A Tale of Two Sickies

Well, a certain theme runs these recent posts. But we shall see.

I have decided to give this a couple more days and see my specialist, or to see him tomorrow if I feel bad enough not to work. And I'm not looking forward to the whole thing. My psychiatrist (and God I wish I could remember what pseudoname I gave him) is very good clinically, but he seems a very decent, comfortable, moral, someone utterly unfamiliar from a personal point of view with the self-loathing that depressed people get, and I find it hard to speak frankly to him about what I am sure are my moral failings.

Good God. I think for the first time I understood there why patients ask drug and alcohol doctors if they have tried drugs, or ever drunk too much, or why psychiatric patients want to know if their doctor has ever been depressed. It's easier saying you can't cope and that you're a failure to someone who isn't perfect.

We were sent to a seminar that covered, amongst other things, the junior "doctor in difficulty" (DID). One anecdote stands out, and uncharacteristically for me this one has an almost happy ending.

Junior doctors get rotated around the wards in ten-week blocks: ten weeks in surgery, ten doing med nights, ten doing paediatrics, etc. Med nights is both the hardest and the most isolated of the rotations, and Shipton at the time was one of the more challenging hospitals to work on, so naturally our story unfolds at Shipton, med nights, late nineties.

Dramatis personae: Andrea and Bethany, best of friends through medical school, inseparable out of it. Half way though the year the respiratory consultants and registrars had their meeting and the subject of intern mental health came up.

Because everyone could see there was a problem. Bethany was turning up late. Her work, initially good, was increasingly sloppy - unfinished drug charts, scanty notes, inadequate handovers. She seemed to lack confidence in her ability to do the job, nursing staff said she was occasionally terse, one of them had caught her crying on the phone. There had been some boyfriend trouble.

Andrea, on the other hand, seemed to be coping with the situation relatively well. Her self confidence had grown, she was calm, confident and concise in her patient care, she looked to be doing well and going far. She was obviously coping with a very stressful situation because although the two girls were never rostered on together, Andrea's day shifts followed Bethany's nights and vice versa, so each one had to clean up the other one's mess. And you can't take sickies on med nights, because it's a week of nights alternating witha week of days and if they can't find anyone, the other person has to do some kind of ubershift to cover you.

But Andrea seemed to be coping well.

And the consultants and the registrars talked about it, and one was delegated to have a chat to Bethany, but it was winter, a very busy time, and just before Dr Sook could say something, word came that one of their interns had taken a potentially fatal overdose and had been admitted to another hospital with major depression.

And of course, it was Andrea who'd overdosed. And if you want to take an overdose, don't take one when you share a room with a good medical intern, because she will come home, find you asleep when you're meant to be driving to work, note your vital signs and put two and two together faster than Deep Blue.

So, what had happened? Why had Andrea looked so happy, seemed so confident? Well, partly because depression is a weakness, and it's one she had felt she had had to conceal, and one she had concealed through much of her life very well, because she was, after all, very very smart. And you are just expected to go from a life where everything has always gone right to a life populated by wide-eyed cripples drowning in dry air.

And Bethany so tired? Because she'd been carrying Andrea, writing her drug charts, checking her patients, rewriting her doses of steroids. She'd done it often through medical school, and now she wasn't going to give up on her friend when she needed her. And she wasn't going to tell anyone she was carrying Andrea, because that's not what friends do, and she certainly wasn't going to tell any of Andrea's assessors that their favourite intern had developed clinical mental illness.

Anyway, they had two sickies that day, the med night was in the Royal getting NAC for paracetamol poisoning and the med day was basically just too tired and upset to do anything. And it all sounds very Readers' Digest, but the thing about some successful people is that by the time you see signs it's often late in the day.

One of the many reasons doctors are so successful at killing ourselves. No tolerance for weakness, no experience of how to cope with our failures and mistakes, deeply self critical, no desire to live as one of the dependent, horribly ill people we see, and access to vast amounts of painless, guaranteed lethal chemicals.

Anyhow, thanks for listening. I am going out to feed the chickens.