Showing posts with label Twitter. Show all posts
Showing posts with label Twitter. Show all posts

Tuesday, 30 June 2015

The Drugs Don't Work, They Just Make You Worse

From time to time, I find myself "borrowing" song lyrics to title my posts. This is in part because I'm not hugely creative and partly because I'm usually listening to music of some sort whilst I'm writing, but mostly because if someone else has said it well before, then there's little chance of me saying it better.

Trying to describe how depression feels is almost impossible. Years and years ago, when I'd never met anyone else who had depression in "real life" and my support network was almost entirely a (sadly long-gone) forum, we used to tell each other "for those who understand,  no explanation is necessary; for those who don't, none will suffice". It's cliched and horribly over-used, but there was an element of comfort in realising that you'd probably never fully make other people understand how you felt, so you were as well saving your energy and not bothering. One particular thread, however, which I recall over a decade later, was entitled "The Sounds of Depression". I don't recall exactly how it started, but we started to share song lyrics (as well as other literary sources) which summed up our feelings. We were unable to express exactly how we felt, but many of our musical heroes did a fine job of it. Years after I first heard them, I find some songs are still better able to describe my feelings than any words I could write. Tonight, I'm thinking of The Verve.

"All this talk of getting old
It's getting me down, my love
Like a cat in a bag, waiting to drown
This time I'm coming down"

Some days, this is exactly what it's like. You fumble through your existence, not ever being entirely sure what the point is. The inevitable drowning that you feel sure awaits means that attempting anything seems like a waste of effort. You won't be able to get out of the bag that encloses you, so maybe it'd just be easier to succumb. Settle down, drift off to sleep and let yourself gradually suffocate. The eventual result will be the same, only with less pain in the meantime.

It's no coincidence that, as well as summing up how I sometimes feel, these lyrics are from a song called "The Drugs Don't Work". Yesterday, I read a very well-written piece by the lovely @katiehodgie about cognitive behaviour therapy and how it doesn't always work, which got me thinking about my experiences of treatment.

I've mentioned this sort of thing in the past, but in different contexts. I described my first contact with mental health services in my post on adolescent mental health. If you happened to read (or hear) the grand round I gave on the same topic, you may recognise it. That's because it was copied and pasted directly from that blog. "Suzie" was, of course, me. I don't mind if people who heard the talk guessed, but I didn't want to just stand and talk about myself openly because it felt somewhat indulgent, and may have detracted from the fact that I wanted to emphasise the importance of understanding mental health for all of our current and future patients, not just myself.

You can see that my first experiences of the psychiatric team were less than ideal. Over the many years which have passed since that appointment, I have had numerous other attempts at treatment. The list of medications I've tried resembles the formulary of a major psychiatric unit. I went for CBT and tried seeing a psychologist. I've met several psychiatrists. Despite all of this, and despite being a qualified doctor, it sometimes takes me by surprise when I remember that depression is a chronic problem. I have to remind myself, and other people, that I might dip again. It's a bit of an apology and a bit of a warning, summed up by John Mayer.

"Suppose I said
I am on my best behaviour
And there are times
I lose my worried mind
Would you want me when I'm not myself?
Wait it out while I am someone else?"

I'm never sure when the best time is to explain that I may be "not myself" for a while. Does it put people off getting to know me? Possibly. Are some people none-the-less shocked by it and unable to cope with it? Absolutely. I think this experience of negativity is one of the reasons I find myself wanting depression to be a transient phenomenon. The idea that friends won't have to "wait it out" again is appealing. Sometimes, I even believe it will happen.

When I am in a "good" phase, I convince myself it was something that happened once before, but something I am now over; a dreadful nightmare from which I have thankfully awoken. When I'm at my lowest, I am like the aforementioned cat, trapped and suffocating in a bin liner wondering when the water will finally wash over and take it all away. But there is a middle ground. The days when I first suspect it might be back. The mornings I wake inexplicably early, feeling anxious about nothing in particular. The evenings I cannot focus on whatever book I try to read. The afternoons where I suddenly feel like going out with my friends later is an insurmountable task. These are the times when I start thinking there might be an answer. Maybe another pill. Perhaps a different kind of talking therapy. Eating better, exercising more, filling my time with positive things. Maybe, this time, it will stop. Sarah McLachlan explained it pretty well.

"Spend all your time waiting
For that second chance
For a break that would make it OK"

I wonder, during these days, what it will be that makes it OK. I live in a kind of limbo, hoping that eventually I'll find and answer. Someone, somewhere will snap their fingers and it will all be OK.

In my case, the drugs do work, at least a little. The appropriate dose does mean that my eating is under better control. I have fewer binges and feel less compelled to consume everything in sight. Although I have dips, it's a long time since I put myself in any real danger or tried to do myself any sort of major harm. So, they help a bit. The psychological therapies I've tried have given me a better understanding of myself and some of my quirks, but haven't really enabled me to deal with things in a different way or had much impact on how I live my life. I have no doubt that for some people, one or a combination of treatments will actually completely cure them. For most, though, I suspect things help a little, but never make it completely go away.

I sometimes feel like it would be easier if I never experienced the better days. There are times when I start to think happiness is a myth, that I will forever experience the world through a sort of grey fuzz. During these times, I start to accept the lowness. I forgive myself for having no energy and allow myself to wallow. I stop looking longingly at "normal" people and decide that's not how I'm supposed to be. I accept that a sort of ambivalence about whether I life or die isn't too bad.

And then there are the better days. I wake up as my alarm goes off, feeling like I've had enough rest. I genuinely enjoy the simple things - my morning cuppa, a sunny drive to work, chatting to an old friend. The fog seems to have lifted. I put the bad days behind me and get on with living. And then, out of nowhere, the black dog comes again. Happening at times when I can so vividly recall normality makes it all the worse; the sheer contrast with the way things have been is brutal. I'm stealing more lyrics now, this time from James.

"Now I've swung back down again
It's worse than it was before
If I hadn't seen such riches
I could live with being poor"

This is sometimes the worst thing of all. Those good days are reminders of what I'm missing. Without them, I could almost settle into the grey and accept things. It's those good days that make me wish for a magic wand, some kind of switch to make it all go away. Of course I don't wish I didn't have good days, but sometimes I think it would all be much easier not to be reminded that there's an alternative existence out there.

If you happen to meet me on a grey day, you may not notice. But if you do, if I seem distant or like I'm not listening, or if I make excuses not to meet you, please don't take it personally. Bear with me. I'll have another good day eventually. Matchbox 20 explain it better than I do.

"I'm not crazy, I'm just a little unwell
I know right now you can't tell
But stay awhile and maybe then you'll see
A different side of me"

Sunday, 22 June 2014

(Not) Just A Minion

There is a temptation as a junior doctor to refer to oneself as "just a minion". This is particularly true of FY1s/residents, but it persists a fair way up the food chain. After all, we just go around obeying orders and doing as we're told, right? WRONG.

A junior doctor tends to be the first person to be called to a sick patient, whether a new admission or a current inpatient who has deteriorated. Every day we make decisions about whether to start or stop fluids, analgesia, antibiotics etc. We are the ones who decide whether a new admission can wait to be clerked in by us or whether we need to intervene immediately. When we review patients, we are not robots, simply asking a series of questions. We are interpreting (sometimes vast amounts of) information and making complex decisions based on that information. We have spent many years training to become critical thinkers, analysts, problem solvers. It would be utterly ridiculous to then unleash us into a job where we are simply yes-men. Yes, we have limited experience compared to our seniors, but we are still expected to think relatively independently.

A lot of juniors are also under the (false) impression that senior = infallible. This is clearly not true. Sometimes, as juniors, we are the ones who alert the consultants to something important. Prescribing diclofenac as instructed is not a smart move if you recall the past history of gastric ulceration - something a senior may not be aware of (because you took the history, remember?). Your boss may not have seen the latest blood results and it may be up to you to point out the deteriorating renal function or rising inflammatory markers. There are also occasions where your seniors will make errors. Pointing them out doesn't mean being arrogant or argumentative, but a simple "I'm interested, why did you decide X?" or "I was under the impression that you do(not) do that in situation Y" could prevent a patient coming to harm.

One of the main reasons I (and, I suspect, some of my colleagues) dislike the "just a minion" attitudes is that it seems to remove an element of responsibility from the junior, as if their actions and decisions are meaningless. You worked hard at university for a long time. You are paid an enviable salary. You are a member of one of the most trusted professions there is. So stop with the "just a minion" talk. You're a doctor, and what you do matters.

(Thanks to @drbobphillips for suggesting I write this post) 

Sunday, 7 April 2013

2 Out Of 3 Ain't Bad...

Or so Meatloaf would have us believe.

Despite what my blog would have you believe, I have actually really enjoyed my first 8 months of working.

My first job, which was in medicine, was tough as there wasn't a lot of senior support and out of hours there was sometimes noone to call other than the consultant if I had concerns - something quite intimidating for a newly qualified junior. However, I worked with mostly lovely people, learned absolutely loads and felt like I really developed as a doctor.

My second job (the one I finished last week) was also medical, and was fantastic. There were a few issues, mostly with other juniors not pulling their weight, but that aside I loved it. I got on especially well with one of the registrars and 2 of the SHOs, but all of my seniors were fantastic. Again, I learned lots and am definitely much more confident in my abilities than I was before I started. I also had chance to get involved with some research, which is great given my academic ambitions.

And now, I have most to general surgery. Eugh. Despite not wanting to be a surgeon, I had thought I would enjoy this rotation. Numerous friends who are medics through and through had told me how much they'd loved their FY1 surgical post. I don't think I will be jumping on that bandwagon though.

A few months ago, I was chatting on Twitter about how I felt I needed to revise some surgery, as after 8 months working in medicine I was a bit rusty. A surgeon on there, who I get on with pretty well, had said I didn't need to know any surgery. I totally unintentionally upset him but saying that I wanted to be able to suggest differentials for emergency admissions so I could order appropriate investigations. I was genuinely confused when he was so angered by my comment that surely I ought to be ordering targetted investigations to confirm or refute a diagnosis and not just going on a fishing trip for information. After all, that's what we were repeatedly taught throughout medical school and it was definitely the case in my medical jobs. It appears that things are slightly different in the surgical world. At induction for this job, we were told that everyone gets the same set of tests ordered and we shouldn't try to work out which were indicated and which weren't - and then I realised that my comment on Twitter had unwittingly criticised the way huge numbers of surgeons expect their juniors to behave (and by implication, criticised them I suppose). It's a big change in the way I think.

I am struggling with the mindlessness involved in this job. A few days in, and I have already discovered that "chase the bloods" literally means "write the results down in a folder". In my previous jobs, I would have been criticised for not acting on results. Now, I'm not expected to act on anything. Yesterday I was chastised for prescribing further NaCl for a patient who had already received several bags. No-one cared that my reason for doing so was that the patient was (still) borderline hyponatraemic and I had checked the blood results before deciding which fluids to write up. It seems I shouldn't try to use my brain, I should just write everyone up for Hartmans, Hartmans, Hartmans.

Of course, there is the distinct possibility that my seniors are just being super-cautious because I have only just started working there. Maybe I will discover that, actually, I am quite happy doing this repetitive kind of work once I adjust to the change. I could settle in and find that actually I love my new job. If not, I've enjoyed 2 of my 3 FY1 jobs. And 2 out of 3 ain't bad.

Sunday, 29 January 2012

Overwhelmed

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

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...

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