51˶

I, Intern: When the Doctor Is on Lexapro

— A pediatric intern manages her mental illness.

by Staff Writer, 51˶

MedpageToday

This weekly series follows six interns over the course of their first year as they step into their roles as practicing physicians.

They are pursuing internal medicine, general surgery, primary care, family medicine, and emergency medicine in hospitals across the country.

This week, we feature the story of a pediatric intern, “,” who has anxiety and depression. She is also author of a detailing her experiences in medical school and residency.

Action Potential (AP) thinks her psychiatric milieu is mundane. She has no hesitation sharing her experience with anxiety and depression, although she prefers to use the pseudonym in her blog and for this story. "I talk to a lot of people about it now. I'm fairly open. The more time goes on, the more other people talk to me. It's everyday, it's boring. It's what I had for breakfast. I had Lexapro for breakfast."

But she didn't always feel that way.

Delaying Help

AP first realized something wasn't right during college. "There were a lot of things I was supposed to do that didn't involve sitting in a room studying, or lying under blankets and reading my phone. Things like making appointments, or getting my car serviced, or going out into the world and just being a person. At a certain point I realized ... none of this is working. I'm making good grades, but this is ridiculous. I realized it was kind of consistent with anxiety."

She recognized she should seek medical help. "But that decision was about as far as I got. I made the decision to call student health services. But actually picking up a phone, and dialing it, and talking to a person was this whole other step. It was absolutely insurmountable. I came up with every excuse not to pick up the phone and do something about it."

It was took months -- and a panic attack -- for AP to make an appointment with a doctor. Then another panic attack prevented her from attending her appointment. Finally, with medications and therapy, AP was on her way to functioning better. She continued to do well in college and got into medical school.

The beginning of medical school came as a relief to AP, because narrow focus was rewarded. "For the first time, nobody really expected me to have a good handle on making appointments, or responding to letters about jury duty, or anything like that. Your only jobs were to be a medical student and survive. That was a list of two things. And I could handle two things."

But even though AP was doing well in her classes, she doubted whether she knew enough to take care of patients. She studied excessively, driven by a vision of herself as the perfect doctor.

A Normal Abnormality

One day she was studying when she found that she couldn't move her neck. She went to the student health center. "The doctor there looks at my temperature, looks at me, asks me what's going on, and says, 'You know, this isn't the first time I've seen this. Have you been under any stress lately?' And I tell him everything. He says, 'You're probably the fourth one this week.'" AP walked out with a referral to a psychiatrist.

"My whole world was different after that," she said. "I was finally able to get things under control."

The doctor's visit was a turning point for AP because it gave her a sense of normalcy. "[The doctor] was just so not surprised," she said. "I think you can build up in your head that this is a very, very big deal," she said. "You're in the medical field, people are going to depend on you to take care of them. You have a psychiatric disorder? Say goodbye to passing a board exam or getting your medical licensure. It's done.

"But coming to the realization from someone else that this isn't only commonplace, it's a little bit boring and expected. It takes so much pressure off," she said.

Intern-Level Care

Medication and a supportive work environment allowed AP to thrive during her clinical clerkships. AP is similarly happy during her intern year. "I love the work. I love the kids. I love my other interns," she said.

But practical concerns surfaced when she tried to establish psychiatric care in her new location. "I found it darkly funny when I ran out of my Lexapro about 3 months in. Now what? I was in a different city, I needed to find somebody else to get a prescription from, and my insurance only covered my own medical system," she said. "I knew all these people in the medicine and psychiatry systems ... It's a big hospital, but it's not that big. You're giving up a certain degree of privacy. To have to walk into the waiting room to the psychiatric care where people you know work, that's asking an awful lot."

Timing was an issue as well. With a schedule that extended far beyond regular office hours and few days off, AP had difficulty fitting in a doctor's appointment. The irony wasn't lost on her when she prescribed Lexapro for many of her patients. "It was, 'Water, water everywhere, but not a drop to drink.'"

A solution came unexpectedly during a weekend brunch with a co-intern. "We had a couple of drinks and started complaining about how crazy this situation is," AP said. The intern told her about an unadvertised hospital program: a psychiatrist who only saw medical professionals in a completely different part of the building, took her insurance, and worked more accommodating hours.

The co-intern only found out about the option after a discussion with her residency program director. AP was thankful that the program existed. "But there's a step missing," she said. "Wouldn't be great before it becomes an issue, before you're sitting in the program director's office?"

Help is generally available, AP said, for those who are vocal about seeking it. Showing that vulnerability may take a leap of faith, she acknowledged. But she encouraged others struggling with similar issues to do so.

"There is no gold medal at the end of the race for the person who went the longest without getting treated or admitting they don't need help. In your head you build it up, like 'I'm fine, I can handle this.' But there's no downside to asking for help. And nobody cares. You are not that important that people are wasting time wondering how you're functioning this well without medication in a stressful situation. You're the one who has to deal with it 24/7, so you decide. Do what you need to do."

Previous installments of I, Intern: