Near misses whilst driving home from the hospital were a warning sign that I was exhausted. However, I chose to ignore it, because that’s what we do as doctors.
The aggressive honking of the car behind jolted me awake. As though nothing had happened, I spotted the green signal and drove on. This was the third or fourth time I had dozed off at a traffic light in the previous couple of weeks. There were mornings where I’d pulled into the hospital car park and fallen asleep before managing to get out of the car. Days where I’d failed to make it all the way home after a night shift, opting to pull over and sleep by the side of the road. Utter exhaustion. At the time, I was working irregular shifts, encouraged to stay late and cover rota gaps. “Sleep well!” they would say as I left work after a long night.
It wasn’t until a very near miss with a tractor that I realised just how tired I was.
I had always received great feedback for my relentless efforts to put patients first, for doing more baby checks than anyone else, for taking on more audits and teaching. But what people failed to notice was that this was to the detriment of taking breaks, of eating or leaving on time. In medicine there’s a culture that encourages doctors to be “heroes”, to go above and beyond, sacrificing themselves in the process without even realising it.
But patients deserve a workforce that is functioning at its optimal level: doctors and nurses who can operate safely, concentrate and process information quickly. I know that after my 15 hour night shifts in neonates, I could do none of these things.
It’s OK to stop for lunch, to say no to that extra night shift, to leave on time. Culture must change because it’s costing lives.
For the first time in my adult life, I don’t have a job.
I used to be a doctor but more recently have been a primary teacher.
The truth is…I don’t know who I am.
I left medicine in June 2019. A story of burnout, mental illness and recovery. Covid hit midway through my teacher training- an unanticipated hurdle in my career change. And then, September 2020 came and I was the class teacher standing in front of thirty six-year-olds. Thirty children who hadn’t been to school for six months.
For many teachers across the country, this year has been about giving children the best education and opportunities in challenging and ever changing circumstances, even if this has been to the detriment of their own health. The huge increase in workload has seen teachers reporting higher rates of anxiety and depression than normal with almost 1 in 4 teachers taking medication for their mental health. (https://www.tes.com/news/one-50-teachers-has-self-harmed-amid-covid-stress Within my school, teachers who had been in the profession for 30 years were talking of leaving, buckling under the pressure of what was being demanded of us. Everyday I dreaded going into work. I became increasingly anxious, worrying about everything. But I talked. I told people how I felt and, as I opened up, others did too. Stigma silences us. One conversation is all it takes.
One of the biggest things I have struggled with this year is loss of identity. I feel like a fraud, no longer legitimately able to call myself a doctor. Yet that is who I am. I don’t feel like a teacher. I’m not sure I ever will. Medicine forms such a huge part of a doctor’s sense of self and, without it, I feel lost.
In the midst of the pandemic last year, when the NHS was at breaking point, I received an email from the GMC. I was one of the 15,000 doctors who had left the register or given up my licence to practise within the last 3 years. The email explained that given the circumstances, my licence would automatically be temporarily reinstated in order to help during the crisis and the health service would contact me directly about further arrangements. I could, however, opt out.
I read it and re-read it. My instinct told me I should return- face my duties, do what was right and expected of me. Wards were overflowing with patients, people were working relentlessly, exhausted and overwhelmed… yet I was not. My training had been cut short: schools closed and students sent home. In theory, I could have returned. But I didn’t. I couldn’t have dealt with returning to medicine when the NHS was buckling, when doctors had been redeployed to other services and people were under such incredible pressure. I didn’t have the emotional resilience. So I opted out.
Every Thursday evening the country united to clap for our NHS heroes. Every Thursday I was filled with guilt as the neighbours banged their pots and pans ferociously, cheering and whistling at the top of their voices. Every Thursday evening, I hid inside and cried.
I may have left medicine, but I haven’t stopped feeling like a doctor.
The light is dimming. I can feel the darkness creeping in. Its deep and penetrating silence. Its heavy weight. Reaching. Pulling.
Lifeless eyes. Apathy. Numbness. Life becomes existence, nothing more.
I have no sense of me right now. Everything has been consumed by planning, teaching, marking and all the other things that come with becoming a teacher in the middle of a pandemic. I wake up at night sweating. I feel exhausted. I cry all the time. Overwhelm.
And then there’s my daughter who may need major surgery in the next few months. Fear of the unthinkable. Uncertainty. Waiting…
The only person who can truly help right now is me.
I am sitting at the nurses station outside the high dependency bay writing up an aminophylline infusion for a boy with severe asthma. It must be coming up to midnight. The rest of the ward is quiet; children sleep whilst parents toss and turn on narrow camp beds. From HDU comes the high pitched hissing of yet another nebuliser. A box of Quality Street has been knocked over and a couple of lonely strawberry creams stare at me from the desk. None of those fudge ones in the crinkly pink wrapper though. A mother appears from one of the cubicles. Shielding her eyes from the bright lights, she asks for some more paracetamol for her child. As one of the nurses disappears to find the drug cupboard keys, my attention is brought back to the prescription.
There is something comforting about the ward at night.
It’s been a long time since I worked nights yet somehow I remember it fondly. I seem to have forgotten the pressure that I felt from being the most senior paediatrician in the hospital, or how I was generally rushed off my feet without a moment to even pause to think. It’s strange how the brain selects what it wants to remember.
I find myself thinking about medicine more and more often. Is that because I miss it, or perhaps simply a reflection of its familiarity? I’m not sure. Next week I begin my teaching career. “How exciting!” I hear you say. Yes, I suppose it is… Except hang on… I don’t feel excited. Instead I feel fear, dread, anxiety, panic…
I don’t deal with uncertainty very well and as such, the build up to September has been hard. I’m entering teaching at a time when nobody knows what to expect, when policies and practices are changing on a weekly basis. That, compounded by my training being cut short, has left me feeling grossly inadequate and out of my depth. So as my anxiety levels rise, I am trying hard to remember all the work I have done in therapy, all the strategies I have learnt to ground myself and focus on what I need in the moment to feel better.
And then my mind drifts back to medicine, to its familiarity, to the patients and their families, to the comfort of the night shift, to the camaraderie of the team.
I am still a doctor at heart. I don’t feel like a teacher yet. Perhaps I will some time soon.
People often ask me why I left medicine. I generally mumble something about being unfulfilled in my job as a paediatrician, about the NHS not being what it used to be and about wanting to create long term relationships with children and their families. But somehow I always feel uncomfortable, like I might be found out. Because the honest answer includes many more layers of uncertainty and indecision. It comes from a deeply vulnerable part of me, a part that had been unwell and off work, a part that had sat in psychiatrists’ waiting rooms nervously turning the pages of outdated magazines.
Two weeks after I left I had to take my daughter to a hospital appointment As we entered the lift, two physiotherapists squeezed in behind us. I couldn’t take my eyes off the stethoscopes draped carelessly around their shoulders. Somehow they represented everything I was leaving behind.
Here I am, twelve months on. A primary teacher. Who would have thought it?!
Some people laugh. “From one stressful job into another!” they say. They’re not wrong. This year has been hugely stressful. Juggling life with two small kids, full-time studying, teaching and everything else that comes with it was almost enough to tip me back into becoming unwell. In February I went to the GP. The anxiety had become pretty bad again. I remember saying, “I’m not sure I can do this”. There were five days left until half-term. Somehow I made it.
And then Covid happened. My placement was suspended. One third of my training- gone. Yet the university are still happy for me to be a teacher. Yes I have been doing online self-directed CPD. Yes, I have continued to learn, but nothing replaces being in the classroom. The whole thing was terrifying. Absurd. Overwhelming. There have been much bigger things to worry about and reflect upon during lockdown, but part of me has felt bereft of the opportunity to celebrate a huge life changing event. Instead, I feel like I haven’t fully deserved this PGCE. It’s been handed to me on a plate. An email confirming that I am expected to graduate based on my progress to date. And that’s that. A primary teacher.
Over the last year, I have come to realise, that the epidemic of mental illness and burnout in medicine is not dissimilar to what is happening in education. Workload. Well-being. Retention. A very experienced teacher, exhausted and anxious, crying on my shoulder. Another, angry and irritable through stress. A senior teacher on anti-depressants and in therapy, struggling with decisions about their career. Another burnt-out and on sick leave.
It turns out that when you begin to open up and share your own vulnerabililty, people share theirs. You realise that mental health problems are all around you. That it is OK to wobble, that the chances are, someone else is wobbling too.
So last month, when asked why I left medicine in a job interview, I told the truth. It wasn’t planned or prepared, it just came out. Vulnerability on full show for the whole panel to see. As I finished talking, the head thanked me for such an honest answer. We worry about stigma. I worry about stigma, but this proved to me that sometimes, the person who stigmatises me the most, is myself.
A few hours later, I got a call to offer me the job.
I have decided to work part-time. It is an essential step right now in order to stay well. It is a compromise but one that I have to make. Balance. So from September I will have a class of thirty 6-7 year olds of my own! I want my classroom to be a safe and nurturing space, where children can make mistakes, where they learn about respect and tolerance. I want them to have the vocabulary they need to understand their emotions and learn how to manage them. I aspire to teach them about things they are interested in to fuel curiosity and a love of learning. And obviously, I will also teach English and Maths!
Exactly one year ago I handed my notice in. I was a paediatric registrar but had had enough. I felt unfulfilled, no longer able to be the doctor that I wanted in a system that failed to value me as an individual.
So I left. Not without tears, but I left.
And today, almost a year to the day, I have accepted my first job as a primary teacher.
The journey I have taken has been bumpy at times. From burnt out, resentful and frustrated to depressed and hopeless. From anxious and irrational to terrified and overwhelmed. And yet now, here I am, excited about a new chapter. Hopeful.
People along this journey have been incredible. I have had family who have cared for me, hugged me when I have needed it most. I have had friends who have understood and stood by me regardless. I have had mentors that have carried me through dark days, who have sat and listened whilst I threatened to give up. And I have had a family of strangers on Twitter. People who have looked beyond a label and seen me for who I am.
So I dedicate this year to you all.
I thank you for your support.
I thank you for your love.
And I raise a glass to hope, happiness and new things.
Every Thursday at 8pm, my neighbours cheer. They bang their saucepans, whistle and shout at the top of their voices. And quite rightly so. Every Thursday at 8pm I burst into tears and run indoors. This week I have made the decision to no longer go out.
People keep asking me if I’m going back to the NHS. I stutter some vague reply about why I’m not, but as I say it, I feel judged. “Why wouldn’t you? You have the skills.” “What kind of person are you?” “Don’t you care that people are dying?”…
And then I realise, these are thoughts. My thoughts. No matter how hard I try, I can’t shake off the guilt. Fundamentally, I am still a doctor. Caring, compassionate and selfless.
With school closures, my teacher training course has been suspended. I am fortunate to fall into the category of students who will most likely still qualify in the summer despite having missed my third and final placement. But for me, this experience was about so much more than just demonstrating competence. It was about confidence, ownership and developing a real sense of the teacher I will be. I now find myself grappling with another big decision. Do I or do I not apply for my first primary teacher job in September?
Back to school anxiety is a well known phenomenon for both pupils and teachers, but when government restrictions are lifted, returning to school will be fraught with all sorts of other hurdles too: behaviour, grief, bereavement, fragmented friendships, gaps in children’s knowledge. Navigating all this will be a challenge for any teacher, but for a newly qualified one who has missed one third of their practical classroom experience… well, I worry it will simply be too much.
I had been finding things tough before schools closed. My anxiety had been bad. Juggling full time teaching, essay writing and parenting was beginning to take its toll. There was no space for me. I had pretty much decided that I would have to apply for a less than full-time job if it was to be sustainable. But now I don’t even feel able to do that. Underconfident. Fearful for my mental health. Aware of how much I have to lose if it goes badly.
And medicine calls. Prior to Covid I hadn’t really given any thought to returning, but since all this has happened, that is all I can think about. Going back to what I am good at, to what, at some point, I used to love. I know, rose tinted glasses and all that… but what if this was an error? What if I was made to be a doctor and somehow got lost along the way? What if…
I have decided to wait and not apply for a teaching position yet. I know this is the right decision, but once again it feels like a hard one. In a bid to get more classroom experience I may apply for a teaching assistant job. Perhaps after a while I will then feel confident enough to have a class of my own. Who knows?
I noticed her in the woods. She was sitting alone on a rock. I didn’t realise she was upset. She looked up at me. Her eyes were tired and full of sadness. Without uttering a word, she spoke. Tears fell down her cheeks.
I sat with her. I listened.
Her life no longer felt normal. Friends and relatives who she used to take for granted, now so far away. Uncertainty. Apprehension. Fear…
I whispered to her. I told her it would be OK. I had no idea if it would be, but it felt like the right thing to say. I then asked her if she’d heard the stream. We listened together, the water trickling gently. We noticed the bright yellow tones of the daffodils nearby. I heard her take a deep breath. She exhaled slowly.
“Thank you”, she said.
She fiddled anxiously with her sleeves and stood up.
“Let me walk with you”, I said.
We walked through the forest together and as we did her shoulders relaxed. The pain that had been written all over her face somehow eased.
The lady crying in the woods was me.
Let this be a reminder. It’s OK to feel. It’s OK to be scared.
Ground yourself, notice and remember, this too will pass.
This week, hundreds of thousands of people took to the streets to applaud the valiant effort of those working in the NHS. A gesture of solidarity, of acknowledgement and thanks. I live in a cul-de-sac. Neighbours stood at their doors, cheering rapturously.
My cheers were filled with guilt.
14th June 2019. My last day in medicine.
I went to medical school straight from school. As one of the youngest in the academic year, I had just turned 18. My mental health at the time was wobbly and moving to university was tough. I cried every day for about three months. Medicine became my comfort. Medicine made me happy. Not the prizes, the publications or the presentations, but the patients. Everything I did was for them. No space for me.
It turns out that’s not sustainable.
Gradually, I became bitter and resentful. Everything that was expected of me as a junior doctor wore me down. The jumping through hoops, ticking boxes and endless admin. The lack of control. Instead I became angry. Angry at a system that disrespected its trainees, that failed to recognise their value. I could no longer remember why I’d loved it.
So, I tried new things. I set up a mentoring scheme to support fellow trainees. I promoted wellbeing across the region. I told my story, one of mental illness and burn out. I leaned on people, I accessed support. But in the end, I decided to leave. Medicine, that I’d had so much passion for, so much enthusiasm… medicine had broken me.
I walked away.
Do I miss it? Yes. Bits of it.
I miss the patients, the unique and privileged relationships. I miss working as part of an incredible team. I miss the care and the empathy.
After I left, I threw myself into primary teacher training. I hadn’t worked full time for over 6 years. Juggling life, school based training, essays, planning… hard doesn’t come close. And now, amongst the crisis that has seized the country, my course has been suspended. Schools are closed. Life is not what it used to be. Who knows what will happen.
Covid has brought with it guilt, grief, uncertainty and fear. Am I OK? Not really. Is anyone OK? I’m not sure.
So as you relentlessly put your patients first, as you leave your families at home to fight this war, remind yourself of what you enjoy about medicine. See past the system. See beyond Covid.
And whilst I admire you all from a distance, I plead you to prioritise YOU. Have lunch, leave on time, reach out for help. There is no shame in finding this hard. No weakness. No failure. Just humanity.
It was sometime before midnight. My husband was asleep. His breathing was deep and rhythmical. I lay awake. Terrified. Convinced he was going to die. My panicked mind was planning his funeral. How would I access his Will? What would I tell our children? How would I possibly cope without him? It went on and on…
My husband is healthy. He hasn’t shown any symptoms of Covid-19, but there I was, 100% sure he would die. So vivid. So real.
That day, I had scrolled through pages of horrific online stories: patients describing their symptoms, ICU consultants imploring people to stay at home, hospitals overflowing with patients, trucks removing bodies. The news. Emails. Work. School. There is no escape from Covid.
Last night I woke up drenched in sweat. Another Covid nightmare.
People say, “It’s OK to be anxious, everyone is”. Somehow that doesn’t help.
On Friday I received an email from the GMC asking me to reinstate my license to practice medicine. I left paeds in June last year. A complex and emotional decision, but one that was right for me. But here I am, faced with a choice:
Do I do what I want to do, or do I do what is right to do?
There is no doubt in my mind that I want to stand with my colleagues. I want to be part of the front line response to this disaster. Solidarity. Union. Care. Compassion. Things that are integral to who I am.
Yet, I can’t. I know I can’t. Going back to an NHS that is overwhelmed, where nothing is as I know it, where people are stretched beyond their limits… I simply wouldn’t cope. My friends told me so. My health professionals told me so. But now, in my inbox is an email waiting for a response.
Guilt. Shame. Weakness. All over again.
So to all my colleagues across the world, forgive me.