Sunday, 29 January 2012


Blogging twice in one week is a rare enough occurrence for me, so posting twice in the space of a few hours is basically unheard of, but I just wanted to attempt to respond all of the wonderful comments I've received since I last hit "post".

I honestly could not have anticipated the volume of responses I have received, and each and every one of them has been positive. Whether you have commented, tweeted, direct messaged, text, phoned or simply read my post - thank you. You are all fantastic people and I must admit I may have "had something in my eye" a few times.

To those of you who said you could relate in some small way to what I'd written - thank you. I hope that you now feel, as I do, slightly less alone. To the amazing friends who have said they are proud of me - you are all incredible people and I feel extremely lucky to have you in my life. To the people who have called me brave, courageous or inspirational - I'm extremely flattered. I don't feel worthy of your comments, but your kindness means a lot.

If only one person reading has felt just a little relief in knowing they aren't alone, then it was worth all the (completely unnecessary) worrying. I actually feel fantastic for getting this out in the open. There have been so many times when I've worried about saying something in case I "gave away" my issues. Now they're out there, I think I can just get on with things.

Much love to each and every one of you xxx

The Real Confession

When I started this blog and called it "confessions of a learnaholic" I didn't have any intentions of making any real "confessions" on it. It was going to be solely about work and uni-related stuff, documenting my journey from medical student to (hopefully at some point) academic clinician. I was going to keep "personal" stuff away from it. The thing is, the longer I've been writing, the more I'm realising that actually keeping the "personal" things away is almost impossible. My decisions and choices regarding academia, studying and careers are influenced as much by my past, my experiences, my personal demons as by anything else. After reading a beautifully honest piece of writing by @LellyMo (follow her on Twitter by the way, she's lovely) which you can read here I decided that actually, it was OK to be open about things. My experiences are vastly different to hers, and I am in no way suggesting that what I've been through is in any way comparable. However, without reading her blog I would never dared to admit what I'm about to say in public. I advise you to stop reading now.

*takes deep breath*

I have depression. And bulimia. Right. It's out there.

I have spent years worrying about whether I should admit this to anyone, either publicly or privately. My regent (personal tutor type person at uni) knows, as do occupational health. They haven't really batted an eyelid and told me as long as I take my pills like a good girl then I'll be fine. Mental health conditions amongst doctors are apparently not at all uncommon, yet no one seems to talk about them. The taboo experienced by the "general population" seems to be felt just as much by those of us who are trained to understand and treat these problems. One of the things which held me back from talking about this previously was the worry that one day, a patient would find out and it would change their perception of me. After all, who wants to be treated by a "crazy" doctor? On one hand, I can completely understand their worry. I wouldn't want someone with impaired judgement making decisions regarding my health (or indeed life) either. The converse to this is that actually, I'm very, very good at knowing when my judgement is impaired. Over a decade of symptoms means I can spot problems incredibly early on. If I'm in the least bit worried that I won't be able to safely care for patients then it's time for a quiet word in someone's ear and possibly some time off.

I am frequently criticised, in the most well-meaning ways possible, for my lack of self esteem. As I'm in a "getting this out in the open" mood, I suppose a bit of an explanation is due (I must place a *trigger* warning here. I suggest that no one reads this at all, but if you must, it's a bit sensitive). A lot of what follows is copied directly to an email I wrote to a friend of mine not long ago, purely because I phrased it about as well as I could then so may as well reuse it. I won't mention any names, but to the person who allowed me to write that email - thank you. Your acceptance, support and love means more to me than you will ever know.

"Right, so, self confidence. Something I don't think I've ever had much of. One of my earliest memories is of me standing in the bathroom just about to have a bath when I was maybe 4 or 5. I distinctly remember my Mum looking over at me and I instinctively held my stomach in, and she told me not to. Now, logically she probably just meant that there was no need to do that, but I remember thinking that she must be looking at how fat I was. My sisters are both naturally very slim and attractive so I always felt like the fat one growing up, even though until my late teens I wasn't at all overweight. I've been cursed with the skin of a greasy teenager which is of course not ideal. Coupled with the glasses and braces I had in high school, you can just imagine the kind of time I had. Horse teeth and fish lips were particularly frequently given "nicknames". *sigh* Now, I'm well aware that no one really has a good time in school but for some reason, probably just my natural personality, I find it hard to forget it even though it's now 8 and a half years since I left...

My consolation prize in life, which went part way to making up for my ugliness, fatness, lack of abilities in art or sport, lack of friends etc, was my intelligence. I might not have been popular but I *was* clever. Sport and art aside (which I was intrinsically untalented at), I was a straight A student without an awful lot of effort required. I did work hard because I enjoyed most of my work (was a complete science and maths geek and I loved music) and I loved reading, but there was never any real need for me to study. I say this not to brag or boast, but so that perhaps it makes sense that I am a little sensitive when it comes to my intellect. It was the one thing I clung on to that I actually had.

I've always been quite a serious, melancholy type but when I hit my teenage years I became quite seriously depressed. To cut an extremely long story short, I got through day to day life by self harming and made numerous suicide attempts. How I never ended up in hospital is something of a miracle. Anyway, when I was almost 16, I had a major low episode. My parents finally caught me cutting myself and making a fairly hashed up job of wrist slitting (a knowledge of anatomy would probably have come in useful then...) and after several horrendous arguments we somehow reached the conclusion that the best thing for me was to stop going to school. It's not a decision I fully understand but it happened. Anyway, I didn't go to school at all for the majority of year 11 and due to being incredibly miserable and having no concentration span I made a bit of a mess of my GCSEs (2As, 5Bs, 2Cs - not terrible but I was predicted 7 A*s and 3 As).

Having missed so much school and having so many bad memories of the place (bullying mainly but lots of other nonsense I'll not go into just now), I wasn't keen to stay on for sixth form, so I went to college to do my A levels. I was largely much happier there but on some fairly bad medical advice, I came off my medications. I worked pretty hard in my first year and did pretty well. When I applied to medical school I got a couple of offers and it was generally accepted amongst my family and teachers that I was going to get in with next to no effort. I will never be able to explain exactly what went wrong during my exams, but between a not very pleasant situation at work (colleague threatened to prosecute me for controlled drugs offences...*) and foolishly getting involved with a boy who turned out to be horrible (in the sense that "no" apparently means "yes"...), I suppose my mind just wasn't in the right place. I can still remember the sinking feeling I got on results day when I realised that I'd screwed up and I wasn't going to get to be a doctor after all. The worst part was that because I was only one grade off what I needed, I had to wait a week or so for the uni to actually decide they weren't letting me in (I suppose they had to see how many people declined offers and things).

When I went to uni I was totally miserable. I was doing the "failed medics" degree, I was miles from home and I was living in horrible accommodation. I suppose it was around then that my eating started to really go wrong. Food made me feel better when not a lot else did, but after I'd stuffed myself senseless I'd feel so guilty and dirty that I'd have to make myself vomit... I went through various stages where I got on top of things but I never really controlled the binges. Hence how I ended up so bloody fat (at my heaviest I was 13 stone 3. I'm 5' tall. That gave me a BMI of 36.).

I can pretend that some things have got better but really little has changed. By some miracle I got through my degree and graduated with a (totally undeserved) first. I got into medical school and skipped first year. I've just about got through OK (resat first OSCE I ever had to do, mainly coz I was so nervous it was all I could do not to vomit all other the examiners). I've got myself a job to start. I had a really, really good appraisal from my last placement. I've published two papers and am working on a third. I've just been awarded a national prize. Yet I still feel completely inadequate and I don't know why. I can look at all the evidence and *know* I can't be shit - but I still feel it."

Since I wrote that, I've been doing a little better (save for the 7 creme eggs I ate in one sitting yesterday - that's what happens when you think "ooh I'm doing well, not binged in a couple of weeks). As I said in a previous post, I think "getting a life" is going to be very helpful. I have now accepted that I may never be fully rid of these issues. By talking honestly and openly about them, I hope that eventually they will be a background irritation. They no longer consume my life the way they once did, and every time I let myself think "I look OJ today" or "I did well in X at uni" then I know I'm a teeny, tiny step closer to "normality".

If you have read this, thank you. If you've struggled with similar issues, I hope this makes you feel less alone - no two cases are ever the same but even knowing someone, somewhere has felt that unbearable emptiness and loneliness that can occur may help just a little.

So. That's me. That's my story. Obviously lots more to it but I suppose in essence that sums up the past 10 years or so. Now I just have to be brave enough to hit post...

*People have interpreted this as me saying I was using hard drugs; I absolutely wasn't and never have done. Actually, I used to work in a pharmacy and someone falsely suggested I had tampered with a controlled substance. Nothing ever came of it and it was pretty quickly forgotten, although of course extremely stressful at the time. I just felt it best to clarify as someone suggested that the GMC could get the wrong end of the stick!

Saturday, 28 January 2012

A Life Outside of Medicine

It's official. I need to get a life. This isn't an epiphany I've had after getting particularly excited about some trivial scientific finding or having yet another rant about the misuse of apostrophes (although I confess they are both frequent occurrences). This is the realisation that when several senior, experienced people tell you something often enough, they are quite likely to be correct.

I did, once upon a time, have a life. When I was doing my first degree I was very involved with the drama society (committee positions, acting, directing...), I was a class rep on numerous occasions, I did all sorts of things with the student's association, I volunteered for several charities... In and around all this, I managed to somehow do enough work to get a good degree, had a job and went out a fair amount.

My descent into loserville began quite slowly but started at about the same time I got into medical school. As I was staying at the same university, I'd been elected onto the drama society committee again. Unfortunately, because the medical school is on a different campus to the rest of the university and because I had a fairly full timetable, I wasn't able to make the majority of meetings, so I had to resign almost immediately. For my first couple of years, I was still quite involved in the student's association, but as fourth year started and I got busier, I had to take a back seat with committees. Irregular holidays which no longer occurred at the same times as school holidays meant I was no longer able to volunteer at holiday play schemes.

I don't say any of this to moan - it's hardly an unusual set of circumstances and I'd be surprised if a lot of other medical students haven't found the same thing. Towards the end of last year, when I was revising all hours for my exams, I basically stopped doing everything - drinking, socialising, going to the gym...

This has got to change. I may sit here argue that medicine is what I enjoy and what makes me happy, but I'm only kidding myself when I say that I'll get through my foundation jobs without some other hobby or thing to do. My social life has taken a bit of a battering this year because my friends are on placements here, there and everywhere so there are fewer people around to do things with.

From now on, I'm going to make a concerted effort to do things. Non medical things. Things that I'm not doing to help me with exams or boost my CV or make contacts. Things that I'll be doing just because I enjoy them. Tonight, I'm meeting with a friend I haven't seen in years for a drink and a catch-up. As I haven't been out socially since before Christmas, I feel that this is a decent start. I'm also looking at local bands/orchestras to see whether there is anything I could join. I was really into music whilst I was at school but have neglected it recently. I've had a bit of a dodgy chest recently, but once that's cleared I'm going to get back into going to the gym. Rather than just doing my own thing though, I'm going to try and get to some classes, that way I might meet new people as well as exercising.

I'm a bit out of ideas for now but I'm definitely going to take this "getting out more" things seriously. Oh, and I'm not doing any revision at the weekends anymore. Not until nearer exams, anyway!

Wednesday, 18 January 2012

Too keen?

Anyone foolish enough to follow me on Twitter will have realised that I've been a little fed up recently. I'm rather inclined towards melancholia at the best of times so a few really quite trivial things have been enough to get me quite down.

This year of uni is proving very, very challenging. For my first block, I was on elective. That was absolutely fantastic; I was made to feel part of a time, the house officers were happy for me to help them out as much as I could, the registrars enjoyed teaching and, of course, I was working in my favourite specialty. Since getting back, things have been pretty tough. I suspect that, in no small part, that is because my elective experience was so ideal. It makes any imperfections and annoyances in my other placements seem so obvious. I find myself thinking "when I was in NZ, x would never have happened" or "when I was in NZ, I'd have been able to do that" on multiple occassions throughout the day.

I am struggling with something alien to me at the moment - it's being made pretty clear to me that my enthusiasm and desire to learn can be pretty irritating, to say the least. This is making me question absolutely everything I say and do. Previously, if someone asked a question I thought I might know the answer to, I would volunteer an answer. Now I'm biting my tongue. I don't answer questions to look good, or to make other people look bad. I simply think it's a useful way of finding out whether my knowledge on a subject is accurate, and if it isn't, of learning something.

After getting really quite upset about it last night, I decided the best plan was to avoid the ward as much as possible. This is a real shame, as it's my best chance to learn how to be a good house officer. It's also the ideal place to clerk lots of patients and hone my history and examination skills in time for the OSCE in June. However, I've decided to spend as much time as I can in theatre and clinics instead. It might not be ideal (and I know for a fact it isn't what uni want us to do during our placements) but at least I might learn something. And even if I don't, I know the consultants won't criticise me just for turning up!

Saturday, 14 January 2012

Reflections on a previous post

Since I wrote my last-but-one post regarding Twitter and networking, I have been trying to work out what it is that makes me feel so uncomfortable. Today, I think I finally cracked it. In the past, when I've got some extra experience in a specialty or been involved in an audit or research project, it's always been because I've sent an email or approached someone involved. I'm not used to people offering to help me out, and I feel a little guilty about accepting. I'm pretty sure that this is what made me feel so awkward about meeting up with people I'd met via Twitter - it actually had nothing to do with the medium on which we'd first communicated. It was all that *they* had suggested meeting, *they* offered to help me get extra experience. I think that's where the feeling of cheating comes from. With other "extra" stuff I've done, it's because I've approached people and asked, so any benefit I get is "deserved" - I've "earned" it be being pro-active and asking if can get involved. In this scenario, totally new to me, I am potentially benefitting purely from the right people having heard/seen things I've said. So, I've worked out just what my crazy mind is worrying about. Now to try and make it stop...

Wednesday, 11 January 2012

Career Stress!

As students, particularly students of a profession, a lot of what we do is a "means to an end". We don't go to university for 5 or more years because we have a deep love for our subject, because we enjoy learning, because we enjoy the challenges posed by essays and exams (although any or all of these may be true). We go to university to become doctors.

As I've mentioned previously, I did a BSc in order to get into medical school. I hated my A levels, but I did them because they were necessary to get into university. I was pretty miserable doing my GCSEs, but I had to do them to do anything I wanted to do in the longrun. You get the picture. In essence, I've spent the best part of a decade doing things that I don't particularly enjoy, but because they are (or were) necessary for me to be able to do what I hope I will enjoy one day. That isn't to say I've hated everything I've done. GCSE drama was fantastic, I loved my Maths A level (seriously) and there were courses I took during my BSc which were fascinating. There have even been bits of medical school that I've enjoyed, although those have been few and far between (I don't hate medicine, I just really miss proper science sometimes).

Today I met with a couple of very friendly paediatricians (yes, we arranged it via Twitter, and yes, they may well read this at some point - hello if you're reading *waves*) to have a chat about career related things. Despite this being a pretty positive discussion, at least in the sense that they think I at least stand a chance of getting into paediatrics in future, I still find myself feeling hugely stressed. I can't pinpoint exactly why, but I wonder whether it's the fact that it's all been brought home just how much longer I'm going to be doing things as "a means to an end". The rest of this year is a given, of course. And then there's my two foundation years, which may or may not be enjoyable (they may also cause me to be killed falling asleep on the drive home from work or to jump off a multistory if recent news stories are anything to go on, but I'm choosing to ignore those particular "risks" for now). Let's be honest, I'm not actually going to have a "proper" job until I'm about 40. That's fine. But what if I get there and I hate it. I've already spent 10 years working towards being a paediatrician. I have at least another 10 to go. That's a very long time for something I might not actually a) like or b) be any good at.

I'm very aware that I'm rambling utter nonsense here. I shall leave you with a last thought: Why is it that even when we can objectively say that we're ok, even good, at something, we can't quite bring ourselves to feel/believe it?

Thursday, 5 January 2012

Thoughts on Twitter

I appear to have updated more than usual in the past few weeks. You may blame the uni holidays, and also the fact that I really ought to be doing some preparatory reading for my next placement and thus of course absolutely anything else in the world seems more interesting and appealing than what I should be doing.

It will come as little surprise to most of you to learn that I am a huge fan of Twitter. I joined initially because I thought it might be fun to follow some of my favourite "celebrities" on there (Stephen Fry mentioned it a lot in his podcasts). Having joined, I discovered some of my friends had accounts and thought it was worth following them. As a lot of my friends are medics (quelle surprise...) I soon found myself connecting with medical students and doctors around the UK and indeed the world. Now, this is great. I get to chat to people who are experts in their field. I can compare notes with students at other unis. If I have a question, I can "Tweet" it and most of the time I have a reliable answer in minutes. All of this is fantastic, not to mention that I have made some lovely friends who I probably wouldn't have met any other way. Recently, however, I have started to have a few concerns about how I use Twitter.

As a soon-to-be (I hope!) doctor, I have followed with interest recent discussions on various media regarding professional conduct and social networking. My profile is semi-anonymous, in that if you access it you can probably work out who I am, but I don't think you could find it by searching for me directly. I tend to lead a fairly dull and mundane life. The most "unprofessional" behaviour I engage in is the occassional vodka (ok, a few vodkas) once in a blue moon. I don't do anything illegal and I don't think I ever do anything which would make people worry about my suitability as a doctor. At least I hope not. Thus, I am rather unlikely to "reveal" anything on Twitter which isn't common knowledge. On occassion I have been slightly concerned that a jokey comment could be taken out of context and imply something quite different from what I intended, but for those situations there is of course the "delete" button. If I feel that something I've said has caused offence or annoyance I am generally more than happy to apologise and remove the tweet in question. I also have the utmost respect for my collegues, so if it is suggested that I've said something unwise then I'll listen, take down what I've written and try not to say similar in future. My concerns regarding Twitter, then, are not really related to professionalism.

I have recently found myself in something of an interesting situation. Given the vast numbers of people using social media and the ease with which one can find and follow those with similar interests, I have been followed by (and follow) several doctors who work in places I have been on placements or may work in future. As I stated above, I'm not really concerned by this as I don't say anything online that I wouldn't say in person. However, it got me thinking. I have expressed an interest, via Twitter, in several areas of medicine. One of the perks of social media for me is that if I say I'm interested in, say, Urology, a trainee or consultant in that area is fairly likely to contact me and offer advice and encouragement. Where I begin to feel somewhat awkward (that isn't the right word but it's the best I can think of for now) is when people offer to meet up for chats etc. Now, I've met plenty of people from Twitter, some of whom are pretty senior, but it's always been purely social. I'm starting to wonder whether meeting people for what is essentially professional networking is ethical. Should I be interacting with people who might be assessing me in an OSCE in a few months? On the face of it, I don't see a problem. I'm not silly enough to expect special consideration just because someone's read my tweets - if I screw up, I expect to fail. I very much doubt that any of the examiners are unprofessional enough to be swayed by something so trivial. In fact, if they are I should probably feel more guilty about doing extra work, audits etc for various people as they definitely know me fairly well. So what's the problem? Well, I wonder whether I'm gaining an unfair advantage by using Twitter. I'm not sure whether contacting these people and taking them up on their kind offers of tea and mentoring is being assertive and seizing an opportunity or if I'm doing something somehow dishonest. I feel in some ways like I'm "cheating" a bit - after all, not everyone has access to Twitter. Is it fair that I potenitally benefit in my career because I use a medium not available to everyone?

I would be interested to know what other people think. I'm pretty sure that I'm massively overthinking what is actually not a problem at all ("how unusual" I hear you cry!) but none the less it's been on my mind somewhat so I thought it worthy of a blog post.

Hope the New Year is treating you all well xxx