Opening up

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This is a story I’ve been trying to write down for years.

It’s the story of how I lived (and am living) with a mental illness through medical school and training as a doctor, and how the culture and workload of medicine have made that both unbelievably hard and incredibly rewarding. If I’ve learned anything about my colleagues in the last 10 years it’s that mental illness in doctors is more common than you’d think.

I was an anxious high-achiever like most medical-student-turned-doctors, but in my final year of medical school my anxiety suddenly became overwhelming. I developed a terrifying, sweaty, palpitating distress about the possibility of medical error. As a medical student my every move was supervised and my impact on patient care was near zero, but my thoughts spiraled uncontrollably. I had inserted a cannula 6 months ago and suddenly couldn’t remember whether my glove had brushed the table as I reached for the equipment, rendering the procedure non-sterile.

What if the patient had acquired an infection? What if it was resistant? What if they became septic? What if they died?

Even if none of these things happened, what if they could have?

AnxietyEvery thought spiral ended the same way. Eventually, I would reach a worst-case scenario that was unbearable, and conclude that if it came to pass, I would have to kill myself. It was the only thought that brought me any relief, the only 'morally just' outcome I could imagine.

I had that thought 5 or 10 times a day.

The hospital I started in had a culture of what they called 'excellence', and what the junior staff knew more realistically as an intolerance for imperfection. Like many workplaces, there was a lot of lip service paid to 'wellbeing' and none of it went deeper than posters and yoga. Doctors who were struggling were not offered support but directed to alternate career pathways or simply not re-employed.

Instead, I sought the advice of a family friend who was a qualified medical specialist. I sat in her apartment and drew up my courage. “What if I make a mistake?” I asked.

My real question was, “how do I deal with the emotional and moral fallout of inevitable mistakes, when lives are at stake?”

Her answer stayed in my head for years after.

“You just can’t make a mistake, you have to develop a bit of OCD about it”, she said.

Ironically, this would be my eventual diagnosis, though she had no way of knowing at the time. It was the first, but certainly not the last time, I was told that 'a bit' of mental illness is required to be a successful doctor, something which I hope is obvious in its harm and lack of recognition of doctors’ humanity.

Private therapy, medication and a change of hospital got me through the first few years of my career but soon I took on a more senior role. Under the increased responsibility and workload, I began to break down. 

My first ‘big’ mistake turned out to be a near miss with no real harm to the patient, but it destroyed my confidence. I cried in the bathroom daily. I obsessed over every decision, paralysed by indecision and fear to the point that I would do hours of overtime, poring over patient folders to triple check.

Every time I called my boss to ask a question I felt like a failure. What I didn’t see was that all my junior colleagues were having the same struggle, and that my boss was expecting and happy to receive every call.

I was far from alone but in silence I felt like I was drowning.

I got tired, physically and emotionally. I was becoming slower at work and as a consequence, doing more and more overtime. There were problems in my personal life but I had no mental space for that. Every criticism at work felt like the end of the world. It became obvious that I was struggling. I wasn’t just crying in the bathroom anymore. A colleague said to me, “maybe you’re just not cut out for this.”

I was terrified she was right.

Every morning I thought of quitting my job. Sometimes that wasn’t enough and I would go to bed hoping I wouldn’t wake up.

One day a colleague turned and said to me, “I’m worried about you”.

She suggested I speak to a doctor she trusted, one of my supervising senior doctors, but I was too afraid of the consequences of admitting I wasn’t coping.

After my consultant corrected me on a minor detail during ward rounds I burst into tears. “I’m sorry,” I kept saying, “I’m fine, I’m sorry”. He let it be but a few weeks later took me for coffee.

“I don’t think you’re fine,” he said. “I want to get you some help”.

I burst into tears again. He asked if I was suicidal. “Only passively,” I said dismissively, knowing this wouldn’t even warrant a psychiatry review if I were an inpatient I had been called to assess.

Together we decided that I would make a time to see the senior doctor supervising my training. I can’t explain to you the relief I felt sitting in her office as she listened to my concerns, and instead of chastising or disciplining me she was sympathetic.

She spoke to every doctor I’d worked with and not a single one had concerns about my medical performance, completely contrary to my own perception. She arranged for me to have a short time off, gave me the name of a psychologist she trusted, and most importantly made a time to see me again. She was open with me, told me about mistakes she had made and how she lived with them.

The things that healed me were both simple and incredibly complex. I learned to sleep at night, to eat three meals a day and exercise. Things so basic they had been forgotten under the crushing weight of expectations I had for myself.

At the same time I went through a slow, deliberate withdrawal from perfectionism. I learned to sit with the discomfort of uncertainty and the possibility of error, to carry and share the responsibility of life and death decisions. I learned to direct the patience and forgiveness I had for my colleagues, inwards. Some of this sounds easy but I couldn’t have done it without the wisdom and kindness of my senior colleagues.

So much of the joy I get out of my job is about connection to other people — to my colleagues as well as to my patients and their families. A lot of my recovery was about rediscovering that.

My shame had been a barrier to opening up but once I did, speaking to my colleagues and seniors was deeply healing.

We had so many shared or similar experiences, haunted by such identical struggles and shames that it was almost laughable we had each felt so alone. As I healed, I also developed as a clinician and a colleague. My communication skills were sharper, my compassion and empathy for patients and their challenges was redoubled, my confidence and efficiency at work improved daily. I was reconnected.

I think about how often a doctor reaches out to another doctor for help, and how these interactions can shape your whole day, week, month or career. The difference it can make to a doctor’s mental health to have a supportive boss or supervisor is indescribable. I try to remember this as I take on more senior roles and have my own juniors to look after.

Then there are the doctors who really stand out, who make themselves present for deeper and more significant interactions. They check in on colleagues who are struggling, offering support rather than recrimination. They foster a culture that supports doctors to be open about their struggles and provides them with help when they need it. It might not be written in the contract but fostering a safe hospital culture should be part of everyone’s job.

There’s so much work to be done and it can’t all be done by juniors — it’s a cultural shift and it requires senior doctors who are empathetic and proactive and honest about the most gruelling aspects of the career we’ve all chosen.

This story is a happy one, and it’s still going. I’m a doctor living with a mental illness, and I’ve been supported through difficult times and have come out a better doctor because of it.

Today, that feels like something worth celebrating. I hope to pay it forward.

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