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The day I blacked out, there was no warning. I was present and then I wasn’t. I was in the middle of performing a chest tube procedure on a young patient with a pneumothorax. I suddenly got a little shaky, felt a little lightheaded. Then gone. I woke up in another room drenched in sweat with someone putting an IV in me and patches on my chest for an EKG.

I’m someone who always wants to be prepared. That’s why I went into emergency medicine, so I could have the skills to handle anything that came my way. Working in emergency rooms (ERs) for 23 years, I was the guy who had the answers, the one people called when the situation was desperate. I was trained to stay calm in the chaos and make the big decisions without even flinching.

My depression didn’t arrive like emergencies do. There was no obvious line that I crossed. It was a gradual erosion, like water wearing away a stone until it finally crumbles. First, I felt exhausted. I thought, I’m just working too hard, taking too many shifts.

Then, my enjoyment of things — activities, friends, even family — slowly waned until I found myself with no energy for them, not even interested. It began to be a struggle just to get through the day. I’d go to sleep and hope the next day would be better and just rinse and repeat, over and over.

But in the ER, I was surrounded by “real” medical emergencies. I could still think clearly and make decisions and perform at a high level that looked fine from the outside. I used that to gauge my mental state, thinking, If I can still function in the ER, I must be okay.

Those skills that help us compartmentalize, to be strong in a crisis and solve problems prevent us from seeing our own symptoms. It’s how I was trained. It’s part of medical culture. Admitting that you’re struggling feels like failure. So you ignore it. You push through it.

I knew all the signs of depression in a patient. And I ignored them all in myself. I was very good at rationalizing. It was the night shifts. It was lack of sleep. It was getting older. But my wife could tell. “There’s something wrong,” she said to me. “You’ve lost the sparkle in your eye.”

Collapsing on the job was a wake-up call.

I had left a patient mid-procedure, which meant a colleague had been pulled from their work to come and finish mine. A patient’s care had been disrupted because of something I wasn’t addressing in myself. Again, I tried to rationalize. I just finished six 12-hour shifts. Maybe it’s the exhaustion? But what I couldn’t chase away was the question in my mind: What happens next time?

Then one night, I was sitting in the hospital parking lot after a shift, and I couldn’t bring myself to start the car. Going home meant I had to engage, to interact, to be a person and I just had nothing left. It was not that I wanted to die. I wanted this constant pain and emptiness to go away, and I had no idea how to do that. It didn’t make sense. I was supposed to be the one fixing my patients, fixing my family, fixing my house. How could I need somebody to fix me? But I knew something had to change.

At that point, I had two choices. One, try not to exist anymore. Or two, try to pick up the pieces and figure out what was wrong. I had to get help, and that was harder than anything I had ever dealt with in the ER.

I had never seen a doctor as an adult. But I found a family physician nearby — someone I had trained during her rotations through the ER. I remembered her as very trustworthy and honest.

I had never sat in a waiting room before, and I was terrified that day, going through all the things I was going to say. When they called my name, my legs were shaking. The doctor came in, and everything that I had planned to say vanished. All that came out was, “I can’t go on anymore. I’m in a bad spot and I need your help.”

She said, “Thank you for coming in.”

That began 2 years of psychiatry, medication, adjustments, therapy, and follow-up appointments. At one point, I was on seven different antidepressants. The thing the fitness magazines don’t tell you is that recovery isn’t linear or quick. I learned that there’s an enormous gap between knowing what you need to do to recover and being able to do it.

Exercise, for example. I knew all the science and research that exercise would benefit my mental health. But I couldn’t even walk around the block because of the medication side effects, the fatigue, the lack of desire. It took me not weeks or months but 2 years before I could consistently exercise again.

I learned that the experience from the patient side of the bed is nothing like what we think it is. For 23 years, I’d written the discharge instructions, handed them to the patient, and called that job complete. But there’s a distinct difference between stabilization — what we do in the ER — and recovery, what a patient does to get better.

That’s where my book, Lifeline: What to Do After a Mental Health Crisis came from, the gap between being medically stable and actually okay. We discharge people into that void every day. It’s not malicious but it’s structural. That gap is where people relapse. It’s where families fall apart. It’s where people get overwhelmed trying to coordinate care with no guidance. It’s where the progress we make in the acute setting gets lost.

As a patient, I wanted the “Z-Pak treatment.” Take these pills for 3days and be all better. I expected that I could do that because I was tough. Instead, I was going to pharmacies, picking up medicines, being asked questions that I didn’t understand. If somebody like me with a medical degree can be lost and confused on how to get a recovery plan in place, I can only imagine what it’s like for our patients.

Meanwhile, I was put on a leave of absence and stopped working. Eventually, my psychiatrist recommended that I not go back, so I have not done any clinical ER shifts since then. It’s been hard.

Being told I had to step away from work might have even triggered more depression because it took away my identity. Being told, “You’re not fit, the patients aren’t safe, you can’t do what you have gone to school for 22 years to learn and become, what’s been your whole life for the last 23 years, you are not that person anymore” — it’s a huge loss of purpose. It was really tough to hear, “You need to sit out this part of the game.”

I wrote my book as a kind of journal and didn’t plan on sharing it. But I wanted people to know: Your mental health crisis is not the end of the story. It’s a turning point and what happens in the weeks and months after you leave the ER or the hospital, that’s where the recovery happens. And there is hope and help available.

I have to tip my hat to the patients I treated who were at the end of their rope or in a crisis and sought help. I wish I could go back and do that in a different way with much more empathy. Especially the moment when we discharge them and say, “Please follow up. Here’s the phone numbers.” Our system isn’t built to support everything that comes after that. What we do is tremendously important. But it’s not enough.

When I suddenly left work, my colleagues reached out, asking, “What’s wrong? What’s happened?” I couldn’t tell them. I just said, “I’m going through some things right now.”

But when the book came out, I knew I had to be willing to be vulnerable and share it. The big surprise was the number of private messages from physicians that I’ve received since then. I expected the book to resonate with patients or families. I didn’t anticipate how many colleagues would reach out and say, “Hey, I’ve been there. I appreciate you sharing your story. I’ve never said this to anyone.”

Again, that’s the physician culture in plain view, the enormous amount of suffering in silence. It’s not a mystery. We have data on the untreated mental health of our healthcare workers. We see the suicide rates. We see the rates of burnout and addiction. But we built a profession where asking for help feels like admitting you’re not cut out for it, where talking about depression could mean losing your license.

Somehow, my book has functioned as a kind of a permission slip for people to say, “If a guy with 23 years in ER can end up in a parking lot, maybe I should be honest about where I’m at too?” The clinical audience needed this as much as the patient audience, maybe even more.

I want doctors to know that asking for help is a clinical act, not a personal failing. The same courage that we ask of our patients, to walk into an ER at their worst moment and be honest with us about what’s happening, we need to be willing to do that ourselves. The physician that gets help isn’t the weak one; he’s the one that’s going to be around.

Kenneth Scott Burnham, MD, is an emergency medicine physician in northwest Ohio and the author of Lifeline: What to Do After a Mental Health Crisis.