A New Year letter from my better self to me:

Dear Me,

This year, for the first time in perhaps your whole life, you have opened your eyes to who you really are.

Your history of anxiety, self-loathing and doubt have left you feeling scared in the face of this discovery. “Is it too late to change?” you say. “I should have done things differently.”

As much as you are enjoying your new freedom and renewed vision, your negativity is holding you back from embracing it.

So I challenge you in this year ahead to change your attitude. Do not see the past as a waste, but as the path that led you here. Do not regret your former actions because without them you wouldn’t see the value of what you are now. This is your opportunity to do something you really want to do; your investment in yourself now is you saying “I am WORTH investing in!”

The months ahead are not going to be easy. The road you’ve chosen is a difficult one, and you will encounter disappointment. You will fail. You will perhaps wonder why you left the safety and security you had before. So let me write the reasons down here so you can remind yourself:

You left because you have a gift that no one else has. You have a goal that no one else can do but you. You have an inexplicable, unshakeable faith in something that inspires you, and so will inspire other people.

Whatever happens, do not give up the fight. Do not regard the opinions of those who confuse the easy path with the right one. You are clever enough and savvy enough to know how far you should go.

You have remembered who you are. Mad romantic, dreamer, visionary, optimist. Do not ever forget it again.

Hitting Rock Bottom – apparently you bounce

rock bottom

It’s been two weeks since I stopped working. Two weeks sober. What a fortnight I have had…

When I woke up the next day at 8am instead of 6am and had nowhere to be, it felt delicious. The hours of the day stretched out before me, with waves of potential, and to be honest, all I really wanted was to have a break for a bit. I knew I would need time to process leaving Medicine. I didn’t quite anticipate the size of the grief reaction that was about to hit me.

The following Friday, I took myself down to Russell Square where the Professional Support Unit is based. I called them before I left my last job on the advice of the Dean and I really can’t recommend them enough for any doctor in training (foundation or speciality) who is in trouble. They provide all sort of help, from confidential mental health support to career coaching. When I called I had a really interesting conversation with a lady who turned out to be herself a creative – she is a freelance screenwriter who also works on a freelance basis for the Professional Support Unit. They allocated her to be my mentor, I suppose because of our common interest in writing.

We sat down together in a little room with the sunlight streaming in, and we talked. She asked me about my strengths, my likes, my dislikes and my values. And do you know, I found it so hard to articulate those things. After all that communications training, and despite my own quadrilingual tongue, I could not think of a word to say for myself. I panicked internally; how the hell was I going to perform in future interviews if the answer to “what are your strengths?” was silence?

I can’t really say I’ve ever thought much about any of those things. My strength was always my ability to pass exams or ARCPs, my values were insignificant because I was already doing something of such great value, and as for my likes and dislikes, that conversation mainly revolved around the choice between doing medicine or surgery, or between being a hospital doctor or a GP.

My mentor (I will call her ‘Jane’ for the purposes of this) then tried a different tack. She asked me to describe different experiences in my life. She got me to talk about the time I did some voluntary work in West Nepal, and suddenly, talking became a whole lot easier. I could actually appreciate the fact that turning up in the middle of nowhere in an unknown country was pretty brave. I could see that, after being told I was going to be an English teacher but then when I got there, they needed me to be an Art teacher for deaf young people and Dance teacher for street kids, I needed a great deal of adaptability and quick thinking to provide that.

“You’re a storyteller,” Jane told me, “You find it easier to talk about yourself through the medium of stories.”

Deep down, I’ve always known this. I novelise everything because it makes it easier for me to understand and therefore easier to cope with the difficult things in life. I didn’t realise this was a good interview technique.

She gave me some homework to do and I left feeling pretty positive. I realised that now was the perfect time to get to know myself a little better – not with a view to becoming self-centred, but more with the aim to appreciate what’s there already and what isn’t, and to have confidence in my strengths while appreciating my weaknesses. I started to look at my CV, which is very medic-orientated, and tried to see how I could change it to make sense to non-clinical people.

Then the doubt set in.

One day last week, a family member called me up with the express desire to talk about my career. What am I doing now? I’m just lying around at home? Officially unemployed. After all that work, I’m unemployed. So how am I managing financially? Oh, I’m using my savings? Well that’s not very sensible, is it? Am I just going to be a housewife now? Am I going to rely on my fiancé for everything now?

It was so distressing that I couldn’t carry on with the conversation. The idea that no longer being a doctor meant I could only ever be a housewife was ringing in my ears, and I was crying. I tried to rally myself: ‘I will find a job. It might even be a well-paid one, who knows? I will earn my own money and be a useful member of society.’ But it was no use, because when you’re faced with people around you who are baffled by your choices:

“I just don’t understand why you didn’t finish F2! Even if you didn’t want to continue being a doctor in the future, why didn’t you finish F2? It’s bad not to complete things. When you start something, you should finish it. You only had 4 months to go! What are your reasons? What’s your plan?”

These are reasonable questions to ask, and I know the people ask them are just worried about me and want the best for me, but I find it hard to reveal my real reasons because I fear they won’t be taken seriously. I left because my heart was telling me to, and my only definite plan at the moment is to finish my novel while somehow finding my way into the right career. Such delicate and vague ideas are too easily quashed before they blossom, so I protect them from the storm around me by keeping them to myself.

People tell me that I’m just too romantic. I’m just a dreamer. A friend of mine told me all the people she knew who had tried to do something different and had ended up crawling back to their original profession with tails between legs, but she also told me that even if I manage to get another job, it will never make up for the fact that I didn’t finish my F2, because this is the biggest mistake of my life and I will regret it.

It makes me feel panicky just recalling these conversations. I feel like a small child who had done something very bad and is now being scolded, but it is worse, because I don’t have the protection of actually being a small child. I am an adult, supposed to be successful, supposed to be self-sufficient, but all I am is one great big failure.

There it was. That word. Failure.

It’s surprisingly easy to go from niggling doubts at the back of your mind to full-blown depression. It’s a well-trodden path for me, so I know the way down pretty well, and down I went. I felt completely and utterly worthless. The weight of my mistakes and my decisions weighed heavily upon me, and I just couldn’t see how I was of any use or benefit to anyone in this world. I was only a burden on my parents, on my fiancé and all my friends. I was so low and so anxious that I couldn’t even bear the thought of locuming! What was the point of continuing? What the hell was the point of me?

Thankfully, the way back up is also a well-trodden path for me, and what I have found is, when you feel that way, you internalise everything. Paradoxically, you do become self-centred, caught in a loop of negative feedback with you in the middle of it. You break that when you connect with other people, and specifically when you help other people.

On my birthday last Friday, I went to look after my friend, who recently was admitted to hospital, and was coming home to an empty house, as her husband was away in Sri Lanka. I made her lunch and did some jobs for her, and helping her made me feel like a good person again, and she helped me by listening to me and comforting me.

I had just come back from running some errands for her when I noticed some books on her bookshelf. They were her husband’s books about the history of Sri Lanka, written during the 1800s. I could hardly believe my luck! My novel is historically based on the British colonisation of Sri Lanka and here in front of me were books documenting that very period! I asked her if I could borrow them.

I am now sitting on my sofa at home, exactly where I was a week ago, when I was so paralysed by fear and doubt that I felt unequal to everything, but now I have a book in my hand. I’m reading two others at the same time. Researching this topic is exciting! It’s actually fascinating to get a glimpse of what happened and how people lived in those days. My hand alternates between pens and highlighters and I’m brainstorming about how to include all this history in my story. The time passes quickly and I am in my element.

Things aren’t completely OK yet, but this enthusiasm is infinitely better than the despair I felt last week. I still feel really concerned that people will think I’m just bumming around and sapping resources, but I’m beginning to see that worrying myself into a frenzy is just about the perfect way of becoming the very thing I’m afraid of. I am not a failure. As for being accused of being a ‘romantic’ – that’s absolutely correct. Count me with the dreamers, and watch me make a career out of it.

The Dangers of Ego: how medicine became my self-esteem

ohne arbeit

The other day, I was on my way to the Royal London Hospital to discuss my resignation with the Dean of my Foundation School, when a man going past on a bicycle stopped next to me.

“Are you lost?” he asked, with an accent that I recognised to be Sri Lankan. I turned away from the map and looked at him, and his features confirmed our common heritage.

I explained I was looking for the hospital, and he pointed me in the right direction, but before I could get very far, he began to tell me all about the amazing pastor at his church, who apparently had died, visited hell and heaven, had a chat with Jesus, and come back to earth again. I suppressed a smile as he asked me if I had time to chat, and said I was in a hurry. He then asked me why I was going to the hospital. I obviously didn’t go into my real reasons, but the moment I said the words ‘I’m a doctor’, he looked at me with such awe, as if I were the one taking return journeys in and out of the afterlife.

It’s not an uncommon reaction. Although the medical profession is much less revered now than it was twenty years ago, people are generally still impressed when you tell them you’re a doctor. “Wow! That’s incredible! You must be clever,” they say, or “I couldn’t do what you do.” As for my Asian relatives, particularly the older generations, I represent the ultimate achievement.

When I think about how hard I’m finding it to leave medicine, I can’t help but admit that part of it is losing that massive ego boost. The moment you qualify, you are seen almost universally as intelligent, selfless, noble, caring and respectable. Another bonus is the fact that people have a basic understanding of what it is you actually do – as opposed to the non-vocational folk like my fiancé, whose job description of ‘business consultant in macroeconomics and econometrics’ is vague at best, and downright confusing at worst. I don’t have to justify myself as a good person because my occupation automatically confirms that. I save lives. I help people. I took an oath to devote my life to healing the sick. What kind of person breaks that promise?

The “Bristol Promise”

the bristol promise

When I think of how amazing and necessary the work of a doctor really is, it’s hard to validate my existence without it. If I am ever one day shipwrecked on a desert island, I’d have gone from being someone you’d definitely want to keep alive to someone who can be eaten without any great consequence.

The funny thing is, when I step back and look at it objectively, I can see quite clearly that Medicine is not the only ‘noble’ thing to do in the world. Our intricately connected society relies on the collective effort of many, and we all can influence the world around us for the better in our own way. The problem is, these things are not always recognised in the same way that being a doctor is. In this world where money and fame is more celebrated than anything else, medicine is still holding on to respect and value by the tips of its fingers, whilst the actions of good teachers, parents, farmers, legal aid lawyers, emergency service personnel and countless others fall by the wayside.

I used to dream about working as a doctor in Africa or Asia with Médecins Sans Frontières, providing healthcare for the poorest and most vulnerable. When I started to become unhappy in Medicine, this dream was the only thing that kept me going, but I realise now that my desire to be of service had become tainted with selfishness. I wanted to make a point, to show that I am a good person, but there’s something paradoxical in the truth about this: if you do something you hate for the sake of being good, resentment will poison any happiness you gain until you can’t do it any more. But if you use something you love to do something good, the happiness you gain will motivate you to keep doing it, and the good you do will be tenfold. The line between selfishness and selflessness suddenly doesn’t seem so clear.

These next few months are not going to be easy, I know. I have already experienced the sneers and sometimes just plain disbelief that I would ever dream of giving up Medicine, and I’ve barely told anyone in my family about it yet. I dread my next trip to Sri Lanka, as there the judgement will be even more severe.

However, I am coming round the idea that my self worth isn’t quite so dependent on Medicine as previously thought. As my best friend once said, “I don’t love you because you’re a doctor – I love you because you’re loyal and kind, and always there for me.”

I am still determined to help people, but perhaps being obsessed with the goal is actually more of a hindrance than a help. After all, my literary inspiration, Jane Austen, didn’t write her books with a view to helping me, but she has. Her books have been my joy and comfort in many a dark moment – one of many unexpected echoes of her quiet, modest life that she will never know. I’m sure if she were alive today, she would tell me to chill out and take myself less seriously, albeit n more Austen-y language!

Perhaps she’d tell even me to listen to Bertrand Russell, who I believe once said:

“One of the symptoms of an approaching nervous breakdown is the belief that one’s work is terribly important.”

My Last Day…s

On Tuesday 1st December 2015, we all thought it was the last day. Every four months, foundation doctors rotate round into their next specialty, meaning a new team, new patients, new rules and sometimes even a new hospital or town. Tuesday was to be that day, but then the unprecedented industrial action was called over the junior doctor contract row. The first strike was planned to take place on our rotation day, and with the government being so continuously unreasonable, the strike seemed imminent. We all said our goodbyes on Monday – to our favourite patients, the nurses, the ward clerks and our senior doctors, knowing how our day to day closeness would fade into brief smiles in the corridors and occasional chats in the coffee shop queue.

For me, there was another goodbye to make: to medicine. It was a very busy day and we were short-staffed, but for once I was grateful for this. It was a distraction from the enormity of what I was about to do: walk out on my profession and my security, into the unknown. My colleagues reassured me with reminders that I can always come back if I change my mind in the future. I know they’re right and I appreciate them trying to make me feel better, but right at this moment, I do not think I will ever come back. Unless financially I am forced to locum to support myself, I think this is it for me.

With this in mind, I found myself becoming very emotional as the day went by. “Is this last time I will write a drug chart? Is this the last time I will order an x-ray?” I even felt sad doing a discharge summary! Grappling with hopeless IT systems and pointless tick boxes has been the bane of my life for the last 3 years, and yet I seem to have become strangely attached to it.

The hardest reality to face was that of blood taking… I remember how nervous I used to feel when I first started doing bloods and cannulas on real people back in medical school. I remember the venepuncture failures when I first started working, and sidling up to my seniors, looking sheepish, to ask for help after two unsuccessful attempts. Then I did a Geriatric job – thin, faded arms with sagging skin and veins as thin as paper, which collapsed into bruises at the touch of a needle. My Paediatric job was the most challenging of all – tiny, premature, newborn hands with miniature vessels made visible only by a transilluminator, and the harsh, yet irrepressible guilt as their innocent screams ring through your ears at 3 in the morning while you stab at the skin they have owned for barely ten minutes.

Thanks to these experiences, I am now rather good at taking blood, and over the last four months, patients have told me often that my technique is painless. It is a skill that I can’t really take elsewhere with me, and it does feel like a waste. I cried after cannulating a patient yesterday.

As I walked around the hospital doing various jobs, I got a sense of how privileged I have been to have occupied this world for a time. I scoop up a set of back-breakingly heavy patient notes, and the unattached bits of paper inside all slide out unpityingly onto the floor. As I sigh and pick them up, I realise I am looking at someone’s cancer records. If I wanted to, I could log into the system and look at their bloods, or pull up their scans and see the tumour myself. I could read their clinic letter and find out what their prognosis was. I am privy to some of the darkest moments of people’s lives every day. How odd to lose that suddenly.

I wander over to theatres to find a consultant, and peer into the operating room to see if he’s nearly finished. There’s an anaesthetised patient on the table, half naked with a long bloody slash down one leg. Hip replacement. Isn’t it weird that I get to see this? It’s so normalised for me now that I don’t even think about it, but other people – non-medical people – would find it overwhelming. Inspiring. Fascinating. Gross.

As the day came to an end, I said my goodbyes, took a deep breath and went home. I didn’t have time to be emotional, as my mind was pre-occupied by the plans I had that evening with some colleagues: we were planning to go into central London in our scrubs and stethoscopes to talk to the public about the junior contract row – a ‘meet the doctors’ initiative. I thought it fitting that the last thing I would do as a junior doctor would be standing up for the profession.

Just as my train pulled into Liverpool Street, however, the news came through that the strike had been called off! And agreement had been reached at the eleventh hour! I messaged my colleagues and there was a lot of confusion over why this had happened and what it meant for us, so our meet the doctors plan sort of disintegrated. I had to laugh because I’d just spent the whole day mourning the loss of my daily grind, and here I was going in the very next day to do it all again!

It did feel very strange that this political storm was going on during my notice period. I’ve been vigorously defending my fellow junior doctors whilst knowing that I’m going to be jumping ship very soon. It does feel like I’m abandoning them, but then perhaps they can use me to their advantage and tell the newspapers that Jeremy Hunt’s schemes forced me to quit!

My actual last day was again very busy, as several patients were unwell. Two patients had post-op bleeding and needed blood transfusions. One developed an awful looking wound infection and another was found to have cellulitis. One was paralysed from the waist down, but had the attitude of an angel and the patience of a saint, while another walked cheerfully around the ward for most of the day, but then would crawl back into bed whenever the doctors came in, complaining of ‘unbearable’ pain and not being able to move at all. I had referrals to make, letters to other hospitals to send, rehab units to call, discharge summaries to do, drug charts to re-write, bloods, x-rays, cannulas, and of course, a tour of the hospital and a patient hand-over to do for the person taking over my job. At about 4pm, I sat down to have lunch. Then one of my patients developed signs and symptoms of a heart attack! Nightmare day! I sorted everything out for him and was just about to leave when the emergency buzzer went off in one of the side rooms. I smiled at my colleague as we ran over – it seemed as if Fate did not want me to leave! Luckily it was just a false alarm.

I finally left the hospital at about 6.30 pm. I expected to feel upset, relieved, overcome by the significance of the moment, but I did not. This long, drawn out goodbye has only left me feeling incredibly anxious, and when I got home, I cried for nearly an hour. My worries about locuming, the future and financial stability got the better of me, and I suddenly felt very scared and alone.

What am I going to do now? How am I going to employ my time? How do I make a living? I try to believe I can do anything I want to, but it’s hard to do that at the moment. My nails are bitten to pieces with the stress of it all, and I can’t shut my worrying brain off. Deep down, I know that resigning was the right thing to do, but right now, it feels awful. This is the culmination of my ‘break-up’ analogy. Divorce papers signed, possessions split, paths diverged – bring on the wine and the ice-cream, because I just need to feel my way through this.

goodbye