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!