“...my hand remains resolutely above the surface, asking for help.”
Humans of Medicine #37
This publication is in conjunction with MMI Mental Health Initiative. Information regarding the project can be found at @mmi_mhi on Instagram.
To me, having depression feels like drowning. In an ocean so dark, so deep that no light could possibly penetrate it, my head is under water and all I see is black. But no matter how much I’m pummeled by the waves, my hand remains resolutely above the surface, asking for help. Anxiety, on the other hand, is like standing at crossroads, but one that branches out to innumerable directions. I stand there paralysed, not knowing where to go. “Ah,” I thought, “Here comes the tachycardia.”
The later years of high school marked the beginning of my mental health issues, mainly due to stresses from school or from my family. If likened to a weight around my ankle, then I fought against it and could still stay afloat. It wasn’t until last year – my 4th year of medical school – that the weight tightened, got loads heavier, and submerged me completely. With COVID-19 still casting its shadow across the nation, I was staying home and having online classes. It was quite a challenging time for my family as we welcomed my brother’s new baby under the looming threat of the pandemic. And naturally, with proximity came friction, in the form of minor conflicts which I took to heart.
Since my first clinical year coincided with the start of COVID-19, the lack of clinical exposure was another point of stress for me. Online learning was hard to relate to and I missed interacting with patients. At least then, the translation of abstract medical knowledge into physical proof that I’m helping people reassured me that this was the path I wanted to take. One month of that, then it was viciously snatched away by the virus and replaced with a computer screen. When we were unceremoniously ushered back through the hospital doors as the situation improved, I felt – not excited or eager – but wholly unprepared. And that drove my anxiety through the roof. Evidently, COVID-19 has greatly affected my mental health as a medical student, and I can see that a lot of my peers have not been spared as well.
Apply enough force and something is bound to break. And I broke hard.
I cried a lot, couldn’t eat or sleep well, and lost interest in things I used to enjoy. After attending classes where I couldn’t focus and pay attention, I would just lie in bed with no energy to do anything. Even worse, thoughts of death plagued my mind. It was almost like I was very determinedly ticking off every DSM-5 criteria for depression. This is not it. I cannot continue going on like this. I grasped onto that thought – a lifebuoy amidst the tumultuous sea – reached out to my tutor, followed her advice, and started going to counseling sessions. For 1 or 2 months, the symptoms reduced as I learned to cope better with stress. But the thoughts of death wouldn’t abate. To be clear, they were not thoughts of self-harm. I would just think I don’t want to do this anymore, I no longer want to exist! Go away, I’d plead with tear tracks drying on my face. Go away, I’d rage with anger ferociously directed at myself. But try as I might, I couldn’t stop these thoughts from invading my mind. That was the catalyst that prompted me to seek out a psychiatrist at a public hospital. After that, I was given a diagnosis and a bottle of antidepressants.
Of course, it wasn’t an instant fix, far from it in fact. There was a never-ending cycle of good days and bad days. The latter were days where merely getting out of bed was a huge challenge. Yet I found no solace curled up in the sheets from the negative thoughts assaulting my mind, an amalgamation of fear, self-doubt and guilt. Because who else can I blame for feeling this way, for thinking these thoughts if not myself? Overthinking was a whirlpool, and escape feels draining and futile. But I certainly did try. I’d drag myself out to exercise, or reach out and meet up with close friends. No doubt, it was tiring, but at the end of the day, I’m thankful for those efforts because rather than just wallowing in sadness, I was doing something to make myself feel better.
The medications helped, as did the sessions with my counselor and psychiatrist. When I was at rock-bottom and unable to think for myself, they helped me organize my thoughts and understand my thinking, which prompted a lot of self-reflection. My thoughts became less disruptive, and I regained the energy to take care of myself and the clarity to focus on the present. A lamentable point was perhaps that I waited too long before seeking help. I thought I could handle it, until the water closing over my head above told me otherwise.
It requires more than being family or being good friends to be able to open up to someone about your mental health issues. They must be people you could entrust your most vulnerable self with. I was very lucky that my elder brother and some close friends were tremendously supportive in fulfilling that role for me. They’d check up on me and be there for me on my bad days. On the contrary, I couldn’t bring myself to open up to my parents yet, fear of their dismissal and lack of understanding a chasm I’m not ready to cross, to the extent where I’d frantically swipe my pill bottle off the table in response to my mother’s curious “What’s that?”. All of which led me to bearing the cost of seeing a psychiatrist by myself.
Being a medical student did no favors for my mental health. From lecture slides as well as first-hand experience, I became familiar with burnout. The academic stress coupled with frequent thoughts of Is medicine the right choice? Am I studying enough? Am I competent enough? were a perfect recipe for that. Not to mention the ever-blurring distinction between time for work or rest that birthed impossible expectations for students to be studying 24/7 because you’re at home so you must be free all the time. Was it any wonder that I got exhausted and sick of studying day and night? In that state, I’d still be doing what I need to do, but I’d be doing it as a robot. Numb, empty. And the tendency to compare myself to my peers made matters worse. But I found my remedy by opening up to them, simply talking and asking them how they’re doing. The fear that other people are doing so much better than me and always seem in control was revealed for what it is – an assumption – and replaced with the realization that everyone is struggling in their own way. It is utterly meaningless to compare when we could be understanding and supporting each other instead. Healing from burnout, on the other hand, entailed more kindness and patience for myself. It involved taking some time to do the things I enjoy, and writing little reminders to take care of myself.
It began with a group chat message, and ensuing events saw me becoming a Global Mental Health Ambassador for the MMI Mental Health Initiative (MHI). Being privileged enough to have professional help and a strong support system, I feel driven to speak up about this topic so that other people are able to access the help that I received. And ever since my psychiatry posting, I’ve found my passion in this field. Like something clicking into place, and leaving less space for uncertainties and worries about medicine as a career path.
To my younger self lost at sea, I say to you: Keep going and be patient. To those battling the demons in your mind and the weight in your heart, I say to you: Take it one step at a time and let yourself help yourself. Brighter days are ahead, and the light will be ushered in by your own faith.
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Author’s note:
“If I were to ask you to rate your current happiness from 1 to 10, with 1 being not happy and 10 being very happy?” I asked. “8” she replied. It was an assured answer, as if she had finally reached shore.
About the author
(Interviewed and written by Dani Liu. Dani Liu is a second-year medical student at Monash University Malaysia. Her circadian rhythm is often ruined by her inability to put down a book. Please note that stickers and gifs are her preferred mode of communication.
Consent has been obtained from the interviewee for the purpose of this publication. The author has rewritten the article with permission from the interviewee.)
Humans of Medicine is a new initiative under MMI. We tell inspiring stories behind portrait shots of our everyday unsung heroes. Curated by Malaysian medical students from home and abroad.
If you have a story you would like to share, please reach out to us at admin@malaysianmedics.org.
