A psychiatrist working in AIIMS received ironically no psychiatric help before committing suicide on Friday. Dr Anurag Kumar knew of his own suicidal tendencies and the depression he suffered from. He wrote about it in a blog post on June 21, which has been read by nearly 700 people.
But still his untimely and unnecessary death could not be prevented. India is short of psychiatrists with just about five thousand of them in the country for a population of 137 Crore. And now the promising career of a young psychiatrist has been cut short by our indifference, ignorance and tendency to laugh at those going through mental health issues.
Here is the June 21 blog written by Dr Anurag Kumar:
I am a psychiatry resident diagnosed with severe depressive episode. While I can’t say that I have recovered completely (as of June 2020), I am far away from the clutches of extreme suicidality.
It all started in the cold days of December 2019 when I was relatively free after getting a good rank in the AIIMS (All India Institute of Medical Sciences) PG (post graduate) entrance exam. When I was preparing for my post graduate exam from January 2019 to November 2019, I had never anticipated that I will feel down after achieving ‘success’. I started feeling empty and low after becoming free from studies. My internship (last year of medical school) too was free in the month of December. I mistook my low mood with boredom and started to explore Delhi either alone or with my Mother (my friends were either in US or preparing again for AIIMS). I continued exercising and meditation which I was doing for the past few months, although they had started to feel burdensome.
While I was deliberating on which medical specialty to take, I used to have crying spells as I wasn’t clear what I wanted to do (though I was clear that I didn’t want a core branch like medicine, surgery, pediatrics, orthopedics et cetera). Finally I took psychiatry after talking to many seniors. In the end of December, I started working for a PG entrance startup called MedMiracle.
When I joined the department in January, I was elated. The department was extremely cooperative and offered excellent opportunities to learn. I, however, was having difficulties in reading books and attending rounds. I again mistook my deficits in attention and concentration with loss of touch with academics in the past one month. I used to feel lethargic and walked slowly than others which I again mistook for post-workout weakness. My self care had become poor and I didn’t bath properly as I was constantly ruminating. In the end of January, I started dating where I found an extraordinary girl with whom I went on a few dates. However my mood was deteriorating and I was having suicidal thoughts as I wasn’t able to manage Medmiracle work with Psychiatry residency. The suicidal thoughts decreased after completing part of MedMiracle assignments but reappeared again when the deadline came closer.
In February, I lost all hopes and started looking for suicide options. I considered jumping from my the tenth floor of my hostel, but was too afraid of residual paralysis if I survived. I am overweight and hanging would have been difficult with the fragile hostel fan. Finally I stumbled across a website that was providing bulk quantity poison and alas! I paid my hard earned internship money to them. I. however told a friend-cum-colleague about it who immediately got me admitted in the same ward where I was working on February 15th. I was kept there for one week where I was diagnosed with severe depressive episode and started on escitalopram. I was kept in the isolation ward hence I couldn’t communicate much with wardmates. Upon showing improved appetite and energy, I was discharged on 22nd February and was advised to recover at home. Initial few days were good, but I again deteriorated and bought shaving blades to cut my carotid on 2nd March when I was admitted again only to be discharged 45 days later in April. This time I stayed for a few days in general bed before being shifted to Isolation room, which enabled me to get a broader perspective of life in a psychiatry ward.
The life in ward before corona outbreak (India implemented a nationwide lockdown on 24th March) was pretty inclusive. All of us had to wake up at 8 am, take breakfast, go for morning activities (exercise, group fun activities) at 10 am, talk to nursing students, nurses and doctors, take lunch at 12:30 pm and dinner at 7:30 pm. Lights were shut at 10 pm in night. You get to see only illnesses in medicine ward; you get to see a mini society in psychiatry ward where patients stay for longer periods. We sat together playing games and celebrated birthdays and discharges. One of my silly pics there:
3rd year nursing students were posted for a one month rotation. I loved interacting with them. The roles had reversed; I was a teacher and they students. Many a times a used to give them homework to read about my medicines. I used to help them clear their doubts and prepare for their assessment.
In morning activities, I used to do exercises and sing songs occasionally. There were talented dancers like Prajwal, singers like Seema and chess players like Khushboo’s father. Uzair was the clown of the group, having a laugh similar to Ravan (antagonist in the great Indian epic Ramayan). In fact depression helped me in getting a break from the hectic life I had been living for the past 8 years (Pre medical days, MBBS, Internship with post graduate entrance preparation). While excelling in academics, I was ignoring my mental health. When I got admitted, the first week of admission was the first week of my life after 11th where I didn’t read any textbook/novels.
Depression gave me an opportunity to teach. I was working in the same ward where I got admitted, hence I had a good rapport with patients, especially those whom I had interviewed as a resident psychiatrist. I taught them about a lot of things including their disease, the medicine and the side effects.
My falling in depression gave me an example to teach my relatives that depression can happen without major stressor and severe depression can’t be treated without medicines. I used to give an analogy of hypertension to explain depression; both can be reduced by exercise, , meditation etc, but if it isn’t controlled you need medicines.
Depression gave me an opportunity to save a life. One of the nursing students whom I was teaching was having symptoms of depression and suicidality herself, and she then went to our OPD and showed herself.
Depression taught me a lot about the working of the ward. Earlier I just had to do sampling, talk to a few patients, get investigations done and attend rounds. Now when I was staying in the ward 24x7 (a real ‘resident’), I also appreciated the role of bouncers, guards, cleaning staff, orderly staff and of course nurses.
Depression increased my knowledge significantly. Multiple sessions with clinical psychologist, Consultant and senior resident lead to multiple intellectual debates which helped me to identify my maladaptive defence mechanisms. I got to know about multiple aspects of the drugs about whom I had read little as an undergraduate.
Depression helped me overcome a part of my fear to interact with people. In the past one month of my admission (Yes, I was that suicidal), I interacted with a lot of patients, their attendants, nurses , nursing students and improved my social quotient. I learnt card magic, played UNO after 2 years, chess after 2.5 years, dumb charades after 5 years, ludo after 8 years and antyakshari after 10 years. I spent a lot of time with my mother who is with me in the ward now. I never spend such a quality time with her during MBBS owing to my type A personality.
Of course everything wasn’t great; this is the reason I was kept admitted in the ward for so long. I was extremely suicidal; I did a thorough Reiki of the ward and when I wasn’t able to find any loopholes, I tried to smuggle scalpel in ward by befooling a junior. I tried to smash the mirror of Doctors’ Duty Room, whose password was changed due to it. I had multiple reasons not to live (which I later wrote in an article) forcing my psychiatrist to add Lithium and Aripiprazole to the regime.
Post Lockdown, the number of patients reduced from 31 to just 8. Nurses stopped coming and many of my friends went back causing significant distress to me. The number of people who came to meet me drastically reduced, causing a feeling of boredom. Morning activities were stopped to avoid a large group in one room. I had my mother however as my strongest pillar of support.
Finally the day of discharge came. I distributed chocolates in the ward and resumed my duty the next day, resuming my role as a doctor back. Although I missed multiple academic activities and OPDs, I am sure that my experience in ward will help me become a better psychiatrist.