My journey back into medicine

May 2018

I sat sobbing. Unable to see through my tears, I pulled over. My body was shaking. It was early afternoon.

The ward had been exactly as I remembered, yet the familiar surroundings had failed to comfort my growing anxiety. The smiling faces of people I knew were scattered among a sea of others I didn’t recognise. And all I could notice were repetitive, circular thoughts persistently interrupting me.

What do I say? How do I justify my long absence? What words should I use? What will they think?

 

July 2018

“Come in, take a seat” I chirped, as I ushered him into the clinic room with his parents. We talked, we laughed. I examined him, formulated some kind of a plan and then sent him on his way for a few months. As he left I sighed. The smile slid from my face. Behind the closed door the exhaustion crumpled me once again. I typed my notes staring blankly at the screen.

I took a deep breath and stood to call the next patient.

“Come in, take a seat” I chirped.

Again and again.

 

August 2018

The child must have been about 7. He was a funny kid, good at football. There was nothing particularly exciting about the consultation but as he left I realised that my smile was no longer as forced. Elements of that interaction that had felt real.

There was feeling where before there had been none.

 

September 2018

There was a boy on the ward. He was sick; I mean properly sick. I had done what needed to be done from a medical point of view. But this wasn’t about medicine. This was about a poor family, whose life was about to be changed forever.

As I drove home that day, I wished I could have done more, said more. Been there.

 

November 2018

I was called urgently by one of the nurses. I followed her into the cubicle. Anxious parents hovered over a cot. The baby was listless, skin as white as the sheet upon which she lay. She was sick.

I knew what to do. I did it; almost automatically.

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A lot happens in six months.

From panic attacks at the thought of being on the ward, to leading a resus situation; yes, in many ways I have done it. I have got back to medicine from a place where I thought I could never return.

I am a different doctor now: one who knows their limits, who understands when to slow down and how to ask for help. I am a doctor who accepts their vulnerability.

That said, I still don’t know how I really feel about it all. Somehow the love and enthusiasm that I had in abundance are still not there. Instead, medicine feels somewhat unfulfilling. I leave work wanting more of the things that fall outside of my role. The care, the compassion, the psychological support, the following up and checking in. The being there.

Perhaps it is time for me to think about other options; because yes, I now realise I CAN be a doctor with mental health problems, but the question is, do I WANT to be?

The value of listening

Spring 2001

I lay on the small bed, staring at the ceiling. He wasn’t usually this late.

I had been an inpatient for 2 months by now and knew the drill. He came in the evening, wearing his suit, straight from his practice in town I assumed.  Generally he would knock, then push the door open and perch on a chair squeezed in between the small table and my wicker bed. I would talk. He would act interested. Then he would leave. He rarely, if ever, said anything.

Once in a while I would go to his office. He’d peer over his imposing wooden desk, fountain pen poised over crisp white paper, waiting for me to utter something worthy of scrawling on his pad. On my way back to the ward I would push my way through the overcrowded smoking room, acrid smoke stinging my eyes. At the top of the stairs I’d shuffle past the nurses’ station and slip into my room unnoticed.

I lay waiting but the consultant didn’t come that night. Instead his registrar appeared as I was getting into bed.  Embarrassed, as I was wearing particularly hideous yellow pyjamas, I pulled my duvet up to my chin and shuffled down the mattress. He sat down and started talking to me. I can’t even remember what we talked about but I remember him.  I remember him because for the first time, someone had seen beyond my label, beyond my diagnosis. He saw me.

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Earlier that Spring, the anorexia had reached a point where I couldn’t carry on. My weight was at a critical point. My periods had long stopped. I had been started on antidepressants with little effect. My poor mother didn’t know what to do. I agreed to be admitted but there were no local eating disorders units for me to go to. The postcode lottery meant that this hospital, over an hour from home, was the only place I could get a bed. Somehow it seemed better than nothing.

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Nearly 20 years have passed since I lay on that bed in the psychiatric hospital. A vulnerable teenager locked behind huge iron gates; not allowed to leave.

I can still see people’s faces: the middle aged lady who sat beside me describing her suicide attempt, the bearded man who sat on my bed and cried.

I remember.

I remember the face of the young woman I befriended who then tragically took her life. I remember it all. That was my normal.

And as I replay these images like an old movie in my mind, I see the registrar. The only doctor during those three months who saw me, who listened and who reached out to a young lonely teenager.

 

Be that doctor. Listen to your patients. See beyond their label. See them for who they really are.

“We all need somebody to lean on”

In the run up to returning to work I tormented myself for days about how I was going to explain my absence to my colleagues. What words could I use to justify being off sick for a year? Should I make up some excuse, pretend I had had another child? Perhaps if I was suitably vague people would get the hint and not ask. A friend jokingly suggested I should explain I’d had really infectious and deadly disease and then cough all over them!

Facing my colleagues was the real hurdle of returning to work. The medicine per se felt like the bit I could do. The rest…. I was returning to a culture that didn’t get me. I was a broken doctor, a doctor who couldn’t cope. A failure.

This is genuinely what I believed.

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Whilst I had been off work things had got pretty bad. Large crowds, busy places and travelling on my own had all become fraught with panic and overwhelming upset. I had isolated myself in order to avoid triggers. I had a few ‘safe’ friends, but gatherings with more than three people…. arghhhhhh. I can still feel it now: tightness in my chest, an irrational fear mixed with dread and panic. Unsurprisingly, I wasn’t exactly relishing the idea of returning to work and having to face a room full of people I didn’t really know.

The first few times I uttered it I remember my voice sounding wobbly: “I have been unwell and had some time off sick.” It sounded so wrong, so foreign. Admitting vulnerability is not something that we do as medics. You could see in people’s response that it isn’t something we are used to hearing  either. A sort of embarrassed “Awww” followed by silence. Why do we find it so hard?

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After a few weeks of being back I started to talk a bit more. I found myself using the phrase “Mental health problems” and surprisingly, nothing bad happened. I began to realise that the worst mental health stigma was in fact what I was inflicting on myself. As I looked around, I saw other doctors struggling, trainees talking about the pressures, the rota gaps, the constant unrelenting demands on them. And then I found Twitter, which has given me access to people, ideas, discussions, support that I cannot begin to describe. My twitter world has made me realise I am not alone. I am not broken. I am human.

With that in mind, I decided that I would speak out. Silence had got me nowhere. Now it was time to share my story. As I described my experience, I hoped that someone somewhere might take solace from knowing they weren’t alone.

And so I talked. I talked to colleagues over coffee, I listened to them share their struggles. I talked at departmental and regional teaching sessions. Because mental illness can happen to anyone and no one should feel ashamed of it. And as I talked, I felt empowered.

Disclosure isn’t for everyone and potential consequences need to be considered carefully. I certainly haven’t shared all the details of my history and what I speak about varies depending on the situation.

But the shame has gone. I feel like I now have permission to be me.

De-stigmatising mental illness in doctors is clearly not going to happen overnight but we can all make a start. Dare to share how you feel. Talk to your colleagues about what you do to relax or wind down after a busy day. Discuss mental health. Prioritise well-being. Let’s face it, if we don’t, no one will.

And in the words of Bill Withers:

“Sometimes in our lives
We all have pain
We all have sorrow
But if we are wise
We know that there’s always tomorrow

Lean on me!
When you’re not strong
And I’ll be your friend
I’ll help you carry on
For it won’t be long
‘Til I’m gonna need
Somebody to lean on”

 

Army

I wrote this piece last year and found it among various other bits. It reminds me of the pain and the exhaustion that come with depression. It contains strong words and references to suicidal feelings that may be triggering. Please be kind to yourself. It is OK to ask for help.

 

Suicide.

Blinded by darkness, it’s the only way out.

The final solution to an exhausting battle.

Suicide is my comfort.

A bleak stillness steals my last breath,

Suicide… The echo that remains once I am gone.

 

Except I don’t go…

I stop.

I notice.

The comforting call of suicide continues. I listen. And I notice.

I notice a solitary bird in the sky. I notice the icy wind on my face. I notice my regular long deep breaths.

As I notice, I reconnect.

Gently waking from a long and painful sleep.

Rediscovering life’s unassuming moments.

Strangely beautiful.

 

And then I talk.

An unfamiliar voice at first.

My own.

Outstretched hands I had never noticed.

I share. I talk.

My load is lifted.

No longer lost and alone in the battle.

Talking has forged me an army.

An army that has made me stronger.

An army that has saved me from suicide.

 

Be someone’s army.

Start by talking.

I have always wanted kids

There is a question that runs through my head from time to time…

Would I have rushed into having children if I had known I had type 2 bipolar? Let’s face it, I could have passed this hideousness on to my girls…

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I always knew I wanted children but I knew that my background put me at high risk for postpartum mental health problems.  I remember highlighting this to my midwife at my first booking appointment whilst also being terrified she would black mark my notes and contact social services.

“Do you have any worries?” she asked.

“Well, yes…. I worry a bit about how I’ll manage emotionally because I am pretty high risk for postnatal depression”.

“OK, why do you say that?”

“I was an in-patient in a psychiatric hospital for three months as a teenager with anorexia and had a tough time at university too.”

“Alright, so we will keep an eye on things.”

What she actually meant was “Well you look a healthy weight and you are smiling so you must be fine.”

That was it. That was the grand total of my antenatal emotional wellbeing assessment. And unfortunately it was no better the second time.

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The days after my second daughter was born I was running on adrenaline and excitement.  Her birth had been so much easier than I had expected (the first one was bloody awful!) and I felt lured into a sense of “everything is going to be OK.”

Except it wasn’t OK. As the days turned into weeks and the weeks into months, I slowly fell deeper into the darkness of postnatal depression. I existed solely for my children. I sat breast feeding at night, tears tumbling down my cheeks. My life had gone. I was going through the motions. Doing what I had to do to keep everyone alive and happy. Inside I was dying.

Yet somehow people didn’t know. I had developed such a slick and seamless act that people couldn’t know. Over time my show started to fall to pieces. My skin was terrible. My eyes became glazed and exhausted. My brow was lined with deep wrinkles of worry. I cried in public.

My health visitor advised me to see the GP. I was started on medication and referred for talking therapy. But I continued to deteriorate whilst I waited. I had no choice but to find a private therapist. Two years on, I am still in therapy. At Christmas I was diagnosed with type 2 bipolar and started on new medication.  The private sector saved me. I was fortunate enough that I could pay. Not everyone can.

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As an NHS worker, I feel guilty, saddened and disappointed that our system is failing so many. When you have lost all value in life, when everything is bleak and death seems the only way out, waiting for six months to get help only adds to the feelings of worthlessness. Every day that you don’t get that help, the enemy is winning the battle.

Could my illness have been prevented… probably not. Could I have been better equipped and more prepared for the challenges that being a parent brings? Almost certainly yes. Antenatal care is the place to start. Emotional support for all parents. Identifying triggers and teaching families about self care. Everyone needs this stuff. People like me need it that little bit more.

So going back to my girls, yes, they are at higher risk of developing mental health problems. Yes, there’s a chance they might have bipolar. Do I worry about them, yes. Do I regret having children? Not in a million years.

My girls are growing up knowing that their Mummy takes medicines to help her feelings. They know it’s OK to talk about emotions. They have parents who are armed with strategies to help them deal with difficulties, and as my husband put it the other night:

“What parent would be able to deal with their child’s mental health difficulties better than you?  You understand it and are learning how to manage it.” Maybe he’s right.

I am bringing my children up to know that there is no shame in having a mental illness.

#PND #MentalHealthAwareness #Bipolar #motherhood #newmum

The doctor I used to be

I sit in clinic with my cup of tea. I see another patient. I listen to the parents. We talk. I order a few tests, arrange follow up. Yet at the end of the morning I still feel useless; I am so far from where I want to be. I know what my peers are doing. They are getting on with it: fellow registrars rushed off their feet working on rotas with multiple gaps, unable to eat their lunch let alone getting a cup of tea. This has become the norm. The norm now seems impossible.

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At Christmas I was diagnosed with type 2 bipolar. As I continue to recover from the last couple of years, I struggle to see how I can possibly manage to work in the acute paediatric setting that I once thrived in: the fast pace, the quick thinking, complex decision making, unpredictability, staff shortages, responsibility… I used to be able to do all this.

I grieve for the doctor I used to be. She had an incredible passion and drive for medicine, for improving care, for teaching and training. She was amazing with her patients. I miss her so much.

 

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Mid April 2018

I went to meet my supervisor prior to returning to work. As I entered the hospital I could feel the panic rising in my chest. Each junior doctor that I passed in the corridor seemed to walk with confidence, exuding brilliance as they strode off. The more people I passed, the more anxious I became and the smaller and smaller I felt inside. I headed outside, the panic growing further. I tried to phone my friend, my husband, another friend. Nobody was available. I clung onto a wall near the entrance of the hospital. I thought of all the resources and strategies my therapist has taught me in the last two years. My breathing steadied and my chest loosened.  Slowly I felt better.

Maybe that is what I need to remember when I am sitting in clinic feeling inadequate, like I am not pulling my weight or haven’t shown my face on the ward. Three months ago I couldn’t walk into the hospital without having a panic attack. Three months ago I was terrified at the idea of having coffee with a colleague. Three months ago I couldn’t manage the drive to work without crying.

It turns out I have achieved a lot, I just need to readjust my yard stick. You can’t run before you can walk.

I know I can still be the inspiring paediatric doctor that I have always wanted to be, the question I have to answer is whether I still want to do that. It comes at a cost and, maybe for me, that cost is just too great.

There are other options out there. Just because your path was mapped out years ago doesn’t mean you can’t stop and rethink, take a risk and start afresh. Maybe a new start is what I need.

Good Enough

I remember my first appointment with my psychiatrist. It wasn’t quite what I expected. Within ten minutes of arriving he seemed to have completely sussed me out. He sat forward in his chair and picked up the pen from the table. He wrote the words “Anxious perfectionist” on a white piece of paper.

I stared blankly at the page.

“This is your personality type” he explained. “In fact, many medics tend to be like this.”

I sat, avoiding all eye contact.

“As an anxious perfectionist you have lots of positive traits.”

He started writing a list on the sheet:

  • Very conscientious
  • Caring and compassionate
  • Applies self fully to everything

“But this personality type also comes with a number of not so helpful traits:”

  • Gives 110% to everything
  • Struggles to say No
  • Creates own stress where there perhaps needn’t be any
  • Struggles to accept good enough

Me, scrawled on half a side of A4. I cried. Relief. Sadness. Helplessness.

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I have always felt comforted by success. There is something about performing well that gives me worth and value. When I was quite young I realised that if I tried hard and did well, people seemed to like me. There was a lot going on at home and I needed people to see me, to like. As I got older, the compulsion to out-do myself got worse.

If it wasn’t perfect, then it was simply no good.

This attitude continued through high school and university. With it came great results. I graduated top of my year, I passed my membership exams pretty quickly, got several publications etc but none of it meant anything to me. No pride at all. No self worth for what I was achieving. People told me how well I was doing; all I heard was empty words.

I now know the price I paid for all this. Medicine was my crutch, my way of controlling everything that was going on inside me, feelings that I didn’t know how to deal with, childhood traumas/ that had never been processed. Slowly, I became numb to everything else. Perfection had become a drug.

But then life changed. Two children came along, I suffered with bad post natal depression, started working part time and realised that I could never be the doctor I had been up until then. This strange fear came over me. Grief for the loss of the driven, ambitious and competent person I had been, a feeling of failure. And worst of all… I don’t even know who I am.

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Slowly, like a germinating seed, the concept of ‘good enough’ is beginning to feel more comfortable. Life has changed and with that I need to realign my priorities and expectations. I now have a husband and two children. I have a diagnosis of type 2 bipolar, which unfortunately isn’t going to go away. It is now my job to take care of myself, to stay well and prioritise what is important to me. The only way to do that is to begin to accept ‘good enough’.

If I stop giving every ounce of my soul to being the best mother, the best wife, the best doctor maybe there will finally be space for me to be the best and the happiest version of myself.

Good enough is plenty good.