Truthspeaking

The Roots of My Disillusionment

The Johns Hopkins University, Baltimore, MD (photo by author 12/09/2015)

After the breakup of my first and only engagement, I couldn’t sleep. Everything I imagined my life would become… was over. And the economic ground under my feet collapsed. A well meaning doctor diagnosed insomnia and put me on zolpedim. It took 15 years to stop.

During my third year of medical school, my hands started shaking. Working inhumane hours while being “pimped” by superiors in a circle of intellectual competitors was wreaking havoc on my self-concept. I was diagnosed with essential tremor by a well meaning doctor who prescribed a beta blocker to blunt my nerves. It took 10 years to stop.

During my first year of internship, I started having panic attacks. That nauseating mix of sympathetic overdrive and existential doom colliding right there on the inpatient ward. A well meaning doctor put me on an SSRI and a benzodiazepine. “Just get through residency”, they said. It took 9 years to stop.

Before residency, July 2014.

Just getting through residency, January 2015

During my first year of fellowship, I became actively suicidal. A well meaning doctor added hydroxyzine to my growing cocktail of blood pressure medications, hypnotics, benzodiazepines and SSRI’s. I chased them down with a glass of cabernet and daydreamed about driving my car off a bridge. It took 6 years to stop.

If you look at my CV, it’s l impressive how much I was able to accomplish while killing my spirit with a million tiny cuts. Then came the pandemic.

In the trenches of COVID.

In March of 2021, I saw 588 patients. In April, I suffered a stress fracture of my right femur. A fracture of the strongest bone in the body in an otherwise healthy young adult is malignancy until proven otherwise. We checked. It wasn’t.

Evidently, 11 years of unrelenting stress and self-abandonment has a way of taking a toll. Even as an attending physician, my hip pain was misdiagnosed twice before finally being taken seriously by an on-call orthopedic surgeon. He rushed me to the OR because of impending avascular necrosis. Opiates were a godsend post-operatively and the good surgeon declined to prescribe them when it was time to stop.

After my injury, my health insurance was discontinued without my knowledge. I had to fight tooth and nail, while completely disabled, to have it reinstated. I learned, with a resilience I didn’t know I possessed, to walk again.

A disability insurance policy and reinstated health insurance kept me from losing everything.

After finally being free of toxic professional circumstances, I weaned myself off of benzodiazepines, beta blockers, antihistamines, zolpedim and SSRIs. Slowly. Over months. Without physician oversight. Because, until recently, no one thought to teach well-meaning doctors how to de-prescribe.

Now, my maintenance medications are mindfulness, exercise, diet and sleep. With a supplemental dose of hormone therapy (which I also taught myself to manage) and alcohol avoidance. I don’t advise lifestyle modifications to be condescending to patients. I say it because I understand the alternatives.

My distrust of medical institutions is just as well earned as that of my patients. The same is true of my instinct to self-advocate. But I don’t buy into the hype of the wellness movement on social media. I strongly disagree with influencer doctors who fuel the physician burnout/suicide crisis by throwing fuel of the fire of public distrust. I don’t paint all doctors with the same brush.

At the same time, I loathe what’s being done to institutional science and medicine by unqualified political hacks. But I agree with their criticism about the ubiquity of prescribing psychiatric pharmaceuticals without an off ramp. I’m a little irked to admit that I agree with the hacks on this point. I’m even more annoyed that my “side” didn’t take on this issue before they did.

This system is fragmented. If you have money, you have access to a degree of health that those without means don’t have. The wellness industry has grown up like dandelions between the gaping cracks of that fragmented system. There are flowers on some of those weeds. And some of those flowers promise to grant wishes if you blow them.

I didn’t make the rules. I’m just learning to preserve my shattered self while serving as many of my fellow humans as possible.

Recovered Ivory Tower physician practicing in Vancouver, BC.

I’ll admit that I’ve muted and unsubscribed from a number of institutionalist physicians on this platform. I’ve had other doctors treat me with flagrant condescension on professional forums. Thumping the Bible of the evidence-base feels patronizing; even for those of us who trained in the Ivory Towers. Some doctors are better than others at acknowledging the gender and racial biases that the evidence base is built on. Anyone who’s heard the phrase “Publish or Perish” understands the profit incentives behind what research gets funded. Allopathic medicine has an enormous blind spot when it comes to cleaning up our own shit.

But there are good ones among us.

The doctor in this house whose work I read every single week is Lucy McBride, MD. Her Substack “Are You Okay?” is the question I wish any of my colleagues had asked when I was in the midst of the downward spiral.

Dr. McBride has written a book, “Beyond the Prescription: A Doctor’s Guide to Taking Charge of Your Health” that you can pre-order now wherever you get your books. She’s graciously agreed to join me for a LIVE at 12pm EST/9am PST on Friday, June 19. We hope you’ll join us for what promises to be an inspiring take on the strengths and the shortcomings of allopathic medicine.

Lucy McBride, MD, is a primary care physician and cofounder of the Ackerly McBride Group in Washington, DC. For over twenty-five years, she has practiced evidence-based, relationship-centered medicine. A graduate of Princeton and Harvard Medical School, with a master’s degree in pharmacology from Cambridge. She was a Fulbright Scholar and completed her internal medicine residency at Johns Hopkins Hospital. She writes the weekly newsletter Are You Okay? and hosts the podcast Beyond the Prescription. Her work has appeared in The Atlantic, The Washington Post, and USA TODAY. She has contributed to CNN, MSNBC, and PBS, advocating for a holistic, patient-centered approach to health.