A few years ago, I found myself in A&E.
I had never felt so ill. I was mentally and physically broken. So fractured, I hadn’t eaten properly or slept well, or even changed my expression for months. I sat in a cubicle, behind paper-thin curtains, listening to the rest of the hospital happen around me, and I shook with the effort of not crying. I was an inch away from defeat, from the acceptance of a failure I assumed would be inevitable, but I knew I had to carry on. I had to somehow walk through it.
Because I wasn’t the patient. I was the doctor.
Each time we visit a hospital we see them. An army of scrubs and stethoscopes, travelling the corridors with a quiet confidence. We imagine, strangely, that they are invincible. That somehow, knowing the mechanism of mental and physical disease prevents them from contracting it. But for some, a stethoscope is less of a protective talisman, and more of a risk factor, and each time I read that another junior doctor has disappeared from their life, it takes my breath. Because that could be anyone. You. Me. All of us.
The problem with becoming a doctor, is that one minute you are sitting in a lecture theatre, drawing a carefully shaded diagram of the inguinal canal, and the next, you are alone on a ward with the weight of a new identity pressing down on your shoulders. A door slams behind you, and you are suddenly expected to become someone else. Unlike most professions you acquire a different title, and along with that title, society assumes that you will also acquire certain characteristics. You will be calm. You will overflow with self-belief. You will be able to witness the worst kinds of misery and death and loss on an hourly basis, and walk away from it all, unaffected. You will work within a system which is so underfunded, so over-burdened, that each day you will see choices made and battles lost, and an unfairness played out on a stage right in front of your eyes, and yet you will not question it. Medical school cannot prepare you for this, despite its role-play and its acronyms, and its willingness to help. Medical school fills you with knowledge (knowledge you worry is leaking from your brain as each day passes). Medical school does not fill you with an ability to survive.
Many people glide from university and into the waters of foundation training without a backward glance. I was not one of those people. In general medicine, before I found the joy and relief of psychiatry, I was someone who floundered. I was too absorbent. Too unsure of myself and how to process what was happening in front of me. I opted for poor coping strategies. I became physically unwell. I became so physically unwell, I was sent for urgent investigations, only to be told it was ‘just stress’ (yes, stress really does continue to have ‘just’ put in front of it). I became mentally unwell, and it’s only when I look back, I realise just how unwell I was. I paced. I agonised. I pulled into my drive at the end of a shift, whispering an uncertain dialogue to myself, and wondered why I couldn’t remember the journey home. Each evening, I replayed every moment of my day, over and over, until I knew every tiny detail of every scene I had been involved with. I felt incapable. A failure. I studied all the doctors around me, who seemingly floated through their foundation years, and I wondered why the wind seemed to catch everyone’s sails except my own.
I felt unsupported. I felt very alone. I’m certain there are wonderful safety nets in place all over the NHS, but I failed to find one. On the rare occasion I was met with a clipboard and a series of questions about my welfare, it appeared scripted and predictable. Faced with a consultant I barely knew, it was so very much easier to stay silent, rather than to admit my perceived inadequacies. To have the privilege of all that training, all that money and time and attention, and then to admit to a stranger you are a mess and feel overwhelmed … it seemed almost obscene.
I’m absolutely fine, thank you.
It was much simpler to stay quiet. But the only problem with staying quiet, is that no one can reach out and catch you if you don’t tell them you’re falling.
There was a photograph in the news last week, of a Chinese surgeon asleep on a tiled floor, still fully gowned, having worked a twenty-eight hour shift. ‘Isn’t he amazing?’ people said. ‘Isn’t he a hero?’ I think, perhaps, it is even more heroic to admit you are unable to accept the attributes society wants so very much to bestow upon you. I think it’s even more heroic to find the courage to stand up and explain to the world that no one should ever – ever – have to carry the burden of heroism.
(photograph: The Independent)
As I walked the hospital corridors, punctured with self-doubt, I knew if I refused to ask for help, I would have to find a way through for myself. And so I saved up my annual leave, very carefully, and I took two weeks off. And in those two weeks, I did what I love doing the most. I read. I did nothing but read. From the minute I woke, to the minute I went to bed. Thrillers, classics, poetry. Plays, autobiographies, essays. I filled my mind with other peoples’ words and thoughts, as many as I could, and at the end of those fourteen days, I had read sixteen books.
And it mended me.
Because words really do have the power to mend people.
Even though I had to go back, back to the misery and the suffering and the endless, unforgiving hours, after those two weeks I felt different and more determined, because now I had all those stories inside me, keeping me strong. The same stories which, for those two weeks, allowed me to escape myself. And for the first time in my life, I started to write. Because experiencing all that taught me the power of creative expression. It taught me that words (and music and art) mend us in a way nothing else ever can. They allow us to see the world through different eyes. To find a new perspective. To escape our lives when everywhere around us, there seems to be an absence of doors.
I was very cautious about writing this blog post. Not because of the window into my own life, but because I don’t want to deter anyone who might be reading this and who wants to study medicine. I need to explain to you that I would do it all again, even the darkest moments, every last bit, because it taught me so much – about myself and about the world, and about other people. I honestly think it made me a better doctor and (I hope) a better writer.
Before I was published, I would talk to authors and be slightly star-struck, and I would tell them how very much I admired what they did. More often than not, the reply would be, ‘yes, but I’m just a writer. You’re a doctor. You’re far more important than me because you save patients.’
And I wanted to say, ‘but you write the words that save the doctors who save the patients.’
I don’t think I ever told them, so I am telling them now.
Because I think out of all the lessons I learned on that journey, this is the most important one of all.
The reminder that everyone breaks.
The reminder that everyone – absolutely everyone – has the power to mend people.
And the people who break and the people who mend others are almost impossible to spot.
Because I have learned they are not always the first people you might expect.
Under the pressure that comes with being a doctor or a medical student, it is vital to remember you’re not alone: BMA 24/7 counselling service
Edit: just for clarification, I never felt stressed in psychiatry. Not once. Not ever. If you are a medical student, and you love people – truly love people (as you may have said in your interview), then do think about psychiatry.