World Mental Health Day: A Doctor’s Mental Health Story

Back in 2016, when I was a new Foundation Year 2 Doctor (2nd year Doctor in the UK), I had the unfortunate but common experience of being a Junior Doctor working in a poorly supported environment. I worked nights without senior support on site. It was in a niche specialty that most doctors don’t get much training in. I was given a handbook on how to handle the medical emergencies and sent on my way. My closest registrar lived over an hour away, which often left me to manage medical emergencies with only telephone support until they could arrive.

I remember one night, a young woman came into hospital. She had been spitting up blood at home after her tonsillectomy. She had been told to come to hospital if that happened, and had been to one other hospital overnight. They had sent her home after giving her some gargles which had stopped the bleeding, but the bleeding had started again. When I got the call to come and see her, I was in the middle of seeing another sick patient.

“How much blood has she lost?” I asked over the phone.

I was told she had vomited 500 ml of blood.

“Sorry, did you say 50 ml?”

No, it was definitely 500 ml they said, and she had been vomiting blood in the toilets prior to arrival, making a total of around 1L.

For context, the human body has around 5L of blood, so this girl had potentially lost up to one fifth of all the blood in her body. I gasped, put the phone down, told the patient I was with I had to go, and ran to see my new patient. 

When I arrived at the scene, there was blood everywhere. She was covered in blood. The bed sheets were covered in blood. There was even blood on the curtains surrounding her tiny cubicle. I had never seen so much blood. I grabbed two nurses and asked them to cannulate, take emergency tests and start fluids. I did my best to calm down the young woman and immediately called my registrar. My registrar gave me some instructions on how to treat the bleeding including the use of special gargles and gauze soaked in adrenaline which I was to press against her tonsil base.

10 minutes later, she was still bleeding. I called my registrar again and she told me to keep trying and call her back in 30 minutes if things didn’t improve. I put my foot down and demanded my registrar came in. We moved the girl to the resuscitation area. Myself and one other nurse spent the next hour and a half with the young woman. That’s how long it took for my registrar to arrive at hospital so that we could take the young woman to theatres to stop the bleeding with cauterisation. That whole time, I kept getting calls about other sick patients. Straight after we took her to theatres, I went off to start seeing my previous patient, followed by all the others patients that were waiting for me. There was no time for a break. 

This is just one story amongst many. It’s not the worst one.

I started to dread going to work. Over time, I started to have nausea, vomiting and palpitations every single morning in the anticipation of what would await me when I arrived. I told myself that this was normal. That it was a rite of passage. That it would get better with time. 

It didn’t. 

I was alone in feeling this way, surely. All the other new FY2s seemed to be doing so well.  I couldn’t tell anyone. I started to feel numb. My stress levels hit the ceiling. I remember thinking “My stress has plateaued out. I can’t feel anymore stress. My body is protecting me.” I stopped answering text messages. I withdrew from friends and family. I stopped answering phone calls from my concerned parents. I couldn’t sleep. I started to binge watch TV to distract myself, often until 7am. I was so tired in the morning I felt even more sick than before. I called into work “sick with a stomach bug”. More than once. I didn’t want to put my patients at risk from being so sleepless. I couldn’t function. I slept during the day. I ate 2 pizzas and 2 tubs of ice cream a day. I couldn’t fit into any of my clothes. I stopped leaving the house. I felt worthless.

I thought to myself “It would be nice, not to be here anymore.” 

Eventually, my string of absences was noticed. I was approached by my consultant. I broke down in tears. He personally walked me over to the Occupational Health department. I was advised to see my GP, who signed me off work. I got support from the head of the educational department, who regularly called me to check on how I was doing. It took me a whole month to find the energy and motivation to self-refer myself to NHS Practitioner Health, which provides direct access to psychotherapy and psychiatric services for doctors.

That’s when I was finally diagnosed with anxiety and depression. Despite all my medical training I hadn’t been able to recognise my experiences as signs of a mental health issue. I was offered medication and Cognitive Behavioural Therapy (CBT). I rejected the former but accepted the latter. I went to CBT sessions. My therapist tried to address my feelings of worthlessness. I cried. A lot. In every session. Sometimes I held it in and only let myself cry in the toilets after the sessions. I would spend 45 mins in there trying to compose myself enough for the trip home. 

4 sessions in, my therapist told me something. He told me how many doctors they were seeing in that practice with mental issues similar to mine. I can’t remember the exact percentage now, but I think it was around 25% of all doctors. I couldn’t believe it. I was shocked. 

I wasn’t alone. 

How I wish I had known this sooner. 

I went back to work pretty soon after that. I opened up about my experience to friends, colleagues and family. I allowed myself to be vulnerable. I thought this might make me a social and professional pariah but I didn’t care. I couldn’t lie about how I was anymore. I was surprised by the responses I got. 50% of the people I told had had their own mental health issues. The other 50% knew someone who had.

I was offered so much support. My dad came over to the UK to help me get better and my mum followed. I realised that I had internalised mental health stigma so deeply that I initially both didn’t recognise I had a mental health issue and simultaneously felt too ashamed to reach out for help. I discovered the power in being vulnerable. I realised how much bravery and strength it took me to open up and that without doing this, there was no way to get better. 

Things didn’t get better quickly. My next job was almost as bad as the last. I ended up taking another 3 months off work (6 in total). The road to recovery was bumpy. I had a few backslides, but none as serious as the last. I learned my own warning signs and put in place measures to look after myself by designing my own wellness plan. I will be talking about this in more detail on October 17th 2021 as part of a self-care event organised by the Royal Medical Benevolent Fund (click here to register). Sometimes I still get anxious, but I know the signs and I know how to deal with it before it gets too bad. 

My story isn’t a rare one. In fact it’s pretty common. I know this from talking to so many colleagues and friends. I know this from the stats on Doctors’ Mental Health. 

A survey conducted by the BMA in December 2020 had the following responses: 

58% (4067 doctors) said that they had symptoms of:

😞 depression

😬 anxiety

😥 stress

😓 burnout

😖 emotional distress

➕ or another mental health condition related to or made worse by their work 

If this sounds like what you’re going through right now, please know that you are not alone. If you are struggling to ask for help, please know that asking for help when we are vulnerable is one of the most courageous things any of us will ever do. For a list of mental health resources click here.

If this sounds like something you’ve already been through, please join me in being honest about our experiences and dropping the “Superdoctor Facade”. It’s time we stop pretending that the emperor has clothes. Together we can create a culture in medicine where we recognise the strength of being open about our vulnerability. Together we can end the stigma.