Former Modesto physician tells of struggles with bipolar disorder

The practice of medicine is among the most demanding professions.

Paul Golden of Modesto worked for 33 years as a kidney specialist while managing bipolar disorder and says it’s possible for people with the illness to have a successful career.

His recently published book, “An Insider’s View of Bipolar Disease,” is filled with facts on the disorder and advice for managing the illness.

Golden, 67, spoke in January to the National Alliance on Mental Illness, Stanislaus chapter, about the book and shared personal experiences in a memoir due for publication in May or June.

He has chronicled five different crises with bipolar disorder over a 40-year span, but the illness did not define his career or his life.

Between those dark and manic episodes, Golden finished eight years of medical education, treated thousands of kidney patients in Modesto without a serious malpractice suit, traveled, enjoyed family time, and pursued his hobby of black-and-white photography.

Golden’s first depression came in medical school in St. Louis in early 1973. He began waking at 4 a.m., gripped by feelings of hopelessness and guilt, and dreaded going to work.

Soon, he could not concentrate on the surgical rotation at Barnes Hospital of Washington University, and then a psychiatric breakdown sent him to the emergency room in hysterics, he said.

Golden credits a psychiatrist at Washington University for saving his life and said that electroshock therapy, which was then falling out of favor, brought him out of the depression.

Though he was afraid to tell his roommate about the crisis, encouragement came from the dean of the medical school, who reassured him and promised it would not affect his schooling, Golden recalled.

Training in Israel

The crisis didn’t stop the ambitious student from completing a rigorous internship in a troubled part of the world.

A visiting professor at Mount Sinai Hospital in New York sponsored him for an optometry internship in Israel. Golden had booked his flight for the 12-week trip when Egypt and Syria launched attacks against Israel, igniting the Yom Kippur War of October 1973.

Golden was sworn into the army upon arrival in Israel. He and the research doctor traveled in a Volkswagen to pick up soldiers with eye wounds. He switched to emergency medicine training at a military hospital in Tel Aviv, which took in soldiers with all sorts of injuries.

Three years later, Golden was in a residency program at University of California, San Francisco, when depression took hold again. “I was in the middle of seeing a patient and I told the chief resident I had to leave. The chief resident subsequently came over to my apartment and told my girlfriend she was concerned I would commit suicide,” Golden said.

He returned to the psychiatrist in St. Louis for outpatient treatment.

Golden was only the second kidney specialist to practice in Modesto, arriving in 1979. At that time, the local facilities to treat kidney failure were limited. He introduced kidney dialysis at Doctors Medical Center when he and a vocational nurse hauled the only dialysis machine, at Memorial Medical Center, across town in a rented truck to treat a patient who awaited heart bypass surgery at Doctors.

Golden concealed his mental illness but had to “come out of the closet” when another crisis occurred in 1982. He disappeared for six weeks to a resort in Scottsdale, Ariz., which became a refuge for getting through bouts of depression.

Golden worked for Gould Medical Group until 1992 and then began his own practice.

“My peers at the Gould clinic (in Modesto) were less forgiving,” Golden said. “I knew they looked at me as different. Even now, it’s easier for people to come out as gay or lesbian than to come out of the bipolar closet.”

Golden has the less severe form of the disorder, called bipolar II, which doesn’t have the destructive symptoms and psychotic features of bipolar I, his book says.

He said he did not experience the disorder’s manic side until 1988. “You have so much energy,” he said. “You feel great euphoria. You get things done fast, without much sleep. I was on a roll.”

Before long, the dark side of mania was manifested in irritability, confrontations with people and risky driving.

Golden saw that a diabetic patient at the former county hospital needed transfer to dialysis, and though it could have waited until morning, he woke a medical resident at midnight and screamed in his face. The resident lodged a complaint, prompting Golden to take a four-week vacation and start taking lithium.

He said a partner announced to staff members that he would not be returning, but the medication enabled Golden to resume his duties.

According to his wife, Sue, Golden bore the stigma of the disorder perhaps more than he realized. At one point, a competitor used knowledge of her husband’s disorder to steer away some patients, she said.

“Paul is a very serious and intelligent man and was very good at what he did,” Sue said.

As a nephrologist, Golden was part of the team that saves crash victims brought to local emergency rooms from the six-county area around Modesto. Called to the hospital in the middle of the night, he would insert a catheter in a jugular vein of a patient who was in shock to start dialysis until the kidneys functioned again.

Knowing he had to be on top of his game, Golden had monthly or weekly sessions with his psychiatrist to talk or to adjust his medication. “It never affected my patient care,” Golden said. “I knew it was time to stop when I started feeling symptoms overnight, and I would take time off.”

No triggers for episodes

Golden said the episodes over the course of his career occurred without obvious triggers. He said he grieved the death of his first wife without severe depression.

Clinical depression is attributed to an imbalance of serotonin, dopamine and other chemicals in the brain. “It feels like a switch is turned on,” Golden said. “One day I am fine and the next I am waking up early, anxious, shivering in bed, feeling hopeless.”

The medical profession is wrestling with the issue of depression among physicians.

According to the American Foundation for Suicide Prevention, suicide claims the lives of 300 to 400 physicians in the United States every year, and rates of depression among medical students are 20 percent to 30 percent higher than the general population.

Dr. Kyle Jones, a faculty member of the Family Medicine Residency at University of Utah, wrote in a 2014 blog that the country is losing too many doctors to untreated mental illness, which worsens a problem with patient access to care.

“So many doctors who have symptoms of mental illness refuse to acknowledge it and don’t seek help,” Jones said in an interview last week.

Part of the problem is licensing requirements that frown on any sign of mental incompetence. “Physicians fear that, ‘If I have to admit I have depression, anxiety or bipolar disorder, I will lose my license and won’t be able to practice anymore,’ ” Jones said.

It’s thought that rigorous medical education contributes to depression among the ambitious, Type A personalities that enter the profession. Doctors-in-training endure long hours without sleep, weeks spent in hospitals without seeing the sun and disparaging supervision from attending doctors, Jones said.

Studies have shown that doctors with untreated mental conditions perform lower quality care, “so it is a patient-safety issue if we are not taking care of ourselves.”

In Golden’s opinion, many professions, including health care, are not ready for total transparency on the issue. When applying for hospital privileges, doctors are asked whether they have been under psychiatric care or taken medication for mental illness.

“If you answer ‘yes,’ they are not going to hire you no matter the job you are applying for,” Golden said. “If you are having trouble with mania or depression, then you should tell your boss you need time off.”

Golden’s story is not for those who like a tidy ending to narratives. After going many years without an episode, a suicide attempt in 2012 ended his medical career. The Medical Board of California investigated and a state psychiatrist’s evaluation concluded his ability to practice medicine was impaired.

Golden surrendered his license because he was at retirement age and faced spending tens of thousands of dollars to fight the accusation, he said.

Joyce Plis, treasurer of NAMI’s Stanislaus chapter, said she appreciated Golden’s well-attended talk in January because it shows that people with bipolar disorder can have productive lives.

“They really have to work on their treatment to be able to concentrate and work,” Plis said. “I suspect there are a lot of people who manage their illness and have careers, but they are probably not telling people about it.”

Golden advises those with bipolar disorder to live with a social conscience. His advice includes:

▪  being proactive and getting educated about the disease;

▪  finding a competent psychiatrist;

▪  having a trusted support team and strategy for managing a career.

Golden said his support for working through crises came from home. He referred to his first wife, Priscilla, who died 23 years ago, as the “patron saint of bipolar disorder.” He and his second wife, Sue, share a Modesto home with two toy poodles.

Golden said bipolar disorder is “not a terminal diagnosis. It is essential you recognize you have a problem and you need to find a psychiatrist you have good rapport with. It isn’t a disease that is curable. You will need to be on medications the rest of your life.”

Paul Golden’s book “An Insider’s View of Bipolar Disease” is available on Kindle or in paperback at Amazon.com.

This story was originally published February 29, 2016 at 3:45 PM with the headline "Former Modesto physician tells of struggles with bipolar disorder."