Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Lena Liu, MD, a Neurology resident at Mass General Brigham. 

If you were to pass me on the Pike at the Brigham or meet me in the Bigelow inpatient floors at Mass General, you would likely take in my white coat and see me as a confident physician who belongs here. And today, I know that I do. But this month, as medical students receive word on where they have matched for residency, I think back to the start of my intern year in the joint neurology residency program at Massachusetts General Hospital (MGH) and the Brigham, and to a time when I was inundated with the overwhelming feeling of imposter syndrome.

What a monumental day it was supposed to be: the very first day of intern year at the famous MGH. The day we became real doctors on the wards—no longer inquisitive medical students, but rather physicians putting in the orders ourselves now. The beginning of a year to be filled with learning and growing. But how could I learn when I was already overwhelmed? I felt like I did not belong here. I couldn’t help but compare myself to my standout peers, the majority of whom graduated from prestigious medical schools. I had come to MGH as a graduate from Hofstra Medical School, and in my eyes, I did not measure up. During orientation, our program director Jay Vyas, MD, PhD, said, “Don’t compare your insides to other people’s outsides,” a quote I had never heard before. There was also the residency mantra, “Never worry alone,” which was repeated at least five times every day. But strangely, I felt alone and isolated from my peers.

My imposter syndrome became so intense that I questioned every order I wrote and every medication I prescribed. It was eating away at my very core, viciously spiraling into generalized anxiety disorder (GAD), and then before I knew it, into major depressive disorder (MDD). When the first symptoms of GAD appeared, I thought, “Huh, I remember learning during med school that symptoms of anxiety can present as physical manifestations when severe enough, but I never thought it could happen to me.” What I quickly learned was that I was not immune to the destructive potential of anxiety and depression. In fact, I let both take utter control of every part of my life. Before I knew it, I had full-blown psychiatric symptoms that impaired my everyday functioning. It became so overwhelming that I wanted to quit my job. I didn’t think I was cut out for being a doctor. Not only that, I thought I was a bad doctor. I thought I would harm patients if I continued to care for them in my current state.

It was truly my nadir, and thankfully my guardian angel identified that something was wrong and reached out her helping hand. Meridale Baggett, MD, was my attending on the Bigelow at the time, and she also happened to be the Associate Program Director for Wellness for the MGH Internal Medicine residency program. She recognized my pain and encouraged me to seek professional help right away by contacting the Employee Assistance Program (EAP). The EAP provides an acute bridge by pairing employees with a counselor while awaiting more formal psychiatric care with a therapist or psychiatrist. I went to the counselor at EAP for a couple of weeks and required further care and treatment. Thanks to Meridale’s immense devotion to my case, she helped me get into the Harvard Medical School-affiliated psychiatric hospital, McLean Hospital, for their outpatient behavioral health partial (BHP) program.

I put my full trust in my psychiatrist, Efrat Shavit, MD, and she started me on several psychotropic medications, not only to combat my severely debilitating anxiety and depression, but to also work on my sleep. It was the first time in those past two months that I was able to get more than four hours of sleep at a time. When my sleep-wake cycle became more regulated, I felt like I was being reborn. With some shut-eye under my belt, my mood symptoms became more manageable. I was starting to get the hang of it, and I began to apply what I had learned during the two-week McLean BHP program to my everyday work life.

In my early stages of recovery in late March 2020, I was re-introduced and re-acquainted with the Bigelow inpatient floors. Coming back during the COVID-19 pandemic helped me prioritize my health — as others called out of work for new COVID symptoms, I called out for mental health reasons. This allowed me to work on my mood symptoms without my residency program knowing the reasons for my absence. I was embarrassed to admit that I needed time off from work, but in hindsight it was the best thing I had ever done for myself. Slowly over the next few months, I began to feel like I could really be a physician again. I was so grateful that I was experiencing emotions like true happiness and joy again.

Although the roller coaster of life brought me plunging to my rock bottom, it also let me rise out of the depths and into an exciting new chapter. Today, I am in my third year of residency at the Brigham and Mass General, and I am spearheading a Mental Health Committee and planning other initiatives for the Mass General Brigham neurology residency program. By sharing my mental health journey, I hope to help pull at least one other soul out from their own rock bottom. I want to pay it forward by raising awareness and destigmatizing what I have since learned it is very common for new residents to go through—burnout, imposter syndrome, anxiety, depression—the list goes on and on. Unfortunately, feeling drained at some point during our careers is an innate part of our profession. We constantly want to help others, but we often forget to help ourselves first. What I went through during intern year does not make me any less of a doctor, or any less of a human. In fact, going through my personal hell has made me feel the most human I have ever felt in my life.

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