“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”

 

I am a doctor and I have mental health problems

Yesterday, I sat with my Granny in her residential home watching the Victoria Derbyshire show. She held my hand as I cried. Finally a topic so close to my heart was being given air time. Everything I feel and have felt for years was being said.

The report told the story of two doctors who took their own lives in the last year. That could have been me. It highlighted the amazing work of the Practionner Health Programme (PHP), set up for doctors with mental health difficulties and addiction. The team are incredibly experienced in dealing with barriers to seeking help and the challenges faced of being both a doctor and a patient. At the moment, only funding those in London can access the service. Dr Clare Gerada, the clinical director, and her team continue to fight to extend their provision to the rest of the UK. I am fairly certain that if I had had access to this earlier in my training I would not have got to the dark and distressing place I was last year.

A few weeks ago I was approached by a journalist via my twitter account @doc_bipolar about featuring in his film for the Victoria Derbyshire program. I thought long and hard about it. I spoke to Lucy, the CEO at the PHP, who was very helpful and supportive. She empowered me to do what was right for ME something I have never been great at. So with that in mind, I explained to the journalist that I felt unable to feature in the film at the moment. Instead I decided to write an anonymous letter to illustrate my points. I didn’t ever think it would be used.

So here is my story.

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“I am a paediatric doctor. I work in the North of England and have done since I graduated from medical school ten years ago. I have battled with mental health problems on and off throughout my training. Things got pretty bad and I was signed off sick for almost a year. Only very recently have I felt empowered and able to reach out and talk about my difficulties.

So why didn’t I ask for help sooner?

There is still a huge amount of stigma around mental illness in doctors. It has always felt as though I am expected deal with everything and anything that is thrown at me in the same way that those around me do. Head down and crack on. Patients come first. Never in my training did anyone teach me to look after myself. People didn’t really share their struggles. We learnt how to take blood, insert catheters, break bad news etc but the self care skills, the skills that I now realise are essential to the sustainability and the well being of our doctors, these were never spoken of.

I was always terrified (and to some extent still am) of what would happen if someone found out I had mental health problems. Fear of what it would do to my reputation. Would I be chucked out of medical school? What if my colleagues no longer trusted me? Maybe I would be reported to the GMC?  Worse still, what if a patient found out and then I was struck off?

As it happened, things got a lot worse. It was initially quite difficult to access support at work and my attempts were met by resistance. I was referred to a psychiatrist by my GP and not long after was signed off work. Last Christmas I was diagnosed with type 2 bipolar disorder. I considered leaving medicine altogether, I couldn’t see how I could still be a doctor with this label. But somehow, with support and care, medication and therapy I found a way back. I am now well and back working in paediatrics.

I am not yet functioning at the level that I used to but I am getting there. I am regaining my confidence and reminding myself that I can do it. And this time it feels different because I have learnt to prioritise my own wellbeing. I work less hours, I leave on time, I refuse to work 13 hours without a break.

So now, by starting a conversation and sharing my story (generally anonymously on twitter or on my blog) I find that others are opening up about their difficulties. I am not alone after all. If only I had known this back then…

Culture change will take time. There are improvements but we are not there yet. Until that time, I don’t feel able to go completely public with this and I worry about how one negative or ill informed comment or reaction would impact on my own emotional wellbeing.”

And so as bits of my letter were read out on BBC 2 yesterday morning, I sobbed.

Maybe I can do this after all. It turns out I am not alone and maybe, just maybe I can inspire others to keep going when there seems to be no hope.

https://www.bbc.co.uk/news/health-45356349

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

My patient died, yet this is how I find out?

As medical students and again as trainees, a lot of time is spent perfecting the art of breaking bad news. Many of us will have seen it done badly and as uncomfortable and horrible as those situations are, we remember them. Why? Because we absolutely swear never to do it like that.

Over the years, I have gained confidence in my communication skills. I know I can lead these difficult and distressing conversations but despite the experience, it never, ever, gets easier.

For each family, that moment is life-changing. The way in which you deliver that information has repercussions for the rest of their life: the words you choose, your tone of voice, the way you sit, your facial expressions… You slow down, you give them time, you listen, you offer them a shoulder, a tissue, a cup of tea… you do whatever you can to make a seriously shit experience just that tiny bit better.

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So why is it that we don’t do this for each other?

A while ago, I looked after a child who was normally fit and well. He had become ill very quickly. The team had worked hard, doing our best to keep him alive. By the time I went home that evening, the boy was doing better. I was exhausted and thankfully had a few days off after this. When I was next on the ward, I heard a couple of nurses talking as I wandered through. In and amongst what they were saying they seemed to be referring to a recent death. I enquired who they were talking about.

“Oh haven’t you heard, (….) died a couple of nights ago.” They were talking about the boy I had looked after; the one I thought had pulled through; the one who seemed stable… They went on to tell me the clinical ins and outs of the situation. I stood there feeling overwhelmed: deep sadness for him and his family, guilt, uncertainty, what if I had missed something. I started running things over, should I have done something different? And before I had time to begin to process this the ward round commenced.

This is not the first time that I have found out about the death of one of my patients like this: a passing conversation on the ward, finding a bed space unexpectedly empty, a conversation at handover in front of 15 other doctors etc. Finding out like this really disconcerts and destabilises me.

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Why is it that we spend years learning to break bad news to our patients in a sensitive and empathic way, yet when it comes to ourselves and our colleagues, there is very little thought put into how we discuss it. Losing a patient is challenging, no matter where you are in your career. It highlights our personal vulnerability: the sadness of losing of someone we knew well, a reminder of struggles in our own life, self-doubt and questioning of our practice, guilt, a trigger for mental health difficulties.  All of this is completely normal, yet somehow it is overlooked when we talk to each other.

Looking out for each other

A few years ago, I looked after a little boy with a long term condition. He frequently attended the paediatric ward and the staff had all got to know him well: hilarious, witty, cheeky, brave and truly inspiring. He was my favourite. A few months into my maternity leave I received a call from one of my fellow registrars. She thought I should know that this little boy had died a few days earlier. I remember holding my trolley tighter, tears rolling down my cheeks in the supermarket car park.

I look back and realise how much that phone call meant to me. I was able to grieve at the same time as everyone else rather than having to wait until I returned to work to find out. That colleague gave me permission to feel. We are humans after all. It is OK to feel.

So, maybe next time you lose a patient, think of a colleague who deserves to find out in a more sensitive way than overhearing something on the ward or realising there is a missing name on the handover sheet. Give them a ring, check they are OK. Allow yourselves to grieve the loss of a patient. #ItsOKtoTalk

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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?