From the early stages of our medical careers, we learn to compartmentalize -- place our immediate emotions, thoughts, or reactions into an imaginary box to be dealt with later.
I compartmentalized while on trauma surgery when a patient died after we performed internal compressions. It's why I could help intubate a patient with COVID-19 in the ED then scrub into a thyroidectomy. It also allowed me and the attending physician to finish clinic after a child disclosed abuse. Compartmentalization is a crucial defense mechanism we use to survive.
On January 7, 2021 I was notified that a family member was COVID-positive, and had been rushed to the hospital and admitted with a real chance of dying or having a permanent disability. I had just finished rounds on my internal medicine clerkship. Upon receiving the message, I immediately broke down in front of my team -- crumpled to the floor, crying. There is an implicit expectation of stoicism in medicine that I defied in that moment.
But I ran out of .
My so-called compartments were already full from clerkships, caring for COVID-positive patients, a year of visible murders of Black people, racism I experienced, and horrific local events. As a Washingtonian, I had just lived through a terrorist attack the prior day about 5 miles away. On , I was sent home early, along with every other D.C. medical student, out of an abundance of caution, given our proximity to the U.S. Capitol. I will never forget the paralyzing fear I felt, not fully aware of what happened and wondering if I would make it home safely.
Since the onset of the pandemic, there have been many times I struggled to contain -- even suppress -- my emotions because we are taught and expected to minimize our needs. As healthcare workers, we know that patient care must come first, but we shouldn't have to invalidate ourselves in the process. Unfortunately, this often comes at the expense of our own needs.
For example, when the trial of , George Floyd's murderer, started, I was in clinic, trying to focus on my patients instead of my deep-seated fears that another police officer would go free. When the senior resident saw me tearing up, she pulled me aside, checked in, and said she'd try to get me home early. I immediately felt relieved, but due to a high patient volume, I ended up staying late anyway.
As a Black woman, I face an increased pressure to temper my emotions to avoid being stereotyped and labeled angry, opinionated, or unprofessional. When was murdered in her home, I had nightmares and panic attacks that kept me up at night. I am also a Black female healthcare worker who has been targeted by the police at gunpoint. I couldn't shake our similarities. She could've been me, and I could've been her. Nevertheless, I still had to be present for classes.
When a faculty member said it was my job to teach my classmates about racism, I was angry and distraught. And after another student asked how I rigged the system to get accepted to medical school, I was hurt. But I couldn't emote because, as a student physician, I had to always be at my best despite personal or national events.
After January 7, something shifted. I began owning my need to feel, which has included asking for help. Of course, it takes time to unlearn poor coping strategies. But we are rarely given opportunities to de-compartmentalize -- process the thoughts and emotions we have tucked away -- despite the emotional intensity we experience on a regular basis, which has been exacerbated by the COVID-19 pandemic.
But these moments are vital, particularly for those of us experiencing two deadly pandemics -- . We yearn for a time when crying in stairwells and bathrooms is no longer normalized.
It is up to us, specifically medical leadership, to alter and reform this system. This could include creating widespread safe spaces, like . Some residency programs and healthcare systems have instituted opt-out mental health support. These changes will require a shift in the culture of medicine but can be accomplished without sacrificing patient care and instead can improve it by supporting healthcare workers through stress and .
The way we operate and train student physicians to function is wholly unsustainable. Our rates of depression and suicide were already than our age-matched peers pre-pandemic. Now, after nearly one million lives lost, with Black and brown people hospitalized and dying more often, it is time to implement risk mitigation strategies not only for the viral pandemic, but also for our emotional wellbeing.
We cannot compartmentalize endlessly because eventually we must recognize we are ill-prepared to cope with that which overwhelms us, and we are left, despite our best efforts, crumpled and crying on the floor.
, (she/hers) is a fourth year medical student at Georgetown University School of Medicine. She is the current president of the American Medical Women's Association student division and a former Clinical Case Co-Chair for the American Academy of Pediatrics. She is also a graduate of the Cornell University College of Human Ecology and the George Washington University School of Medicine and Health Sciences.