Worried

[masked_rose86]

Hi All,

I introduced myself hear a long time ago....it has been a crazy year so I haven't posted on this forum since.

I am a newly licensed pharmacist (just got the license yesterday after studying for the 2 board exams for 3 months....so glad that is over with!). My husband and I met at the beginning of our schooling (he's an MD) 4 years ago. We got married just about 8 months ago.

My husband started residency in a new state where we went to school. He just started a little over a month ago, with his first rotation in the ER. It actually went fairly well, sure there were several overnights, but he really had only 9 true shifts in the ER that month, plus 2-3 meetings a week and 1-2 days in clinic. Really not too bad at all. He seemed to be handling it okay.

He started his first month on wards 5 days ago, and was in charge of 5 patients and all that came with it (orders, discharge summaries, etc) and he's suddenly a completely different person. When I came home from work the first day he was postcall, I've never seen him like this.....not in the 4 years I've known him and he went through VERY stressful times (boards, rotations, etc). He was completely depressed, crying, and claiming that he didn't think he could do it anymore and should quit. He mumbles and seems incoherant and can't really think straight. He got a good nights rest on Tuesday night, and seemed a lot better on Wednesday....he seemed more himself....not this zombie person I have never met before. Well it happened again today (Thursday) to the point where I think he stopped mid-day and went and talked to the head of his residency program, and was given this week off to reassess things. I think the program director seems to think (what everyone would logically think, including myself) that it is just the beginning and he's having a lot to learn. The only problem with that assessment, is my husband is completely not himself. I've never seen him cry (not even happy crying---like even at our wedding---he had one tear that only I could see). He is mumbling, degected, and depressed....I mean I would call this clinical depression but it doesn't make sense it happened so quickly (a course of a few days) and also I think he is mainly just overtired. But he really seems very close to deciding that he can't handle it. Which scares me a little mainly because of 2 things: first he has worked 8 years at this point and if he quits.....I'm not sure if he can get into another residency program ever again. And what do you do with an MD without a residency/board certification?? While I don't want to say this is a big deal....but we have a huge amount of debt for him to just not use his degree and/or pursue another. I guess he might have to play Mr. Mom while I work the next several years full time to pay off our debt, but that wasn't initially the plan all these years we've been together. Granted I love him enough that I would change that, but it also just scares me that this is who I've known the last 4 years......I mean medicine was a part of him: he loved it. Now I'm scared that if I talk about medicine (which is also my life----the pharmaceutical side) that I won't be able to share that part of my life with him if he quits because it will make him sad. Now granted we will cross that bridge when we come to it....

Anyways, I have no idea if anyone knows of a similar situtation or options for someone who doesn't finish residency. Do they offer second chances (aka if he were to apply to a residency that is "easier" in the future) or is there something an MD can do without a residency? I guess I'm just trying to prepare for the worst..... Granted living with this man who is not my husband.....I mean I don't recognize this man who has always been my rock when stressed out with school and I've NEVER seen him come unglued like this....

In any case, he has been given this week by the program to reevaluate things. He has an appointment with the psychiatrist (I guess that works with the residents) this Monday. I am really scared that they will just drug him up though....because while I would like him to get some medicine if he needs it.....I just know also that I don't think that is the only thing he needs now. But who knows....maybe he will be himself after some sleep. He has only gotten 10-12 hours in the last week-ish.......while that is extreme, if he can't handle a residents lifestyle.....maybe it is best to figure something else out.

I don't know.....I'm just feeling at a loss right now :-/

[SoonerTexan]

Christine,

All I can say is I'm so sorry, and I hope it all works out. I'll be praying for you!

--Marissa

[Ravenclaw]

I'm so sorry you both are going through such a tough time. I hope things get better. I know it is totally normal to feel inadequate in the beginning of residency but as you mentioned, your husband's reaction does seem extreme, not to say it won't get better for him. I hope it does. I don't know for sure about what you can do as an MD without board certification but I do think there are jobs out there in the private industry i.e. health insurance. Maybe someone with more experience in that could chime in.
The first few months of residency are extraordinarily hard, while the work doesn't get necessarily easier the new docs usually gets a better handle on it all at some point during the first year and their confidence bulids. I really hope things get better soon.

[poky]

Christine -

I'm so sorry you're going through this; it sounds horribly tough. Have you tried asking him when he's rested and more like himself what he thinks is going on when he's losing it; what it is that's so completely overwhelming about this particular service?
I hope the psychiatrist can help him; if he was better with a night of sleep, it sounds to me like probably a combination of sleep deprivation and other stresses just pushing him past the point of being able to hold it together - I'm afraid the sleep deprivation probably isn't going to be easy to get rid of, but if he can identify and address the other source(s) of stress, that could make the difference.

[SuzySunshine]

You're both going through a lot, give him some time to see if he can get back on his feet in this situation before he abandons it.

With that said we have a couple of friends who finished med school and never did residencies because they decided it wasn't for them. One was a consultant for many years and now works for a medical device company, the other one also works for a medical device company. There are tons of jobs for MD's without residencies if he has any kind of business sense they should be really easy to find.

[TulipsAndSunscreen]

First, I'm really sorry. This situation seems very, very challenging.

Second, I've worked with many MDs over the years as a biotech consultant (we didn't have any because we were a very small firm but I know all the bigs names take them) and have also seen them in industry roles in medical devices (mostly surgeons) or pharmaceuticals (more medicine folks). It's definitely possible to leverage this degree into something else though obviously he should get help first to try and figure out what's wrong since these jobs are not without stress and some sleepless nights either.

[MrsK]

Wow. This sounds very difficult. Has your DH ever had problems with depression or anxiety in the past? I'm thinking he could be having panic attacks. It's a new situation and there is a lot of pressure. The hours can make them really nuts. I know that my husband turns into godzilla when he is working nights.

I wouldn't give up on residency just yet. Perhaps your DH can take a Sabbatical if he needs to. I know many residents that have had breakdowns or other personal issues (hospitalizations, divorce, anorexia, family illnesses/deaths/births) and have taken breaks or postponed residency. They can resume their training off-cycle.

As for the psychiatrist -- they won't just prescribe meds. Medication helps but there is always a theraputic component. Psychiatrists will not just write a script and not counsel the patient.

[MarissaNicole]

Two words: SLEEP DEPRIVATION!

Seriously, give it two more weeks before you start to fret. I say this because DH and I went through a similar situation where for several days I freaked out and had no idea who this man was (and we were miles apart). This happened this time last year when DH was on his first away rotation. About 2 weeks in he called me to say he wasn't sure he wanted to be a surgeon. DH has ALWAYS wanted to be a surgeon, it has always been in his personality and everything I have ever known about him. I called my parents BAWLING, freaking out because I had finally accepted the fact that he wanted to be a neurosurgeon and now he was changing his mind and I didn't know who this person was...I freaked out! (Way overreacted, looking back now). About a week later DH was able to say that it was sleep deprivation and that he honestly had felt "crazy."

I really think your husband is just going through a shock and what he is saying and feeling is not really him. I know its scary but give it another two weeks. In the meantime just tell him you'll support him in whatever he wants to do... I think my husband just needed to hear that as well.

[GrayMatterWife]

Two words: SLEEP DEPRIVATION!

I don't know if this is the problem, but I second MarissaNicole's intuition.

Sleep deprivation affects everyone differently. My husband doesn't cry or despair, but he becomes angry. In a very passive/aggressive way. It is really disturbing, in the same way I think that maybe an emotional breakdown might be, because it is such a radical departure from his norm. He went through a really bad bout of it during the month he was on PED-SURG in his intern year. Honestly, I thought about packing up DS and going to stay with my folks, just so that he would be awful, alone, without feeling guilty about being so crappy.

But, that being said, your husband's sounds very severe. I've known one other resident (I'm sure there are many more) who struggled the way your husband is. I don't mean to be alarmist, but the resident ended up trying to harm him/herself. I strongly encourage you to help your husband seek out some professional help in addressing this. He most likely CAN handle residency, but he needs the tools--whether there are pharmacological, therapy, or whatever--for doing so.

Can he take a leave of absence or quit and then return or re-match later? I missed what your DH's specialty is. Some specialties--in all practicality, no. For example, if you quit NSG (my husband's specialty), I really can't image that you could return or re-match in that residency. But, you well may be able to take a break then re-enter into another specialty. However, I would caution you against framing this as a situation of getting into a "easier" residency. Honestly, I knew a BRILLIANT woman who matched into what folks might consider an "easy" specialty for residency, and the program was so demanding and the patients were so needy that she nearly quit medicine after finishing. She became deeply depressed. If your husband is struggling, the issue may be more than simply the effects of sleep deprivation on his personality. He needs to figure out how to handle the stress of being a doctor, rather than figuring out how to be a doctor in a less stressful specialty, if that makes sense.

Can he do something else, other than practice medicine, with an MD? Yes. He can teach human anatomy at the junior college level. He can go into research. He can go into scientific textbook writing and editing. He can go to law school and practice med-mal or mal-defense. He can go to grad school and get a PhD. As SuzySunshine mentioned, you can work for a pharm or surgical components company as a rep or executive. I've known doctors who've left the practice and gone into investing--usually as hedge fund advisors. There are lots of options, as long as he does not want to practice medicine. You have to completely at least one year of internship (to be what's sometimes called a "doc-in-the-box") to obtain a permanent medical license.

I am so sorry you are going through this. I cannot imagine anything more unsettling in terms of the first year of residency.

[radwife]

I'm so sorry that you're going through this. I remember DH acting differently during the first weeks of residency too. He was on-call the very first night in an unfamiliar hospital with all these additional responsibilities. It's scary and overwhelming. I hope talking with someone will be helpful for your DH.

I just wanted to offer up my support. I'll be thinking about you and wishing the best for both of you.

[masked_rose86]

Hi All,

THANK YOU so much for the words of support.....I just needed to be able to hear from others experience. It scared me since as MarissaNicole said...I've always seen my husband as this person in love with medicine. I feel like in some ways I won't know him if he doesn't really continue on this path (silly I know.....I guess).

It isn't so much me giving up on him continuing, it is he that is seriously considering quitting. He is in an Internal Medicine residency. Is it really possible to rematch after quitting?? He mentioned trying for Family Practice but I don't feel like that would be that much different (plus a longer) residency.

I am somewhat annoyed too, because we reloacated to a state where my family is now over 17+ hours away for him to go to this residency. In the other state he was considering family, I'd be unlikely to find a job. I'm lucky enough to have a good, fun, full time job now in a saturated pharmacist market. I guess I will NOT worry about this now if/until it happens.

His parents are coming to be with him for the next 5 days, and it will be good to have them around to support him since I am working a lot this next week. Hopefully he comes to a conclusion that will make him happy.

Thanks so much for the support/prayers/words of comfort.

[ladymoreta]

I also want to offer my support. That is scary to think of all the medical school debt, and imagine those years and that money being useless. But like others have said, there are uses for a medical degree, and there are some very happy M.D.s out there who are not practicing medicine in the traditional sense.

But... I also think it's easy to just be overwhelmed at first. It's very good that he's seeing a psychiatrist, and like MrsK said, even if they feel your husband would benefit from medication, they will also recommend therapy. Most likely, he will learn some techniques to help him when he's feeling overwhelmed, and he will end up being a very happy doctor.

If he is willing, try to talk him into sticking with it for three more months. With an "end point", maybe he could manage the anxiety. Then, after October, if he still feels like this is not for him, he could start looking into Family Medicine or alternatives to residency.

[MrsK]

If he is willing, try to talk him into sticking with it for three more months. With an "end point", maybe he could manage the anxiety. Then, after October, if he still feels like this is not for him, he could start looking into Family Medicine or alternatives to residency.

This is a good idea. I do this in other areas of my life it works really well.