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!