The publicity surrounding the death of yet another junior doctor has moved me in a way that I cannot even articulate. The thought that our working conditions could be so crushing that seemingly, the only way out for a vivacious, loved and valued member of our community was death by her own hand has shaken me to my core. Not only because this is a senseless and tragic loss. Not only because she was not the only one, but one of a long list of junior doctors who have died by suicide. But because, as someone who has lived and breathed the path that she was on, and lives with a mental illness, I am not surprised. There are so many factors that are contributing to this epidemic, from the increasing competitiveness of the industry, to the current economic climate, pressures to build a non-clinical portfolio and bullying and harassment, just to name a few. I am writing this in the hope that anyone who is undergoing a particularly stressful time in their life might feel they are not alone and to emphasise that a life with mental illness does not mean a life without meaning and that you can be a good doctor and have a mental illness – the two are not mutually exclusive.
I have lived with depression for most of my adult life. I have had two serious relapses, and unlike many people, they seemed to sneak up on me out of the blue. Within a matter of weeks, I had gone from vivacious, outspoken, athletic and happy medical registrar to someone whose mind had slowed down so much I could barely speak. The black dog does not just depress your mood so much as he slows your mind to a grinding halt, until all you feel is hopelessness and shame. For someone who needs their mind to be quick and sharp for a living, it was a disaster. The year was 2013, and I was two months away from sitting my FRACP exams. I recognised the symptoms, they had been there before, and I immediately sought help from my GP and psychologist.
The road wasn’t easy. Unlike the last time, where I had an almost immediate response to sertraline, I battled with such intense orthostatic hypotension I was forced to withdraw the drug days before my written exam. Luckily, I passed. The following months were spent juggling clinical commitments, titrating medicines, dealing with side effects and attempting to prepare for the clinical exam. The mood had improved, but the meds clouded my mind. I was vague and never present, I would stop thinking mid-sentence and completely forget what I was talking about and I wasn’t able to think on my feet for my exams as much as I needed to be. Strangely enough, my clinical work never suffered, and I wonder if it had something to do with the years of working through hunger and exhaustion as an intern and resident that built resilience over time. I’m not sure that’s a good thing. For the outsider looking in, I could have looked lazy and slack – apathetic at best. It was better than being sick, but it was scarcely a compromise and in the end, I failed my exam.
Despite these challenges, I moved on to start ICU training the following year, while having another go at the exam. While the first time around, I attempted to just fit depression around the exam, I decided to try fitting the exam around depression this time. I knew I was vague and forgetful, so I wrote everything that the patients would say so I wouldn’t get off track. I practiced more than your average candidate. I cleared my commitments so that only the exam was a source of stress. I worked on looking less emotionally flat. I had a great study group. I outsourced domestic duties. But over and above all of this, I emphasised that my life as a doctor was not the be all and end all, and that life without medicine was just as good as life with medicine. Luckily, I passed. There were a few key things that stopped me from falling off the perch completely, besides my husband. Unlike many doctors with depression, I immediately went to my director of physician education, head of unit and senior medical registrar and told them what was going on. They were nothing but supportive, gave me some time off when I needed it, cut me some slack with mock exam deadlines and tried to ease the stress as much as they could. I know I’m lucky in that sense, although this should be the standard response. When I was over the other side, I founded a mentorship program for BPTs and was invited to speak to the candidates about resilience and mental health. In my small n = 1 study, I have yet to experience any discrimination from being open about having a mental illness. I know this is different for other people – this is where we must all work to change this. Although my personal experience was overall a positive one (besides having depression in the first place), the standard response of referring to a psychologist, although helpful is not enough. We need to address all the contributors to stress and distress among doctors – from rostering, to leave allowances, bullying and harassment. Forget about what it was like in your day. The time for action is now.
I wish I didn’t have depression, but I do. If there is anything positive to be gained from it, having depression has taught me about resilience, compassion and patience. It has made me aware of the importance of looking after yourself and those around you. I really do believe that it has made me a better doctor. If you are struggling, know that those around you are there to support you. Contact your supervisor of training, if you feel comfortable. Even if your direct supervisors are not coming to the table, there are other avenues to pursue. Use them. Know that there are those of us who care and are working hard to change the culture of bullying and harassment in medicine. Know that your failures and set backs do not define you as a person, or as a clinician. Medicine is a rewarding career, but it can also be a source of great distress. It’s ok to admit that.