This is the second of three posts I’m writing about my breakdown. In When the Plates Came Crashing Down I talked about how it felt when I broke and as I made my way back to work so in this one I’ll talk about the process of coming to terms with my situation and how I have benefitted by adjusting to my new circumstances.
The Joy of a Broken Toy
One of the best Christmas presents I ever got was an Action Man jeep: I loved it. My favourite game was jumping it out the front door and down three steps into the garden. Time and again I did this until one day I noticed the axles were now poking through the plastic wheels: I had broken the jeep. Was it useless now? Did I pick it up and throw it in the rubbish? No. I tried to fix it, with some success, and then treated it more carefully after that: it remained a favourite for many more years. Since my breakdown I’ve often described myself as a broken toy and I’m thankful that some people around me realised I was worth fixing and treating more carefully.
What use is a burnt out Emergency Medicine consultant? That was the question that faced me after my breakdown. What could I offer if I wasn’t able to ‘queue bust’ whilst supervising juniors, seeing resus patients, fixing printers, inducting locums and ensuring it all happened within four hours? My response to this question has come to define my way back into the workforce as well as help explain to me how I got into this mess in the first place.
Early on in my recovery I realised I wasn’t going to be able to get back to how I was before, at least not long term: whatever happened, my life would have to change. Initially this was driven by a realisation that I couldn’t go back and do what I did before, my brain just didn’t work like it used to. However, slowly I started to realise that I also didn’t want to go back to how I was before. To function as I had done in the past required me to sacrifice so much of who I was, to become a person I (and others) didn’t like and to ultimately break…why would I want to go back to that? I realised that getting better meant not becoming who I had been but becoming who I should be…who I wanted to be. The problem now was working out who that was and whether anyone would pay that person!
I knew two things from before my breakdown: I was a doctor and I could teach. I had written evidence of this in feedback from patients and staff, something really important when your self confidence is rock bottom, so I started with these. Did I want to be a doctor? It may seem a strange question to ask oneself but in the recent past I hadn’t even been sure I wanted to be a doctor anymore…not if it meant continuing as I was. So I started thinking about my career in Emergency Medicine, reading blogs about Emergency Medicine, listening to podcasts by enthusiastic, motivated Emergency Medicine colleagues about resuscitation, violent patients, handovers and team working. FOAMed hit a spot I didn’t realise still felt anything, dulled by the constant pressure from the four hour target, and I fell in love with my specialty all over again. Not only that, I realised I loved to learn. I’d spent years just getting by, squeezing CPD in to hastily taken study leave but now I wanted to stretch myself. I took online courses, headed off to conferences and I even signed up for a year long postgraduate diploma in Sports and Exercise Medicine. Did I still want to be a doctor? Absolutely, but would anybody pay me to do so after what had happened? Fortunately my hospital felt it worth the risk. Within the ED I was working reduced hours and always had another consultant working alongside me, which didn’t come easily or cheaply but did make me feel valued. Sadly, despite this support, it eventually became clear I wouldn’t be able to provide the clinical cover I used to and between us we realised that the department could have part of me or none of me. They could have opted for the latter but thankfully they didn’t and they supported me in a new job plan of permanently reduced hours so, six months after my breakdown, I was back working part time in the ED.
What about being a teacher? Would anyone pay me to do that? If you look back at the list of jobs I thought defined my role, you will notice that they are all about the shop floor. I had come to value only the skills that assisted in meeting the four hour target but, now I was starting to rediscover myself, I needed to realise I had a range of skills beyond that and perhaps other people might value those and have use of them. Having enjoyed teaching in the past and inspired by the teachers I was tapping in to for my rediscovered passion to learn, nervously I made contact with our hospital’s Medical Education lead and asked if she had use for one slightly damaged EM consultant. She said they needed more consultant input to the Foundation programme and more support for teaching and training at all levels and felt that I had the skills to help them with this. Importantly she considered this ‘part of your recovery plan’, it appeared I was worth saving, worth investing time, effort and money in…and none of it was about the four hour target: I had the other half of my job.
So began my new life as a broken toy, a little damaged, needing to be treated a bit more carefully but considered worth saving. What has it been like? Well, firstly, I know that I am different from before. I still struggle to have as many thoughts on the go as I used to, I need more time to process information, my memory lapses and my brain just tires more easily. However, because of this I’m better at recognising when I’m at my limits so I give myself more time to do tasks, I take less on (‘no’ and ‘not yet’ have re entered my vocabulary), I allow myself time to think and make use of written or electronic information rather than expecting my memory to cope. I’m better at controlling my emotions, sensing when and why the fear or panic starts to rise and then countering the soaring, runaway anxiety with clear, factual reality. At meetings I often keep a piece of paper in front of me that reads ‘Don’t panic, don’t get upset!’ just as a reminder. In short I’ve gotten better at looking after myself because I know if I don’t and things go wrong again, it will be much harder to get back.
From a clinical perspective I’ve stopped running around trying to fix everything and now concentrate on what I can achieve within my limits: seeing the sickest patients, supporting decision making and educating. I make sure I give to the present but I also give something to the future. The four hour standard is an insatiable master with no memory: work hard today and whether you succeed or fail the standard will demand it all again tomorrow with no gratitude for yesterday, it exists purely in the present. The time I spend on the shop floor teaching and training, however, can be built on, day after day and is appreciated for years. Staff want quality face time with their seniors on the shop floor and I’m enjoying giving it to them. Not only that but half my job is set aside to continue this off the shop floor with more than just ED staff. I am privileged to spend time with people who want to learn and are enthusiastic about it, it is energising and inspiring. I used to say I envied the people who built roads and bridges because they could look back at what they had made, point to it and tell their kids… ’I helped build that’ whilst I had nothing to look at, nothing tangible to point to. Now I’m realising that this is not the case, I have staff who need training, educating and supporting and I can look at those doctors and nurses, point and say ‘I helped build them.’
However, it is not rediscovering my love of clinical EM or teaching and training that has given me the most joy this last year, no it has been the rediscovery of my empathy for others. As I spiralled towards my breakdown I became increasingly self obsessed and self absorbed: every decision that got made, every problem that arose, every bump in the road was about me first. How did this effect me? What would it mean for me? Why was it happening to me? I suspect it is part of a survival instinct, when you’re at the end of your physical, mental and emotional resources, everything is a potential threat: selfish self preservation. Now, thankfully, I’m no longer on the edge and I’ve got room for other people, particularly other staff. I can see more clearly the impact the system is having on others, can understand what it is doing to them, feel their pain…and it hurts. I make more time to talk to staff, take time to listen, time to just ‘be’ with them. If they are busy I try to lift their burden, if only for a few minutes; if they feel they are failing I explain why they aren’t; and if they just feel like nobody cares or understands, I try to care and understand… it is amazing the power of a well placed bottle of pop, thank you or arm around the shoulder. My biggest joy at being broken is trying to give back to those who need support. If those of us who’ve fallen into the traps, made the mistakes or been broken by the system and managed to get back can’t look out for and support those who haven’t yet, who can? We often learn more from our colleagues who’ve made clinical mistakes than those who always get it right so let’s make sure we do the same when it comes to sustainability planning: listen to the broken toys.
If you are currently broken, I hope you might see that rather than looking for a way back, it’s probably better to look for a way forward. Going forward there are opportunities to change, opportunities to grow, opportunities to be who you should or could be perhaps, rather than who you were. You are worth more than you feel at the moment and are definitely worth saving. Moving on won’t be easy, may not take you where you planned but there is a future for you.
Should you know someone who is broken, help them, support them, invest time and effort in them because they almost certainly still have a lot to offer. Who you get back may not be who you lost but surely it has to be worth trying… you’d want someone to do the same for you, wouldn’t you?
Make no mistake, whilst my breakdown has ultimately worked out for me, it would have been better all round if I’d got here without having to break! There is joy in being a broken toy, it is just such a shame that our system to often insists on breaking people before considering whether to look after them. You see, I also had an Action Man hang glider. I played with it day after day after day, as it crashed into walls, the ground and occasionally the sea. It got damaged too, but I repaired it and treated it as before…walls…ground…sea, walls…ground…sea. After about two weeks it was beyond repair so I threw it in the bin.