Being human

Recently I looked after a mental health patient. They were admitted to our ward after having been assessed by the out of hours mental health worker and were waiting for a formal review by the psychiatric team. This happens uncomfortably often on the paediatric ward and really highlights the rise in mental health problems in young people.

As a medical doctor, I saw this young person on the paeds ward round that morning. This was a teenager, a child who was so distressed, terrified and overwhelmed by their own thoughts. Their face was emotionless, yet their eyes full of sadness and fear. The room was silent. The curtains still drawn.

In that moment, I saw the fifteen year old me staring up from under the covers. Exhausted. Vulnerable. Hurting.

I knelt down by the side of the bed and listened. As the patient talked I moved closer. I held their hand. I stayed there.

Some would say this was not in my remit as a medic. After all, I had been told to “go in, say a quick hello and make sure they were medically fit before psych come”. But in that moment, there was no way I was leaving.

So I stayed and I did and said all the things I wish the professionals had said to me the first night I was in hospital at that age. And once the young person felt safer, only then did I leave.

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As soon as I had closed the door, the emotions were overwhelming. Tears poured down my cheeks as I ran towards the doctors’ office. The junior trainee followed me in, sensitively checking I was OK.

I have been pretty honest about my struggles at work- people know that I have had serious mental health problems and talking has helped break down the stigma. As I sat crying, the two junior trainees with me were incredible. I told them my story. I told them about my admission aged 15 to a psychiatric hospital. I told them I had been suicidal. I told them I had had anorexia… And they listened.

They listened without judging as I explained that I had wanted to open up to the patient. I had wanted to expose my vulnerability and highlight that mental illness is all around us; that they truly weren’t alone. But it seemed wrong; as though I would have been crossing an invisible line between doctor and patient; as though it was a deeply unprofessional thing to do.

My colleagues told me otherwise. They empowered me, they believed in me and they encouraged me to do what felt right.

So later that morning I popped back to the young patient’s cubicle. I knocked, went in and sat on the edge of the bed. I asked permission to tell them something personal that I had never told a patient before but I thought it was important for them to know. They looked confused but agreed.

And so I did it. I explained to the child that at the same age, I had been depressed, I had thought about ending my life and that mental illness is all around us, we just don’t know about it. They were not alone. There was hope that things could be different.

As I stood to leave, the patient whispered

“Please can I have a hug?”

That hug will be one I carry with me forever.

 

To admit or not to admit- That is the question (Part 2)

Does admitting vulnerability have to be a bad thing?

I remember a patient I looked after several years ago. She had been admitted to a general paediatric ward with the medical complications of her eating disorder. The idea of nasogastric feeding terrified her. She sat sobbing on her bed. Although I never needed artificial feeding when I had anorexia, I could totally 100% relate to what this girl was going through.

It was a strangely quiet night shift. I had the option of getting some sleep but instead I sat with the girl and we chatted. She cried- I held her. She talked- I listened. As I left the room she said “Nobody has ever got it like that before. Thank you”. The following morning her mother came to find me. She was so grateful for the time that I had spent with her daughter but she had seen through my empathy. “You understand in a way that others don’t, like you know what it is like. Have you had a sister with it or something?”

In that moment I didn’t know what to say. I worried I had crossed the boundary of professionalism, thought I would get into trouble. I don’t even have a sister… I could make one up…… But somehow honesty was the only way. And so I explained that I had suffered from anorexia as a teenager, that I had been in hospital for 3 months and that things had been tough. But I could also tell her that I had come out the other side and now had a healthy relationship with food. The mother looked at me and tears started rolling down her cheeks. I immediately regretted what I had said.  She unexpectedly leant forwards and hugged me. Into my ear she whispered “Thank you, thank you so much for giving me hope.”

Admitting vulnerability doesn’t have to be a bad thing.

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Opening up with patients

All too often in the healthcare sector, we refer to vulnerability as a negative attribute. We are expected to pick ourselves up, brush ourselves off and get on with things. Stigma silences us. In their study, Malterud and colleagues demonstrate that vulnerability can be beneficial in the doctor patient relationship.

Clearly there is a boundary when it comes to sharing our own struggles with patients. After all, we remain the professional in the relationship and as such, need to be aware of how the disclosure may impact on that. Revealing insecurity doesn’t have to be done by spelling things out though. Thoughtful questioning and understanding can be sufficient to help the patient feel valued.

However, opening up can leave us feeling exposed. I was convinced that I would get into trouble for my behaviour. I worried about it for days. What if someone at work found out? What if they thought I could no longer be a good doctor?

It turns out nothing happened. Of course it didn’t. I did nothing wrong. Being true to ourselves isn’t always such a bad thing.

I broke

Three weeks today I return to work after a long period away. This wasn’t leave that I had looked forward to or planned. It was imposed on me by my health, or perhaps I should say my ill health.

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Back in June 2017 things had got pretty bad. In fact I hadn’t really realised how bad. It had all crept up on me insidiously. A thick dark fog had descended on the world. My soul, my passion and my enthusiasm for life seeped from my exhausted body. Yet my mind was racing, my thoughts so jumbled that at times that I could not make sense of them. I was worn out by the constant indecision, the questioning, the anticipation and anxiety. I felt like I was at breaking point but was compelled to carry on. Giving up work was not an option. In fact I despised myself for showing any sign of weakness; having time off epitomised failure as a medical professional.  People tried to tell me otherwise, but when it came to my situation, all I heard were empty words.

 

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There is a culture ingrained in medicine of not asking for help. Fragility and vulnerability are not desirable attributes in a doctor.  This misconception silenced me for years. I tried my best to be tough, to repeatedly pick myself up, dust myself off and crack on. So, when my psychiatrist advised me to take some time off work, I sat opposite him and sobbed. I was broken. I was a failure. My job had finally defeated me.

As I left my local GP surgery the following day with a sick note in my bag, all I felt was guilt. My colleagues, my patients, their families… nowhere in that moment did I think to spare a thought for myself. Medicine teaches us to be kind, empathic and caring. Maybe it’s time that we started to treat ourselves with that same level of compassion…

What do you do for yourself?