as(i)am ;

Hope is something that helps us live on 

Hope gives us the strength to persevere 

Hope makes us believe "everything is going to be okay" 

Hope forms the light at the end of the tunnel 

“Deep into the darkness of night, when the cicadas hummed and crickets chirped, my mother entered my room, tenderly kissed my cheek, and told me that the time had come. I promptly got out of bed, gathered the few possessions I could carry, and began trekking to the Long Hai Sea. The fierce jungle heat made the escape that much more difficult. Fear consumed me as my heart thumped an unknown rhythm. Upon reaching the banks of the sea, we climbed into the boat and took off. I took one last sorrowful glance at the country that had nursed me, wondering if I will ever be able to return, but as I gazed into the horizon, a sense of hope and optimism for the future eased my pain." 

This was the story my mom had told me countless times of her escape from Vietnam during the Communist takeover. The story, however, does not simply end there. What happened to her after she fled has made me deeply admire and respect her. Her strength, determination, and hard work have become principles that I strive to live by every day. 

"When I first arrived in America, I was filled with optimism of a life better than the one I had left behind. However, that optimism was quickly replaced with fear and intimidation. How am I ever going to be able to lift my head up? How will I ever make it in this country when I don't know a single word of English?" 

My mother recalls the intimidation she felt when she stepped onto American soil not knowing a single word of English. She was able to find a job as a typist, but she knew this was not what she wanted to do for the rest of her life. My father reassured her that she could make her future brighter by attending college and learning English. So that was exactly what my mother did. She went to a community college, while my father worked day and night as a janitor to pay for her tuition. My mother struggled with English, but she never gave up. She dearly wanted a better life for her future family so she did all she could to learn the language. Her excellence in college led to a scholarship, which enabled her to achieve a master's in electrical engineering. Shortly after, she began working for NASA. 

Sunday, 2016.   

The clock struck 7:15 PM; and my phone screamed September 18th.  The Texan air was particularly soft that evening: Light clouds dissipated into my skin as my mind --unguarded-- sat on the dining table.  

Crunch crunch.  Leftover BBQ. 

Splish splash.  The fountain in the backyard pool. 

Buzz buzz.  A message from her. 

“At your earliest convenience, call me.  I have something to tell you.”

Ring ring. I dialed. Pthu pthu. She spit dark, piercing lyrics on my thoughts: “He… committed... suicide... yesterday.” 

A brief but shattering silence ensued.  I fell into an emotionless abyss of pain. Emptiness soon engulfed this hurt: And in the following months, I felt dull.  My skeleton was shaded in gray.  My fingers wrestled with gravity.  My legs were constantly grasping for air. My body was glued to a bed of loneliness. 

Life was motionless--I swam against still current.  I curled up in bed and attached myself to the comfort of gray.  I housed many thoughts; yet too little emotions.  Throughout the day, my worries fragmented into glass pieces that pulled me away from reality.  It all felt like a dream. 

The pressures finally collided: Anxiety began treading in air. 

The stress of relocation.  The distance away from family and friends.  The long classroom hours.  The heavy workload from grad school.  The fear of failing. The fear of disappointing.  The shame of weakness.  The death of a friend. 

My soul was stretched and both arms reached towards a string of contrasting ends: The emptiness of the present and the fear of the future.   

Stretch stretch.  “Was there an end?” 

No.  The darkness tempted--mercilessly. 

Yes.  My soul begged--mercifully. 

My hands crawled towards the weapon. 

Ring ring. I dialed. 

You have always tried to be a good student, a good friend, and a good son/daughter. But, somehow it's never been enough. It's not enough to just be a good student with decent grades, no you have strive to be the best of your class. 100s on every test, 2400 on the SAT, heck even skip ahead a few classes in math while you are at it. Get into medical school, law school or engineering school. But that's not enough, you have to go to the best...Harvard, Yale, MIT.

You're tired, burned out, constantly ridden with anxiety, but you drop everything for your friend in need to offer a shoulder to lean on. 

At home, you're expected to help out with cooking, cleaning, and caring for your younger siblings and elderly grandparents. But that's not enough, you also have to spend weekends helping out with the family business. 

Your school work piles up, your friends are always asking why you won't come out with them, and your parents are unhappy with your lack of familial duties.

The second time I thought about suicide, I traced the lines running across my friends’ arms. Like railroad tracks, she said. Bullshit. It’s like the Grand Canyon. Except I didn’t have to be in outer space to see the scars. You were 16. 

I have thought about suicide hundreds of times since then. But when I am thinking about suicide, I don’t think about the word. Instead, all I feel is tempted. Because it would be so easy. Because the possibility of suicide was so real I could only pray that my friend would survive. I was helpless. That feeling of helplessness, that's why I am in medicine. 

I have never come close to acting on that temptation. But maybe you did. Maybe you acted on it a dozen more times since our friendship was cut like the skins down your arms. Before I decided to write today, I remembered the times I imagined my last, great moments and what I would do. Instead of the glory moments of my childhood where I was a hero saving a child from getting hit by a truck or stopping an airplane hijack, I was alone. I was in my room. And no one was there to talk me out of it. 

Sometimes, I would fade away as I watched the blood flow out of me, weapon in hand. Mr. Y with the knife in the bathroom, I would think. Because why live? I would remain fixated on the blood until, slowly, there was no more blood left to come out of me. Other times, I would imagine time pass by as I wasted away in my bed. Apathetic. Emotionless. Gone. And because no one cared, I would die because even if I decided that I cared about myself, I couldn’t care enough to save myself. All in my dreams. 

Most times, I would end up imagining the notes I would write to the people I love right before I killed myself. I could imagine myself writing feverishly in the middle of the night to each one of my friends. Sometimes during class, while everyone was listening the professor, I would go over the last words that my friend sitting next to me would read. “Don’t remember this me. I know I promised, but I am sorry I won’t be able to spend more time with you.” 

On October 1, 2016, APAMSA held their annual National Conference. In conjunction with the new APAMSA Mental Health Initiative, this year’s theme was “Promoting Wellness from Within: Caring for Ourselves and Our Communities”. We focused on ways in which healthcare students and practicing providers can care for their own mental well-being throughout their lives and careers.

As part of the National Conference, we held an essay competition asking two questions related to mental health. Thank you to everyone who participated. There were great essays all-around. Check out the two winning essays below and start thinking more about mental health!

Question 1: How does a healthcare provider/student’s mental well-being affect a patient’s health? Provide an example (can be from your own experience or fiction).

Winner: Victoria Sun, MS2 David Geffen School of Medicine at UCLA

Many healthcare providers often overlook their own well-being because they are so preoccupied by their packed schedules. A study in 2015 by the Mayo Clinic showed that over 50% of physicians admit to feeling burnt out and that 40% screened positive for depression. Although the issue of physician burn out has recently been gaining more attention in medical schools, our healthcare system has had difficulty changing the demanding culture in hospitals. A major barrier to responding to cases of burn out has been the physician’s contradiction between acknowledging one’s limits as a provider, and the perceived responsibility to be regarded as self-assured and caring.

Acknowledging compassion fatigue or suicidal ideations might damage the relationship physicians have with their patients. For instance, during my first year of medical school, I noticed that standardized patients primarily gave feedback regarding how the student made them feel. Patients seem to expect physicians to be empathetic but remain collected. I have found that when I show too much emotion or nervousness, patients lose trust in my decisions. A lack of trust might result in the patient not believing that my treatment suggestions will work, and the patient’s health may suffer as well. Thus, the physician’s self-confidence and ability to communicate effectively with patients are crucial to improving patients’ health outcomes.

Physicians need to maintain composure and their patients’ trust, but remaining silent about the prevalence of mental illness and fatigue among the medical staff will only worsen health outcomes. A 2016 article in Health Affairs reports that mental illnesses are the most expensive medical condition in the US. Lost productivity contributes most to indirect costs. Burnt-out physicians are less efficient and enthusiastic towards their work. Physicians might feel unable to go to work or relate to their patients. Medical schools and hospitals need to understand why burn out happens and prevent physicians from reaching that point. Physicians need to meet many demands and easily forget to take care of themselves. Nonetheless, physicians must keep reminding each other and themselves that if they want the best for their patient, they should be mindful of their stress levels and mental health.  

Question 2: Describe a way students can promote mental health and awareness in the healthcare community.

Winner: Jiaqi Li, MS1 University of Maryland School of Medicine

As part of Healthy Choices for Baltimore, an initiative in which medical students teach grade school kids about health and nutrition, our goal is to not only focus on telling kids to eat fruits and vegetables, but having them understand how to lead a healthy lifestyle. On my first trip to Midtown Academy, one of my co-teachers asked the class what being healthy means. The answers ranged from “not being sick” to “eating apples” to “running a lot.” I also asked if they thought that being healthy included being happy. Among a chorus of ‘yes’ and ‘no’s I realized that everyone, from a young age, is taught that health is almost entirely physical. I told the class that they were forgetting something very important: that being healthy included mental aspects as well, or how we feel and think.

From my personal experience, colleges and medical schools are currently incorporating mental health into aspects of campus and student life. Many of my friends worked at the counseling call center at the University of Maryland, College Park, and there was a plethora of pamphlets, social media notes, and word of mouth that made this service known to the campus. What I’m less sure about is the promotion of mental health in younger generations, and I think that’s a great place to foster an understanding of mental health.

At the University of Maryland, School of Medicine, every medical student takes on a service learning project as part of their medical curriculum. A vast majority of these projects include teaching or mentoring younger students in the areas. I think that one simple but effective way to promote mental health and awareness is for us, as medical students, to emphasize mental health when the topic of health in general arises. In tutoring or mentorship programs, medical students should make an effort to ask students how they’re doing, how they feel, and enforce the idea that while academics are important, so is how they’re feeling or what they’re thinking about. Students can also create their own initiatives that bring psycho-social activities, stress-reduction programs, and mental health education to different schools and organizations such as YMCAs and Boys and Girls Clubs.

Within our own graduate student community, I think the idea of a peer counseling call center would be extremely beneficial. Sometimes it can be difficult to talk to an actual counselor or psychiatrist, due to scheduling, paperwork, or apprehension. An anonymous call center run by trained graduate students would allow students to simply call and talk to a peer about any problems or issues they might be encountering. Often times, a peer can empathize more than a professional.

From an anonymous medical student answering “What you would tell someone who is struggling?”

June is here! You know what that means! This month's social media challenge asks, what would you tell someone who is struggling right now?