The DO Book Club, June 2023: “Long Walk out of the Woods: A Physician’s Story of Addiction, Depression, Hope and Recovery”

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In “Long Walk Out of the Woods,” Adam Hill, MD, shares the story of his harrowing journey through depression and alcoholism while navigating the rigors of medical training. He shines a much-needed spotlight on the paradoxical behavior of the medical community, which offers care and compassion to patients yet often turns a blind eye to its own professionals in need. The difficulty of accepting help, notifying his colleagues of his treatment and the struggle to find a job are thoroughly detailed in Dr. Hill’s moving memoir.

Although many college students turn to alcohol and drugs for entertainment and diversion from negative emotions, most cannot also meet the demands of a premed program. Not only does Dr. Hill make it through premed and med school, he goes on to train in pediatric oncology. One can hardly think of a more emotionally charged profession for a sensitive person at high risk for alcoholism and depression.

Dr. Hill includes the poignant stories of several patients and families that he has cared for over the years. He judges himself rather harshly when he is unable to attend one child’s funeral. He reflects on the unattainable standards of perfection that medical residents and fellows are held to. With little time to process or reflect on serious illness and unexpected deaths, some clinicians can slide slowly into depression, hopelessness and cynicism.

A trauma cycle

The author chronicles the grueling pace and repeated trauma he endured as he went from one catastrophe to the next as a pediatric resident. As many physicians who read his story might have experienced, Hill must answer the next page or deal with the next emergency with little or no time to process his terrible feelings of loss and disappointment. On one lonely Christmas spent in the hospital while on call, Hill exits a tragic resuscitation attempt, where a chronically ill six-month-old has died. 

“I did not want to talk about what I had lost because it paled in comparison to what others were actively losing,” Dr. Hill states in the book. “I felt ungrateful for questioning my own feelings when a family had lost their child and another child was critically ill in the intensive care unit. I was trained to function in a way that acknowledged that my needs mattered less than the needs of other people. When those personal needs are emotional ones, and we are continuously told not to pay attention to them, not to get too affected in front of patients, well, depression can feel like just another bodily function that must be suppressed.” (p. 35)

As Dr. Hill unadvisedly goes off his antidepressant medication, he turns to alcohol to numb the very intense negative feelings he has while training as a pediatrician and then as a pediatric oncologist. The exposure to children suffering from childhood abuse and neglect wore heavily on the young doctor as he perceived no one really wanted to talk about the problems or address them more broadly. He personalized much of what he saw as though he was solely responsible.

In a highly ironic chapter, Dr. Hill describes how dreams and plans of suicide become the only way that he believed he could take control of his chaotic and tragic life. He cuts himself with a sharp knife and remarks, “I never forgot how I felt in those moments: for the first time in a long time, I felt as though I was finally the one in control.” (p. 59)

At another point he goes to a gun store to purchase a handgun. Only the built-in delay of obtaining a license allows him to surface long enough to reconsider his plan and agree to get help.

Reaching out for treatment

As the incidence of physician suicide climbs higher each year, Dr. Hill attempts to encourage and normalize asking for help and beginning treatment as soon as possible. Notably, many employment applications, medical licensing and hospital credentialing forms include questions about prior treatment for a mental health condition. The author identifies the harsh treatment and stigmatization of professionals who are honest about their mental health histories as a major cause of impaired physicians shunning treatment.

With no local hospitals willing to take a chance on him, Dr. Hill traveled a long way from his home to accept a job serving the Choctaw Nation in Oklahoma. When he tries to get back into his chosen training program, he undergoes intense scrutiny and monitoring. In a precursor to sharing his story in a memoir, he comments, “I decided to proactively share my mental health story in the recognition that my journey was my greatest strength, replacing self-talk of ‘suffers from addiction’ with ‘empowered because of it.’”  I explained the incredible gifts of perseverance, strength and passion I had been given because of my disease.” (p. 88)

Dr. Hill was accepted back into his training program and then later was employed as an attending physician. By sharing his story, he vowed to try to change the stigma of reporting mental health diagnoses with the hope of helping other health care professionals at his institution and elsewhere. He identifies that “for suffering individuals, honest conversations about mental health often stay closeted because of a lack of safe spaces to share.” (p. 134)

Creating change

The author spoke publicly and participated in an administrative task force to transform his health center’s addiction policy from a “tone of bureaucratic self-protection” to one centered on “human beings with treatable medical conditions.”  His effort to change policy came from his personal history of shame. Hill writes, “I learned vulnerability in an atmosphere of authenticity displays true strength.” (p. 146)

The book ends with some very touching narrative medicine pieces from the author’s travels on a medical mission to Kenya and his transition to pediatric palliative care medicine. The author makes good on his pledge to show vulnerability and to pay forward the grace and kindness that so many showed to him. As another “doctor as the patient” memoir, Hill shares his perspective as a physician with depression and alcoholism. What are our patients with these diagnoses thinking and feeling as they suffer with these diseases? What are our colleagues going through? Here is one articulate account that informs and touches the reader’s soul.

If you are in crisis

If you are struggling and need support, don’t hesitate to please call the National Suicide Prevention Lifeline by dialing 988. You can also reach out to the Physician Support Line at 1 (888) 409-0141.

More books

You can find all of the past The DO Book Club reviews here.

Related reading:

The DO Book Club, May 2023: “Endurance,” “Practicing from the Heart” and “Uncaring”

The DO Book Club, April 2023: “On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients”