It had only been 5 years into my taking lithium when my urine turned from golden yellow to a consistent translucent lemonade. As an internal medicine resident and incoming nephrology fellow living with bipolar disorder, I had hoped to have at least 20 years before any renal concentrating deficits began. Lithium had always been my “hero,” albeit imperfect, and hand tremors and nausea seemed a paltry price to pay for the drug's mood-stabilizing and anti-suicidal effects (1). Ironically, soon after choosing the field of nephrology, my polyuria and nocturia began.
For many years, I have been intentionally transparent about my struggle with mental illness. Bipolar disorder is a lifelong journey, and each person's journey is unique. I have not triumphed over bipolar disorder; rather, I strive to live vibrantly while navigating my disease. Therapy and medications help to control my mood fluctuations. Still, sometimes the suffering wins. My ascents typically signal impending plunges. When depressed, I have physically hurt myself so that my outside pain matches my inside pain. During some periods of intense suffering, suicide feels seductive because it offers peace. I know that I am not alone in my internal battle against mental illness and against its stigma in medicine: through writing and speaking about my mental illness, hundreds of physicians, nurses, therapists, and social workers have shared their personal experiences of mental illness with me.
I feel optimistic in pursuing a career in nephrology because as I interviewed for fellowship, I met many successful nephrologists who openly shared their own personal connections with mental illness. One critical factor in being a successful provider with mental illness is to be affiliated with a workplace that allows me to openly step back, when necessary, without fear of repercussions. Too often, medicine discourages transparency. This is unfortunate, because like lithium, health care providers are imperfect heroes. We suffer from conditions, such as depression, anxiety, posttraumatic stress disorder (PTSD), substance-use disorders, and kidney disease, just as our patients do. Why would we as health care providers be any less human than our patients? Medicine often struggles to accept this concept.
This denial has deleterious implications on the care that we provide. Patients with chronic kidney disease (CKD) suffer from high rates of mental illness, which is associated with increased mortality (2). Our patients—the teacher, the mother, the cashier, the doctor—are all imperfect heroes. Mental health is within the purview of kidney health providers because it deeply impacts the care we provide. We must not focus solely on the kidneys at the cost of sacrificing the person. When done thoughtfully and intentionally, bringing one's authentic self into medicine can provide powerful healing for both patient and provider. Disclosure is not the only way to genuinely connect with someone else's suffering, but I believe it is an effective way. I have found it powerful to exist together as my true self with my patients and colleagues. Personal and professional need not be mutually exclusive lifestyles; medicine opens the door to many intimate conversations. We can convey humility, strength, support, and power by saying, “I share in some of your experiences. I have taken these medications too. I’ve struggled with these side effects and found these ways to help mitigate them.”
Cipriani A, et al. Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ 2013; 347:1–13. doi: 10.1136/bmj.f3646
Kimmel PL, et al. Psychiatric illness and mortality in hospitalized ESKD dialysis patients. Clin J Am Soc Nephrol 2019; 14:1363–1371. doi: 10.2215/CJN.14191218