Beyond the grave: where are spirituality and mental health in medical training?

Tyler Murray is an Internal Medicine Resident (R1) at the University of British Columbia who graduated from medical school at the University of Toronto in 2017


“I cried my eyes out three times today.” I now recognize what this is; it is not the first time. “I am emotionally exhausted.”


“There are happy tears and sad tears. And these are HAPPY tears.” I AM HAPPY… but today was a HARD DAY. “Actually, I’m not sure what to call these tears.”

“Soul tears?” I cried soul tears today.

Like never before, I cried today.
Soul tears.
For me.
For you.
For her.
For all of us
who understand,
who have been to the brink:
that unimaginable place in the dark
where you feel so alone (though you know you aren’t).
It’s cruel, really.
A vehicle for healing, I am sure—
but not by my design.


Black hole.
“I will bring them down.”

No one wants to hear about my problems. My shit.
I know it’s shit—but I cannot logic myself out of this one.
My thought processes feel fixed; rigged.
The neural highways have been paved, opened wide, and I can no longer close them down.
My thoughts have been hijacked, flooded, overrun.
I can’t think.
I can’t concentrate.
I can’t even read. To think! Me.
I would one day be unable to focus long enough to finish one page of a book.
I can read 100 pages an hour at baseline.

I MUST be sick.
I know what this is.
I know all the signs.
I have checked all the boxes.

But I don’t WANT to be depressed.
This is bullshit.
I know I am.
But it’s not WHO I am.
I love life and myself.
I reject this.
I wrestle at work. Can’t sleep, can’t eat, can’t read.
Stop writing, stop thinking. Seeking quiet thoughts
in a roaring mind.
I am NOT depressed. I am NOT depressed,
I repeat;
But I am.
It’s not my fault.
People die. Terrible things happen to good people.
But why her? Why now? And now, why is this happening to me?
It’s not my fault.
But I feel like it is.
Because I am told it is.
Stop thinking this way. Stop feeling sorry for yourself. You have everything. You are not depressed. Look at you. Think! YOU can’t be depressed. Look at all your accomplishments. Look how far you have come.

You may have been right about my past.
But you could not have been more wrong about my present.
You don’t get it.
It is my fault now. Thanks to you, I feel it and believe it.

But it is NOT my fault,
I repeat.
Constant contradictions.
Competing thoughts.
Completely incomplete; competing continuously for complete control of MY consciousness, never complete, always continuous. Absolutes turn gray; my path is lost in the swirling, crushing darkness that surrounds me and has filled the entirety of my mind.

I know I am depressed.
But I don’t want to be,
and I don’t know what to do.
I have never been here before.
I have never lost focus, concentration, control over my thoughts, my emotions, my mood,

I know I am not logical, not well; and it KILLS ME.

“28% of Medical Residents may be depressed.”
Like someone is questioning the validity of this potentially impactful statement with such a little, seemingly insignificant word—may.
I am not empowered.
I am scared.
It really means: I am next.
1 in 3.
Odds approaching a coin flip.
Even if I started out happy?
Absent family history. No predisposition.
28% chance, prevalence. Irrelevance.
For a disease THAT KILLS.
A disease which targets the pursuit of all humanity:
I am mortified.
Horrified, terrified, fried, frayed.
Praying, prayed. Plagued. Played. Playing with fire.
On fire.
Under the flame.
Up in smoke.
Snuffed out.
Turned to ashes.
Swept under the rug.
Cast out.
To where?

But ashes give life:
The sun rises every day.
The Light returns.
The tunnel is not infinite; its end exists.
I rise from the ashes, the rubble.
I wrestle, break the chains under my strains.
Undeterred, I rise.
Rebuilt. Reborn.
Following my Light. My wife:
my beacon of hope.
The Light in the storm.
A perfect storm, indeed—
Of exhaustion, death, personal destruction, and rebirth.

For I am an angel of death.

Our balance?
She is an angel of GOD
who crossed my path
when I needed it most.
Saviour in the storm,
beacon of Light.
I threw myself in:
closed my eyes,
and jumped.

The storm
is starting to lift.
I can read, write, think
once again—of my own volition.
Initiative returns. My smile genuine.
No more hiding, withdrawing, pretending;
masquerading as healthy, sane, and MYSELF.

I am Me.
Reborn and stronger.
Like the Phoenix,
I am both defined
and destroyed
by the Flames.

Find your Light,
and today
will always be the day.


Dedicated to:
My Wife, My Savior. I love you.

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