Surgeon Shares Burnout To Suicide Story To Take Away Stigma

Transcript

CONTENT WARNING: A head’s up we mention suicide in this episode. The National Suicide Prevention lifeline is 988.

Problem Solver

Mike Ivy takes great joy in solving problems. As both a trauma surgeon and a hospital administrator that’s what he’s often called to do.

There's like we're not administering DVT prophylaxis the way we want to or the patients are getting too cold in the O.R., or we should be feeding them differently, being able to look at that, identify the system error and find a fix. 

Mike first became aware of his ability to solve problems 20 years ago when he was a young trauma surgeon at Yale New Haven. He recounts the tale on a recent panel about learning from mistakes. He says he was about to operate on a high school soccer player who had been kicked in the side and burst his spleen. Nurses prepped the boy for surgery. Mike was gowned and ready to go. It was the kind of situation where every second counted but someone stopped him.

Anesthesia says, ‘wait we don’t have any blood in the room.’ I’m like what do you mean we don’t have any blood? We just need O negative. They’re like, ‘the blood bank’s a 10 minute walk. The guy’s not here yet.’ My hair’s on fire, right? I’m doing everything I can for this kid. He’s not dying in the moment but he’s close. I know he’s close. I’m like ok ok it seemed like it took forever.

The blood finally did arrive and Mike was able to operate and save the kid. But he knew the hospital got lucky that time. So Mike decided to do something about it. He put together a committee to solve the blood problem. And after eight months of going through the proper procedures the hospital installed refrigerators in the operating rooms, so there would always be a blood supply immediately available. 

I really felt good about making a difference there.

But years later when he couldn’t figure out how to fix his own personal problems, he nearly ended it all. 

This is a story about how Mike’s own crisis led him to confront the larger systemic mental health problem pushing millions of health workers to the brink. 

This is 2 Lives. I’m Laurel Morales.

Sign of Weakness

Mike Ivy grew up on Naval bases. His dad was in the nuclear submarine community. At the time a mental health crisis was seen as a sign of weakness.

There are people who struggled. But it was very hushed You know, if it was the sailor or it was their spouse, I mean, it was just talked about as if it was something that shouldn't happen to you. It was all very kind of secretive. 

When Mike was 10 his dad almost died of an acute perforation of his colon.

My mom was worried. Our neighbors were worried. I mean, it was … 50 years ago and health care was not what it is today. 

But a doctor saved him. And when Mike saw what a surgeon could do, it never left him.

I was just amazed at the ability of a surgeon to kind of change people's lives.

He decided then and there to become a doctor. 

After college Mike joined the Navy to pay for medical school, but the stigma surrounding mental health hadn’t changed much. 

By the time I was on active duty in the late eighties and nineties, people recognized that PTSD was a thing and it was a thing that was not avoidable necessarily…I was with, you know, third Battalion, first Marines for a couple of years. We were in South Korea on an exercise and a helicopter this was a helicopter carrying about 33 Marines, one sailor, one Navy corpsman crashed right near us. And it was a bad crash. One of the external fuel tanks ruptured and it was a huge explosion. About 20 of the guys died, 14 were injured badly. And they were it was literally like 200 yards away from me. 

Mike says his sergeant major who had done four tours in Vietnam was triggered by the crash.

He was a Marine's Marine. He didn't want to admit that he needed to get help.

When Burnout Becomes Depression

In med school Mike met the woman who would become his wife. In 1990 they got married and started a family in San Diego, then moved to Connecticut. Mike became a trauma surgeon at Bridgeport Hospital. And he loved it.

You can really impact somebody's life. There’s not too many times in medicine, actually, where you feel like you can save somebody's life. And it's a team sport. When that goes well, it's just the best thing in the world.

In 2002, Mike became the Associate Program Director for the Yale Surgery Residency and the following year he became the Chief of Trauma at Bridgeport Hospital.

MIKE: It was a lot of extra work. I was still taking trauma calls six times a month. And I was still clinically busy all the time. So I worked very hard.

LAUREL: How many hours would you say? 

MIKE: I mean, people are going to think I'm exaggerating. You know, probably at that time, probably close to 80 hours a week. 

At this point Mike and his wife had three children. Mike started to feel burned out by all the work and home life demands.

It was I was way out of balance. It's one thing to work that hard when you're younger, but by that time I was, you know, 40. You know, I was married and had kids and I was just not home for them. Or when I was home I was tired…And so I would miss things on a pretty regular basis. One of my daughters, who's not that healthy. So then if you're not home for that, you. Yeah, you feel like you're letting them down. You're just letting your family down. You know you're not around enough.

Mike constantly felt he wasn’t doing enough at work or at home.

MIKE: You're constantly torn between patient need or needing to be at this meeting or doing something else and then trying to be there for your family. You would end up feeling like you were letting down both sides.

LAUREL: What kinds of things were you missing out on? 

MIKE: You know, dinner pretty regularly… little league games or ballet recitals or school concerts or, you know, meetings with teachers or I mean, just kind of name it… We were still taking call kind of the old fashioned way where, you go in Monday and you would leave Tuesday evening. So you know it's a 36 hour shift. You know, you go home, you're tired and you're tired the next day. 

He was exhausted and began to ruminate on feelings of guilt, inadequacy, and burnout. But because of the way he was brought up, Mike didn’t feel he was allowed to admit to any of these things.

It's easy to dwell on the things that haven't gone well. Then you start to feel guilty real guilt about letting them down and then about letting down the people at work. ‘Hey Phil, can you cover this gallbladder for me? I got to go home.’ So that both ends of it, you feel like you're letting people down.

Burnout quickly turned into depression, but he wasn’t aware of how severely depressed he was.

MIKE: When you're depressed, you don't think right. You know, you're not It's very hard to think clearly. And so then you're … just blaming yourself. So then every day, you’re driving into work and driving home from work and you're just laying in bed and you just feel like you're failing at multiple things. At some point that becomes overwhelming. I mean, you just want it to stop. By the time it's gone on for months you know, I think there is this, you know it it'd be okay if I died. And then I think that from there you go into this idea that this isn't going to end until I do die. And it's then it's not a big jump to thinking about ending your life. And, you know, I'd seen a lot of people die at that point. It didn't take a lot of time to come up with a plan. Like, how am I going to do this? 

LAUREL: You had a plan in mind? 

MIKE: Yeah. Yeah. Some of the part that seems still hard to believe in retrospect. It's like I didn't realize that I was depressed and suicidal. I mean, I really thought I was burned out, just trying to find my way out of these problems, even as I was figuring out how to end my life.

LAUREL: When did it hit you?

MIKE: One morning, I was driving to work and had decided, you know, not to end my life that day. And I'm driving across the bridge. 

It was at that moment in this liminal space – between here and there between crisis and solution –  that Mike recalled a lecture from med school.

…where one of the psychiatrists said you know, when you're evaluating people who are depressed, you may need to ask questions about whether they're having suicidal thoughts or they are thinking about harming themselves. And you need to find out if they have a plan. Because if they have a plan like that becomes a much more urgent issue. And really I'm driving across the bridge and I'm like. Oh I just I didn't realize, I was like. Oh, I. Wow. I can't make this better. I need to figure out how to do this differently.

Ultimately what stopped Mike from hurting himself was remembering a couple kids he knew when he was growing up whose mom had died from suicide.

MIKE: I just didn't want to do that to them… I had seen how hard that was so everyday I was like alright I gotta suck it up. I have to be alright. LAUREL: Whta do you remember about those kids? MIKE: They struggled… I think it was really hard for them, unbelievably hard. 

So when he arrived at work he called the chair of surgery someone he greatly admired, Ronnie Rosenthal.

And I said, ‘hey Ronnie, you know, I'm really struggling. Do you mind if I come up and talk to you for a bit?’ And Ronnie’s like, ‘of course, come on up.’

By the time Mike left her office they’d come up with steps to take care of his mental health.

I walked out of that room with a little bit of hope that, like, maybe things will start to get better. The bridge taking me from from one place into a healthier space. There was a transition I made on that bridge from that hole that I was in to a place where I was like, I got to take care of myself. 

Mike changed jobs so he could spend more time at home and started going to therapy.

It help me gain insight into what I was doing there. It helped me recognize when I was ruminating on a topic and be able to step away. It helped me to interrupt that cycle that I was kind of in and it helped me. In some ways, I feel like depression is a rut and just in this rut and you can't figure out how to get out of it. And therapy help me kind of stop the rut and find a path out. It helped me see that we could do things differently, you know, which was incredibly important.

Mike Turns A Weakness Into A Strength

Mike’s kids are now in their teens and twenties. His younger daughter decided to become a doctor. Mike beams with pride when he talks about her graduation at Case Western Reserve.

MIKE: They have this great tradition where if the graduate has a relative who's a physician, the relative can hood the graduate. I mean it was great. It was sublime. 

LAUREL: On the one hand, I'm sure you've got so much pride. But on the other hand, are you also worried? 

MIKE: I think the younger generation in many ways, certainly Julie, is much more aware of kind of mental health, navigating mental health issues. I worry about about all my kids because, God, I think, you know, they clearly are inheriting that that predisposition When I was a resident in the early nineties if I'd said, Hey, I take more than 36 hours, I can't do that anymore. I got to go home. Well, hey, I've have been kicked out of program and B, like people would have been like, you was just is weak. No, I mean, it would’ve been a real sign of weakness. And, you know, Julie's generation that's crazy. I mean, there's a real change in the belief.  So the culture's changed profoundly. LAUREL: They can say, I'm taking a personal health day or mental day. And I need to I need to do this. 

Mike’s had many conversations with his daughter about burnout. She tells him she knows help is available, if she needs it.

The way they do it is, they say, if you are struggling, you know, contact this person or if you're struggling, email this person or call that person or go to this office. She said, and nobody says, ‘hey, and when I was struggling, this is what I did.’ And she just felt like the way it was being done might might be increasing the stigma, not decreasing it… 

So Mike decided he could be that person to share his personal experience.

I'm at a point in my career where I can, you know, talk about my earlier experiences and maybe. You know, I think there is this stigma associated with it. Like, well, like if you you're depressed, you're not you're not successful. And and you're not going to be successful and it's going to hurt your career… Objectively at the time I was a very successful time in my career professionally and it's caused a lot of stress. I think it's good to get that message across. Like, look, you're not throwing away your whole career by reaching out for help. You know, because that's a fear. 

So in 2021 Mike decided to share his story. The first time because of the pandemic he told it over zoom with many frozen muted faces staring back at him, not knowing how his story was being received.

MIKE: Preparing to give the talk the first time …and I’m like wow like it really took me back to where I was. And it was you know, it was kind of a dark place. I have a coach who's a who's a licensed clinical psychologist. And so I spent a lot of time talking to my coach. You know, it was not a genuinely not a good place. First couple of times, you know, five or ten times are hard. LAUREL: Like it was triggering. MIKE: Yeah.

But one by one people reached out to him to thank him for coming forward. And he knew he had to keep sharing it whenever, wherever he could.

I knew, you know, from that first talk, I was like. Okay, there are people who need to hear this. There are people who are struggling who need to understand that it's okay to struggle and you just need to get some help. You can get through this because I got through it.

The toll the pandemic took on health care workers – the sheer numbers of people they watched die, the distrust and hostility toward health care – all this meant Mike’s mission became even more critical. 

In 2022 more than half of health workers reported symptoms of burnout, and many were dealing with insomnia, depression, anxiety, post-traumatic stress disorder, or other mental health challenges, according to the New England Journal of Medicine.

Last year more than half of nurses and 20% of doctors were planning to quit according to the American Nurses Foundation and the Mayo Clinic.

So Mike continues to share his message.

MIKE: The intrinsic message was like, if you feel like you're struggling like I was, please reach out. Just reach out. And I get that reaching out doesn't always… you got to reach out to the right person, and it's. And it's hard. Therapy is hard. It takes a lot of time. The medications take time to work as well. I mean, nothing is easy about it, about the journey, but you got to start it.

LAUREL:  I’m sure you're not the only health care professional who's faced this, but you are probably one of the few who's willing to talk about it. So I wonder if you get a lot of people who are depressed come to you... 

MIKE: I get enough. And some of them said, you know, I felt like it was okay to reach out for help because I know that you did and you got through it. And I’m like that's the whole point of doing this. It was it was the whole point. It's got to be okay for people to get treated.

Studies show just over the last five years a big change in how surgery residents feel. In 2015 less than half felt like their attendings cared about their wellbeing. Today 90% feel cared for.

LAUREL: I wanted to ask, a word that you've used a couple of times, and I just wondered if you wanted to comment on it, and that is ‘weak.’ Being seen as weak both in the military and in your as a trauma surgeon and, and then later on. And I'm just wondering if that word still brings up shame.

MIKE: I mean, weakness implies, you know, failure and shame and personal failing, moral, moral failing somehow needing help would be seen as some kind of personal failing. And I would just say that actually reaching out for help is is really incredibly hard. And not just reaching out for help, like the whole part of it. It's hard like deciding you need to reach out, making an appointment with a psychiatrist or a psychologist, going there. Therapy's only going to work if you actually open up. So you got to open up like that. I mean, that's hard. Who wants to go to a stranger's office and like … cry for 45 minutes? It's actually it isn't that is not weakness. And it’s just really hard to do.

Mike understands now admitting he needs help is actually a strength.

This is 2 Lives. I’m Laurel Morales.