Trouble in Paradise: the Type A personality effect

I feel very rested. I’ve just come back from a wonderful skiing holiday in the French Alps, and aside from the terror of voluntarily throwing myself down a frozen mountain, it was a chance for me to relax and reset.

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I did a bit of soul searching while I was away. There’s something about fresh air, white snow and beautiful views that opens your mind to a new perspective, and I’ve been pondering over the fact that I’ve become increasingly stressed over the last few weeks. To make things worse, I’ve been increasing my stress by getting annoyed with myself for being stressed – which is very counterproductive. I was getting snappy with my closest friends and family, and I felt like I was tearing my hair out most of the time. It’s a vicious circle that I find myself in more often than I like – I feel that I should be able to handle everything, and that struggling is a sign of weakness. Now even more than ever, I feel I should be able to handle everything. After all, I’ve just left one of the most intense professions there is, so everything that follows it should be a breeze, right? Right…?

Apparently it’s not that simple. While we were away, conversations with my skiing crew gave me a reality check: I’ve just left my career under distressing circumstances and started working at a start up in an industry that is completely new to me without any training. I’m trying to finish this novel that means so much to me, while also trying to work with my brilliant mentor Gyles to help other doctors who are struggling with Medicine. If this wasn’t enough, I’m doing an online course in marketing which demands at least 7 hours a week, and to top it all, I’m trying to plan my wedding. To say I’ve bitten off more than I can chew would be an understatement.

When I left Medicine, people shook their heads and told me that finding a less stressful job elsewhere would be impossible, because every job is stressful in its own way. I never believed that, because to me, the stress that came with Medicine seemed to be on a different level. There aren’t many jobs in which taking your eye off the ball for just a moment could actually kill another human being. I really don’t know how Air Traffic Controllers do it.

But I have to admit that, in a way, it is true. Every job is stressful, but the crucial part of this concept is that every job is stressful for me. Somehow my attitude towards my old job has seeped into my new life. I continue to set high expectations for myself and am constantly seeking approval. I allow myself to feel overwhelmed by the workload, even when my colleagues are telling me I’m doing fine. It’s left me questioning where this outlook on life came from, and how to change it.

Wikipedia defines Types A personalities thus: “ambitious, rigidly organized, highly status-conscious, sensitive, impatient, take on more than they can handle, want other people to get to the point, anxious, proactive, and concerned with time management… high-achieving “workaholics”, push themselves with deadlines, and hate both delays and ambivalence.” Reading this definition made me feel a bit depressed because it pretty much describes me to the letter.

It makes me think back to being an A-level student. All of my peers who got into medical school were, to some degree or another, ‘high-achieving workaholics’. It was inevitable – medical school places are hard to come by. Bristol told us they offered just 250 places per year for 30 000 applicants. To be chosen you had to fight hard. You had to be obsessively hard-working to get the grades and work experience necessary, organised enough to have several different hobbies and ambitious enough to be good at all of them.

I’ve read that who you are and how you think depend very much on the people you surround yourself with. You direct circle of peers unconsciously set your boundaries, so personal, professional and financial success tend to be an average of those who have the greatest influence over you. In medicine, this can be a good thing, because it can mean that standards are held high, but I think it can be fundamentally damaging as well. As doctors I can’t help feeling that we tend to drown a little in our shared intensity, with over-ambition in one feeding the overwhelm of another.

I remember sitting our fourth year exams at Bristol. It was an intense year because it was the year we studied all the sub-specialities. I recall the sheer panic I used to feel, gazing at the huge pile of books before me and wondering where the hell to start. A helpful revision tip from one of our professors was simply to ‘learn everything’.

So there we sat trying to cram the enormity of medicine into our addled brains. What was odd, however, was that it was an incredibly lonely experience. My dad had told me stories of how he as a medical student in Newcastle used to have study groups with his friends and how they used to help each other out. I had assumed that I too would experience this nurturing, communal atmosphere, but the reality was a bit of a shock to me. It felt more like a competition, to be honest. The medical school made it worse by making some of the exam pass marks variable – the grade boundaries were set depending on the standard that year. This was an incredibly unkind thing to do, because it set the students directly against each other. You’d always be hoping that someone else got a lower grade than you so you could have a greater chance of passing.

The only way to be certain you were studying the right things was to do past papers. Everyone gets used to this practice at school because teachers do their level best to get hold of paper for you – however at medical school, past questions were a closely guarded secret, mainly because the board of examiners couldn’t be bothered to go through the rigmarole of writing different questions each year.

There were rumours on several occasions that past exam questions were circulating around some of the students, but no one ever spoke of them directly. If you had them, why would you share them? There was no incentive for student collaboration, and every reason to be secretive. People would lie about how hard they were working, or pretend that they’d ‘done no revision at all’ when you knew they had spent the last week burning the midnight oil face down in a copy of Kumar and Clark.

Not all doctors are the same, of course. I had a Greek SHO colleague in my orthopaedic job called Georgios. He was an incredible person to work with, because nothing ever seemed to frazzle him. No matter how many patients came through the door, or how full the theatre list was, or even how useless the system seemed, he still found time to discuss Greek philosophy with me over a hot drink and a cigarette. His motto, which I still repeat often in my head in his gloriously Greek accent, was:

“Relax. Have a coffee.”

The stress I feel now is definitely of a different kind. I do want to perform and be successful, but I know that there’s little chance of me doing anything truly catastrophic in my new job. It’s funny because, if I hadn’t been a doctor first, I might have had a very different view of things. I could see how, in a parallel universe, someone as highly strung as I am could easily crumble in the start-up environment. It’s demanding and uncertain, and because I like the team, I really want this to work out.

But having been a doctor, the silver lining is right before me – I just have to remind myself it’s there. The fact is, no one’s going to die if I make a mistake. No family’s life will be destroyed if I have a bad day. I won’t be hauled up in front of the GMC or struck off if I’m too tired to do the job properly. In exchange for that, I have given up the profound wonder of healing and curing the sick, but I honestly feel rather glad of that. I’ve come to see how damaged I am in my approach to life, and am in need of a little self-healing. Life is stressful and demanding enough; adding one’s own unremitting self-criticism and cruelty is really quite unnecessary.

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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.

Peach, 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.