I need a therapist!
my life as a junior doctor
I want to share the story of how I went from a 23-year-old newly qualified doctor, nicknamed ‘Dr Dance’, to an empty shell of a girl, riddled with anxiety who saw only one way out.
It all began on the first Wednesday in August, or ‘Black Wednesday’. The much dreaded day of change-over for new doctors: baby-faced and fresh from graduating medical school, now confronted with a ward-full of sick patients and no idea how to login into the computer.
“But the only part of medicine I had ever been any good at was the ‘feeling’ part. I cared about people and their stories.”
My first rotation as a junior doctor was in the Acute Unit of a busy hospital. Ward round up first: me and the consultant versus 20 patients to see, treat and hopefully move on or move home within the space of a few hours.
I rush from manually evacuating a patient’s bowel (nurse kindly reminding me that it’s a two-glove kind of job) to placing a catheter. No time for lunch, the jobs keep piling up – call the psychiatrist, my patient is trying to escape the ward; call the haematologist, my patient is bleeding out; call the surgeon, please take this patient off my hands and operate!
‘BLEEP!’ The incessant sound of my pager haunts my dreams, the knowledge that someone wants to add something to the endless list is enough to make you want to smash that tiny device into oblivion. ‘BLEEP – CARDIAC ARREST!’ A frantic sprint across the hospital, coming to a skidding halt as you reach the right ward. ‘Maya, get the blood gas!’ The patient has anyphalxis, she can’t breathe, her oesophagus is constricted with inflammation and if she’s not treated fast she will die. The panic in her eyes is reflected in my own, I feel for the pulse and stab. The relief is palpable as the tube fills with blood.
I leave that room exhilarated but also with the drowning sense that I’m not prepared for any of this. My university training had been largely observational rather than practical based. I’m staring across an immense chasm, my patchy knowledge and experience on one side and the responsibilities of a junior doctor on the other.
The first panic attack I ever experienced was at the end of my first month as a doctor. An incredibly sick patient had arrived in the department. Struggling to interpret one of the most horrific looking heart traces I had ever seen, the nurse rushed toward me demanding that I talk to the distressed family. I hadn’t even been in to see the patient, let alone started treatment, how was I meant to explain my incompetence to her frantic relatives. Terrified and out of my depth, fight-or-flight kicked in…and I ran.
Things began to spiral from there, as the days and weeks passed, I helplessly watched as the other junior doctors around me grew in confidence and efficiency. Meanwhile, I was barely holding it together, every perceived mistake a confirmation that I did not belong and wasn’t safe to be practising.
The terror intensified with every nurse who approached for an ECG check, with every patient who asked me what that mass on their scan meant, with every doctor who demanded why I had not yet chased up that patient’s blood test. I was drowning but covering it with a smiling mask, desperate to appear like I was coping and not, in reality, one eye-roll away from walking away. ‘Put up a shield,’ ‘Switch yourself off,’ advice I received to help me cope with the stresses of the job.
But the only part of medicine I had ever been any good at was the ‘feeling’ part. I cared about people and their stories. I desperately wanted to help but felt like I was causing more hurt than anything: the anger and impatience in a patient’s eyes after I missed a cannula for the fourth time, chipped away a little more at my confidence and sense of self.
And worst of all – some days I would catch myself not caring in the least about any of these patients, all I wanted was to escape myself and the growing emptiness inside. If I didn’t invest everything I had, who would suffer?
It has taken weeks of therapy, a diagnosis of transitional anxiety and imposter syndrome, a prescription of citalopram and most importantly the endless support from family, friends and colleagues to work out the answer. Me – I would suffer.
In a dangerously over-run and under-staffed service, those junior doctors working on the front-line are often the resultant casualties of a system on the brink of collapse. This has been seen time and time again from the widespread strikes in 2016 to increasing rates of burnout, anxiety and depression in new doctors.
Doctors are presumably masters of diagnosis, but all too often we miss the signs: the young doctor who begins to withdraw, silent in the canteen, staying hours after their shift ends. And subtler changes in behaviour: less prone to laughter, irritation quick to rouse, defensive to the point of arrogance, actions which unintentionally drive people away from those vulnerable folk most in need of support.
Guilt at leaving a department under-staffed and an overwhelming sense of failure for high achieving young people is enough to deter many from seeking help. It terrifies me now to realise that female doctors have up to four times the risk of suicide compared to the general population and a quarter of junior doctors have had suicidal thoughts.
The World Medical Association has recently amended the centuries old Hippocratic Oath, the pledge all graduating medical students make, to include this welcome statement: ‘I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.’
This is a momentous step for the medical community, in acknowledging that in order to care for our patients we must first care for ourselves, and hopefully it is a testament we will begin to see reflected in practice.
- Weaver M. What you need to know about the junior doctors’ strike [Internet]. the Guardian. 2018 [cited 10 December 2018]. Available from: https://www.theguardian.com/society/2016/sep/01/what-you-need-to-know-about-the-junior-doctors-strike
- Johnson S. Burnout, depression and anxiety – why the NHS has a problem with staff health [Internet]. the Guardian. 2018 [cited 10 December 2018]. Available from: https://www.theguardian.com/wellbeing-at-work/2017/apr/25/burnout-depression-and-anxiety-why-the-nhs-has-a-problem-with-staff-health
- Hemmings C. Doctors’ mental health at tipping point [Internet]. BBC News. 2018 [cited 10 December 2018]. Available from: https://www.bbc.co.uk/news/health-45356349
- Natalie de Cates A, Knott G, Cole-King A, Jones M. ‘Dying to help’: female doctor suicide and the NHS workforce crisis. Journal of holistic healthcare. 2017;14(2):30-36.
- Miller K. New Modified Hippocratic oath – World Medical Association [Internet]. Global Health Ethics. 2018 [cited 10 December 2018]. Available from: http://www.globalhealthethics.org/?p=2439