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I think you have depression…

Post by Annonymous

Foreword:

This generous guest blog has been written by an Emergency Physician who, understandably, wishes to keep her identity anonymous.  In it, she describes the raw and gritty experience of being diagnosed with a mental illness while fighting to remain functional as a doctor, mother and wife. For her, there has been no easy solution, but she shares some strategies that she has learned to employ in order to keep her head above water.

As we lead into Crazy Socks for Docs day (1 June 2018), we acknowledge the poignant reflection made: that the physician wellness movement is important and effective in helping us maintain good health; but if you may be suffering more significantly with depression and anxiety, then you need to seek professional help.

“I think you have depression. I don’t think that you think you have depression, but that is what I think you have.” There was a long pause on both our parts.  “Really?” I said. “Really? Are you serious?” As if asking her to repeat herself would make her change her mind. “Well, okay then.”

How did it come to this? Depression? Me? I am a 40-something professional, accomplished woman; a wife; a mum; a daughter; a friend; an emergency physician. Why and when did it go wrong? How did I end up in a psychiatrist’s office, with five-year-old magazines in the waiting room, and the odd other patient waiting who on any other given day look like they would be my own patient in my emergency department?

When did it go wrong?

I am not sure when it went wrong. I am not sure if there was an actual time that it did go wrong. When I look back at myself, my life and my behaviours five and ten years ago, my personality traits were always there. Exuberant, “young at heart”, attentive to detail, perfectionist, multi-tasker extraordinaire. But they seemed normal, even a bonus at times when needing to get a lot done – as any reasonably high achieving person will attest to. Most medical professionals have a degree of these traits. They come to the fore during the demands of medical specialty training, where for most doctors, the proverbial plates are spinning a million revolutions an hour. Certainly my husband, whom I have known almost my entire adult life, did not notice any dramatic change. He did, in recent years however, slowly notice a more agitated, cranky and tired version of myself who – rightly or wrongly – seemed to be saving the best of me for the outside world, while just scraping through on the home front.

Endlessly tired, cranky, snappy and ungrateful. Desperately loving my children so much, but at the same time just wanting them to go away and leave me alone, to stop being so loud, so needy, so present. Dropping them at school thirty minutes late for no reason other than I couldn’t be bothered getting them there on time. Anyone who knows me well certainly knows this is not me. My husband never even knew this was going on. Crying for no reason. Standing under the shower, sobbing, feeling empty and alone inside, lost and like one could or would understand.

At work, somehow portraying the complete opposite. Bright and chirpy on the outside, although in retrospect I was scattered on the inside, often paralysed when required to make decisions. Not great when you are the resus consultant in a hellishly busy emergency department. I am still amazed no one ever called me out on it. My department is wonderful and supportive – we are all close and have worked together for years with many of us having done our undergraduate and postgraduate training together. I am not sure whether people noticed and just didn’t feel it their place to ask if I was okay, or if the place was simply just too frenetic for anyone to notice at all. There were no poor outcomes I guess…

I can talk about all of this honestly now – without welling up, and without the guilt that has at times consumed me over the last eighteen months along this journey to acceptance of the “new me”. I don’t know where the “old me” has gone I am not sure if she will ever return. I have my doubts. And does it matter?

The most difficult part of this journey to acceptance has been the challenge it has posed to my identity as a doctor, especially as a doctor in a critical care speciality. I work at the pointy end of medicine. People die unexpectedly. Life changing decisions are made rapidly and with mind numbing regularity. Families and loved ones are told horrible news. The old adage “we see people on the worst day of their lives” holds true. To manage this daily you need to be at the top of your game – intellectually, physically and emotionally. You need to have the fortitude to really be with your patients, their loved ones and your staff, while somehow still managing to maintain an emotionally protective shield which helps you process other’s life events – but not too much – so as you don’t drown in your emotions. Above all, you need to have something left to give at the end of the day for your own family. They are, after all, the most important people in your life. This is very hard – some days more than others.

My game was slipping. I can see that now. I often had nothing left.

It has taken nearly two years, a caring psychiatrist whom I see regularly, trial and error with medication and a supportive husband and workplace, but I am finally in a good place. For now. I am aware, thanks to my psychiatrist, that I have a chronic illness and I need to treat myself as if I have one. I will fluctuate. Hopefully there will be years between episodes of major depression but maybe it will be more frequent than that. I am aware of my triggers and the need to manage them to the best of my capabilities. I know I need to swallow my pride and ask my bosses for help and understanding when I recognise I am becoming unwell. This is hard, but I need to not be embarrassed or feel guilty to ask for roster changes and role allocations to help me through exacerbations while still maintaining my work life and commitment to my job. I need to communicate more with my husband and let him help me instead of thinking I need to manage it all on my own. I need to not get bogged down with “jobs”, and enjoy time with my kids.

The hardest part has been juggling my need for compassionate rostering at times with my need for privacy at work. I feel guilty that some of my colleagues need to cover for me at times. However, I have a chronic illness. I need to move beyond the idea that mental health problems are less important than physical problems. I would love to think that all my colleagues think the same, but I am not sure. I need to have the insight to know when I need time off.

This has been an intensely private experience. I am aware people talk and I have tried to quietly let some of my work colleagues know how bad it has been at times. I am sure some have known I was not okay. But I worry that at times I have just come across as a cranky, stressed doctor not enjoying my work at all. I realise I have probably been quite negative at times when I have been unwell and a downer to be around. As I improve and come out of the fog that is depression, I develop more insight to this and hope my demeanour when unwell hasn’t clouded my colleagues’ opinions of me. I strive to do well at work no matter how I am feeling – being a doctor is such a strong part of my identity and I do not wish to put my career, my patients, or my colleagues at risk.

So where to from here? Medication, seeing my psychiatrist regularly, attempting to practice meditation – I am still struggling with this one! I strongly believe the wellness movement is great for people who are well to stay well, focused and improve performance. But if you are unwell, suffering mental health symptoms or those around you are expressing concerns, you need to seek professional help. Wellness strategies alone are not enough. And they might backfire – making you wonder why you just can’t “fix yourself”.

Swallow your pride. Use the insight of those around you who care, even if you can’t quite see it yourself. Get a great GP. Don’t be scared to consult a psychiatrist. Take medication if that is what is needed – the imbalance of neurotransmitters is real and organic, and it isn’t something you can simply “get over”. Discuss things openly with your superiors if you can – that will be a load off your mind. Be open to letting others help you out of what can become an abyss.

Mostly, learn to be kinder to yourself. And know that there are always brighter days ahead.

If you need help or any of the contents really resonates with you and you want to discuss it anonymously then you may want to make an appointment with your GP

In Australia call Lifeline – 13 11 14

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