Medicine is stressful, there’s no getting past that. As doctors we juggle complex emotions each day (our own and our patient’s) make snap second decisions that are potentially the difference between life and death; suffering and healing; a life weighed down by trauma and guilt, or a way forward to hope. We have little time to recover from these stresses, have a cup of tea, debrief and regain our equanimity. Sometimes we can do all this, come home, switch off and let the complex decisions we make wash over us and dissolve into our unconscious. At other times, they weigh down heavily on us, affect our sleep and well being, and spill over into our whole lives. We are only human. We have emotions just like every other human being and can’t always compartmentalise these. Sometimes we forget that though. We have been programmed from our medical student years to expect ourselves to be somehow superhuman and intolerant of our humanity, coupled with a drive to perfection which is in-bread in most young people who get as far as medical school. This is exacerbated by our patient’s expectations of us, media coverage of things that go wrong, and complex bureaucratic systems that seem out to penalise and criticise, rather than constructively help us. The NHS is underfunded and under resourced and blame is put on the clinicians rather than the system. Sometimes it feels like we are King Canute trying to hold back a sea that is ready to overwhelm us.
Medicine has affected my mental health. I started out as a fresh eyed medical student, excited and slightly trepidatious about what lay ahead. I was endlessly fascinated by how humans work, both physically and mentally, and relished the privilege of helping people at some of the most difficult points in their lives. However, I soon realised that medicine wasn’t that healthy for me either. I felt that I needed to put on a show, pretend that things I found really stressful were easy for me, and treat my emotions as inconveniences that got in the way. My self-esteem, already somewhat fragile, was affected as I strongly wanted to do medicine, but could see people around me who I perceived were coping so much better than me. I nearly burnt out as a house officer. I used to wake up at 3 am, even when I wasn’t on call, worrying about patients and whether something I had done had killed them. On occasion I phoned the ward to check that Mr or Mrs So and So was still alive. One morning I went into work, looked at my long list of house officer tasks and realised I didn’t know where to start and couldn’t do any of them. I went home. I only had three days off. There was still a strong desire within me to do medicine, I felt it was where I was supposed to be, and I was worried that if I was off too long I would never go back, or people would criticise. I learnt the value of talking, admitting my difficulties and realised that people were amazingly supportive and not rejecting as I had feared that they would be. I found going for long walks in the Dorset countryside with my SHO the most reviving. I also learnt that I needed to be slightly kinder to myself, or I thought that I had.
Fast forward nearly 20 years, a marriage and 4 children later. I was still struggling on a daily basis with my mental health, but I don’t think I was fully aware of it. I worked part time, and multiple mini-sabbaticals of maternity leave actually helped me to cope. I felt amazingly rewarded most days, but also was constantly on edge at work, feeling like I was approaching a war zone each day, scared about what would be thrown at me and whether I was up to it. I knew that I had helped many people, but it didn’t seem enough. I was constantly scared of making an error. The pressures of appraisal and CQC, constantly analysing myself and my practice really didn’t help. There were days when I stayed at work past 11, just trying to catch up with the endless reams of paperwork. Sometimes I had an almost OCD like feeling of needing to check and double check what I had done to avoid errors. I recognised that this wasn’t quite healthy, and I tried to be more disciplined with myself, leaving earlier, trying to let things go. I still had the worry about killing someone. On occasion I would phone patients at the weekend just to check they were still alive. I would wake in the middle of the night, heart racing, realising that I had forgotten something.
We then moved, I thought this would be good for me, and it was in the long run. My husband, equally under stress from working in the NHS, but in slightly different ways to me, was nearly burning out and a new job opportunity took us West. It was a very stressful move. Our house sale fell through and we ended up living in temporary accommodation for nearly a year, at the same time as settling to new jobs and new schools. I had to work extra to make ends meet, and I remember thinking; I’m coping, how am I coping with this? I think I was living on adrenaline. There were tell-tale signs that things weren’t right though and trouble was brewing below the surface. The minute I stepped through the door of our too small rental, I could feel anxiety raging up with in me. I felt like a caged animal and needed to escape, but where to?
We finally moved and I thought all my problems would be solved, but the anxiety wouldn’t go, and built up instead. I tried some counselling, which helped a bit, but didn’t quite get to the root of it. I could feel myself getting panicky going on home visits. What if I couldn’t find the house, get it all done and get back in time for the school run? I would arrive at the home feeling weird and shaky and pretending that I felt fine, hoping that the patient wouldn’t notice. Small things took the shape of large obstacles, dark and forbidding. Finally, I went to my GP who persuaded me to go on sertraline. That in itself was an experience. I was floored by the initial side-effects, which gave me insight into what I had been prescribing for my patients for so long. However, I persisted and slowly started to feel better. The anxiety receded. I took up running, writing, I tried to make medicine not have such a large importance in my life, which somehow made the scary aspects of it more manageable. I went to the GP Health Service. I really can’t recommend this enough. I find travelling stressful, so did it all by face time with zoom, but found my therapist amazingly insightful and helpful. I worked on my self-esteem. I worked on my experience of trauma in medicine and trauma in other aspects of my life and slowly I came out the other side.
I am still not completely well. I think mental health is something that I will always struggle with, particularly if I stay in medicine. How can we not struggle with the pressures on us? It feels like the NHS is at boiling point and can’t be maintained at it’s current rate. However, I am a passionate believer in the NHS and it’s ability to care for all, no matter what their income. We need to enter into conversation as professionals about how we can save the NHS and safe-guard ourselves. I find medicine constantly rewarding and part of my identity now, but often feel the tendrils of anxiety and low mood hanging around me like a lurking mist at the corner of my vision, ready to smother me. Keeping my eyes ahead, focusing out rather than in, can stop me from plunging down. Sleep is important. I have more in my armoury now and feel stronger and more confident. I know there is a core part of me, separate from my fragile human mind and body, that cannot be broken. But medicine is stressful.
Originally Published in the Blog Recognise Prevent Recover (see followed websites)