Raymond

Tell us your name, age, location, and what you're up to.

The name's Raymond, 24 years old and about to be 25 in... damn, 2 months. Living in Houston, TX and attending Baylor College of Medicine as a 3rd year student. I got here mainly by hanging out with a bunch of nerds in high school. The friends that I had in high school were mostly Indian and Asian, and many of them had already had set plans to go into medicine. As high school students, they knew they wanted to be pre-med and do it in college. I didn't know what I wanted to do at all — I had thoughts of being an architect, a lawyer, and later in the game, even in computer science making video games (because I'm a nerd), but after taking CS I was like "No way am I doing this for the rest of my life". So I thought, what am I going to do? I got into Rice with my friend Chris, who was also pre-med. A lot of Rice people did pre-med and I thought, why not do it too? I was also interested in political science because I liked History, so I was like, why not explore my horizons? That was a mistake — history was much better. PoliSci was boring; it's a lot about comparing nations, but you can't really compare two nations because there is no control. Their experimental design is inherently flawed. Also, the professors I had weren't very engaging.

So, going into medicine at the onset, doing pre-med classes was more of a group mentality for me than anything else. I thought, I'll have this option and if I ever want to do something else, I can.

At what point did it become your passion, or did you keep stumbling down that path?

There's a set story to how it became my path. As I became older, I became more and more aware of people who need help. I volunteered and did stuff like Habitat for Humanity. By my sophomore year of college, I had joined the Rice Habitat group but hadn't done much for it so far. I got an email from the CIC (Community Involvement Center) people at Rice saying that no one had passed on the Habitat for Humanity leadership, so the club was going to die. I thought, that sucks — I volunteered with my dad for a few weeks in the summer in high school and I liked working for it. Part of it was because I wanted something on my resume; part of it was because I really enjoy helping and building things. The way Habitat works is people apply to get a house, at cost — something like $60,000. Habitat makes no money off the sale. In order to get the house, they also have to put in 200 hours of sweat labor. They have to work on their own house and other people's house for a while. I remember I was roofing (setting down black tar people) in July at Houston and it was BALLS HOT, when the sun was reflecting off the roof and it was miserable. But there was this man, this Hispanic dude, who was there all the time and really intently working on the house. I was thinking, "This guy's really into it." During a break at lunch, I was talking to my dad, who said, "Oh, this is his house." I thought, "Wow, this is why he's so intent on making sure everything is exactly right." Later that day, his pregnant life came with a pitcher of lemonade, passing it around to all the volunteers saying, "Thank you, thank you for building our house." That had a deep impact on me, realizing that this man was here because it was going to be his house, and I was helping this man become a homeowner. He and his wife were very nice, and that had a really deep impact as the start of my real thoughts on the importance of helping others.

That led me to take on the leadership of the Habitat chapter at Rice. The way Habitat works is that they buy a big plot of land and build a bunch of houses together, because it's cost effective. I remember working on the same plot of land in high school when it was just a big concrete slab, and now that I was back a few years later in college, nearly the entire plot was developed. It was awesome.

Anyway, we met at the community area, but it was the middle of the economic recession after the 2008 turndown and a lot of sponsors had scaled back donations. Organizations like our college chapter couldn't obviously shell out $60,000 to build a house, so I was thinking of how we could help. I was looking outside seeing all these kids running around in these neighborhoods, and it hit me — living in a house is a huge first step. These kids are living in a home with a safe place to grow up. The next step is to make sure they get educated. I'm sure a lot of these kids may not have good access to education, so I thought, we should start a tutoring program with my chapter at Rice. What I realized that day in that house was that there was something I could do to help others. And because I could do it, I had a responsibility to do so. That was a huge turning point of my own thinking in my head.

That's also the crux of when I realized medicine was the right path. I knew I was smart enough to do med school. I knew I could finish school and become a doctor. But not everybody has the ability to be like that. Because I knew I could do it, I had the responsibility to do so, and become a physician that would impact many lives over my career. I could've easily been an banker and made a ton of money and then do whatever I want to do, but I saw these two paths — one dedicated to helping others, the other dedicated to making money, I saw that I had the ability to help people so I did. That was made on that day, when I was sitting in that house talking to a volunteer coordinator, seeing a bunch of kids run around in a neighborhood I helped build.

So I started a tutoring program and passed out a bunch of flyers in the neighborhood, figuring out how to set up tutoring in a community center right around the corner. I asked them for space, and it was an interesting experience in organizing things. People came out; some kids even came out regularly, which was great. Over the course of that year, I saw the futility of what I was trying to do at points. There was one kid who was 12 or 13 (6th grade), and he couldn't multiple 3x or 4x a number. Even then, he was trying to use his fingers. That was one of the low points of college with me, sitting in a room with a kid who was 12 years old but couldn't multiply. I don't think he was stupid; he was in an education system that let him pass along for so long before catching it. I also realized that I couldn't do anything to help him, unless I went down every day to talk to him myself, which was infeasible.

In education and medicine, how do you reconcile that there's only so much you can do?

I kind of think of it like in Ultimate Frisbee, since I play competitively. The way you deal with a loss is that you play with all that you have. And then you can walk away, not feeling bad that you didn't give it your all. In that same sense, there are only so many things you can do in medicine or in tutoring. I could've been very aggressive and told the kid, come here every day, I'll teach you, etc. But I also had to do classes, had to get into med school. Something I've heard in medicine as a student from other doctors who are very interested in philanthropy and helping the underserved is that sometimes, the best way you can help others is by helping yourself at that point in time. If you don't achieve what you could achieve for your own career, you aren't helping others down the road because you have not accomplished all that you could have. There's always this feeling of "how much of this is helping me, versus helping others", but it never goes away. But I think that because I have this thought, I'm doing it for the right reasons.

What do you think about altruism?

For one, I think the ALS Ice Bucket challenge is stupid. I mean, it's great that it's raised so much money for ALS, but even after being in rotations for 8 months, it's easy to see the majority of cases of death come from heart disease or diabetes. If you really want to help the majority of people, you should focus on things like diabetes, heart failure, etc. Or establishing good food access in urban areas so people don't have to go to McDonalds and can afford to get fresh vegetables for their families. That would have a much larger impact on public health.

Do you ever have a sense that things would work better if you could direct it?

I often wish that we (as doctors) could just direct how healthcare is set up. I wish we were like Canada where health is set up by a panel of doctors, not politicians who pay lip service to religion and say, "Oh we should help everyone" but when the money needs to be spent, that never comes out. We spend so much money on Defense, funding Israel, and research R&D, likely because politically they need that democratic outpost in the Middle East. I understand why the War in Afghanistan happened. Iraq — completely unjustified. It's criminal that we spend trillions of dollars on that, when if we spent trillions of dollars making healthcare better in the nation, we'd be so much better off. We had one lecture trying to sort through the healthcare policy like Medicare, but it really should've been a whole semester class. That shit is complicated. Looking at how Medicare benefits are set up was insane. I don't even want to take the 5 hours to figure it out, and I can't imagine that people who don't have access to the Internet or aren't motivated would ever figure it out. Why can't we have a simple policy that everyone can figure out? It's so frustrating.

It's been an eventful summer, and something that's been on my mind especially is how to react to the news of horrible things happening so far away from me. For one, it really entrenches the fact that I live in a pleasant bubble, and I've been trying to break down how I process the news — the shock, awe, guilt, helplessness, and also distance/removal from things happening a world away. Do you have any thoughts on how we react to the news?

You can't do something to help someone else if it is a detriment to what you could do in the future to help others. For example, during the big tsunami or Haiti earthquake, you could've bought a ticket and been an aid person on the ground. But you would've lost your job, and been wiped out financially. If you stick it out, you'll build up experience, network, and capital to be able to mobilize a much more effective response. It's all about whether what you're doing is detracting from the future. Right now, you're 24. There's not that much you can do. But in the future, maybe you can do much more.

Regarding homelessness, I see it a lot. I volunteer at a homelessness clinic in downtown Houston and I rotate through Ben Taub. My philosophy is, I don't always give money to people I see on the street if they ask me, but I will always buy them food. I will always go, take time, and buy them something. I guess my broader interests aren't just medicine but also social work. I was listening to someone giving a lecture about social work — they were saying, most doctors are great social workers. I thought, no they're not; they usually pass off the social work to a social worker. I feel like most doctors don't even want to bother with stuff like that. But it matters to me. What's the point in healing someone's cancer if they end up on the street again? A person isn't just a body. They're a mind and a soul as well. If you heal the body, but the mind and the soul are broken, what have you accomplished? Not much, really.

I gave a speech for the first year's white coat ceremony recently. It was one of the defining moments of my medical career so far. It was about this guy I met at a Ben Taub ER, which is a long room with beds on either side and curtains you can pull for some minimal privacy. Half of it is the psych side, and the other half is medical. They had admitted a guy with a BAC of 0.22 with facial lacerations. In the shock room, you see stabbings and shot wounds. A lot of the times, people who are stabbed were stabbing someone else. You get inured to what has to be done which in the case of trauma is cutting off someone's clothes to look for additional trauma. When someone is drunk and not aware of their surroundings, this becomes difficult and often no one takes the time to try to calm the person down, or maybe even they cannot be calmed because their mental status is too altered. In this case an officer held him down by the neck as they put him in four point restraints because he was "combative". And so when I talked to him, he said to me, " They shouldn't have just been that rough; I can't swallow now." I asked him, why are you here? He said, "I slammed my head through a glass table. I couldn't take it anymore; I got to the point where I just couldn't handle it." I asked him if he had tried to kill himself before and he said, three times. He started out antagonistic but became more and more vulnerable, to the point where he was telling me how he has always been anxious, ever since he was a kid. He used to hide in the closet as a child. He was so anxious, he didn't know what to do. He never saw anyone for his psychiatric issue because his parents were poor and he could never see anyone. He said, "I tried to get Medicaid but I'm not eligible for that." He pays child support for 3 daughters. His cousin shot himself 3 years ago and sometimes he hears his cousin in his head. He's never told anyone because he's afraid they'll take away whatever custody he does have of his daughters. On the cusp of that, no one knows what it's like — he said, "I'm all alone and it's my fault. I'm fucked up, man. I don't know what to do." This was all while I was kneeling down at his bedside in the ER with the chaos of nurses and doctors and students running around. He's saying this to me, crying. He's tried to kill himself three times and the last two times, he was hospitalized and all they could tell him was that he was drunk again. And they called it induced mood disorder, and they didn't try to look for any underlying reasons.

I think that was why he didn't want to talk to me in the first place, because he never got any proper attention from the medical staff in the first place. He could only say, "I'm all alone." I told him, "You're not alone, many people have been where you've been, and you can get treated." He asked him to call his mom and grandmother and tell them that he wants to get treatment. While this was going on in the ER, I was trying not to cry. It was heartbreaking. I cried after I left, in the hallway, and then called his mom and grandmother. They were super excited that he wanted to get better. They didn't know what to do, because he would get like this every couple months. We didn't know what to do, but we wanted him to get help. He's not a bad person; we just didn't know how to handle it anymore. This was the end of my shift. I stayed an extra hour, since towards the end of an attending's shift, they don't want to see any new patients, so I waited to tell the new attending that this guy had the need for psych treatment and a follow-up appointment. He was crying and thanking me, because no one had done anything for me like what I did. I cried again in the hallway after that. That was the crux of medicine for me. This man had been suffering for over 20 years, never with treatment. If someone just listened to him, he might've been so much better off than he is now. He was definitely not aided by the fact that he never had access to help. Also, mental health in the Hispanic community is not talked about.

Immigrant families often struggle with mental health issues. It's a topic I've seen show up consistently, but I wasn't really aware of until I went to college with a bunch of other young people and realized just how high the incident rates were, and how little support there is available in this culture and community to tackle mental health. What support do you recommend for making this more treatable in a community where talking about mental health is stigmatized?

I have a story. A few friends were in town, one of whom brought along some friends of friends I didn't know. We went to Proof, this bar in Midtown and one of these nerdy guys gets barred because he's wearing dad sandals (of course, that's my crowd). I was thinking, what do we do now? So I thought, let's go to my place, 'cause I've got beer and a beer pong table. So we go to my place.

After a while, I noticed that the random friend of a friend has been missing for a while, so I go upstairs to my bathroom to see what's happening. I see her sitting on the edge of my bathtub, holding her arm. And I see a big cut on her arm, because she had taken my straight razor and cut herself, deeper than she had intended to. It needed stitches. There was blood everywhere. I also had to be at the hospital at 5am, and it was 2am. I immediately switched to doctor mode. I asked her, "Have you hurt yourself before?" And she was saying, "No one can know, don't tell anyone." She was drunk too. She had been texting and trying to call someone, but they weren't picking up. I asked her, "Have you tried to kill yourself before?" And she said, "I don't know why I did this. I have a great life. I have food, shelter, good parents, and a great education. I don't know why I did this. This was just a mistake and I'll be a mistake, and be my happy self and no one will know." So, I don't know her at all, but she also wasn't very willing to tell her psych history. She just kept saying, "I don't want to die; I don't want to die today. This was a mistake, I cut myself too deep." So after all this, thank god for her sake that I wanted to be a surgeon because she needed stitches. (To clarify — her life wasn't in danger; she just needed stitches, but she was just saying that she didn't want to die.) I had some suture materials for my practice, and I irrigated her wound the best I could, then sewed her up the best I could. At that time, either she had to go to the ER or I had to do it myself, but she refused to go to the ER. (Also, it would've cost $2000.) And what would that accomplish? Her parents would know, and it would get worse. So, the acute issue was resolved. She was sutured, stopped bleeding, and I told her how to take the stitches out. Over the next few days, I made her send me pictures to make sure it wasn't infected, and then she took out the stitches herself. So yeah, it was good that it was resolved, but the deeper issue lies — I'm positive she will try to hurt herself again. So this girl is Asian, and I'm pretty sure she feels like she can't talk to her parents about it.

The extreme of it is this one dude I saw in the ER, who was covered in burns on his chest because he would burn himself with cigarettes. He did this compulsively. The only way to make people like that better, at least in the case of that girl in my bathtub, was to be able to talk about what's happening. Make them know they're not alone, and they can come out and get help for it. But that's not the way society is set up, not the way most cultures are oriented. For all the money that we spend on healthcare, so little of that is for mental health. The man that I met in the ER was suffering for 20 years with no help. There was no charity care. If he been treated and stable, he would've been a productive member of society. So many people are homeless because they're schizophrenic, or bipolar, or don't have treatment for other mental health issues. Without an easy or obvious way to access mental health, people who were holding down solid jobs for $60k a year end up losing their jobs, often ending up in prison or homeless. And it's a shame.

This project started because I'm interested in the transition between teenagers and "mature adults" — this "emerging adulthood" phase. I've always thought of med school students as these professionals who are going to be responsible for lives — how do you handle taking on that responsibility? Is it something you wing like almost everyone does, or do you feel like there's some culture in med school that helps you assume that responsibility?

I haven't felt like a child in a long time. Not since I was 16. I felt very much like a rational person as a teenager. I mean, I have more experience now than I was when I was 16, but I always did react to things maturely. In my first relationship, I made a lot of mistakes but I learned a lot from that, and I won't make those mistakes again. When I was 18, I reacted like a typical teenager, and then my mom was like, "Oh, I forgot that you're still a teenager and not an adult, because you act so mature all the time."

There is no doubt that the culture that we have today, our generation, has a vastly prolonged adolescence dude to the nature of college, financial dependency on parents necessitated by the bad job market after graduation, and social media. I feel like social media makes us less responsible, less sincere, less genuine people in general because of how it can deliver instant social gratification at the touch of a few buttons via the glowing of a screen of whatever device you choose to use. I wish I could reassure you and say that medical schools really delve into the psychology and necessity of caring and responsibility, but they don't. Really, it is assumed that you can already see that for yourself, and honestly that should be enough. But it is not because there are physicians who abuse their power, who are incompetent, medical mistakes happen for endless number of reasons and in part, I think, because doctors lose sight of the magnitude of the profession we have chosen. Don't get me wrong, there are doctors that have all this in mind, and those are the excellent physicians you want to have caring for you, but by no means is it 100% of the people in the field.

But given that, when you're studying in school, you're focusing on getting the good grade or move on to the next step. But now, when I study things, I'm reviewing it because if someone goes down, I need to know what to do to resuscitate them. If you don't know it, people will suffer and die. That is a very sobering reality. So right now, I want to do trauma surgery. I'm currently in my general heart rotation, so various kids with malformed hearts come in needing surgery to fix them. All the surgeries are open-heart surgery, so they're all on bypass. Looking at how the surgeons stitch, you realize if you aren't good or mess up, you will seriously injure someone. How much you prepare and how capable you are will directly dictate how that child does in the post-operative period. The quality of care you perform will determine the quality of life for this child. That's a huge responsibility. And for trauma patients, if someone comes in with a bad injury, you don't have time to examine or study your notes. You have to know and make decisions immediately. Once you go, you need to know exactly what to do to get you to this state. These are the things that make me excited and terrified to be a surgeon. You no longer have to know your shit to be the smartest one; you have to know your shit to save lives.

Also now, I'm not just working for myself. A lot of that is being at Baylor and working at Ben Taub in the Trauma clinic. You realize, there is a wide range of experiences. Most of your friends in New York probably have excellent lives. In the broad spectrum of things, they are living the life. I've talked to people who have talked to people with really terrible lives beyond the circumstances they were born in. That's ... I saw a patient on my second to last shift that I partially blocked out of my head because it was so tough listening to her story. I talked to a woman who's been an alcoholic since she was 9 years old because she had anxiety and found that at an early age, alcohol made her feel better. She had a terrible family life and an abusive husband that she had to run across 3 states to get away from. He beat her, and she needed to get away from him. We were in the exam room and her hands were shaking back and forth because she hadn't had anything to drink that day. She was suffering from alcohol withdrawal and was shaking from it. In that situation, there was nothing I could do. Whatever she came in for was not anything related to what she was telling me, but all her psychiatric symptoms came up when talking to her. That's the nature of the homeless clinic. They come in for a sore throat, but then when they tell you their whole stories, you realize there is a slew of issues that need to be addressed first. You always end up treating not what they came in for, but for everything else. They could come home for a cold, but you end up treating acute liver failure because of 20 years of alcohol abuse.

When I hear about these things, it's very hard for someone not in the position of a caregiver because sympathy and pity don't do anything, but it's impossible to ignore. How can someone that's not a doctor in your position help?

The only way I can see helping is changing policy, cultural attitudes, and where money is allocated in local, state, and national resources. Create a healthcare system that supports psychiatric care for people with no money. Nothing except for that will fix this. You can make one person's experience better, but the system will continually churn out these people unless the system is improved. All I can do is treat the symptoms, unless you go into the realm of actually educating the nation, changing the national attitude towards help, or actually getting the government to seriously fund mental health institutions and mental health care. Decriminalize drugs so that when someone is caught with drugs, instead of being thrown into prison, they're mandated to go into rehab, where they can actually get better instead of rot away. That will do a huge amount for the situation in the United States. When a man is homeless and intoxicated on the side of the road, instead of throwing him into jail, throw him into a facility for alcohol rehab. There's a man in the clinic who came in who had been vomiting uncontrollably for 5 hours, and it was 9AM at the time. He was diaphoretic, sweating like crazy, and was just like, I need help. He was crying, saying, "I don't want to drink, I don't want to, but I can't stop." He was crying and so helpless in the face of his alcoholism. That kind of man doesn't need prison, he needs a rehab, and he needs treatment. The ways his brain was wired wouldn't let him break from that. It's not because they lack self-control, it's because their brains are wired so that it is incredibly hard to overcome. It's a chemical, neurological thing; it's not a willpower thing.

So going back to your original question, medicine does make you grow up very fast. But you can also block it off. That's why some doctors may seem very cold. For them to respond, they shut down their emotional responses because if they responded to everything, it would tear themselves apart. It's not easy. Even I have become a little more inured to it. But I never want the day to come where something truly happens in my medical career, and I can't muster up a few tears for it. That's the day I lose my humanity, I think. There's a lot of old school physicians who think themselves as scientists — cold, clinical, rational, detached. You tell a patient they have cancer, this is the prognosis, these are their options. That's what a lot of doctors thought you had to do; be objective and irrational. I think that's completely missing the point. Like I said before, people are bodies, minds, and souls. Treating the bodies but neglecting their minds and souls still amounts to a sick person. There was a woman in the ER with stage 4 gastric cancer. She was young, in her late 30s. She had been to Ben Taub before and they couldn't figure out what was wrong with her; they eventually realized she had cancer later. Because of her experience in her doctor, her relatives were telling her to try the homeopathic stuff (which is also nonsense), but I can't blame her for wanting to try something that wasn't associated with the hospital, because the hospital had failed to diagnose her for so long. The sad fact about doctors is that they're human and make mistakes. No one can get it right every time. So she was in because she came to the ER with terrible abdominal pain, and she was in the shock room because she got treated. She was in incredible pain, but I sat and listened to her and got her the pain meds she wanted because at that point, she was just in incredible pain. Being there and supporting her emotionally just did more for her than anything medically that could be done. Right before my shift ended, I checked in on her and asked if she was doing better. One of her relatives was there at her bedside, so I checked up on her and she said, "Thank you so much, I'm doing better." She was smiling a lot, saying, "I just wanted the pain to go away enough so I could smile again." This woman, with stage 4 gastric cancer, who was going to die in next 10 years, had this terrible prognosis. She never had any unhealthy habits in her life, but she got gastric cancer. And all she wanted was the pain to go away. When you see that, when you see people my age with "problems" that aren't really problems, complaining about their lives, it's like... you don't even know what could be happening to you. You don't even realize how bad life can really get. You should be grateful for what you have. Sure, your life might not be ideal, but if you can fix it, (and I bet most people can with enough self-reflection and effort) you should do that because there are very nice young people dying in incredible pain under fluorescent lights who would probably give everything to trade places with you.

Seeing what you've seen has really affected your perspective. For my project, we also talked about relationships and what you've learned from dating. What have you learned from it in this growing up process?

After my last relationship, I was very much in love with that girl, despite the fact that the relationship wasn't ideal for me. I made mistakes for sure, but everyone makes mistakes, and it shouldn't be held against someone once they realize it and sincerely repent and make it better. They try to apologize, make it better, or change their behavior. But that girl broke my heart, and it took me a long time to get over that. But I realized that a lot of the relationship caused me a lot of stress, because I realized that she didn't really think about me in certain situations. The person I want to end up with is someone who makes me better as a person, and who I can make better as a person. I want it to be this mutually, symbiotic relationship where you can talk to that person honestly. There were times when she would make a mistake and I had a very legitimate reason to be upset. When we talked about it, she would immediately pass it off as not a big deal at all, essentially refusing to take responsibility for how her actions had hurt me. She wasn't apologetic and instead of saying, "I'm sorry", she was telling me to calm down. That's a relationship I don't want. When someone makes a mistake, minimizing it in their mind to make it seem like it wasn't their fault is not what I want.

This probably goes along with a lot of what you see in pop culture like in Girls. There's this quote attributed to Marilyn Monroe, "If you can't handle me at my worst, then you sure as hell don't deserve me at my best." But that's bullshit. You shouldn't show someone you love your worst. You should show them your best. Why would you want to put the person you love through situations that cause them hardship and pain? That's not okay. It's not okay to do that to someone you love. If you love someone, you should always try to be the best person you can be for someone. Otherwise, that person will only take from you, and then if they leave you, you're left with nothing. I think a lot of what young people are really bad at is being honest in talking, and also dealing with their own issues. My ex had a lot of issues she hadn't dealt with, and she dealt with those issues by not thinking about them. If you opened up those walls, she would not be okay. This goes back to mental health as well. You can't make someone better mentally, if they don't want to be helped.

How prevalent do you think this attitude is? It's a little disappointing to hear so many cases of it. How many people are walking around carrying things that could potentially detonate and hurt the people they love?

At least 50% I would guess. It's incredibly sad. Someone in the class below in med school committed suicide this summer — happened very recently. She was this incredibly gorgeous, popular Indian girl with a boyfriend of several years who cared a lot about her from everything I saw. I only interacted with them one or two times. This boyfriend that I talked to valued her so much and felt lucky every day to have her. With all this — being a med student at Baylor, at this great school, objectively she had everything going for her. But she still had this depression that drove her to commit suicide. That's the nature of mental health in this country. When you're a physician, when you're reporting to the board for your state license, people would rather check "No" than "Yes" to "have you ever been treated for depression"?

There's a somewhat fuzzy line in modern times between recognizing serious mental health issues, and the over-diagnosing of the natural sadness and loneliness in life that is hard for anyone to endure. I sometimes wonder if that's a cultural thing, where we want to chase away any bit of sadness or loneliness with immediate hits of euphoria. I'm reaching a little bit here, but thinking about the growing popularity of the rave/drugs scene, or even just the nature of text/instant message communication these days. Do you think depression is over something like ADHD, where people are over-diagnosing sadness for illness?

There's a med school mnemonic for how you diagnose for depression. SIGECAPS. You have to have 4-5 of those symptoms to be diagnosed for it. Something I realized when I was taking Psychiatry was that when I was adjusting for my breakup, I had adjustment disorder with depressed mood. I didn't get treated for it, because when something happens to your life, it impacts your life.

I think mental illness exists in a broad spectrum all across the population, and some people are better equipped to deal with it than others. A "mild" depression in one person could be completely manageable but in another could significantly impact their quality of life because people have different levels of ability to cope with that kind of emotional stress. But I do think that many people live with some kind of depression without telling anyone because they just deal with it, and then I also think that there are some people that are over-treated. What the actual numbers and stats are, who knows? I certainly don't.

Thanks so much for all your thoughts here — I know all of this impacts you very personally. Do you have any closing thoughts?

I've had the privilege growing up in an amazing family with excellent parents who have supported me in everything I've done. My philosophy has come from critically thinking about myself and my position in the world. I don't know where my desire to help people came from. Maybe it was something I was born with; maybe it's my strong moral compass. All I know is, after going through what I've seen in volunteering with Habitat and seeing the people that I could actually help, I realized that my life is much more meaningful and productive doing these things because they deserve it. That's what has shaped the person I am today. Being in medicine has shown me that there's nothing else I want to do. It's hard to describe how powerful it is seeing someone's face when you've done something so small for them in the ER. Seeing how moved they are that I just talked to someone in the ER, just listening to them talk for a while, listening to them questioning God why this is happening to him or her... doing those little things and seeing how much it can impact them is in that second... there is nothing else. Why would you worry about things that objectively don't matter at all after you have experienced the intense extremes of fortune life can have? Like, oh my table's not ready at a restaurant... whatever, just wait. You could be dying, have a family member who is dying, or any number of other terrible things I could list. If everyone could honestly appreciate what they have and then not be a jerk to anyone ever, the world would be a much happier place. ■