She introduced herself but I still wasn’t able to make eye contact with anyone, so instead I traced the patterns in the carpet with my eyes until they crossed and I made myself nauseous. Those days I was nauseous more often than I wasn’t. I was four months pregnant, and I was newly unemployed.
“Are you taking any medication?” she asked.
“I’m on 150 mg of Zoloft,” I said to the trash bin by her desk, “My doctor increased the dose last week. I was on 100 mg daily.”
“Have you noticed any improvement?” Her voice was even and neutral. To her, there was no shame in this interaction. Today was just another day at work.
“I’m not crying as much. I just don’t feel anything. I guess that’s better.”
She did the thing where you allow for silence. The patient is then supposed to feel compelled to begin the conversation. It offers a starting point for the interviewer. I did it with my patients when they came in with bizarre, non-specific complaints and all the tests are negative. They look nervous. They avoid eye contact. I tell them, “I believe your abdominal pain is real, but we haven’t found any source for it.” Then I ask them what they think could be causing the problem.
Then, silence. The silence usually provides the answer.
“I don’t really know what to say. I’ve never been to therapy before. I don’t have any previous psychiatric history—well, no official diagnoses. I’ve had irritable bowel since I was a teenager, but I’ve made accommodations for it so it doesn’t interfere with work. I had what I now think was a depressive episode that lasted six months during my first year of med school, but it’s med school. Everyone is depressed in med school.”
More silence. Even her facial expression was neutral.
“I’ve never been on medication before. I know it’s supposed to take six to eight weeks to kick in, so I’m trying to be patient. I’m just used to working. I’ve never really taken time off before.”
There it was: the jump-off.
“How do you feel about missing work?”
My face warmed and I could feel my vision blur with tears. I fought it, but one managed to escape. I hated crying in front of people.
“I feel…guilty. I had whooping cough during my surgical ICU month and I still went to work. I would cough until I urinated on myself, but I still showed up. I lost my voice the day before one of my patients coded, and when we were doing CPR I could barely whisper out orders to the nurses. Thank God my co-intern was there to help me. It’s for the best anyway, I had no idea what I was doing.”
More neutral-faced silence.
“There’s no reason to not go to work when you’re an intern. Everyone is stressed. There’s plenty of research that shows that a large portion of interns have depression. They still manage to work.” I could feel another tear making its way down my cheek. I was weak, and it disgusted me.
“They ended up doing a bedside sternotomy, but they couldn’t restart his heart. I had never seen a heart so bare and out in the open like that…it was just quivering in his chest. I know the cardiothoracic fellow thinks it’s my fault because the patient wasn’t on blood thinners, but he didn’t tell me to put him on blood thinners. I had never managed a patient post-cardiac bypass surgery. Anyway we don’t even know if the patient had a clot or a bleed, so the blood thinners could have made it worse. That fellow was such an asshole…I had only been a doctor for five weeks…”
She hadn’t written anything down on her legal pad, which I found comforting. The patient dying was sad—it was my first kill—but that’s not why I was there. I didn’t know why I was there. I was an intern in emergency medicine: patients die all the time. There are precious few true successes. In the ER, you’re a soldier going down with the Alamo, especially in the county hospital where I was in training. The injuries sustained by my patients from poverty, addiction, and racism happened long before I saw them, and would most likely be waiting for them outside the hospital doors.
She asked me a few more questions about work. I knew my obstetrician must have mentioned it in the referral note. When I went in for an unscheduled clinic appointment the previous month, crying and anxious and ashamed, I confessed that I had thought about killing myself but didn’t want to burden my co-interns with my shifts. Apparently, that sort of thinking is maladaptive, because she then made me take a leave of absence, started me on antidepressants, and sent me to the counselor, where I sat staring at my swollen feet.
I didn’t notice the depression at first. I just assumed the complete lack of energy was from the pregnancy. When I started fainting at work, I assumed it was from all the vomiting in dirty hospital bathrooms that smelled of blood, urine, and sweat. When I started to think the attendings were talking about me behind my back, I didn’t think I was being paranoid. I thought they talked about how I was stupid and worthless because I was an intern and I assumed I actually was stupid and worthless. When I started crying for hours on end every time it rained, I thought it was because I was pregnant, I was an intern, and I was stupid. It made perfect sense at the time.
When I started fantasizing about driving my new car off the overpass, however, I figured I should check in with someone.
“Was this a wanted pregnancy?”
“Yes, we were trying for almost two years. My husband and I both come from big families, so we want a lot of kids. I was going to wait until after residency, but there are so many stories you hear about women waiting, and then waiting until after fellowship, and then after they start their practice—they end up spending thousands of dollars on IVF to have one child.”
I could feel her looking directly at me while I looked at my hands lying purposelessly on my lap. Her gaze made the back of my neck hot and cool at the same time. I hated anyone seeing me like this. My clothes, my words, my movements were always meticulous. Precise. Impactful. My father raised me to be a diplomat, a leader, an activist. My mother raised me to be a gracious hostess with perfect style and a warm demeanor that puts everyone at ease and keeps them engaged and entertained. This was their hope for me. This was their expectation—and I always delivered.
When the depression hit, I couldn’t put on my makeup or get dressed. I stopped bathing. I couldn’t even garner up enough energy to slip into my scrubs for work. I could only lie in bed and stare at the ceiling until it seemed like it was shaking and spinning and would fall on me at any minute. I couldn’t take all the voices trying to get to me. Texts, phone calls, and invitations went unanswered. I uninstalled Facebook from my phone and avoided reading the news. And, eventually, I couldn’t stop crying long enough to go to work. I never thought about the baby. I only thought about dying.
We talked about work and my marriage. We talked about my family. She asked about my hopes for my future, but I didn’t have any.
“I’ve gotten on the wrong flight, and I can see everything I used to be getting smaller and smaller and then disappearing completely. Now, I’m just a passenger. I know where I’m going, but I’m not the one piloting. I just sit and wait. I look out the window. I hear the engine. It gets louder and louder until I can’t hear anything else, not even my own thoughts. I’m a body floating through the air.”
Now, she began making notes. I couldn’t see anything now, only my own tears.
“It’s weird, because when I was a teenager I did exactly what I wanted. I didn’t care about peer pressure or anything like that. I said what I wanted, dressed how I wanted, did what I wanted. At fifteen, I was completely free. My Dad was travelling a lot for his job and my mom was getting through a master’s degree. They were busy and left me alone. I liked being alone. Then I got into medical school and moved back to Houston after college, and all of a sudden I was never alone. I think before I was just a kid so no one really paid attention to me—I’m one of five kids, you know? There were too many of us to expect to get individual attention or anything. When I moved back after college…It’s like—I’m a first generation American, and I have a whole community of people expecting me to play the role.”
“What role is that? Who do they want you to be?”
“You know: perfect daughter, perfect wife, eventually perfect mother. I’m supposed to do all this while outcompeting everyone in medical school and residency. I have to look good and dress well but still be humble. I have to be the ideal representation of a Muslim woman. I have to make good on my parents’ sacrifice. But it’s not just my parents—I’m everyone’s golden child. Even my friends—I’m really their friend. I support them and boost their confidence. I console them and entertain them. I don’t have anyone that I talk to. I don’t even really have anyone that I have fun with…”
Not only was I weak, now I was self-indulgent. I felt ugly and had a strong urge to hide my face.
“I’m sorry—I know this is the point of meeting with you, but I’m not used to talking about myself this much. I sound like a child. These are not real problems. There are people dying in Syria right now—shit, there are people dying in Chicago! I don’t really have any problems. I don’t know what happened. My brain just broke. My husband is great, my family is great, my friends are great, work is great. This is all neurochemical. There’s no reason why I want to die. It just seems like I’m eventually going to die anyway, why bother with putting it off? Why spend all this effort moving from one obligation to the next?”
Her face finally made an expression.
“What I’m hearing is that you feel your life has been decided for you. Do you feel as though if you didn’t perform for everyone, they wouldn’t love you?” She was beginning to formulate the stereotype in her mind: another one of those perfectionist girls who throw up after dinner and color-code their notes and have hourly itineraries on vacation. Except I wasn’t—not really. I was a woman who liked traveling alone. I liked seducing strangers on the street with my eyes until they blushed and I knew they would think about me when they were alone. I liked wearing heels so I could make other women feel small. I liked the way I looked after sex when my eyeliner smeared all over my face like war paint. I was a bitch pretending to be the mother of Jesus.
“What would happen if you stopped doing what was expected of you?”
The thought never even occurred to me. I looked at her, finally, completely confused.
“When was the last time you felt like you could be yourself?”