I Risked My Career to Save My Life

During my military career, and as a resident in oral and maxillofacial medicine, I began to recognize the fact that during periods of sleep deprivation, which were initially inherent to my military training, I found myself thinking dark thoughts I had never experienced before.

I made an appointment to see a psychiatrist, and was diagnosed as having depression. Scratch that. I was diagnosed as having “high-functioning depression.” “

“High-functioning depression?” Although it sounds like an absurdity, I didn’t doubt it. It was not something I was ready to question. My brain didn’t let me question it. My dental, medical, military, and identity careers, reputation, identity and ego were all at risk if I admitted that I was not “high functioning”. In my deepest depression, I even tried to hide my feelings in my mental health appointments because I didn’t want to be called “high functioning”. “

However it has become more apparent that not speaking up about difficult things can lead to us putting our lives at risk. This is often due to the immense psych-ache that comes from the pressure and energy we put on ourselves to maintain our careers and image of perfection while neglecting basic needs like nutrition, sleep, exercise, and community. Here I am. Talking about difficult things in the hope that sharing my experience will help other people and encourage them to share their voices, even if it is privately in a mental healthcare appointment.

Based on my own experience, sleep deprivation was the main reason for my mental decline. While I waited for an operating room to become available I can still recall a night in which I asked my higher-level resident if anyone else had the same dark thoughts (signs and symptoms of severe depression) that I had while on duty. It was my first attempt to cry out for help. It was frightening. My mind didn’t feel like mine.

Up until that point, it was embarrassing to admit that I was struggling. I knew that no one enjoyed being on call so I tried to not complain. I was embarrassed to admit that I was tired from sleep deprivation. I was ashamed of my need for sleep, which is the most basic human need.

Additionally my judgment was impaired when I was in deep depression and exhaustion. I believed I had to keep the career path I had chosen on paper or I would die. I couldn’t see any other option and my brain was obsessed with the risks of letting others know that I wasn’t OK. Finally, I realized that this was not about saving my career. This is about saving me.

At that moment, I surrendered. I called my military program manager, and I said that I needed to take a medical break. “

He replied with compassion, understanding. “When?” He asked.

“Days ago or months ago, but for now I’ll be content,” I said.

The next day, I was placed on medical leave. To save my life, I risked everything to save my career. It should have been easy to make such a decision. It was not, however, clear for me at the moment.

When we are under pressure to perform flawlessly and fear that a mistake will end our careers or damage our reputations, depression can cloud our judgement and make it difficult to see the most important things in life: our lives.

The outcome? I risked my career to save my life. Although I was medically discharged from military service, it means that I can speak freely without fear of losing my career. It allows me to have difficult conversations in the hope that others will be able to see and get help, even if their world seems dark and limited. If you are there, you should hear it.

Your life is more important than your career. Nothing. That’s all I can say.

“High-functioning depression” meant that I minimized what I was experiencing secondary to depression and functioned highly until I could barely function at all. High-functioning depression often means that you function. Until you don’t.

Ultimately, I rebuilt my career to recover. This began with allowing myself to pivot as discussed in “Recovering after burnout: a permission for me to pivot. “

I have spent years silent about my career choices, worried that my inability or inability to take calls and my inability while sleeping-deprived could be viewed as weaknesses. I was afraid to admit that I was advocating for both my mental health as well as my life. That’s a problem. I feel afraid to advocate for the safety and health of myself and others. I worry that I might sound weak. This is a serious problem.

Silence does not solve the problem. It is not possible to avoid talking about it. I can’t help but call for prolonged sleep deprivation not to be a bigger problem for others. Let’s continue talking.

Physicians need sleep. This system must change. Many are not okay. I was one of them.

We need to be able to talk about the difficult things and create environments that encourage psychological safety and allow people to ask for help.

And if you want to hear it: It is OK to have basic needs and advocate to meet them. You are a human being, not a robot. We need to create a system that is human-friendly, not robotic.

If you are experiencing dark thoughts, please seek support. The best time might have been months or days ago, but now is the best time.

Jillian Rigert, MD, DMD, is an oral medicine specialist and radiation oncology research fellow.

This post appeared on KevinMD.