Surgery Resident Switches to Psychiatry to Work Toward Achieving Long-Term Societal Change

My arrival into the specialty of psychiatry is unconventional. Initially, I had charted my path toward becoming a surgeon, but it soon became clear that my true passion involved addressing the hidden psychological scars that are unreachable by a scalpel. As an intern on a notoriously high-volume trauma surgery service, I was constantly exposed to the horrors of interpersonal violence. A day did not go by without a stabbing or gunshot victim entering the trauma bay doors.

Although a multitude of these encounters are permanently etched in my mind, one seems to always rise to the forefront. My team and I were paged to the trauma bay, alerted to the impending arrival of a young male who had been shot in the chest. We immediately halted our rounding on about 60 patients and expeditiously made our way to the emergency room. The young man was already positioned on the stretcher, unconscious and by definition dead. There was no pulse. The overhead light illuminated the bullet holes that had pierced his chest. Our attending, calmly but with clear urgency, instructed the senior resident to perform a thoracotomy in order to allow our team to trace the source of his hemorrhage. As my senior resident sawed through the patient’s ribs to expose his heart, it was clear the bullet had infiltrated his chest cavity. I was shaken and almost paralyzed by the enormity of the scene. I wondered, “How did this happen? Why was he not in school? Did this happen in his neighborhood? Could this have been prevented?”

The attending’s authoritative voice pierced through the haze of the moment and shifted my attention: “Chidi, massage his heart, quickly.” I did as I was told—I massaged his heart between my hands, literally attempting to imitate its function to perfuse the body and oxygenate the brain. “Quicker, with more rhythm! Look, like this ...,” and she took over. Ultimately, it was futile. We could not revive him; he was pronounced dead. As we walked away, I took a glance at the room: It was littered with remnants of supplies and stained with his blood. I felt helpless and enraged. As a team, we took about one minute to decompress and migrated to the elevator to finish rounding. This scene would be replayed countless more times with other young people in the weeks and months that followed.

There were some who survived their injuries. Following medical stabilization and satisfactory postoperative examinations, they were discharged from the hospital. From a surgical perspective, the goal had been achieved; however, the psychological trauma not only remained, but intensified among team members. The intrusive memories and dreams persisted, depression set in, and their spirits remained demoralized. Again, I felt helpless and enraged. My attempts to convince myself of the “good” our team had done were futile, because I knew our treatment was too far downstream on the river of health. It was clear that quality health care required interventions years prior to what placed these patients in the hospital. Thus, I made the difficult decision to switch specialties. I viewed psychiatry as a preventive force to obviate the carnage I had witnessed.

Psychiatry has opened my eyes to the power that physicians hold to promote widespread change. My day-to-day interactions with patients have allowed me not only to address their immediate concerns, but also identify the systemic forces underlying their presentations. As an APA/APAF Public Psychiatry Fellow, I have had the opportunity to participate on the Council on Advocacy and Government Relations (CAGR). Through CAGR, I have attended conferences and workshops geared toward collaborating with state and federal lawmakers on mental health policy. The monthly council meetings have opened my eyes to the ways in which psychiatrists can work in an interdisciplinary manner with legal professionals and other advocates. When my fellowship ends, I will continue advocating for mental health parity at various levels to help advance health equity.

From social and political determinants of health to mental health stigma, it is clear our country and indeed our world are struggling with a mental health crisis. I am grateful to have been exposed to experiences that have opened my eyes to the collective experience of humanity.

Psychiatry provides the opportunity to operate within and outside of clinic walls to shift extant systems crippling our society. As I continue my training, I am encouraged by the work that mentors, peers, and colleagues are pursuing, and I am hopeful. Over time, I hope we catch more people upstream before they experience events that prematurely shorten or end their lives, much like my memory of the souls lost in the trauma bay. ■

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