For doctors with depression, A&E can be especially tough. I should know

This article was taken from: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2018/mar/27/depression-doctor-ae-tough-nhs

By Ben Janaway

A worsening environment in the NHS is taking its toll, and many of us feel we don’t deserve the help that is offered

Depression is difficult. And as other passengers know, a hard day or moment can derail you. Working in A&E with depression can be especially hard. In the bustle of emergency care you can feel alone, running from patient to patient; some you can save, some you can’t. Pressure to treat patients quickly with compassion when you are terrified of missing something and trying to hide your symptoms is draining.

I was diagnosed at university. I didn’t want to see friends, and I was spending more time in bed, becoming angry or sad. These feelings didn’t go away, and I seemed to wade through life and eventually avoid it altogether.

After a bad breakup, I became a shadow of myself, tearful and hopeless. I would bury myself in self-improvement books, work, projects and the gym. I was searching for an escape, but as anyone with depression knows, an escape isn’t so easy. In my lowest moments the only solution seemed to be death. This would become an uneasy partner.

Although I made it through medical school, I

Often I felt overloaded. And I wasn’t the only one. Admissions were at an all-time high, staff levels were falling, and there were times when I needed to decompress. I often went to the hospital chapel. I am not religious, but peace was comforting. I learned it was okay to feel lost, and to take time to get back on track. In times of intense panic I told senior colleagues, and took the time to slow down. Somehow I was able to avoid becoming another number in the growing rates of physician suicide.

I began to write down my thoughts and to create new ways to solve problems, so next time I would be ahead. In medicine this is called reflection, but I saw it as growth. I also worked with wonderful people, and learned that many shared depression. One in particular, who went on to take her own life, kept me going.

Being a doctor is an honour. You are charged with the chance to save lives, placed in a position of trust by those young and old, often at times of intense fear. My depression helped me to understand how this felt because I lived it. I knew hopelessness, fear and panic. I knew paranoia, anxiety and darkness. I too searched for moments of hope in a mire of grey. And it helped me speak a language often advocated by medical policy, empathy. I never had to fake it.

People are often beaten down for admitting they have a mental health issue. But years on I recognise that depression presents you with more opportunities to grow. Healthcare staff feel under immense pressure to perform, and the nature of medicine means that we must toughen up. I fear friends lost their lives because of this.

approached becoming a doctor with apprehension. Life was about to become a lot harder.

Two years later, I began an emergency job. In a specialty that was under intense stress, with staff leaving and targets missed, the daily grind was wearing. At this point I was under the care of occupational health and regularly seeing a therapist.

Despite therapy, I would go home and find the cases of the day replaying in my head. . With depression, mistakes often become monsters, circular thoughts that prey on you in the early hours.

Often I felt overloaded. And I wasn’t the only one. Admissions were at an all-time high, staff levels were falling, and there were times when I needed to decompress. I often went to the hospital chapel. I am not religious, but peace was comforting. I learned it was okay to feel lost, and to take time to get back on track. In times of intense panic I told senior colleagues, and took the time to slow down. Somehow I was able to avoid becoming another number in the growing rates of physician suicide.

I began to write down my thoughts and to create new ways to solve problems, so next time I would be ahead. In medicine this is called reflection, but I saw it as growth. I also worked with wonderful people, and learned that many shared depression. One in particular, who went on to take her own life, kept me going.

Being a doctor is an honour. You are charged with the chance to save lives, placed in a position of trust by those young and old, often at times of intense fear. My depression helped me to understand how this felt because I lived it. I knew hopelessness, fear and panic. I knew paranoia, anxiety and darkness. I too searched for moments of hope in a mire of grey. And it helped me speak a language often advocated by medical policy, empathy. I never had to fake it.

People are often beaten down for admitting they have a mental health issue. But years on I recognise that depression presents you with more opportunities to grow. Healthcare staff feel under immense pressure to perform, and the nature of medicine means that we must toughen up. I fear friends lost their lives because of this

The truth is rather different. Patients are not mocked for illness, so why do we do this to ourselves? As a doctor you can make moments significant, end fear and create hope. Depression has been a door to that realisation. The issue that plagues doctors with depression is the harsh and worsening environment. We are increasingly expected to come in for extra shifts, and feel guilt if we do not. Sleep disturbance, night shifts and exhaustion are all known triggers for a depression relapse, but the NHS lifestyle demands sacrifices above and beyond what many of us can give.

Help is there, but many of us feel we don’t deserve it. The NHS is aware of the problem, but the solutions come at a cost. Giving us time off or amending our rotas means leaving gaps that others have to fill. We can’t rely on goodwill for ever, it’s not an infinite well. The solution is to recognise that depression is common, but that an understaffed and overloaded NHS is more common.

Working in A&E showed me just how far grit, determination and a supportive team can get you, and with the right structural changes and funding, this is something the NHS could truly be proud of. But as doctors, we need to stop feeling guilty for not being superheroes.