By Mohini Dasari, MD

My experiences with mental illness have been intimately tied with my experiences of being a surgical trainee. If you read my medical chart, you will see diagnoses like postpartum depression, generalized anxiety, and adjustment disorder. If you read my residency rotation reviews, you will read descriptors like “hardworking,” “reliable,” and “good team leader.” You would not guess that I almost quit residency less than a year from graduating because I had crippling depression and found no joy in anything. Fortunately, a friend and a mentor suggested that something else might be at play and encouraged me to seek help. But the worst was yet to come.

The first three days of transplant surgery fellowship, I missed my toddler’s bedtime, arriving home after 10 p.m. each night. My husband’s eyes were sad and concerned as I told him about the cases I did, how rounds went, how I didn’t have time to eat. He wondered if this would be our life for the next two years. Wasn’t fellowship supposed to be different from residency? I reassured him that not all days would be like these ones. When I asked my program how to cope, they suggested I ask my husband to keep my daughter up until 9 or 10 o’clock when I arrived home. I chose not to do that.

The seven months I spent in fellowship were the worst of my life. I felt passively suicidal on many a 2 a.m. drive home from a case where I was barely taught, not allowed to do much, yet reprimanded for the little I did do. Transplants are beautiful operations that change human lives, but never had I ever felt so dehumanized. As an antidote to my loneliness, I craved mentorship and community, which I had in residency. The isolation made me incredibly depressed. My physical and mental health, self-esteem, and marriage suffered so much that I was not sure any of it would recover even if I did leave.

Some readers may wonder why I chose transplant, given its demanding reputation. I loved what we offered patients, thought carefully about the decision for two years before applying, and was mentored to believe that I could do it. I voiced concern about being a woman and an expectant mother, but was reassured that if I really loved it, it was possible. I severely underestimated the damage of long days that bled into nights, emotional isolation from my colleagues, and distance from my family. I engaged in therapy from my office weekly via Zoom. I always hoped the walls were soundproof because I was usually crying hard. Occasionally, I would have to leave a case briefly for an appointment. One attending gruffly remarked, “I usually reschedule my doctor’s appointments around cases.” I was so depressed; I didn’t care that he was reprimanding me for leaving the OR. I asked a resident to cover for me and ran to my office, thirsty for therapy. My therapist was by my side through the toughest months of my life. Thousands of teardrops later, I realized that leaving was the only way out of the darkness, other than death.

“I might need to leave,” I breathed through my mask into the air between us. We were doing a kidney transplant, and it was going well. The attending was letting me lead portions of the operation, my confidence was flickering, and I felt closer to happiness than I had felt in a while. I glanced over my bright pink surgical loupes at their eyes, which were fixed on the iliac vessels calmly flowing below us. Nothing was happening requiring our immediate attention, so I wondered how they were going to respond. “No, you’re not leaving,” they said matter-of-factly and continued operating, as if nothing had happened.

The concept of leaving, which was daunting even up until the day I resigned, felt more realistic after my conversation in the OR where I broached the subject of leaving. The brevity of their response left me feeling hopeless. Instead of engaging in further conversation, they ended the discussion. My statement was my vulnerable cry for help, which went unanswered. It had the opposite effect; it solidified my conviction that no one would care if I did leave or try to make me stay.

A mentor counseled me to use the word “leave” instead of “quit” when delivering my resignation. I feel empowered by the concept of leaving rather than quitting. To me, quitting implied failure – as if I wasn’t strong enough to finish fellowship. Leaving implied a well-thought-out choice. Which it was. But in the months that led to my departure, I didn’t feel empowered or brave. I felt scared, depressed, and frustrated, with many things, but mostly with myself. This is what medical training, especially within academic and demanding environments, does to us: it makes us feel inadequate if we cannot conform to the set standard, even when the standard requires that we put everything and everyone above ourselves. Attendings, residents, fellows, scrub techs, nurses — we are all tired cogs in the same antiquated wheel. If one happens to possess one or more marginalized identities, then it really is death by a thousand papercuts.1

My message is not that transplant surgery is a bad field, or that someone considering a career in medicine should not. My message is this: the cumulative effect of sleep deprivation, irregular meals, missed bedtimes, and family dinners should not be underestimated. Mental illness, substance use, and suicide are all within the realm of possibility. The stress almost cost me everything.

The saddest part about leaving is that I loved transplant surgery up until my very last day. I loved the operations, the intricate anastomoses, seeing the organs reincarnate with reperfusion, and most of all, how patients can flourish afterwards, in body and spirit. I developed close relationships with several patients and families, which gave me a sense of purpose going to work, even while struggling for my own life.

I am still grieving the loss of a subspecialty that I truly loved. I just didn’t love it enough to irreversibly destroy my mental health and my family. Perhaps one day each of us can pursue the specialties of our dreams without having to make that choice. That time is not now. Until then, I am here to tell you that you are allowed to leave. It is not our job as trainees to fix all the issues with training environments we find ourselves in. Certainly not at the cost of our mental health, our families, and our peace of mind. As someone who almost lost everything I hold most dear to me because of the training environment I found myself in, I can firmly say that no specialty is worth that price.

I can see my scared former self scrubbed into that kidney transplant, anxiously awaiting a compassionate response about needing to leave. Since leaving, I have been working on redeveloping self-compassion. To help me with this, I imagine younger versions of myself as my daughter. I look at my beaming two-year-old, and I tell both her and me this: The opposite of leaving is arriving. You can arrive at a place of well-being, love, and new possibilities. You can be happy. It will be OK.

Mohini Dasari is a general surgeon.