It has been over six months since my last blog post. And although it feels like the worst moments with my mental health have passed, there have been a considerable amount of challenges I have faced in this next chapter of my life. Having almost completed my first year working in the NHS as a doctor, I can comfortably say I have had a very mixed bag of experiences. In my last piece I wrote about dealing with grief. It felt quite fitting during the Winter months, which tends to be such a dark period for me, and quite literally as well. Being in the height of Summer now, it seems only fitting to write about something a little less melancholic. However, this post is about my first year as a junior doctor – to not mention those dark moments would be doing the profession and all those in it a disservice.
The biggest moment for me as a doctor was back towards the end of December, when I was deemed eligible and fit to start working nights on-call. Initially I was termed ‘at risk’, as there had been a recent adjustment in my medications. This meant that if I were to start working nights from the off in my job, my mental health would be at serious risk of deteriorating and in turn could cause me to relapse. Of course, if this were to happen, I would have to take sick leave to recover. This eligibility only came to fruition in April when I started my first week of nights on-call. I was incredibly nervous in preparation for this, but I soon adapted well to the shifts and adjusted my sleep pattern accordingly. It came as a huge relief when I completed the set of nights and I was able to reset my circadian rhythm and return my sleep pattern to normal. The relief came from a place of eagerness to be at the same level as every one of my peers, who were also contracted to work nights. The last thing I wanted was to be suffering from a condition that hindered me from achieving my full potential as a doctor.
Many people have asked me, why would I opt in and strive to work nights if I could get away with not having to work them? I must be mad, right? I only fully understood this question when I started them. Nights are hard. You are not only fighting against the urge to sleep, you are dealing with very sick patients on the ward, with only two other more senior medical doctors to support you and provide advice. These shifts can last up to 12 hours long, with no breaks rotored in. It is a very scary when you are covering two floors on your own as the junior. You carry a bleep, which on average alerts you to a ward every 20-30 minutes. This bleep also alerts you when there is a patient in need of immediate medical attention. This is otherwise known as the ‘arrest call’. I found that when it was quiet for a short period, I made every effort to grab a hot drink and some food.
One of the biggest challenges on nights, especially when it’s busy, is to prioritise and triage jobs and tasks given to you by ward nurses. You need to make important decisions at times whether or not a job i.e. re-prescribing analgesia for a patient with chronic pain, can wait over another i.e. a very sick patient who needs to be reviewed. It involves quick decision making, being able to multitask, and treating patients to the best of your ability, all whilst maintaining a sound mind.
Why would I put my mental health at risk in order to work nights, when I was previously given a get-out-of-jail-free card? Ultimately, I would answer by saying that I don’t feel any different from any other doctor that works within the NHS. I still don’t believe that I suffer with a mental illness, rather I believe it lives alongside me, and I need to take care of it. I never lean on my mental health as a justification for certain behaviours, which is an important point alone. It is however a reason, i.e. if I were to become unwell and require time off. I strive to overcome any issues I may encounter, and work around them in order to succeed and thrive in spite of my mental health issues.
Of course, working the twilight hours isn’t even the darkest part of the job description. Death is an inevitable part of life in hospital, and I regularly find myself in the position of having to verify it. The vast majority of people who come through the hospital front door are treated, made better, and sent home. But of course, despite the best efforts of doctors, nurses and other healthcare professionals, not everyone can be cured of their illness. Often these are palliative patients, who are end of life, whereby every other means of treatment has been unsuccessful. These patients’ deaths are regarded as ‘expected’, or ‘anticipated’.But that’s not always the case. . In relatively rare circumstances of young or fit patients who are rushed to hospital following incidents, every effort is made to save their lives, but not everyone can be saved in these scenarios. In between these two kinds of circumstances mentioned, there are many other situations whereby a patient passes away in hospital.
The task of verifying a death never gets any easier, you just get more used to doing them. The first time I verified a death was quite a harrowing experience, and I came away from it feeling incredibly empty and drained. I had never seen a dead person in a hospital setting, let alone verified a death before. It was all very raw and brought out feelings I hadn’t felt for quite some time. I have now been able to establish a routine and method to them, which helps mask the emotions that inevitably accumulate whilst performing the verification. This is even harder when you have known and looked after the patient prior to their passing. Having the capacity to verify the death of a person is such a privilege, and yet such a burden at the same time. You act as the final judge of whether someone is no longer in life, and in some ways, you are also taking that life away from them.
I wanted to use a quote to set the tone of the piece, but was struggling to think of one. I therefore spent the best part of a morning trying to think of a quote that would be applicable to set the tone. It wasn’t until a teaching session I had at lunch when I decided “Oh I like that, I’ll use it”. For some context, the session I attended was about professional support for junior doctors working through exams and annual revalidation etc. They were there primarily to introduce themselves to us, so that if necessary, we knew where to go for support in times of difficulty associated with work. At the end, the speaker left us with a quote to reflect on which, after doing some digging (i.e. a quick google search), was revealed to be based loosely on a quote by a 19th century Scottish Reverend by the name of Dr John Watson, aka Ian Maclaren. ‘Everyone you meet is fighting a battle you know nothing about. Be kind. Always’.
Although it seems like I talk about my mental health a lot, it does not mean that I am constantly suffering, nor does it mean that I need special treatment or privileges. I do however, have my own battles to fight, much like everyone else. It is a fact that a large number of healthcare professionals live with mental health issues similar to mine. These people have their own individual struggles, trials and tribulations that I wouldn’t know about. Which is why I feel it is so important to live by a philosophy of kindness, compassion and care. Be it in work, in a supermarket, or even in Costa when I order a coffee, acting pleasant doesn’t take a great deal of effort, but it does go a long way. Whether your colleague has just worked a night shift, been called to a cardiac arrest, or just verified a death, it is integral to maintain a gentle attitude. For whatever they have experienced, and no matter what their emotions may have been, as an associate, acquaintance, or friend, showing them a warm heart creates a better environment to work in. I know it does for me.