Recovery, or the impression of it

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!

Today’s cliche

I wanted to write a little blog post about self care, which is a horrible hackneyed term these days, so I apologise. Maybe I’ll rename it for this purpose, ‘trying to feel a little better during the shit bits.’ I’m on night shifts at the moment. Some people love working at night, lucky you. I am a morning person, always have been a morning person, and here I find myself in a permanent job where the majority of my work is after 5pm. (This is the time normal people are rumoured to finish work, and also around about the time I would choose to go to bed if given a choice).

So, since I first started doing night shifts, many years ago, I would find myself feeling utterly miserable, hopeless and tearful in the run up to, during and following runs of night shifts. For me, that’s just the norm. I feel super anxious, sleep badly, feel nauseous, generally achey and unwell, gorge on awful high carb, high fat, high sugar junk food, and worry the world may be ending. During the actual shifts themselves I normally feel ok due to the cortisol high, but it’s as soon as I get home that the fear hits again.

So, this time, I have made a conscious decision to try to look after myself a bit better. I have been feeling a little wobbly recently (sure it’s just all the rain and grey mornings or something) anyway, so didn’t want these nights to totally throw me off.

So, to self care. I have not done any yoga, or gone running. I have not had a massage or a spa break. I have not had a hair cut or a mani pedi. If those are your things then great.

I have made my biggest saucepan full of vegetable soup. No recipe, just all the veggies I could find, a handful of lentils and some vegetable bouillon stock.

I made my own damn bread. I baked every little bit of love I possibly could into that bread. I invited some family over to try it with me, shared the love.

I have been writing in my journal every day, at the beginning of the day to clarify my plan, how I am going to look after and be gentle to myself today, and at the end of the day to unload.

I have set up my space in the spare bedroom, so what little sleep I have is undisturbed. I have water by my bed as I know I always get dehydrated. I have easy snacks, and some painkillers, and vitamins, to help coax me through. I have my softest, squishiest dressing gown and my warm slippers ready at the end of the bed.

I have read, and listened to audiobooks, and to favourite songs and radio shows. I have not put myself under any pressure to spend as much time as possible with my kids, despite half term arriving, or to help out with the household stuff. For these few days I hope my family will forgive and understand me doing the bare minimum outside of work, of making things easy for myself.

I took the time to think about what I would eat at work, a balance between nutritious and delicious. Have planned really great sandwiches, and made amazing overnight oats with roasted, spiced plums with honey and butter. And dark chocolate Tunnocks caramels, which I have hidden away on a top shelf just for me.

And I don’t think I will ever feel great working night shifts, but I like to think that a little bit of looking after myself may help, or at least might help me recover quicker afterwards. Maybe some ideas may sound useful to you, I always love hearing anyone’s tips for surviving the struggle that is night shifts.

You’ve Got the Love

I have almost come to the end. I have one shift left to work in the Intensive Care Unit, and it turns out, that I really bloody love it there.

It has been just the best experience for me to have, at just the right time. I have begun to realise that I am capable of other things, not just the work I have done for the last 11 years. And that there are other amazing teams that I can work with, and look forward to seeing every day.

I will be leaving with a very heavy heart. I am properly crushed to think that I might not ever work there again. I had a definite tear in the eye this evening as I walked away from my penultimate shift.

But I have schemes in mind…

The hyphenate career is all the rage now. If you believe everything that social media tells you, everyone has to have a ‘side hustle’ these days. Maybe, whilst I slowly continue on my wibbly wobbly path to Emergency Medicine, maybe I could forge myself a little side hustle into Intensive Care Medicine. After all our two specialties interact on a daily basis, wouldn’t it be great to really develop a proper understanding of both, really help to facilitate our two teams, which often feel in direct combat with each other, to really better understand, appreciate, and work together, to make the right choices for our patients. After all, the things I love most in my job, is looking after really sick patients, making hard decisions that need to be made, and working with a really amazing team of people. I think that easily includes both Emergency and Intensive Care Medicine.

Add in my second side hustle into medical education and pastoral care, my other big work loves, and I worry there may be more busy years ahead of me. And I haven’t given up on my plan to become a major trauma consultant either. And of course an awesome wife, mother, gardener, cook, and friend.

I feel exhausted already.

And rather excited.

Well, all amazing things start from impossible dreams…

Celebrate

I wanted to write a happy post. I think I’m starting to get to the point where I can actually take stock and realise some of my big achievements from the last year. Now this is massive as I have spent most of the last year focusing on the genuinely tough times I’ve gone through, but my perspective has definitely started to shift in the last month or so.

I am almost at the end of my four month block working in ITU, and I am feeling really sad about it. It was a huge challenge to me when I started working there, feeling totally out of place, a bit useless and stupid, really unsure of my place in the team, what I could contribute. And you know what? I’ve done alright up there! I have learnt a huge amount, and I think I am genuinely getting to grips with lots of the very specialised concepts finally. Only the basics of course, but it feels so nice to learn totally new stuff. I have also hugely enjoyed working with a whole new group of people. They have all been so lovely and welcoming and patient and enthusiastic. I really feel like a useful member of the team now, and really sad that I will be leaving soon. (Though not sad at all that my working hours will practically half when I move back to my normal job).

I think it has been incredibly valuable to me to learn that I am capable of new things, of learning and using new skills, of forming new relationships and joining a whole new team. When things were particularly bad in my life I felt utterly trapped, that I felt unable to return to my job in ED, but felt like there were no other options out there for me. Now I know that I do have options, and I absolutely could be valued working somewhere else. That somehow makes it easier returning to ED knowing that I choose to be there because I want to be, and not because I am trapped there. And one day if I no longer choose to be there, there are alternative possibilities available to me where I could make good friends, and enjoy the work that I do. I can’t tell you how important I have found that feeling.

When I became ill I realised that all my balance had become hugely out of whack, and that a big issue was that I just had no boundaries between my work and the rest of my life. I still don’t feel that I have necessarily got that right, but I have made a few huge changes that I feel I should celebrate here. I made the decision to not check my work emails from home about six months ago, and since then I have not checked once. I had had so many times where I read that heart sinking email just as I was about to go to sleep, or as I was enjoying a day off, or when I was spending ‘quality time’ with my children. And that has a massive impact on how easy it is to switch off from the pressures of work. Since making it an absolute no for me to check those emails except when I am at work and can actually do something useful about what they say, I feel so much more relaxed, and have less anxiety about what awaits me at work. I also made the decision to never check how busy the emergency department is when I’m not working. It’s safe to assume it’s busy most of the time, but if I’m not there I have absolutely no control over that, so I am not going to waste my home time getting anxious about it. I can’t completely avoid hearing about it through social media etc when it’s really bad, but by stopping myself obsessively checking I have given myself a lot more free brain space to use for more positive things instead.

Another big step for me was making a formal request for flexible working. From when I return in August I start a three month trial period of a fixed rolling rota, whereby I will know what I am working ahead of time, can predict when I will or won’t be working, and plan around it, and where I have a set day off. It will be huge for me to always know that on that particular day of the week I will never be working. I can choose to take a class, or join a group, book a regular appointment, or just have it that that day is set aside for me to look after myself, rest, have fun, see people, reset. After years and years of never really knowing when I will or won’t be working, I can’t wait to have a bit more stability in my day to day life. And once I have set that boundary in place it will be nice to be able to say “sorry, that day I don’t work,” and not feel like I have to explain or justify it to anybody.

Whilst these three boundaries I have set for myself have really helped me I also feel that my desire to be good at my job, and have good relations with the people I work with, led to constant people pleasing. If asked to do something whilst on shift, I almost always say yes, however busy I am and however many conflicting demands I have. This is the next big area for me to tackle, and one I still feel very unsure about. With the above things it has been slightly simpler, I made a strict rule for myself, and I stick to it. When I’m actually on shift working in the ED the level of demand varies from moment to moment, so at times I can say yes to all the little jobs very happily, and another time taking one tiny extra on can break me. I need to become better at judging that from moment to moment and only taking on as much as I can cope with, and politely saying no far more often than I previously have, whilst still pulling my weight.

Yesterday I had my last therapy session. I won’t say ever, because we have left it very open ended, and I think that now I will be much more comfortable asking for help when I need it. I have pretty much lost the terror of relapsing now though. That was very much with me for months, but now I’ve got to the point where I realise I have good days and bad days and wobbles, but so far I have got through all of those wobbles, and kept going, and gradually, steadily, doing better all the time. I am looking hopefully at the future, and have lots of ideas and plans of things I want to do. Which is amazing. I am conscious of trying to pace myself, and not entirely sure the best way of doing that, but there is a lot of cool, exciting, challenging stuff that I want to get done in the next few years, and I’m looking forward to that!

So, I haven’t got to the point where I can say how having a bit of a break down was the “best thing that ever happened to me, it made me the person I am today!” But I’ve definitely stopped looking over my shoulder constantly, waiting for it to catch me again. Instead I’m able to see the progress I’ve made, and look forward to exciting stuff ahead of me. And I’m really grateful for that.

Anonymous

Writing a blog, particularly my own, very minor one, is a strange thing. It kind of feels pretty anonymous. I don’t really use my name on here, or my kids names, and don’t tend to be specific about where I live etc. I know that occasionally random people I’ve never met read it, and I’m totally ok with that. I also know that lots of people I know really well read it, and I think I’m ok with that too. I sit here, in front of the screen on my phone and type really personal things, and because I’m not saying them out loud that somehow feels quite easy. Much easier than saying those things out loud, face to face with people.

It’s strange though, the effect of writing really personal things and putting them out for anybody to potentially read. As soon as it’s out there I have no control really of where it ends up.

When I went off sick last year I found it almost a blessing really being able to write about my poor mental health/burnout/depression/anxiety/acute stress reaction/hormonal imbalance/whatever the hell it was that sent my brain screwy, on here in that semi-anonymous way, knowing that probably a lot of people I work d with would see it, or hear about it that way. It saved a lot of awkward face to face conversations. It meant I could try to explain something inexplicable in the best way that I could, without having to look in anyone’s eyes. I hoped that the people I worked with for all those years would know me well enough, would have built up enough respect for me, to understand that this was a blip, this was not who I really was.

And there comes that big awfulness about mental illness. The shame of it. The feeling that having been ill for a while makes you less. Makes you less reliable, less competent, less worthy. It makes people feel that maybe because you’ve been ill, that when you’re better you won’t really be able to do your job properly anymore, you’ll be a risk, a burden, an inconvenience.

Recently some people from my current job have come across this blog. And it’s lovely that anyone takes the time to read it at all really, but I’ve found it a bit hard really, knowing it’s out there for new people to see. Thinking that people who have only known me a few months might now be looking at me differently, worrying that I might not be up to things, not as competent as they may have thought me before knowing these things about me,

And isn’t that shit really? I wouldn’t be worried at all about it if I’d been writing blog posts for the past year about getting appendicitis, or breaking my arm. I wouldn’t feel like people would be a little nervous that I would suddenly flip out or let everyone down. The reality is there was a time when I wasn’t able to do my job, and I sought medical help, and had time away, and had a very supported return to work, building up to the point where I feel I am absolutely functioning in every way as well as I was before. Who knows, maybe better as I am more aware of the importance of looking after myself, am better able (slightly) to draw that line between work and home, am far more aware of the impact that mental health can have on the patients I look after. I like to think that being as open on new about the difficult times I have had might make it seem slightly less worthy of shame to people, might help someone else ask for help, realise they need to do something different, realise these things can affect absolutely anyone, regardless of how strong, resilient, reliable they have been in the past. It doesn’t make it easy though does it?

‘Properly sick’

I’ve found it really hard to find the words recently. I’m doing ok, really I am. If anything I’m finding it harder to talk about that, as if I’ll jinx it. Like saying the dreaded Q word in the emergency department (the q word being ‘quiet’ for anyone not in the know) or saying ‘ Good Luck’ to an actor.

I have one more shift tomorrow before I start a whole week of annual leave. This is really the first annual leave I’ve had since last August. While that is technically true it feels like a bit of a cheeky statement. What about those four whole months I had off work last autumn? Like they were a fabulous holiday, rather than the most terrifying, distressing time of my life. There have been a few innocent conversations I’ve had with people recently about somebody being off sick, and on finding out the details of their medical problem, adding “oh, properly sick then.”

However much people try to normalise mental health and mental illness, there is still a very real supposition that a ‘proper illness’ involves hospital admission, surgery, broken bones. I’ve had all of those things in my past, and none of them were a fraction as debilitating as my introduction to mental illness. None of them made me question the entire direction and purpose of my life, and what it was actually worth. I think we all struggle when it’s something that is impossible to quantify, measure, see on a scan. And particularly if it’s something that you haven’t experienced yourself it is hard to really comprehend.

So here I am talking about it yet again, because maybe eventually it will become easier for us to understand and take seriously. And yes, I am ok. I am starting to settle into ITU, and really enjoying working with some of the people I’m getting to know up there. Some of the medicine is starting to make more sense to me, though I think a paltry four months is nothing to really get to grips with the weird and wonderful world of intensive care. I am really looking forward to my week off, spending some really nice time with my husband doing all my favourite things. We even have our first ever night away without the kids booked, the first in nine years, which I am incredibly grateful to my mum for offering. I am back working towards my big career goals, with small achievable plans set for the near and medium future. I am back on track.

The trauma of the past year is still very much with me though, and I am still working out how to deal with it, and process it. I definitely feel like I’m in the early days of it, rather than the proud, “I went through a really difficult time, and it made me the strong, incredible person I am today” days. Who knows if I’ll ever get to that point, but all I can do is keep working through it, day by day, trying not to get too scared by the bad days, and one day I can hopefully look back and acknowledge how far I’ve come.

And today, well I’ll be looking forward to some of this maybe next week…

Shaky Ground

Hey guys, such a long time since I last wrote!! But they say it’s good to talk so here I am. I am six weeks into my four month secondment on the Intensive Care Unit, I am learning loads, having lots of new experiences, and everybody has been incredibly nice to me. I am so pleased to be making some progress towards my long term career goals, and that feels great.

However, it is such tough going! The hours are long, it is hard having to constantly work with new people, try to establish new relationships, get to grips with a whole load of new idiosyncrasies. Hard to always feel like I’m on the back foot, not knowing what I should, lacking the skills they want from me, always having to ask those silly questions, not quite knowing what I’m expected to say. It’s been really hard being away from my wonderful ED family, and their constant support  I feel set adrift slightly, with people who don’t realise what’s been going on for me these last few months.

I have also been working really hard at home. Every day off I do actually get I have an endless to-do list. We have finally done the big room swap, so that after more than eight years of sharing my bedroom with children, we now have our separate rooms. There has been a lot of cleaning, wall painting, furniture assembly and moving, endless rearranging of our possessions. It has been more hassle than I really anticipated, but now that it’s all done I am so grateful.

Not only am I pretty happy with my first ever attempts at decorating, but they have been sleeping really well in their bunk beds, and I have been sleeping really well without them in our room!

We still have the new guest room and study to sort out as they’ve just become a dumping ground, but I’m trying not to force myself into rushing through it all, when what I really am desperately in need of is a break.

The other stress at home is trying to help my eight year old process her first experiences of grief. One of our chickens got attacked by the neighbours dogs, and ended up needing to be put to sleep. We’ve had a chicken die before, but my daughter wasn’t too fussed (as my son hasn’t been this time), but I think it came at just the point that my daughter could really start to understand what death means, and the implications that really has for our lives. There have been lots of tears, lots of difficult conversations, and also some slightly challenging behaviour which I’m sure is all linked. Me being away at work the vast majority of the time surely doesn’t help the situation.

I’m finding it difficult, coming from such a struggle with my mental health over the past year, to correctly interpret my feelings at the moment. When I’ve just had a bad day, worked too many hours, reacted to an innocently meant sarcastic comment, compared myself unfavourably with colleagues who have far more experience in ITU than me, and I become scared that I’m becoming sick again. I constantly worry that I could get sick again so easily, how my whole life became deranged so easily. I feel constantly like I’m on shaky ground, mere breaths away from sick leave again. I don’t think I am, I think I’m doing ok really, but the fear is always there.

I’m not sure I’ve really got any better at setting boundaries, at asking for help, at resting, at looking after myself. As soon as life gets hectic again all of those self care activities I got so good at, are the first things to go out of the window in favour of just surviving the days. But I am surviving, and making real progress at work. It just doesn’t come easy. I guess this is an ongoing process, and that’s hard to get my head around.

A whole new world

I have made it through my first full week in Intensive Care, working 73 hours, and sleeping considerably less. I have learnt loads, seen things I have never seen, asked a million questions, and got slightly fewer answers. I have met loads of lovely people, many of who seem to really love their job, and also heard lots of really negative, untrue, and unfair comments about the Emergency Department. I have seen lots of people get better and leave the unit heading for the wards and home, and I have seen three people die. I have really enjoyed parts, and really not liked others. If I’m honest the bits I have loved most are the bits that are most similar to my proper job as an emergency doctor – with newly presentating sick people, trauma, overdoses, sepsis, when it is busy and consuming and a little bit exciting. The stuff I have liked least is probably the parts that are more representative of day to day ITU, the slowness, the focus on minutiae, the spending of what feels extreme resources of time, skills, people, equipment, drugs, and essentially money, on the hopeful positive outcomes for a small number of people. What they are able to do is utterly remarkable, totally well meant, and slightly mind blowing, but I’m not sure that I whole heartedly agree with it.

It has been hugely humbling to go back to a position of being very junior, of not knowing very much, not even knowing all the things I don’t know yet, of having to rely on everyone else to tell me what to do. It has been hugely revealing to see things from a different perspective, and play a very different role within a team. I am very pleased I made the decision to do this, whilst finding it a big old challenge.

Meanwhile, despite working all those hours, I have also found the time to paint the kids new room and start moving their things in. We are hoping to get the great room swap done in the next few weeks, once all the new furniture is bought. I cannot wait to finally have my own space.

I have also seen my therapist, who I think is done with me. I don’t have another appointment for three weeks, and I suspect it will be my last. We’ve kind of run out of things to talk about, and I continue to feel really well mentally, despite all this crazy upheaval.

And I have spent some time in my garden, planting veg and enjoying the flowers, and the palpable sense of the world springing to life around me.

I have one more night shift to complete tonight, before I actually get two whole days off and actually spend some time with my children doing proper Easter holiday things before diving back into the shiney new world of Intensive Care. Wish me luck!

A new beginning

Tonight will be my last shift in the Emergency Department before I start a four month secondment in Intensive Care. I am kind of shitting myself if I’m honest. When I started out in medicine I rotated through different departments every 2/4/6 months, and whilst I will never be the person to love change and a fresh start, I survived it and enjoyed most of my placements. I’ve been in the same department for more than ten years now, so such a massive change will be interesting!

I really don’t know how I feel about the timing. I finally feel like I am back to functioning like a normal human being, finally taking work in my stride. But wow, these last six months or so have cast such a long shadow upon me. It is a massive confidence knock to see your entire world shift, and totally lose sight of who you are. I think the pure joy of feeling so well has been replaced slightly by the weight of how much everything has changed. And just as I start trying to process it all, here I am moving to a very different job.

So, wish me luck. And I will be back to Emergency Medicine before I know it, hopefully filled with new knowledge and new confidence. And I will just try to find the time through all the long shifts I will be doing, to slowly keep patching myself together, to come back stronger on the other side.

The switch

I am going to start this post by saying how well I am feeling. How, if you see me now, with a big smile on my face, it probably means I’m really happy, rather than trying to hide how scared I am. If you ask how I am, and say “I’m feeling really good”, it’s probably because I am, and not because I don’t want to bore you, or freak you out, by talking about how bad I feel. If you ask me to do something for you and I say “yeah, of course”, it’s probably because I have a free moment, and I feel capable of doing that thing you’re asking of me, and not because I really want to hide how totally incompetent I feel. Yeah, I’m doing good.

A few weeks ago somebody at work offhandedly said to me “I bet it feels like you’ve never been away.” This comment really stuck with me, because I have been away from work before, twice, for over a year on maternity leave, and those times, when I returned, it really did feel like I’d never been away. This time, after only four months, it felt like I had been away for a lifetime, been on Mars, that my very molecules had changed somehow, and that I would never, ever be the same again.

Returning to work this time was one of the hardest things I’ve ever done. I had a couple of good shifts, but generally week by week, shift by shift, I was feeling worse and worse. The more I expected myself to be feeling better, the more devastated I became that I wasn’t. The more support I got given by my seniors, who were bloody exceptionally supportive and kind and understanding, the more I thought that there was no amount of support that could ever make this job possible for me to do again. The more people got used to me being back, and treated me normally, the more different I felt to that old me.

I got pretty desperate. I felt that despite all this help I just was not able to function as a doctor any more. And doctor is who I am. An emergency doctor who loves her job and who does it well. Who works hard and earns the money to support her family. And if I couldn’t do that, then really what was the bloody point of me anymore? I would be walking to work, and picturing myself just accidentally stepping in front of one of the many cars speeding down the busy road outside the hospital.

And then, ten days ago, I had my hormone coil removed. The coil that I had fitted eight months ago during a particularly busy, stressful little period of my life. Within two days of having it taken out I felt like somebody had flicked a switch in my brain. I didn’t feel terrified any more. I didn’t feel angry at everything. I didn’t feel utterly hopeless. And I’ve had such a good week. I have worked the most hours in a week that I have since being back at work, I have worked some really busy shifts, made some tough decisions, done some procedures that I have been totally avoiding for weeks, and done them with the joy of a schoolchild doing something new and exciting, rather than as a scared little mouse. It has been utterly joyous to feel that way again, the way I know I used to feel about my job. It doesn’t mean I love every moment, that I don’t get irritated when somebody takes up time in ED with something that is in no way an emergency. That I don’t get frustrated when I waste twenty minutes trying to find my patient that somebody has moved and hasn’t told me. That I don’t feel overwhelmed when issues crop up with four of my patients all at the same time and everybody needs to be sorted at exactly the same time. But now those emotions are reasonable, and measured, and ebb and flow through a shift, rather than the constant sense of dread that was always present before.

In a way I feel guilty. Guilty that something as simple as a three minute procedure with a nurse at my GP surgery seems to have ‘fixed’ me. Guilty because I know that for most people there is no simple solution to complicated mental health issues. I am also a little worried that this is just a temporary reprise, and that if I let my guard down the fear will find me again.

I’m also a little pissed off. After looking into it, apparently 1 in 100 people who have a mirena coil will suffer mental health effects from it. If that’s the official number then you can bet that the reality is a lot higher than that, but at no time since I went off sick did any health professional mention it to me as a possibility.

Ah well, onwards and upwards. I am looking positively for the future, while trying to remember some lessons that these months have taught me. That I need to make it a priority to look after myself, to pace myself, to say no to the things I don’t want to do, and occasionally to the things I do want to do too, if I simply haven’t got enough time. I need to rest, and take things slow sometimes. That I need to schedule in time to do the things that really light up my life, even if that’s as simple as reading a book or listening to Desert Island Discs. That I have really enjoyed connecting more with people from work, outside of work, and that I should really try to keep that up. That we need to take the time to look after each other, and notice when somebody else is struggling. That it’s ok to admit when you are struggling, and ask for some help. That it’s good to talk about this stuff, as so many people are having a tough time, but thinking that they are the only one. I have definitely learnt that lots of people that I hugely admire as clever, caring, tough, inspirational doctors and nurses, have had their own horribly difficult times. Maybe if we were all a little more open about it then we might feel less ashamed of finding it really hard at times.