The End…

‘I would certainly strongly recommend that he does not return to his former type of work and the pressures that this involves.’

The report had been sitting in my inbox for nearly two weeks before I felt able to open it. I knew roughly what to expect, after all I’d had the conversations with the psychiatrist, but somehow, to have it presented written down added a degree of formality, or maybe finality, to the situation. Was this the end?

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‘From Dr McCormick’s account it is clear that he has never fully recovered from the episode when he became ill in 2015.’

I think it is fair to say that my employer has struggled to manage my illness over the last few years, however, in recent months I have found myself ‘under new management’ and with a new Medical Director who wants to actually do something positive… for me… about this situation. A review by an independent psychiatrist was the first part of the agreed plan.

‘It is clear… that his symptoms have developed purely in the context of work stresses – workloads in combination with his driving, perfectionistic personality – with progressive development of stress and anxiety symptoms over several years as he has increasingly been unable to provide the quality of care that he feels is essential for patients...’

Although I’ll admit to feeling apprehensive in the beginning, being able to explore my emotions and behaviours without having to justify them or fear judgement was a useful exercise. It helped me to see not just the problems I faced but also how and why I reacted to them in the way that I did. However, this wasn’t about blaming me for my breakdown, no, it was about understanding some of the reasons why it happened to me.

‘It is clear over several years he has become progressively “burnt out” by these stresses, increasingly frustrated and angry, increasingly despairing and ultimately developing breakthrough symptoms in 2015 progressing to an acute decompensation late in September 2015.’

More than that, having a professional, a fellow doctor, validate my experiences and put them in a medical context meant that I could perhaps accept my situation a little better and feel a little kinder toward myself. This was more than just ‘failing to cope’, it was a definable illness with both psychiatric and physiological consequences.

‘At present within the relatively protected environment he is working in, Dr McCormick’s mental state is stable and if anything is improving very, very slowly. In the absence of any specific treatment and/or further stress, it is likely that he will continue to improve slowly although it is not at all clear whether he will, at any point, fully recover not just symptomatically but in terms of resilience and cognitive functioning…’

My feelings about my failure to ‘get over it’, ‘pull myself back together’ and get back to clinical work is still one of my biggest struggles. Why is it taking so long? Why am I not getting better? Why have others made it back while I am still struggling? Understanding the current state of my recovery and my prognosis, whilst painful, has at least helped me be realistic: realistic about my abilities; realistic about what I and others can and cannot expect of me; realistic as I try to plan my future.

‘…On the other hand it is clear if he were to push himself into a significant stressful and demanding situation he would decompensate again.’

Part of that reality is that it seems being a frontline EM clinician is now beyond my capabilities and that continues to be harder to admit and accept than I realised. For all I have been through, Emergency Medicine was never the problem. EM is a fantastic specialty filled with amazing colleagues and experiences and we are privileged to work with some of the most interesting, understanding and desperate patients in the healthcare system… but the system is struggling and it takes its toll on staff and that is why I cannot stay.

‘I would certainly strongly recommend that he does not return to his former type of work and the pressures that this involves.’

And so we come back to the original line from the report which opened this blog, the one which indicates the closing of the book on my EM life… but it is taken out of context, and that is a foolish thing to do. The following line must also be read if I am to have a full picture of what the psychiatrist has seen in me.

‘I have no doubt that Dr McCormick is functioning well in his current role… and my impression is that one way forward would be to expand and consolidate this role as opposed to working directly in the clinical front line.’

As I wrote some time ago I am a broken toy: I may not be as robust as I once was but I still have some use. For sure, one chapter in my medical career, one long, exciting and difficult chapter is coming to a conclusion but it is far from the end of the book. As I turn the page, another has already begun. I have no idea what comes next, how long, or exciting or difficult this new chapter may turn out to be but I am, at least partly, the author and so, if you’ll excuse me, it is time to get busy writing.

 

Simon

 

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