Sadness and Professionalism

I've written before on the sadder parts of working in paediatrics, and how I think it's ok to find it upsetting (it's entirely coincidence that I wrote that post exactly one year ago). As I've got more senior and been more directly involved with patient care and decision making, I've found that the harder parts of my job have got, at times, even tougher.

I am quite involved with the medical student paediatric society (hi LUMPS) and as part of this I mentor students who are interested in paediatrics. One of the commonest questions they ask is "how do you cope with the sad bits?" - most commonly they wonder how I deal with deaths and child protection issues. The honest answer is that I'm not sure I do, at least not in any way that I can really express to anyone else. Paediatricians, on the whole, are a pretty nice bunch, so there's always lots of peer support. Even very senior and experience colleagues still get upset by horrible things happening, and the general consensus is that it's ok to be sad when sad things happen. Still, I find myself wondering whether it's "professional" to be upset by things I see at work.

Is it ok to feel sad when you see a child who has had injuries inflicted by their own family? Is it wrong to cry when a baby you've looked after since their birth passes away? Do these emotions, or expressing them, make me a bad doctor? I'm a naturally self-critical person and so tend to feel like anything I do, say or feel is an indicator of how terrible I am, and I guess this is just another example of this. In reality, I suspect being upset about a patient is no bad thing, as long as it doesn't influence how you treat the next one. So cry, take 5 minutes for a cup of tea, go home after your shift and have a glass of wine, do whatever you need to. But when the next patient comes along, they deserve the same care and attention as all the rest.

It's not unprofessional to be sad. But it is unprofessional to let that sadness affect the care you provide to others.

Another Year Over, A New One Just Begun...

Well, 2016 is over. If you're to believe the mainstream media, it's been the worst year ever, and it's fairly easy to see why. With Britain voting to leave the EU and Donald Trump now President-elect of the United States, many liberal-leaning people will have found this a fairly disasterous 12 months. Even if you're a right wing Euroskeptic, there have been so many celebrity deaths that it has at times felt like a sick joke. That said, there have been many positives too. I'm not a huge sports fan, but even I think TeamGB having their most successful Olympics to date is pretty cool. Globally, carbon emissions have stalled and poverty has fallen. The tiger population has increased for the first time in a century. Hyperbole and drama may sell newspapers, but they're unlikely to reveal the full story.

For me personally, 2016 has been a pretty successful year. I (finally) passed my membership exams, started working at registrar level, graduated from my MSc and moved in with my boyfriend - can't complain at that! Of course, some things haven't gone quite so well. I didn't record my resolutions last year, but no doubt they'll have included weight loss, which hasn't happened to any significant level, and increased exercise, which has happened on occasion but hasn't really been sustained. Nonetheless, on the whole, it's not been a bad year for me.

So, will I be making resolutions this year? It's difficult not to, but it seems silly making the same ones  I've made (without much success, obviously), year on year for over a decade. Whilst I'd love to be slimmer and fitter, they're relatively superficial goals. Instead, I'm going to set myself some other challenges:

- I am someone who looks after other people, both in my work as a doctor and at home when I like to feed and generally "mother" my friends and family, however I'm pretty bad at looking after myself. Therefore, I am going to try much harder with self care this year. There are lots of little things I can do, but mostly it's about remembering that I'm actually worthy of being looked after.

- I tend to be quite a negative thinker. I assume the worst in most situations, and almost always assume that I have done the wrong thing, annoyed people and am generally a terrible human. Linked in with my self care resolution, I'm going to try to think more positively, particularly about myself. There are plenty of things I'm probably good at, and believing in myself doesn't make me a dreadful person.

- I compulsively apologise for everything - sometimes I even say sorry when I'm not sure what I'm sorry for. It's silly and to be honest, probably quite annoying that I basically apologise for existing. So, I'm going to stop saying sorry unless it's actually warranted.

As I've stated on many occasions before, I've struggled with my mood for a long time, and I'm hoping that these resolutions will help with that. We live in a world where we are constantly shown how well everyone is doing. One of the lovely things about social media is that we are able the share our friends' good news and happy occasions quickly. Engagements, weddings, graduations, pregnancies, holidays and nights out are all photographed and shared within minutes. It's therefore easy to believe that everyone else is living a perfect life whilst we're barely holding it together. To borrow an excellent quote from a friend's daughter, the problem here is comparing our friends' "highlights" with our own "outtakes". So the next time I scroll through facebook and feel miserable that everyone else is partying, holidaying, succeeding and being perfect, I need to remember that my own profile looks just the same. Anyway, there's nothing wrong with watching Netflix in your onesie with a cup of tea - it just doesn't make a great photo!

You're So F*ckin' Special, I Wish I Was Special...

I once heard a friend of mine, frustrated with a mutual acquaintance, utter the words "he always has to be special!" Said acquaintance, this friend felt, was never satisfied with being "normal", he must be "special". I remember it well, because I realised when she said it how easily she could have been talking about me. I don't know this particular acquaintance well enough to know whether his reasons for needing to be "special" are the same as mine, but the comment on it made me think about myself and the way other people may perceive me.

Let me clarify. I don't like being "average". Getting a "satisfactory" rating on an assessment upsets me. It's not because I think I'm better than that - I don't. In fact, it's quite the reverse. I inexplicably consider myself to be absolutely rubbish. I feel like most people start out at neutral and I'm already minus 50. If I'm not special, above average, exceeding expectations in some areas, then I don't even out at "ok".

One of the odd things about low self esteem is that, to the casual observer, it can look remarkably like arrogance. A frustration with others not doing things I can do looks like a stuck up "why can't everyone be as good as me?!", when in reality it's more like "it can't be difficult if I can do it!", much like disappointment at an "average" rating might suggest I think of myself as better than that, rather than worse. Unfortunately, hearing yourself described as overconfident or arrogant only serves to reinforce the belief that everyone thinks you're rubbish, making you more likely to do/say the things which get you labelled as arrogant. I guess in medicine, we'd call it a positive feedback mechanism, although ironically it's fuelled by negative feedback.

Another odd thing about low self esteem is that, after a while, it becomes so ingrained that you don't even consciously think about it any more. On being asked "how did that go?", you instantly reply "dreadful", even though it may not have been that bad. You're no longer capable of seeing yourself in any way other than crap at everything. A boss of mine once told me to "stop with the self deprecation, it's boring". Naturally, this was a sign that, on top of all my other flaws, I bored people around me too. When said boss later said I was "demonstrably not crap", all I could think was "but you said I was boring".  The lower your self esteem gets, the more you cling on to negative feedback as gospel and reject anything positive as either "trying to be nice" or "they don't know the *real* me" (see earlier blog on imposter syndrome).

This blog seems to go round in circles sometimes. I started off thinking I had something useful to say, and now I'm not sure I do. Perhaps just the writing is therapeutic. Either way, I'm sorry I insist on being special. I'd be delighted with normal, if only I felt it were genuinely true.

World Mental Health Day

Today, 10th October, is apparently World Mental Health Day. The World Health Organisation apparently endorse this, and I guess it's one of campaigns aiming to raise awareness of mental health and illness globally.

I always find the concept of a topic as vast as mental health being squashed together in one day a little odd, but although there are a vast number of mental health issues which are lumped together under one heading, they do have something in common and I can't criticise anything aiming to improve people's awareness of such a common and yet seldom discussed group of problems.

Any regular readers of my blog will be aware that my own mental health issues are longstanding so I can't pretend I don't have a personal stake in this. For that reason, I always feel slightly guilty pushing the mental health agenda. However, it's an important issue that will affect 1 in 4 of us (I think that's probably a conservative estimate) so I won't avoid talking about it.

My first experiences with mental health problems were back when I was a teenager. The support I received was less than ideal, my parents and school didn't really understand what was happening or how best to help me and even the professionals I encountered seemed out of their depth. A lot of my experiences were covered in this pseudo-anonymous post, which I initially wrote as a presentation to give at work. It's now nearly 15 years since that first consultation in that dreadful old building and I still remember it vividly. I can't ever change that, but I hope that when I meet young people in my professional life who are struggling, they remember their encounter with healthcare in a more positive way - someone cared, someone listened.

Unfortunately, it's not just a teenage problem. Although it's pretty common for mental health difficulties to begin in adolescence, they frequently persist into adulthood. Mine certainly have. Despite my struggles, though, I'm doing ok. I'm in a stable relationship. I'm holding down a (fairly intense at times!) job. Not everyone is so lucky. Mental illness is one of the most common reasons for claiming incapacity benefit. Plenty of people struggle and suffer, and yet stigma still persists.

Once again, my blog has become a ramble with no real direction or structure. I'm not sure it says much. But, if you're reading this and you're struggling, you aren't alone. Help is out there. And remember that just because you've been unfortunate enough to get unwell, doesn't mean you aren't awesome.

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There are a number of places you can get help should you need it. The services I've listed are free to call and open 24/7. A more comprehensive list is available through the NHS choices website, but not all services are free or open at all times.

If you're struggling today, or any day, the Samaritans are there to listen for free - call 08457 90 90 90.
Children and young people can contact ChildLine on 0800 1111 whilst adults who have concerns about a child can call the NSPCC helpline on 0808 800 5000.
If you feel in danger of hurting yourself and don't have a crisis plan, please call 999 or go to your local A&E department.
If alcohol is a problem, you can call Alcoholics Anonymous on 0845 769 7555.
If you need help with drugs, you can speak to Frank on 0800 77 66 00.
Men with any difficulties can use the online chat/email service here
If you're struggling with an eating disorder, Beat can be called on 0845 634 1414 (adults) or 0345 634 7650 (for under-25s)
 

Paediatrics? That must be heartbreaking...

It's not unusual for people, on hearing that I work in paediatrics, to ask how I can do it. "Gosh," they say, "isn't that really upsetting?". When I mention that I have a particular interest in children with cancer, they start to look at me like I've sprouted a second head. Even medical colleagues of mine, who deal with illness, pain and sufferring on a daily basis, sometimes struggle with the idea of these things happening to children. My response, generally, is a little blase. "Oh but it's so much fun!", "I get to cuddle babies as part of my job!" or "Well the tough bits are tough, but they're so rare!". What I don't think I ever say is "Yes, it is. I love what I do but it breaks my heart".

There's a lot of talk about burnout and resilience at the moment. I find it difficult to understand what's really meant by either term, but I certainly find myself worrying that admitting things are tough is somehow suggesting that I'm not cut out for this. I know different people mean different things when they talk about being "resilient", but I have to say that a lot of the time when I read headlines saying we need to "improve resilience" amongst doctors, it feels like someone in an ivory tower is telling us to "man up". I know a lot of people say that isn't what's meant by it, but I also know that I'm not the only person who hears it that way.

Increasingly, I'm realising the need to be honest about how tough my job can be at times. I'm not complaining - I love it and I genuinely can't see myself doing anything else - but downplaying the stresses and strains does no one any favours.

There are phrases that make all paediatric trainees break out in a cold sweat. "Category 1 section, obstetric theatres" - something has happened during a delivery and they need to get the baby out now. You sprint to theatres, check the oxygen is working, get out tubes and catheters in varying sizes. Someone hands you a white, floppy, lifeless baby. You hear an anxious parent ask "why aren't they crying?" as your anaesthetic colleague tries to reassure them that sometimes babies born by Caesarian are a little bit shocked and take a while to wake up - and you know they're trying to convince themselves as much as the parents. Mostly, it's ok. You dry the baby off, position their airway, sometimes give a few breaths, and then they gasp, cry and pink up. Except the times they don't. The times they stay white. The times the heart rate doesn't improve and you start chest compressions and give adrenaline and do everything totally right and it just doesn't work. Maybe you detect a heart rate after 10, 15, 20 minutes. You start trying to explain cooling and neuroprotection and know that nothing you're saying will be taken in because up until half an hour ago, these people were having a healthy baby - a normal thing that millions of people do - only it's not quite gone to plan. Sometimes, a well meaning senior tells you to get a sense of perspective. Your day was pretty bad, but nothing compared to what those poor parents are going through...

It's not just the very sick children that can upset you. Part of our role as paediatricians is in child protection; assessing children who have been abused or neglected, usually by the very people who were meant to love and protect them. You might be treating a child for a chest infection and realise that this three year old, ill and in pain, turns not to his own mother for comfort, but to a doctor or nurse he's never met before. You might be listening to his chest when you see a hand-shaped bruise on his back. You could be just walking into the room when you realise he's malnourished and dirty. You have to act to protect this child in the best way that you can.

There are so many things that can get to you as you go about your work. Sometimes, it's seeing a parent struggling to come to terms with a horrible situation and realising that you can do nothing more than offer a hug, a listening ear and a cup of tea. Other times, it's watching a child undergo futile and sometimes painful treatment because their family aren't yet ready to accept that nothing more can be done to help them. It might be being hugged by a gorgeous little one and then finding out that Mum is actually foster Mum and she doesn't understand why no one will give him a forever home.

The point of this post is not to attract pity, sympathy or praise. I chose this career with my eyes open and it's a wonderful, rewarding, fulfilling one. But it can be difficult, and admitting that should be something that it's ok to do. Would you want your child to be cared for by someone who didn't care? If you can deal with the situations I've mentioned above (and yes, all of them have happened to me over the past couple of years) and not be saddened, I would genuinely wonder whether you were in the right career. I once described paediatrics as "the little girl, with the little curl", a reference to an old nursery rhyme...

There was a little girl 
Who had a little curl Right in the middle of her forehead; And when she was good She was very, very good, But when she was bad she was horrid. 

I still feel like it's the best way of summing the job up. When it goes well, when good things happen, it's brilliant. And when they don't go so well, it's fairly dreadful.

Paediatrics? I love it, but it breaks my heart. And that's ok.

Je Suis Brusseleir?

This week, Europe was rocked once again by the news of a terrorist attack. Only months after the senseless loss of life which occurred in Paris, this time Brussels was the target. My Facebook newsfeed is filled with friends and acquaintances adding a Belgian flag to their profile pictures in a show of solidarity. There are photos from cities around the world lighting up major attractions in black, yellow and red. "We stand with you, people of Brussels!", people are keen to proclaim, in much the same way that the Tricolore was plastered over the much of the internet and the developed world back in November and all of social media stood in unity and defiantly stated "Nous sommes Charlie" after the Charlie Hebdo shootings in January of last year.

On the one hand, I get it, I really do. These attacks have lead to suffering and loss of life in the alleged pursuit of an ideology I will never understand. Of course people want to show unity, sympathy, solidarity. We want to shout, loud and clear to any terrorists who may be passing, that we will not allow these attacks to alter our way of life. To cancel mass events and stop drawing potentially offensive cartoons is, we assume, precisely what they want - and so we will not let them win. We will carry on our daily life. The Londoners will get the tube. The Parisians will go to gigs. The Brusseleir will make their way to work, to school, to the shops in their usual way.

The thing is though, that I start to feel uncomfortable when I think of the hundreds of thousands of people around the world who we don't automatically show solidarity for. If I don't stick a Belgian flag overlay on my Facebook profile, there are some who may assume (incorrectly) that I don't care about the recent devastation in Brussels. But if I do, I worry that I am suggesting European life (or perhaps just life in the "Western" world) is somehow more valuable that that elsewhere.

If you're interested, you can easily find a list of terrorist incidents which have happened just this year - and there are a lot of them. Perhaps we don't really pay attention to attacks in Somalia or Iraq because we have grown accustomed to the violence which is sadly ongoing in those nations, but war or no war, the loss of life is still tragic. Maybe the events in Turkey or Libya simply haven't been on our radar because those places seem too far away from the world we know, but they still resulted in the deaths of innocent people.

Don't get me wrong, I stand with the people of Brussels, as I did with the people of Paris and London and Belfast before them. But whilst "je suis Charlie", because any of us face the risk that one day we could head to our workplace and not return, I am also the 3 year old girl killed in and Iraqi chemical attack. I'm a Nigerian mother blown up at the market. I'm the Somalian blown up whilst enjoying a meal in a restaurant. I'm all of these people, and thousands of of others too.

The sad fact is that I cannot keep up with all of these attacks. They are happening almost daily, with even more violence which is not classed as terrorism continuing to ruin the lives of many people. And for that reason, I cannot bring myself to stick a Belgian flag over my profile pictures, although I do not judge those who do. I stand with the people of Brussels, but more than that, I stand with the people of the world. It is simply a happy accident of birth and a chance arrangement of schedules that mean I have not been directly affected by any of these terrible events. As my sadly-missed Grandma would have said, "there, but by the grace of God, go I". So yes, I am Charlie and Paris and Brussels, and I am Baghdad and Tel Aviv too. But mostly I am a human, and I stand by all of my fellow humans through whatever atrocity we face. I believe that only in truly realising that we are all people with hopes, dreams and ambitions which are not defined by creed, colour or national boundary will there ever be peace.

 

"Imagine all the people, living life in peace..."

Just Keep Swimming (Or Running...)

Back in November, I announced my somewhat ridiculous-sounding plan of running the London Marathon in April. I'll be honest, the idea scared me at the time and I wasn't entirely convinced I was going to manage it. As I embarked on my couch to 5k starters running plan, it hit home really just how unfit I was. Even the 60 second running intervals in the first week felt tough. I've tried couch to 5k in the past and always got stuck at week 5, where the running increases from 8 minutes at a time to 20 minutes solid. I wasn't sure it would be any different this time.

I'm happy to say that I finally broke the (mostly psychological) 8 minute barrier and yesterday managed to run continuously for over 30 minutes. I know I still have a very long way to go, but I think in getting to this point, I've realised just how much running is due to mentality. Although my fitness has improved, the biggest change has been in my attitude towards it. I've realised that previously, it wasn't being out of breath or achy legs that stopped me, it was not believing I could do it. Now that I've realised that, I'm hoping I can continue to push myself and will manage to complete the marathon (even if I have to crawl across the finish line).

I'm under no illusions as to how tough this is going to be, but I'm doing it for a very, very good cause. I'm raising money for CLIC Sargent, a fantastic charity who help support children and young people with cancer and their families. Anything you can spare in sponsorship would be greatly appreciated. I know money is tight at this time of year, but every penny really does count and will be put to excellent use. £15 pays for a copy of CLIC Sargent’s DVD to help families of a child or young person who has died of cancer to deal with their grief. £25 pays for an hour of a CLIC Sargent Nurse’s time, allowing them to co-ordinate a child's care and arrange for treatments to be given as close to home as is safely possible. £50 pays for three hours of a CLIC Sargent Play Specialist’s time, letting them use models, toys and photographs to prepare a child for their treatment.£75 pays for three hours of a social worker’s time, letting them provide practical, financial and emotional support to the family of a child or young person with cancer.

Every penny you can spare will spur me on with my training and help CLIC Sargent continue to provide their incredibly valuable services. Please go to https://www.justgiving.com/amanda-friend/ to sponsor me.

Thank you.

Christmas Reflections

Christmas, for many reasons, is a time of year when I always feel particularly contemplative. I'm not a religious person - I was raised in a "respecting all religions but following none of them" kind of household and seem to have continued along that path into adulthood - but there's still something about Christmas that seems special. There's no denying that, as a little girl, at least part of the excitement was about presents, but I think it's always been about more than that. My Daddy used to finish work at lunch time on Christmas Eve, we would probably see friends and cousins who we didn't see often, there would be lots of people visiting and, of course, no school for us or work for our parents, so we spent lots of time together as a family. Overwhelmingly, though, what sticks out in my memories of my childhood Christmases is that everyone was happy. It was simply a time of seeing the people you loved and enjoying being together.

During my teenage years, as many of you will know, I had a rather difficult time with my mood. A time when everyone was so cheerful, and the general attitude appeared to be "you should be happy, it's Christmas!" suddenly became difficult to cope with. The general tolerance for misery seems to drop at this time of year, and anyone who isn't feeling full of the festive spirit not only has to contend with their own difficulties, but also with accusations of bringing everyone else down and spoiling Christmas.

Now, as an adult, I enjoy Christmas again, but a combination of my teenage difficulties and work and family circumstances mean I'm all too aware of how difficult this time of year can be. I'm working again this year, but come Monday when I have some time off, I'll be heading up to see my parents and sisters before spending New Year with my boyfriend. I'm lucky to have not only a job that I genuinely enjoy and that pays me enough to be able to spoil the people I love, but (more importantly) people I love close by, happy and healthy.

Working over Christmas in a hospital is an odd experience which brings with it a strange combination of emotions. I still smile when I remember the sweet nonagenarian who burst into tears of happiness when Santa came around the ward and gave gifts to all the inpatients. The same day, I had to tell a lady that the symptoms her son had brought her to A&E with were likely due to metastatic cancer. Another year, I got a Christmas kiss on the cheek from a very mischievous older gentleman patient before discussing end of life care for someone else. Last year, I saw babies and children spending their Christmas in hospital - for some it was their first Christmas, for others it would be their last; for a few it was both.

Whatever you're doing this Christmas, spare a thought for those who aren't enjoying the festivities in the usual way. My colleagues in the health service, from the domestic staff keeping the wards clean to the consultant surgeons performing life-saving operations, will be there to ensure you and your family are well looked after. Those in the fire service and police force are making sure our streets and homes are kept safe. Thousands of hospitality workers are spending today serving up countless turkey dinners and glasses of prosecco to help other people have a merry day. To everyone working this Christmas - thank you.

If Christmas is a challenge for you, know that you aren't forgotten. Those struggling to get through the day without a loved one - be it for the first or the fiftieth time - I feel for you. If you're spending the day in the hospital, either as a patient or visiting a loved one, I hope Christmas is comfortable and that the New Year will be brighter. If you simply feel overwhelmed and are struggling, there are people who care and who will listen.

Merry Christmas, everyone, stay safe and I hope 2016 brings health and happiness to all xxx

There are a number of places you can get help should you need it. The services I've listed are free to call and open 24/7. A more comprehensive list is available through the NHS choices website, but not all services are free or open over Christmas.

If you're struggling today, or any day, the Samaritans are there to listen for free - call 08457 90 90 90.
Children and young people can contact ChildLine on 0800 1111 whilst adults who have concerns about a child can call the NSPCC helpline on 0808 800 5000.
If you feel in danger of hurting yourself and don't have a crisis plan, please call 999 or go to your local A&E department.
For those who need help with domestic abuse, contact Refuge on 0808 2000 247.
If alcohol is a problem, you can call Alcoholics Anonymous on 0845 769 7555.
If you need help with drugs, you can speak to Frank on 0800 77 66 00.

A Marathon Journey

Anyone who's read this blog before will realise that I'm a fan of a metaphorical journey - the journey from schoolgirl to doctor, the journey from messed up adolescent to semi-functioning adult, that sort of thing.

Well, recently I made what may turn out to be one of the most ridiculous decisions of my life so far - I decided I'd make the journey from lazy so and so to... marathon runner. Yes, that's right, marathon runner. On 24th April 2016, all being well, I will complete the London marathon.

To give you an idea of quite how huge a journey this is going to be, I'll give you some details on my current fitness levels and running ability. In 2010 I completed a 10k run for charity in a not-at-all-impressive time of 1 hour 20 minutes. I say run, I did minimal training and walked most of it. I haven't really run since. I intermittently get the gym bug and start building up my fitness, but I have always avoided the treadmill like the plague. I even had a personal trainer for a while, but whilst we did a lot of work to build up my strength, we did very little to do with running. Our sessions were mostly "interval" training, so I'd do short bursts on the cross trainer or bike, followed by 5 reps of dead lifts or similar. In February, I started a job with over an hour's commute each way and was so exhausted I basically stopped all forms of exercise. I've been saying since August that I'd start getting fit again, but until this week I hadn't done much about it. I've downloaded a 16 week beginner's training plan, and have just over 23 weeks to train. My plan is to use the C25k programme to get me able to run for 25 minutes or so over the next 7 weeks, and then to move on the the training plan (which seems to suggest you can start with no running experience at all, but includes 20 minute runs in the first week). It's going to hurt.

So, why on earth am I putting myself through this? Firstly, because I had been thinking for a while that it was about time I did something mad to raise money for charity, and secondly, because whilst I know I need to get fit, I'm absolutely dire at doing things without a specific target in mind.

I mentioned charity, and I am hoping to get some sponsorship for this. I've decided to raise money for the fantastic CLIC Sargent. As a paediatric doctor with an interest in oncology, I'm aware of the brilliant advances in science and medicine that mean we can now cure more children than ever of cancer. We're lucky enough to live in a country where the NHS means that families don't have to pay for treatment. Whilst there's still a long way to go, the treatment of children's cancer now is getting better and better. What I also know as a hospital doctor is that hospitals can't do everything. The emotional impact of a cancer diagnosis on a child or young person is enormous. The disruption to family life is huge. Parents may not have to pay for their child's treatment, but there is often a financial burden - be this travel to and from a treatment centre or having to temporarily give up work to care for a sick child. We are getting better and better at treating the physical disease state, but hospitals can't do everything. This is where charities like CLIC Sargent come in. They do an amazing job of helping children and their families cope emotionally, be this through formal counselling or just providing activities allowing them to spend time together without worrying about hospitals. They provide grants to families who are struggling with the financial impact of a childhood cancer diagnosis. They provide free accommodations for families who live too far from their treatment centres to reasonably be expected to travel. They supply a range of information aimed at children of varying ages so that their diagnosis and treatment is explained in terms they understand. In short, the care provided in hospitals is excellent and gets better year on year, but we couldn't provide the fantastic support required by our patients and their families without the help of charities like CLIC Sargent.

My training might hurt, but each time it gets tough, I'll just remind myself that it's nothing compared to a childhood cancer diagnosis.

If you'd like to spur me on with sponsorship, please go to https://www.justgiving.com/amanda-friend/

Thank you.

I'm Not A Lousy Doctor - But I'm A Lousy Friend

If you've read this blog before, you'll probably be aware that I'm a prolific tweeter. In fact, I'd be surprised if you were reading and had come across this post via anything other than seeing me tweet about it. One of the things I love about Twitter is that it makes the world a smaller place. One of my favourite Tweeters is the lovely @dr_ashwitt; although she is as far from me as is basically possible (Melbourne, if you were wondering), I frequently read her tweets and think "oh my God, me too!". Recently, Ash re-posted a link to a post she wrote a couple of years ago about her experiences of depression. She urged other doctors to post their own 140 character experiences of mental health issues, and #MH4Docs got a fair number of tweets which Ash has collated here. I haven't actually tweeted yet, but I've been pretty vocal about my own issues over the years and it's good to see that people feel they can open up about these things. The thing that really made me think, though, was the sentence she used to link to her blog.

"I have depression, but that doesn't mean I'm not a good doctor."

I think a big part of the reason that a lot of health care professionals (and non-health care professionals, come to think of it) are reluctant to open up about mental health issues is the fear that their abilities at work will be called into question. I know that one of my major fears when I "admitted" to having depression was that people might think I was unable to do the job I love and have worked for for a long time. 

My mental health problems don't mean I'm not a good doctor. I have a need to be busy which means that I will crack on with as much work as I can, and I'll find non-essential tasks which just "need doing at some point" to keep me occupied. Focusing on other people means I'm not thinking about myself and my own emotions, so I'm unlikely to slip into a spiral of despair. My lack of self esteem and constant impostor syndrome mean I'm keen to please and make an extra effort to be friendly and polite. Work makes me feel better and I think my own issues mean I will always work as hard as I can. Possibly I'm at risk of burnout, but it's nothing I've ever felt close to, and the other hobbies I've developed to occupy myself and prevent negative thinking mean I have outlets outside of medicine.

No, depression doesn't mean I'm not a good doctor. It does mean I'm not a good friend, though. Being nice and polite to people can be frankly exhausting. After a whole day smiling and engaging in banal conversation and generally giving the impression that I'm a functional human being, I am absolutely worn out. I very rarely agree to after-work plans because I know I'll be too tired to be good company. If I've made arrangements, there's a good chance I'll flake out at the last minute because I just can't face being around people any more. Finally living alone rather than with flatmates is a Godsend because it means I can have meltdowns in the living room and kitchen rather than being restricted to my bedroom. On nights out, I'm renowned for disappearing without telling anyone after being consumed by an overwhelming wave of misery and wanting to get away before I spoil anyone else's night. As for relationships, I am probably one of the worst girlfriends out there. I take insecurity and anxiety to ridiculous levels, any compliment is analysed repeatedly to ensure it isn't actually a heavily veiled insult and "I love you" is not infrequently followed not with "I love you, too" but "..really? Do you actually though?".

So yeah, I have depression, and that doesn't mean I'm not a good doctor. But it does mean I'm not a good friend. If you've stuck around anyway, thank you. I may not say it with nights out or long conversations, I may cancel half of our arrangements and you might feel like you're walking on eggshells when we talk, but you are loved and appreciated.