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.