I break my blogging silence today for a post that I keep meaning to write, but have just felt incredibly hard to actually do. I haven’t been able to find the words, or the courage to actually do. I’ve been back at work for a full year now, after a four month period off sick with burn out, or some such thing. Those brief four months are still having a massive impact on my day to day life, and I am finding that a very difficult concept to get my head around, and an almost impossible idea to verbalise.
The first three months back at work I’m pretty sure I was still very unwell. I wasn’t managing to function at anything like an acceptable level to myself, and was continuing to work at reduced responsibilities. I was absolutely adamant that I wasn’t going back off sick again as the very act of going back to work had been one of the hardest thing I had ever done. During that time, and if I’m honest for some time afterwards too, I was having fairly frequent, intrusive, suicidal thoughts, related to no longer being able to function as a doctor, and therefore no longer able to financially support my family, and therefore essentially useless to them. I did not say anything about these thoughts to anybody, but also luckily did not do anything to act upon them. At the end of these three months, two things happened. Firstly I had my mirena coil removed, which I am sure had a fundamental role in me becoming unwell initially, and also I started my four month secondment in ITU. Two days after the coil was removed I felt considerably better, particularly with regards to the physical effects of my mental health; the tight chest, the difficulty breathing, the racing heart, the nausea. Things just felt lighter, and I felt so much more like ‘myself’. And whilst moving to ITU was hard going in many ways, it brought so many benefits to my well being to be out of the fairly toxic environment of ED.
I am heading for six months back in ED now. I have not found this a fun six months. This isn’t the post about the terrible conditions in Emergency Departments around the country, the insane waits for a hospital bed, the amount of patients waiting on trollies in corridors for hours on end, the loss of dignity and privacy for those patients, and the impossibility of being the doctor I want to be whilst working in those conditions. But that is definitely a huge factor in my day to day wellbeing. This, alongside the fact that every member of staff there is so busy and so overloaded, that they just do not have the capacity to look out for their colleagues, or provide a reassuring ear over a cup of tea. We cannot properly care for our patients and we cannot care for each other either.
With this environment in mind, the effects of my four months off sick are casting very long shadows. My entire view of myself and my place in the world has entirely shifted, from being a capable, resilient person, to being fragile and vulnerable. My concept of risk has entirely changed, the risk of doing the wrong thing when treating a patient, and the consequences for myself and my family of me making a mistake. The risks of that department to my mental health, and in extension, my physical health also. The consequences of that to my family also. The risks of showing anything other than total control at all times, I am really conscious of how other people may view me, and judge me as a result of having that time off. I feel I need to have my mask well and truly up at every moment, and am terrified of letting that slip. That in itself is completely exhausting.
I no longer have any love for Emergency Medicine, and I really, genuinely did before. The department no longer feels like a safe, second home and family, but a place of threat that I need to armour myself up to face. I can no longer find it within myself to recommend my specialty as an exciting, diverse career with a great team, because I just do not feel that way. Whilst I am working, at full capacity and responsibility, I have definitely changed the way that I work, and not in any positive way that I can see. I try to stick to the easier, safer elements of my job. The things that I used to see as fun; the procedures, the complex patients, the challenges, are now seen as dangerous, and are avoided if at all possible. Which means all the things that used to give me a buzz of achievement, have now been lost.
I have recently started revising for my next exam. I am a pretty disciplined person so I am prioritising time revising, and I very much hope to make it through the exam, but I do question this use of my time, and the potential impact it may have on my mental health, when I’m not sure if I really want to, or indeed will be able to, keep working in this field. I just haven’t thought of any alternative at all, and the burden of being the sole earner for my family continues to weigh on me.
The thing that really bothers me is that I am certain that I am not the only one dealing with feelings like this. I have experienced the absolutely dreadful lack of support in getting through situations like this, and I suspect, listening to other people’s experiences, that I may have been particularly unfortunate in falling through the cracks, but I know that the support that there is, is patchy, and often unhelpful. I see how little we do to monitor, improve, and support the wellbeing of our staff, and I have tried to take small steps to change this, but it really is an overwhelmingly uphill battle. There is not the time, funding, or interest in highlighting the impacts of our work environment on the wellbeing of staff members, or the knock on impact that has for our patients, in terms of staffing the rota, retention of staff, knowledge, experience and skills, work hours lost to sick leave and loss of productivity. The total lack of insight at senior levels to this issue is just staggering really.
Anyway, in summary, I am working, I am functioning, but it is a daily battle still, and I wonder if it will ever go back to me feeling ‘normal’ again. I am still struggling to institute more healthy work practices, and feel like those work/life boundaries are definitely not encouraged in our current work climate. I don’t feel empowered to talk about these difficulties, this post is really the first time I have felt brave enough to discuss it and I have found it exceptionally hard to write. But maybe putting this out there may just help one person, take one tiny step to a more healthy way of working. And then maybe they could give me some pointers!
Inner Grace 