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Caring For Ourselves

This is a reprint
of the 1995
Stanford Medical
School convocation
speech, presented
at Stanford
University School
of Medicine, Stanford

Dr. Lawrence is
now a resident in
internal medicine
at the University
of New Mexico in

Dr. Lawrence's speech
can be heard through
MedWorld Radio.

By Liz Lawrence, M.D.

  Hello and welcome to Dean Bauer, to the deans and the faculty of the medical school, to the friends and families of the graduates, and, of course, to my fellow graduates. On behalf of the class, I would also like to extend a particularly warm welcome to the staff of the Office of Student Affairs, without whom the class would not have made it through medical school orientation, let alone through medical school.

  I am tremendously proud to be here today as both a graduate and as the speaker for the class. Graduation from medical school is a major passage in each of our lives. It marks the culmination of years of graduate study, the recognition of a long-aspired-to goal, and the final gathering of our class before we depart for new places and new responsibilities.

  Today is also a time to reflect on the different paths we each took to arrive at this point. My path was perhaps a bit more circuitous than most, and I would like to tell you some of my story today. I do not often reveal this part of my past, but I do so now in the hopes that there are lessons in it that apply to all of us. In 1984, at the age of 21, I was voluntarily hospitalized for depression at a private New York City psychiatric hospital. It was very disturbing to be a patient in that setting. I remember seeing other depressed patients withdraw to their rooms, unable to muster the energy or will to interact with those around them. I recall being frightened by my loss of freedom to come and go as I pleased. I worried that my friends and colleagues would always judge me harshly for having been hospitalized for depression.

  During my training to be a doctor, I have often felt that I needed to keep my history of depression hidden. I believe, however, that keeping this part of my past a secret has only lent support to the notion that mental illness is something to be ashamed of and to the misconception that it reflects a weakness in one's character. Today, I discuss my past with you for three reasons: to challenge these stereotypes about mental illness, to remind ourselves of our own vulnerability, and to encourage all of us to take care of ourselves

  It is easy to believe that our new title of M.D. will protect us from the diseases that affect our patients. This distinction between what can happen to us and what can happen to them pervades medical care, but is greatest when we discuss mental illness. Perhaps it is too terrifying to contemplate the loss of control that comes with a psychiatric illness. Perhaps it is too upsetting to be labeled a psychiatric patient in a world in which that term is fraught with negative connotations. Perhaps it is too confusing to be afflicted with a disease as poorly understood as many of the psychiatric illnesses. Today, however, even as we become doctors, we remain vulnerable to both physical and mental illnesses.

  A young pediatrician I knew - a woman who graduated from Harvard Medical School and who completed her residency at University of California, San Francisco - recently killed herself. I did not know her well enough to know any of the details of her depression. Her death, however, raised many questions for me. Would her pain have been eased if she felt comfortable talking openly of her depression? Would she have felt less isolated if others had shared their struggles with her? Are we prepared to recognize the signs and symptoms of depression in our own colleagues?

  This doctor's suicide, the questions it raises, and my own experiences with depression lead me to conclude that we are all vulnerable to the illnesses that face our patients. We can, however, reduce the severity and consequences of these illnesses by taking care of ourselves. I don't mean simply by eating right, sleeping well and exercising regularly, for surely these are goals that elude most interns. I mean that above all we should recognize our own vulnerability - that we have needs and weaknesses that sometimes may be as pressing as those of our patients. On those long and frightening first nights of call, we will need to remember that we are not the first interns to feel overwhelmed. We need to reach out to others and to enjoy relationships and activities outside of the hospital. We also need to support each other during the tough years ahead - to endeavor not to judge each others' shortcomings and to recognize those in need of an extra hand.

  It has been eleven years since I was hospitalized for depression. During those eleven years, my life has changed tremendously. I have managed a New York City bookstore, worked in public health in New York City, and, of course, attended Stanford Medical School. I have been happily married for almost seven years, and this year my husband and I became the proud parents of a baby boy. Perhaps the most dramatic change comes today, as I take that final step from patient to doctor, from one in need of care to one who will deliver care. I hope that I will always remember that I was a patient before I was a doctor, and that I will surely be a patient again someday. If each of us can remember that we are susceptible to the hardships that confront our patients, and if we can avoid judging our patients for the illnesses they have, I believe that we will be not only caring physicians, but also physicians who have the strength and wisdom to care for themselves.

Thank you.

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