When the Plates Came Crashing Down

 

This is the first of three posts I’m writing about my breakdown (an original, a prequel and a sequel, if you like) and whilst some of this story is obviously quite dark I hope it will ultimately be a positive message.  I’m writing in the hope that it may help those in similar circumstances to realise they are not alone, to maybe help those around them understand what they are going through and to help others avoid the mistakes I made.

When the Plates Came Crashing Down

As a child of the 70s I spent far too much time watching people spinning plates on TV. Record Breakers was best, there would be somebody spinning china plates on top of racks of flexible poles, rushing from one wobbling plate to the next to give it an extra spin of momentum, chasing the world record.  However, eventually the performer was stretched beyond their ability, running from pole to pole, wobbling plate to wobbling plate and finally losing control of the situation resulting in the inevitable smashing of falling plates.

On September 22nd 2015 the plates came crashing down around me as I worked my late shift in the Emergency Department.  It wasn’t a particularly busy shift as far as I remember but there were ECGs to be checked, refused referrals to be sorted, IT issues to be solved, clinical cases to be discussed with juniors and my own patients to be managed when…suddenly they all just fell around me.  The nurse in charge who’d known me for years looked across with a worried expression and asked ‘Are you okay?’ and I heard myself say ‘No, I don’t think I can do this anymore.’  Somehow I got to the end of my shift, sent an email to my colleagues explaining the situation as best I could and drove home.

That was the official beginning of my breakdown.  Even now, it’s hard to explain just how I felt.  Initially it was like my brain had suddenly lost bandwidth, I could do routine stuff… get up, eat, run, cook, sleep…but if I needed to use more brainpower to make a decision…what will I eat, where will I run, what time should I go to bed…then I was overwhelmed and froze.

Things improved over the next few days but I still wasn’t right.  It took me a while to work it out, to recognise where the limit on my brain was, and basically I had lost the ability to multitask: I could only manage one thing at a time…serial processing, not parallel.

This was the scariest time for me.  I had enough brain function to think about how damaged I was but not enough to see a way out and only negative emotional responses. Fear.  I was an EM consultant who couldn’t multitask, my career was over.  Would that mean I had to retire early?  Would it class as retiring due to ill health or would I be sacked?  How would I earn money?  What would happen to our home, my wife, my kids?  I was finished and my family were going to be dragged down with me.  Failure.  Why had I broken when so many others hadn’t?  Even my colleagues, putting up with the same situations as me, were still managing.  I was inadequate, I was a failure and I wasn’t fit to call myself an EM consultant.   Guilt.  My training and career thus far had been built around the fact that we just keep going and you don’t drop your colleagues in it by going off sick but now I had done just that.  I had committed the cardinal sin of being a doctor: I hadn’t coped.  Fear, failure and guilt were my default emotions.

Soon frustration and anger followed, mostly directed at my own hospital administration but I had more than enough to go round.  Patients, staff, our Royal College, the government… basically anyone I could link to my situation got a hefty dose of my anger…almost all of it completely undeserved!  As you can imagine, I was charming company at this point and my wife and kids bore the brunt of it.  I remember vividly hanging some washing up in the first couple of weeks and my wife trying to tell me how the wing mirror had been knocked off her car.  I couldn’t cope with unfurling a wet sock whilst getting this new information: one task was draining but two was impossible.  I became really angry with her for talking to me: surely she should know better than to do this, surely she should know I wouldn’t be able to cope, surely she should understand how I felt.

It was a very dark place to be and whilst I would never have said I defined myself by my ability to be a doctor, the way I was responding to my breakdown suggested otherwise.  Not only that, I could see I wasn’t able to be much of a father or a husband either so I was trapped in my breakdown, basically left questioning who I was and I hadn’t got an answer.

Thankfully there was somebody who did have an answer, someone who knew there was a way out, even if I couldn’t see it.  I had been to see my GP as soon as I was off work and he was the person who slowly guided me forward.  Anil was calm and reassuring, offering knowledge and experience with a hefty dose of realism.  At the first meeting we had he told me I’d not be back to work ‘properly’ for six months and he was right.  Every time I said I was okay and ready to go back to work he would gently probe how I was getting on, listening carefully, letting me tell my stories and helping me understand the reality of my recovery.  I remember admitting how panic stricken I had become over a small task someone had asked me to do for a kids’ game whilst in the next breath telling him I was ready to be signed back to work.  It was crazy, just the guilt talking, but Anil gently pointed out this inconsistency to me and helped me realise where I really was…and that it was okay to still be there.

After six weeks my multitasking just came back again, I suddenly realised I was sorting out breakfast for the kids and putting some washing on.  It was quite a moment and marked a turning point in my recovery.  Now I could process information better.  Now I could start to piece together more complex trains of thought.  Suddenly there was a light at the end of the tunnel.  I began to do more complex things at home; cooking, shopping, the kids’ homework and even began making wooden Christmas decorations from our old garden furniture! I was able to make decisions about things around the house without being paralysed by fear but most of all I was able to start thinking through my situation: Where am I? How did I get here?  Where do I go now?  What do I want to do?  I spent a lot of time on these questions and I’ll deal with them in more detail in the two subsequent posts.

I also started to be a nicer person again.  Obviously I hadn’t been great company for the previous six weeks but the angry, bitter, negative person I had become over the preceding decade also slowly faded and the old me started to reappear, much to my wife’s relief and delight!  I could feel this change too and it made me wonder how much of me had become damaged getting to where I was and whether I was prepared to go back there?  Resilience, however, was a big problem.  People would see me and think I was fine but inside I was walking on the thin ice of hope and self belief.  Sometimes it would just crack and I’d know to be careful and edge away from whatever was happening but occasionally I’d just fall straight through and the darkness would close in again.  Each time, eventually, I’d get back out on the ice again, wary but determined and over time the ice thickened and I got better at listening for the cracking sounds but I was learning to tread carefully and with less fear.

Under Anil’s guidance and with the unwavering support of my colleagues I got back to work… slowly.  The first day I was shaking on the way in and exhausted coming back home yet I’d only been in the office looking at the build up of emails!  It was clear that my brain was functioning well enough to survive at home but work required a different level of cognition.  The same was true when I eventually set foot on the shop floor to do clinical work.  As I walked to the staff base one of the nurse smiled and said ‘It’s good to see you back’ and it meant the world to me.  That said, I almost turned and ran the first time someone asked me a question but I stood there, took a deep breath, and dealt with the problem.  That first four hour shift I must have taken a break every fifteen minutes to let my head settle but realised this was what I needed to do now and slowly, eventually, the breaks became less frequent and the clinical time increased.

Eventually I got back to working three days a week with most of it clinical but then I started to feel things going wrong again.  I could feel the old frustrations and anger rising again, the cognitive load becoming too much and my personality regressing to its pre-breakdown state.  This could have been a moment of crisis but instead it was one of opportunity.  I took the positive decision to go part time in the ED and found work elsewhere in the hospital…more of the process around that decision in the next post.  Since then I have worked only two days a week in the ED and not had any further major problems.  I still get frustrated, still find the cognitive load too much on occasion, still feel the panic rising when it gets busy but I’ve learned to recognise and manage these situations much better now.  I’m different to how I was pre-breakdown, a broken toy, but that doesn’t mean I’m not still of use.  I still spin plates but I don’t try to spin as many, I know my limits and most importantly I know when to ask for help!

Simon

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22 thoughts on “When the Plates Came Crashing Down

    • drsimonmc says:

      P, thanks for sharing that with me. If you feel like I did I hope you’ve spoken to someone about it. Having these feelings bottled up inside is a horrible place to be and they become much more destructive. If you actually admit them and share them with someone else they often lose some of their power.

      If you’re still working you need to let your ED or another consultant know…if you find that difficult then ask them to read what I’ve written and say you feel that way. It should probably end up with you being off work for a bit and perhaps a conversation with your GP. If you’re already off work, there is a way back. I’m just writing the second piece trying to explain how I went about that…should be out soon.

      Whatever happens you need to remember that you aren’t alone, many others feel or felt like you and I, and actually most people want to help. Also, you aren’t a failure for feeling like this, you’re just you. Blaming yourself for not coping with the situation in EM is like blaming a diabetic for not coping with a glucose load…it won’t work, they need help.

      Simon

      P.S. If you really can’t speak to someone local to you, email me and we can start trying to work things out. drsimonmccormick@gmail.com

      Liked by 1 person

  1. Rachel Stansfield says:

    Simon, thank you so much for writing this. At the end of F2 I couldn’t understand why I was even bothering to spin the plates. After some time off and some very kind, supportive senior colleagues I’m beginning to want to do it again. Articulating your thoughts in the post above has been very helpful to me as a reader. Wishing you and your family all the best.

    Looking forward to your future posts, Rachel.

    Liked by 1 person

  2. Anne Creaton says:

    Thanks for writing this. I also feel that part time ED work makes it sustainable and even enjoyable. Having other work that does not involve the same level of multitasking also helps me prevent my brain from imploding and fragmenting! Thank-you for having the courage to share what I think is probably happened to so many of us!

    Like

  3. Sue Newsome says:

    ‪Extremely honest,and brave to share. As an ex RMN it’s easy to presume because you can manage other people’s health you should be able to manage your own.

    Like

  4. Mandy says:

    Thank you for sharing. As an RN in ED my plates dropped after appearing as witness in a Coroners court. I’ve never read such an insightful, personal account. With the help of a supportive manager, therapist and time, things have improved. But I’ve also realised its time to try something new, as much as I love ED.

    Like

  5. Beej Shah says:

    Well written – thank you. I was starting to feel like this in GP and I could not work out what was wrong with me, its good to read something I can relate to. Feeling more human now that I am home on leave for two weeks (luckily very well timed).

    Like

  6. APV says:

    I recognise some of what you suffered, it was growing like that before I stood down last year, I was lucky but going back part time for me still leaves me listening to the ice cracking!
    See you in June

    Like

  7. aspiedoc says:

    This is powerful stuff. Can you publish something similar in a popular medical journal? Unfortunately not all departments are as supportive as yours. Can’t stand the heat, get out of the kitchen is still very common in medicine. Was also good to read about how you could carry out routine activities such as run but not make decisions. My ex department seemed to believe that being off sick with a mental health problem meant you should never be seen outside the house and God forbid be caught running or seeing a friend, despite both being therapeutic!

    Like

  8. Claire says:

    I had a breakdown and left work 20 days after you. Have had to go part time and come out of training but I am back doing what I love and glad you are too.

    Thank you for sharing.

    Like

  9. Viv Pepper says:

    Thank you for this, my plates are definitely wobbling at the moment, I’m a practice nurse in a gp surgery, not as immediately urgent and life saving as yours but at the moment I can’t even see the trees let alone the wood, thinking of leaving will be a shame after 45 years but getting to the point where I can’t take the pressure any more, as you say I can only cope with only one thing at a time and not even that at times. Hope your recovery continues after all it’s only a job.

    Like

  10. Patricia MMP says:

    Thank you for this. It makes my own thoughts more real. I find myself quite overwhelmed more and more these days… but it also worried me as I have a friend I that is concerning me. The smile is mostly gone, the banter is no more, the excitement is not there anymore. Not sure how to help my friend … any ideas? Thanks so much …

    Like

    • drsimonmc says:

      Patricia,

      Thanks for your comments. It is incredibly worrying how many people are relating to my situation. As far as your friend is concerned, i think one of the most powerful things you can do is to take some time just to sit down and ask how they are…I mean REALLY ask. Express your concerns, gently, and offer any help you can. I think most people who are struggling know it, they just don’t know quite how to say so or what would happen next if they admitted it to anyone. Knowing they have a friend with them would be a big help.

      I’m writing my next blog which touches on this subject, it might help a bit.

      Simon

      Like

  11. unhappydoctor says:

    Not so much a breakdown for me, but rather a permanently broken brain now. I finished my last long day shift in intensive care. There was no crash of plates, just a calm final thank you to my consultant, we had tried for days together with my partner to get help from GPs, mental health teams, anyone really. What a nightmare trainee for this already harangued consultant . There’s no going back to work now, not after a failed suicide attempt, ending up in my own hospital, how useless is a doctor that can’t even calculate fatal doses successfully. A true time waster taking up ED resources and ITU teams.

    What is really sad, is dedicating years to the NHS, really believing in it, and advocating for the most vulnerable of our patients, and yet when I needed it, no one cared. I’ve given up on getting help now, being told 6 month waits, lists full, too sick for therapy, not sick enough for crisis teams, being offered endless benzodiazepines from my GP as they’ve run out of energy to help, or told to join the lunchtime bingo group at the community centre, or go to ED if you think you want to kill yourself again. See you own junior trainees, in a heaving ED, and whinge about how you want to die. Everyone will really thank you for that. Plus they’d stop you dying, which defeats the point really.

    If the NHS mental health services can’t help an articulate, educated doctor who works within the health service, how on earth do others less fortunate stand a chance at getting help.

    Like

    • drsimonmc says:

      What can I possibly say that would help…probably not a lot. I’ve been very lucky in how things have ultimately worked out for me. I recognise some of the roadblocks to recovery you have faced but had enough people who were interested in me to make getting back possible.

      What I found worked for me specifically were two things. One was getting out of the house and in to the fresh air…walking and mostly running worked for me. It meant I wasn’t sat around with just my own thoughts going round and round, yet at the same time gave me time to think, if that doesn’t sound a bit odd! It also meant I got physically tired which helped a bit with sleeping. The second thing was actually doing some CPD, medical reading etc as it proved to me that I still had a brain that worked (if not quite as well as before) and could possibly be of some use in the future. I find it hard to believe that you can be of no use to anyone anymore, despite what you might be feeling or being told. What you do in the future will definitely be different to what you did in the past, but given that what you did in the past broke you, why would you want to go back to that? There is definitely a future for you somewhere, perhaps in medicine, perhaps not, but please, don’t give up on yourself.

      Simon

      Like

  12. sam says:

    Thank you for such an eloquent and honest piece of writing. It’s good to hear about someone elses experience especially as you are out of the other side now. I’ve been having a similar argument, worried I’m skiving off work, but unable to cook myself a meal or make simple decisions. I’m looking forward to being on the other side of this and reading things like this gives me a bit more confidence that it is possible. Thank you

    Like

  13. Inspiredtrainee says:

    Hi Simon
    I have been advised by one of my senior trainees to come and read your blogs. I was having difficulties at work, thinking too much about everything, at times overthinking and hence destroying my work life balance. I think the moment came for me when I realized myself that this cannot go on like that and has to stop and I started switching my DOCTOR bits off as soon as i left work. I would still turn it back on for reflections etc but otherwise kept myself busy with gym, badminton, cycling etc and it helped a lot. I still think back when I come back home and sometimes feel it getting on my nerves, but I do not see myself as sort of person who goes asking for help. Or maybe I am underplaying things a bit. Having worked in the same department you have, I can say that the team was extremely supportive and in fact you were one of the people I would look up to and learn from the most. A lot of things put me off from ED but it was never the team I worked with. Having worked in 3 other EDs I can well see how similar problems might have very different outcomes for other trainees/consultants. I think of it as a battle, with limited resources, small army, all we really need is to watch out for eachother and most of the times that gets us through hard times. Many thanks for your support during and after my rotation.

    Like

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