How Does a Doctor with OCD Navigate Life, Career, and the Everyday?
by Rachel Davis
In medical school, my peers described me as a “mousy person who just kept to herself.” Not long ago, I heard through the grapevine that a former classmate remembers me as “not a nice person.” I immediately felt angry, sad, and defensive, but I know why I was perceived that way. I kept to myself and seemed to only care about grades. I know that people didn’t really like me—I seemed standoff-ish and cold. But I didn’t mean to be. I wasn’t trying to honor everything; I was just trying not to fail. I was trying to manage debilitating anxiety so I could become a doctor. As I think back about my time in medical school, I’m sad about how I was perceived and about how much I struggled. I feel compassion for myself now as something was going on, something even I didn’t fully understand, something I wish I’d known when I was that 22-year-old medical student.
I grew up in a religious family in rural southeastern Colorado and, for reasons I still don’t entirely understand, I always wanted to be a doctor. For that desire I am eternally grateful—it is a gift that has given me purpose and direction. When I was three, so legend has it, I wanted to be a brain surgeon. When I was eleven or twelve, I would sneak upstairs (after my parents had gone to bed) grab The American Medical Association Family Medical Guide and stay up late, memorizing symptom flow charts. By the time I was thirteen, I determined I had polycythemia vera, and possibly Hodgkin’s lymphoma. One night, I stayed up into the early morning hours, sitting on my bathroom sink; trying to be sure I wouldn’t accidentally swallow my tongue. The thought consumed me. The human body fascinated me, and it terrified me.
I was a creative child, and creativity, in my mind, fostered boundless worries. When we’d drive by a car accident, I would perseverate on gruesome images and horrible thoughts about what must have happened to the people inside. Weekly Sunday school, Bible studies, and Southern Baptist revivals fueled my fear of going to hell, and I would attempt to prevent this outcome by habitually reciting, “Dear God, please forgive me. I love you very, very much. In Jesus’ Name I Pray, Amen.” For as long as I can remember, I have lived with a constant sense of dread and a fear that something was—and is—terribly wrong.
I took an Emergency Medical Technician (EMT) class when I was fifteen and started volunteering with our rural ambulance squad. I worked as a Certified Nursing Assistant at our local nursing home. I exposed myself to blood and death. I comforted a nineteen-year-old boy as he died in a ditch, crushed beneath a van. I prayed that a beautiful blue-eyed blonde little girl would live, as a police officer dragged her lifeless body out of a lake. She did not live, and, instead, I sat with my hand on her mother’s shoulder as she screamed. I comforted a woman with dementia as I dried her after a bath—I remember her timid, beautiful voice as she started singing, “When peace like a river attendeth my way…” I joked with a 73-year-old man as I cleaned the pus from around his catheter, trying to help him preserve some sense of dignity. I washed glass out of a man’s hair, solemnly and quietly, a couple of hours after we picked the body parts of his friend off the highway. This is how I began to learn to live; helping others during the worst times in their lives gave meaning to my life. Now I understand that this meaning was also helping me move beyond the horrible noise in my head.
I was tortured during my first year of medical school. I barely slept. I learned it was easier to get up in the morning if I drank a lot of coffee before going to bed at 2am. I snuck away between each lecture to be by myself for a few minutes. Attempting to calm my mind, I recited the Lord’s Prayer, over and over and over and over. My preceptor asked if I was alright because I was so thin. Not so thin; too thin. I was too thin, partly because I didn’t make time to eat and partly because I was so worried about money that I didn’t buy enough food. I was so ashamed that my preceptor had noticed. I couldn’t let go of the images I had seen during my time as an EMT. Things were unraveling. 9/11 happened during first year Anatomy, and I couldn’t stop thinking about death.
My experiences as an EMT were necessary and critical in helping me move past my anxiety and actually live life. It was less painful to deal with real trauma than to be helpless against my fears. I could actually DO something about real-life disasters, even if it was just being with people as they died. But these experiences as an adolescent and early adult did add another layer of traumatic experience to the primary trauma of living in my brain. My time on the ambulance was a double-edged sword, but I don’t know that I could have disentangled myself from my anxiety without this exposure…and without my overarching goal of becoming a doctor.
A classmate of mine wrote in our school’s humanities journal about his struggle with depression. I reached out to him. He was kind, and this gave me the courage to ask for help…but not right away. I told my parents that I thought I might be depressed, and they told me I probably wasn’t. They would not—or perhaps could not—accept that their daughter was struggling. When I did finally allow myself to see a therapist, I only felt comfortable seeing a Christian therapist. This therapist asked me to sit and listen to God. So I spent hour after hour sitting in silence, wondering what was wrong with me, because God certainly wasn’t speaking to me. This only made things worse so I eventually surrendered and saw a “secular” psychiatrist. She prescribed medication, and we met weekly for therapy. This was the beginning of a new life. I began to have room to breathe and the strength and space to interact with other people. It was also when I was diagnosed with obsessive compulsive disorder (OCD).
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Fortunately, despite OCD and thanks to meds and therapy, I enjoyed my clinical rotations. I provided good care, and my patients, residents, and attendings liked me. It was nice to be liked. Since I didn’t have to direct all my energy towards survival, I had more room for the nuances of human interaction. I felt more normal and a little less alienated from the category of human. However, even with treatment, I still had religious (and other) obsessions. On the obstetrics/gynecology service, I couldn’t bring myself to participate in abortions and some other procedures, not because I wanted or needed to make a political statement, nor because I felt judgmental. Rather, it was because I was still afraid of going to hell, a remnant of scrupulosity carried over from growing up as a child with OCD in a very conservative, Southern Baptist family in rural Colorado. It was because, while I had figured out how to do well in medical school, I still had severe OCD, a diagnosis I wish I had known sooner. I have compassion for myself now. Back then, I just felt shame.
Now, a doctor for thirteen years, I am privileged to serve as Medical Director of Student and Resident Mental Health on a health professions campus. I am passionate about helping my student and resident patients discover how to thrive, not just survive. I am moved when I have the opportunity to help someone change their perspective from desperately avoiding failure to pursuing meaning and joy. It is my mission to help my patients remember they are indeed resilient. I strive to reduce stigma and combat the fear that seeking help for mental health issues will interfere with being a physician.
Last year, as President of the Colorado Psychiatric Society, I collaborated with key stakeholders to work with the Colorado Department of Regulatory Agencies to eliminate the mental illness screening questions that stigmatize and marginalize mental health problems and discourage students, residents, and practicing physicians from seeking the treatment they need.
I still have OCD. I’m a doctor with OCD. A couple of years ago, one of my supervisors remarked, “You come in here every week looking like you’ve done something wrong.” I was embarrassed that he picked up on that, but he was right. I still live with the perpetual feeling that I have done, or will soon do, something terribly wrong. I have learned to live and practice effectively despite that feeling, but I guess I don’t always succeed at hiding it. It resonated with me when a particularly articulate patient with OCD shared how exasperated she is of being told she has a “resting bitch face.” She said, “An OCD sufferer is fighting a war with a brain that randomly gets hijacked by horrifying images and thoughts, and sometimes this secret war makes its way out of our tortured brains and furrows our brows, making us look ‘bitchy’.” I’m aware I sometimes still come off as stand-offish and overachieving—this is because I’m just trying not to let my OCD show through, and I’m doing my best to make sure bad things don’t happen.
My desire to be a doctor is what helped me overcome my extreme anxiety, and my desire to continue to be the best possible doctor helps me navigate each day. I feel very fortunate that I seem to have been born with a purpose. I have also come to realize it is not only “in spite of” my OCD that I am a physician but also because of it. I was driven to do hard things at a young age, in part, because I needed a distraction and a sense of meaning outside of the chaos in my brain. My OCD leads me to be extremely conscientious, very honest, empathetic, and perfectionistic—characteristics that, when reigned in, contribute to being a good physician. I like working with very ill patients, especially in the emergency department, because bad things are expected to happen, and I am prepared to manage bad things. I feel comfortable working with suicidal patients and panicked patients and desperate patients, because I am good at managing crises and bringing calm to chaos. I’ve learned how to take a lifelong struggle and utilize certain aspects of it for good.
This doesn’t mean everything is perfect. I still do not often feel calm. I have learned that my brain is rarely capable of feeling capable. So, I just move forward. I still take medication, and I see a cognitive behavioral therapist. I incorporate exposure and response prevention therapy (ERP) principles into my daily life. All day, every day, I make conscious decisions to resist the OCD and make choices that lead to effective functioning, both for me and my patients. I have learned to set aside, on most days, the constant feeling that something is dreadfully wrong. But sometimes I still listen to my fears, like when my patient misses an appointment, and I find myself on Google, trying to find her obituary.
I see so many students and residents afraid to be seen as weak, afraid to be human; so full of shame that they might need help or possibly even have an illness. The classmate of mine who wrote about his depression gave me a gift in his story, and this allowed a sliver of light to penetrate the suffocating shame. I hope my story offers the same to other students, residents, and practicing physicians. I also hope my experiences help faculty and other educators consider that it may be exquisitely difficult for “high functioning” students and residents to seek help because they are able to hide behind their performance. Yet, they can have mental illness, receive treatment, AND be successful physicians.