our new jobs and discover it comes with new challenges, expected and unexpected. Depending on practice type (private or academic), our patient care load/calls increase, or we get hit with tough expectations for academic promotion. The excitement potentially abates with long work hours, balancing personal time, loan payments, expanding family responsibilities, navigating difficult relationships exacerbated by the busy nature of our jobs. Occasionally, increased expectations may lead to feelings of disappointment, dissatisfaction, and disillusionment. Burnout creeps in and has the potential to evolve into full scale depression. But wait, how did we get to this point? Surely, many would give up a lot to be in our shoes, to have our "amazing and fabulous" life.

I would like to share a story of a friend and colleague. We spent time outside work with a group of other physicians— a family and support system we called home. First was the withdrawal, then a loss of interest in activities that once excited us. We noticed the weight loss and praised this, given its potential cardiovascular benefits, but the light we once saw in the eyes had dimmed. Exacerbated by the pandemic, we were all exhausted and the red flag signs were missed by all of us – a group of highly trained individuals, well-respected in a broad range of diverse medical and surgical specialties. In hindsight, they were all there: hopelessness, apathy, loss of appetite, weight loss, and social isolation. The subtle but persistent cry for help, but we had become deafened to the sounds of it from our colleagues. We can discern it easily in our patients, but in ourselves, we assume it can't be that bad. Shortly after, a life was lost to death by suicide. It hit us all like a wrecking ball. Our home and support system came crashing down and everything we knew went up in flames. Although one of us is gone, the work of saving lives continues without missing a beat. But families and friends are devastated, and we might not recover from this loss for a long time. It was a wakeup call, a rude awakening, urging us to rise from the depths of misery, from the ashes of this most horrific tragedy and to take action to ensure this does not happen again. It is a contradictory state, the ultimate conundrum, incompatible with everything we know. A person trained to save lives takes their own life – a tragic irony.

We must stop normalizing excessive work, stress, and burnout as part of the physician life and benefits package. We need to de-stigmatize therapy and normalize mental health as an essential part of clinician wellbeing. Healthcare institutions need to prioritize provision of mental health services to all staff. Clinicians underrepresented in medicine and women may be especially vulnerable to stress given the additional challenges they have to navigate as it relates to race/ethnicity, gender norms, and social responsibilities. Recently, the Department of Health and Human Services raised an alarm regarding the crisis that is health care worker burnout and resignation. The proposed recommendations include making mental health care more accessible to health workers.

As early career physicians, we need to begin right if we want to have a long and fulfilling career. I argue that prioritizing our own mental health upholds our oath of doing no harm. We harm ourselves when we fail to care for ourselves and unfortunately are conditioned to do so by the years of training we have had. See a counselor or psychologist as part of routine care. Intentionally engage in activities at work and outside of work that bring you joy. Find support in the people that care about you and those you care about. This needs to be a priority. We need to heal ourselves before we can effectively heal others.

"Physician, heal thyself."

In Memoriam: AOO.

This article was authored by Demilade Adedinsewo, MD, MPH, FACC, with contributions from Olayemi Sokumbi, MD. Adedinsewo is an assistant professor of medicine and non-invasive cardiologist at Mayo Clinic in Florida with a clinical focus in women's heart health and echocardiography. Sokumbi is an associate professor of dermatology and laboratory medicine & pathology at Mayo Clinic in Florida. Twitter: @DemiladeMD