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Residency was going according to plan until a phone call changed everything.
Dr. Nzodom is a third-year resident at Louisiana State University-Our Lady of the Lake Psychiatry Residency Program in Baton Rouge, Louisiana. The details of the patient have been changed.
I recently attended a conference where burnout and resilience were the main theme. I was so fascinated by efforts to prevent physician burnout and promote wellness that I began to reflect on my own personal struggle with loss and stress over the last year.
Residency was going according to plan until the day when I received a phone call to inform me that my patient had attempted to self-harm and had committed a homicide in the process. At first I was so shocked that I asked the person to repeat herself several times. As the details of the tragedy unfolded, I envisioned the horror of the event. My first thought was, “How could this happen?”, followed by “What have I done?” I abruptly hung up the phone and cried. Feeling as though my heart had been ripped out of my chest. I started reliving my last interaction with my patient over and over again. I could not stop wondering if I had missed a clue or something the patient had said that would have indicated the severe danger that lay ahead.
When I got home, I sat on the floor and felt a sense of derealization. I kept thinking that this happened because I’m a resident and I must not know enough yet. Then I thought, “Why me? I always try to do my best. Why is this happening to me? What did I do wrong?”
20 Meditations for Residents
As expected, I barely slept that night, but I decided to go to work the next day. I did not quite know how my day was going to go but I did not want to be home alone. I needed to be in an environment where I felt safe and where I could do something productive. Being there for my patients would be a good idea, I thought, but I found myself crying between each appointment in the clinic and getting tearful each time a patient talked about something sad. I started to take extra time with the patients and pay careful attention to my risk assessments.
I found myself worrying more about my patients’ safety and those around them. It was easier to talk to the faculty about my grief than to my peers or my family. I could not find the courage to explain what had truly happened. I constantly felt emotionally exhausted and disconnected from my surroundings when I was not with a patient.
My next step was to get lost in my work. As chief resident and an APA diversity leadership fellow, there was a lot to do. I volunteered for projects, developed a personal agenda, and created a checklist of all my tasks to ensure their completion. Being busy, productive, and seeing results gave me a sense of purpose. I felt I had to keep swimming so I would not drown, so I swam as if my life depended on it. Every time I crossed out an item on my checklist, I felt a sense of personal accomplishment, I was getting a piece of myself back.
Turning a corner
After many months, the shock wore off. I have grown a great deal. Talking about this tragic event is still difficult; writing is easier. Sharing this story gives me a sense of hope and also helps me to acknowledge the progress I have made. I believe that resiliency is not only about adaptation and adjustment but also about learning. I do not remember when I started to heal and I’m doing it at a snail’s pace. I am more aware and thankful for the support system that surrounds me at work.
Part of recovery has been to tolerate my own vulnerability and to accept help. I do not want to let this incident define me. I have had to learn and understand my limitations. Slowly, I have started to accept that what happened was beyond my control. Luckily, I am still as passionate about psychiatry as I was when I first started. But now more than ever, I’m better able to understand what my patients go through and I am more determined to make an impact on my patients and in the system in which I work.
To sum up, these were the steps that helped me get back on track. After a tremendous loss or stress on the job, you might jot down your own list:
1. Allow yourself to feel a wide range of emotions
2. Identify your support system and let them be there for you
3. Process your emotions with the help of a therapist
4. Be mindful of your wellness and self-care
5. Get some rest or try to get an adequate amount of sleep
6. Try your best to maintain a routine
7. Write about your experience and share it with others
8. Finally, read literature on patient suicide and risk assessment. The references below may help.1-4
1. American Psychiatric Association: Helping Residents Cope with a Patient Suicide. 2007. https://www.psychiatry.org/residents-medical-students/residents/coping-with-patient-suicide. Accessed June 5, 2017.
2. Pilkinton P, Etkin M. Encountering suicide: the experience of psychiatric residents. Acad Psychiatry. 2003; 27:93-99
3. Lafayette JM, Stern TA. The impact of a patient’s suicide on psychiatric trainees: a case study and review of the literature. Harv Rev Psychiatry. 2004;12:49-55.
4. Mangurian, C., Harre, E., Reliford, A., Booty, A., & Cournos, F: Improving Support of Residents After A Patient Suicide: A residency Case Study. Acad Psychiatry. 2009;33:278-281