Depressed 4Th Year On Carms Tour, Starting Residency = Bad Idea?

[marcusaurelius]

hey all, 

 

as the title mentions, something has been eating away at me a lot lately as I progress half-heartedly through carms this year. Im a 4th year. I am clinically depressed. Its mild-moderate (alternates between lows and highs). The root causes IMO are some personal issues, spiritual confusion/disturbance and identity crisis, as well as failure to maintain balance in my life. It feels like I spend 99% of the time in wishful thinking and just wishing for things to change but obviously nothing changes. Im so stagnant, yet highly functional; ive done fine in medical school, no functional impairment. 

 

Ive reached a point where Im having serious doubts about starting a residency. Its been very difficult to find motivation and my routine is absolutely horrendous: hours upon hours of compulsive internet browsing, almost zero social life, gaining weight. Ive done just fine (even above average) in clerkship but had certainly failed to achieve a healthy balance and as I go through carms, Im afraid the routine is gona continue into residency and i dont think i will be able to get by in residency like ive been so far. I have ZERO desire to read around cases and just learn on the spot like a lazy slob. I cant seem to find the motivation to pick up the textbook. I cant make myself care about reading guidelines and journals etc. It wasnt like that. I was very into medicine the first two years at least. I knew this was my passion. But i cant understand where it all went coz certainly feels like im in the wrong profession (yet in some weird way, I cant imagine my life without medicine; somewhere, I still love it. Maybe its an obsession rather than passion? I dont know anymore). 

 

Anyways, besides the rant, Im wondering if you guys have suggestions about what to do next. Ive got a pretty solid application lined up for internal medicine but im really scared i will decompensate in residency, wont be keeping up with my readings, and will get more  depressed. Do you think I should still go ahead with the match while i have the chance? Is the idea of taking a leave of absence after matching ridiculous? will the programs find it unacceptable? 

[FutureGP333]

Obviously difficult to comment online and without knowing you at all in person, but as a almost newly minted physician, I am sure you can appreciate the severe and disabling clinical depression can be (and how quickly it can spiral downhill). The weight gain, lack of concentration, anhedonia, etc...all point to simmering moderate clinical depression (more than 2 months I assume?). Have you spoken to your family doctor [or even a walk-in doc for extra confidentiality] about these issues? Obviously if you are having some SI as well, that bumps things up quite a bit in regards to the urgency of speaking to a medical professional.

 

I myself have gone through a very similar thing and can tell you from experience, other medical professionals (e.g., family doc) are very understanding and supportive. Almost 1/3 of us will suffer from mental illness at some point in our lives - why would that number be any different for physicians (not to mention the insane stress we are constantly put under)? Things are always confidential when you seek medical help and as long as your mental illness does not impact patient safety or your clinical judgement, you have nothing to worry about in regards to a medical license.      

 

Maybe it's time for a low dose SSRI for 6 months, or at the very least, some baseline psychotherapy/CBT? Whatever you decide, don't let this get worst before you decide to talk to a medical professional.  

 

...best of luck with caRMS and I am sorry to hear you are going through this. Depression sucks, and unfortunately, it may become a life-long battle for you of some ups and downs. If however, your insight and judgement remain intact (which it sounds like) - prognosis is much more favorable.    

 

P.S. You should definitely match. The worst case scenario is that you get accepted to a program and then have to take a leave of absence from there in July - at least you will receive disability insurance from the program and you have a guaranteed spot once your mental health is improved.  And no - programs can not hold it against you if you need time off for medical reasons (the same would apply if you are a women and need time off for maternity) - we are still in a time-based curriculum model, so you would just make up any missed rotations later. However, you do need to match first though as the disability $ aspect of it is through a private insurance company (like Manulife), which you automatically qualify for as a resident.  

 

P.P.S. I would also look into the CFMS disability insurance for medical students while you still are in fourth year. You don't need a medical history for it, and private disability insurance hates mental illness so I'd lock in on this as well ASAP ($4000/m). You would get this on top of any resident disability if you needed (e.g. $~7000/month). 

[carazadie]

Hi OP. Sorry you have been going through this difficult time. Especially around CaRMS, it must be tough. I'm going to echo the previous poster in urging you to seek medical advice if you haven't done so already! If you start residency (or even if you don't), it will be so much better to have those supports and treatment strategies in place beforehand!

 

I will also suggest that you put off making any major decisions about whether or not to start residency until after the match. You have been going through an incredibly stressful period this year with CaRMS applications and now the interview process. This is probably the most stressful part of medical school for all of us. You might find that some of your love and enthusiasm for medicine returns once the stress of this process is over and you know where you're going to be training for the next few years. Of course stress is not the only cause of what you are going through, so I think you should pursue treatment even if you feel better after the match.

 

I'm not sure about the logistical aspects of taking a leave of absence, but I imagine that it would be possible. Also not sure what your options would be as far as dropping out of residency.  CaRMS is a "legally binding contract", but I can't imagine that a program would force you to stay if you weren't coping well. I think you should investigate the potential repercussions of dropping out - maybe someone else can comment on that. 

[LostLamb]

This might be a good time to get in touch with your student affairs office at your medical school. you will not be the first or the last medical student who has run into this. They might be able to offer some resources and other suggestions tailored to your situation.

 

Second, it would be a good idea to see your family doctor/campus walk in doc who can explore things more thoroughly.

 

Physician wellness is a big deal. Don't ignore the signs of being unwell. Start looking for help sooner rather than later.

 

Good luck. Sending good thoughts your way.

LL

[placenta]

I'm sorry to hear this, and I am sure you are not the only one feeling this way. We end up spending a lot of time for others, sometimes this results in decreased opportunities for us to pay attention to our inner need/change...I hope you are feeling better. 

 

In regards to the contract, I have found the following information on CaRMS website, if this helps you at all: "The participating residency program and institution, in their discretion, may release an applicant from their binding commitment if they deem it would cause an applicant serious hardship. If applicable, CaRMS must receive a letter of support from an applicant’s undergraduate medical school, acknowledging and outlining the hardship".

 

I think also talking to your PGME office may be helpful as well. 

 

Best of luck!