I distinctly remember one Tuesday morning during the second half of my first year of ophthalmology residency in 2014. It was 6 a.m., and I was hysterically crying while standing in my kitchen, holding a pair of scissors to my hair. "I'm just going to cut it off!" I screamed to my husband, Francesco.
What had triggered this moment of scissor-wielding desperation? I was late for surgery, and I could not find a hair tie to tame my unruly, long hair. I had not slept in weeks, thanks to the constant screech of my pager. A thin shred of sanity remained; the missing hair tie severed it.
Francesco gently took the scissors from me, then aided me in a frantic search, and after ransacking our tiny apartment, saved the day with a rubber band. Crisis averted, I threw my hair in a ponytail, rushed out the door, and proceeded to the OR as if nothing had happened.
When I arrived home that evening, Francesco greeted me with a pack of Sam Goody hair ties. We laughed about the morning and affectionately dubbed it my "Britney Spears moment" as a throwback to the pop star's nervous breakdown-induced shaved head in 2007.
While it may seem humorous that such a minor mishap could trigger such an extreme reaction, looking back, I don't find it as funny as we did at the time. It was indicative of my very fragile mental state. I was clinically depressed, but undiagnosed and untreated. I woke every day with a crushing feeling of despair that felt like a 1,000-pound weight on my chest. Exhaustion from call only amplified these feelings.
I was aware that my co-residents also struggled to some degree, but I carried the belief I must be struggling more -- at least based on what others shared or showed on the outside. I remained severely depressed throughout my residency and fellowship, but I never sought help. I didn't feel like I could ask for time off to seek out therapy and didn't want to expose myself as weak. I thought about dying frequently.
When I finished training, I was completely numb and detached from my life. I had assumed this would magically fix itself when I completed my fellowship, but it did not. I finally sought professional help when I was a year into clinical practice as an attending, at which point I was diagnosed with posttraumatic stress disorder (PTSD). Apparently, I had developed this from years of chronic stress over my time in training. I had no idea that this was even possible -- I had thought that PTSD was a diagnosis solely reserved for soldiers in war, or accident or assault victims.
The Happy Specialty?
Something I've heard frequently among my ophthalmology colleagues is that we pride ourselves on being a "happy specialty." We are indeed privileged to help patients see -- something that is incredibly rewarding. However, this is not an invincibility cloak that shields us from stress and mental health conditions. Mental illness does not care what your specialty is. It is a risk that can, and does, pertain to all of us.
As an ophthalmologist who has struggled with a mental health condition, I'd always felt like there was just something wrong with me. That everyone else had it figured out. That everyone else was happy in the Happy Specialty but me. That real mental health issues were for general surgeons and emergency physicians and internal medicine doctors on the COVID front lines. I looked around and saw what appeared to be everyone else happy and thriving in their jobs -- except me.
I now understand that you can't necessarily trust what others display on the outside. Many physicians, and residents specifically, harbor fear that any perceived form of weakness will be held against them. That they will be seen as less than. That they won't be supported for the best fellowships or jobs. That if they ask for time off for therapy, or to see a doctor, that their mentors and peers will see them as lazy or inadequate. And that a history of treatment for a mental health condition may hold them back from obtaining a medical license -- since many states specifically ask about a history of any such conditions on licensure applications.
This cultural stigma surrounding mental health keeps us from honestly sharing our experiences. Organizations are working to change language on credentialing applications and increase awareness around this issue. But we, as ophthalmologists, could be doing more.
A Breaking Point
In December 2021, my PTSD worsened such that I stopped sleeping almost entirely for several months. Medication and therapy were not able to control my symptoms. I was so exhausted that it felt unsafe to be driving to the hospital, let alone working, yet I continued to work, perform surgery, and take call.
I cried every morning upon opening my eyes, while getting dressed, and while driving to work, only stopping when it was time to paste a smile on my face and walk through the hospital doors. I cried every evening upon arriving home. On my last day at work, I had a panic attack in my car in the hospital parking lot. I then went inside and performed five surgeries.
That evening, when I finally requested a prolonged medical leave, I felt deeply ashamed. It felt like I had failed everyone -- my colleagues, my patients, my hospital, my family, and myself. For months, I hid myself away like a hibernating groundhog. Not knowing what to say, I withdrew from my former colleagues and friends. It took many long months of medication and therapy before I started to emerge from my hole. And although I tried, I was never able to return to my clinical practice. Each time I came close to returning, my symptoms would worsen again. Looking back, I wonder if things may have been different if I'd sought professional help during residency, rather than 7 years later.
Many months later, I eventually worked up the courage to share on social media what had happened (at a high level). I shared that my job had made me ill, and that I had left.
The response I received was overwhelming. I had feared a negative reaction, but instead I received loving and supportive comments -- some from people I knew well, and many from people I barely knew. I received messages from dozens of other doctors and healthcare workers who relayed similar stories. I learned that I was very far from alone in my struggle. We just don't talk about it.
A Widespread Issue
A few months ago, an ophthalmology resident named William West Jr., MD, died by suicide. I was incredibly saddened to learn of this. His death garnered national attention. In his final words, , "To those in a position of authority over residents, a simple reminder that we come to you seeking the possibility of a better life. Some of us with challenges you do not see or backgrounds of which you are not aware ... I hope that an effort can be made to understand, support, and mentor the residents rather than simply to assess and drive them toward their highest potential as doctors."
Let's take West's words to heart. If this resonates with you, let me know. If you would like to share your story with me, I'm here to listen. If you have ideas for how we can improve our residency programs and mental health resources for ophthalmologists, reach out to me.
The first step in making change is to acknowledge there is a problem. And until we, as ophthalmologists and other physicians, can share openly about our mental health, about our authentic inner experiences, change will not happen. That's why I'm here, sharing this with you, my ophthalmology community. Let's start the conversation.
If you or someone you know may be experiencing a mental health crisis, contact the by dialing or texting "988."
Sarah DeParis, MD, is the director of quality and clinical standards at the . She can be reached at sdeparis@aao.org.