Facing disasters

“My PTSD is about a third better. You don’t realize how stressful doctoring is until you’re not doing it anymore.” My friend and ex-partner, an echocardiographer, told me this 4 months after he retired. He selfdiagnosed PTSD from his career as a cardiologist, and estimated it would last years into retirement, perhaps forever. As a fellow, he had wanted to become an interventional cardiologist, but he knew he could not take the stress. We don’t talk about the stress we experience as cardiovascular interventionalists, and a literature search turned up almost nothing on the topic. I suspect that stress, like Voldemort in the Harry Potter books, is That Which Must Not Be Named among interventional cardiologists. Several factors prompt us to push stress under the rug. First, interventional cardiovascular medicine is (unfortunately) a male-dominated specialty [2] and men are famous for hiding stress behind a façade of bravado. Second, if one acknowledges stress then one must deal with it, and dealing with stress is difficult [3,4]. Finally, the frantic pace of professional life gives us no time to pause and acknowledge or deal with stress. If your patient dies on the table after prolonged resuscitation, how can you take time to de-brief yourself and the team when you have 5 more cases to complete in that day? Cardiac interventionalists experience many types of stress, but three types are common. The first is the stress of treating patients, common to all physicians, that leads to high levels of burn-out and suicide within the medical profession [5]. It starts during training. Depression and burnout occur in 29% of all residents