Doctor Distress (1/2)

By Rachel Kellett

Even the most enthusiastic foundation doctor on a busy acute medicine ward would agree, when your supervising consultant gives you three days notice to present at the grand round, it’s unlikely to leave you jumping for joy. She had an audit to show and wanted a case to be compiled and discussed too. I was already finding the job challenging enough without this. But you don’t say that to your supervisor, do you? You smile and agree to their request, knowing how bad it would look not to.

The previous week a patient I’d become attached to died suddenly. Some nursing staff were tearful, so took time out in their office for tea and a chat. As doctors, we rarely acknowledge this need. We dismiss our emotions, get on with the job and see the next waiting patient. That day I felt overwhelmed so resorted to a method of emotional repression I’d learnt as a child. I took myself to the toilets and repeatedly punched my abdomen, and then I was able to re-focus and continue clerking. That night I knew that what I’d done wasn’t right, that for a while I’d been depressed and needed help, so booked my appointment to start antidepressants. At the point the consultant asked me to do the presentation, I was on day four of treatment.

The day following the consultant’s request, I turned up for my thirteen hour shift and realised I couldn’t do the presentation. I nervously approached her and explained that I had a lot on and I wanted to do a good job, but with such short notice I didn’t feel able to. Relief flooded me when she said it was ok, that she was annoyed that she’d only been told about it herself on the Friday, and so understood.

The ward work continued. However, my consultant became increasingly frosty over the next couple of days, avoiding eye contact, let alone the normal banter at handover.

Then grand round day came around. My colleague and I arrived a few minutes early, so when passing her to take my seat, I tried to break the ice. I asked her if she was presenting her audit. She snapped at me “Well I didn’t have much choice did I?” I responded, asking her if it had been an issue, why hadn’t she brought it up earlier, instead of telling me it was alright. The consultant informed me I’d let her down and was “Just the same as all doctors when they come to the end of a job”. I was hurt, but it was futile to speak more about it, so sat down.

For the remainder of the job, she proceeded in the same cold way.

Under normal circumstances I would certainly have done a presentation. But life wasn’t ‘normal’ for me. I was depressed, self harming, suicidal. The presentation felt like one burden too many to cope with whilst managing my day-to-day work. Regrettably I didn’t feel able to talk to the consultant (my clinical supervisor), about what I was going through personally. When patients attended with self-harm, she was openly scathing and I didn’t feel she would support me.

Job rotation finally came round. Moving house and jobs are meant to be life events, but I was starting to feel a dab hand at it. Medical training makes us a bit like nomads. In the new job my consultant was really approachable, which was a great relief as I was getting worse. Despite this, I continued to function at an appropriate level for my grade.

The evening that I took myself off to end it all, I had been at work during the day.

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