I was diagnosed with acute myeloid leukaemia in 2011, when I was 17, the year before medical school. And as everyone is at first, I was devastated. But after a while, I developed an attitude, a mindset, that not only helped keep me healthy during the tribulations to come, but happy too. It wasn’t a walk in the park, to be sure, but I guess one thing I realised (probably with the help of that mindset) was that the pain of blood tests, biopsies, chemos and even bone-marrow transplants were temporary. They’d pass. The anxiety and fear that precedes them were often just as bad. But that came from us. And it doesn’t help. It only makes things worse. So why do that to ourselves? Ultimately, it didn’t make sense to linger on them. And I guess another thing was that in those times, and for all the other things I’ve faced since; ICU admissions, the relapse, a third cancer, there was an end-goal in sight. To survive. But though I’m now well past the danger period, the chronic illness I’m left with as a side effect of the whole treatment lingers. It may stay with me forever. And coping with this, alongside another beast that’s come up, in large part because of it – depression – has been harder than I could’ve ever imagined. Harder even than what I went through to get here.
Looking back, the first time I realised that I was depressed was after a good friend of mine passed away. After my second transplant, I started writing about my whole journey, to try and help other patients out, as well as to try and help doctors and future doctors like yourselves become even better healers for their patients. And through that I met him. But after his passing, I struggled. I felt personally responsible… that I could’ve done something more. And also, I despaired, for it was So. Damn. Unfair that HE should pass. He hadn’t done anything to deserve this… he was too young. What would happen to his family, Goddammit! I didn’t feel anything for weeks afterwards. I just scrolled absently through Facebook… YouTube… not enjoying it, not wanting to get outta bed. I questioned whether I even had reason to live at this point. What did it matter, when this could happen to someone so innocent? I guess this is something we’ll all have to go through at some point… Since then, I’ve done several talks in front of med students and doctors about grief in medicine. What ended up getting me through the numbness was me asking what George would have wanted for me. And I knew that he would have wanted me to be as happy and healthy and successful as possible. I would let him live on, by learning from him. His attitude to life, his prioritising his loved ones over himself. I also learned that I need to take care of myself. Because in this introspective quest to honour him, he taught me one more thing, and that was that in order to take care of others, you need to be healthy and happy yourself. But that’s not always easy to do… Especially when you’re stressed, and pressured, as happens in this course. And when you add to all that the chronic pain that leaves me staggering, or else hunched over, panting, every single night… it’s no wonder that I relapse into that darkness every now and again, as many with depression do.
Over the last few years, I have become better at tackling this beast. Both through that mindset of trying to take a step back and asking, from that objective perspective, how I can get out the current mess I was in (I’ve had to put out quite a few fires now this way haha =P ) and the help of a psychologist, I’ve developed a system to help recognise when I’m down, and get me out of it, as fast and well as I can. It’s vital to have a plan to tackle something like this. I don’t think enough people do.
When you are depressed, it’s almost impossible to pull yourself out of it just through sheer will. During my battle with cancer, I could see a second way of looking at things, or at the very least, find something to smile about. In depression, your very mind is working against you. So it’s vital that you make a plan in those moments where you’re NOT down. And it’s vital that you get someone to help you do this. Because for a while, I was doing this myself. That’s how I dealt with the whole cancer thing I guess… But for this beast, when your mind is stuck at a miserably cheerless set-point, you need to get another, outside perspective to pull through. Often, for me, that was my parents, or friends. But I highly recommend that you see a psychologist too. I saw one, at the request of a neurologist, a few times. And though it was daunting at first; the idea of opening up to a random stranger is uncomfortable even to me – someone who’s literally posted his life story (including probably too many personal details…) on the internet. But that very fact makes them perfectly suited to this task! Because these are people who you never need see in real life, who literally, by law, can’t tell anyone anything you tell them, nor judge you! I see now that it doesn’t make sense to do it on your own. It’s not weak to do so. It doesn’t make sense. Why put yourself through any more strife than you need to?
So what gets me through those blue times? Well, it’s helping people. After losing George, I realised also that I needed to have something to live for. A deep sense of purpose that’d always keep me moving towards something tangible and meaningful. Because in those dark times, I completely lost any faith I had in this world, and my ability to change it. I think that’s why young people in particular, who are just finding their place in a seemingly cold, harsh world; who don’t have jobs or a family or an identity yet, have higher rates of depression and suicide. But doubling down on that deep desire I had to help people gave that sense of purpose back to me. To me, there’s no better feeling than lifting someone out of misery, or putting a smile on someone’s face. Unlike money, wealth, women… that feeling can never be taken away from you, nor seem hollow in the face of everything. But it’s important to also have somewhere or something that moves you deeply beneath all this. And nothing illustrates this better than this one day that I’ll always remember. I was going in to hospital. This was after I’d relapsed, and I was getting maintenance chemo that’d hopefully increase my donor’s immune cells’ attack on my cancer. As you can imagine, I was tired beyond anything as I found parking and walked up to get jabbed. I always smile and joke around with people if I can while I’m walking around hospital though. You never know who’s having a rough day, or who just needs a break from it all in those walls in particular. But I had to wait 2-and-a-half hours for a blood test. And then, when it was time to see the doctor, I waited another 2 hours before the receptionist, a friend of mine, blamed me for the delay when she’d forgotten to put me in the system herself. And I don’t know why, but I guess a lot of things simmering below the surface just took over… Why was I trying so hard to do so much when there was still so much suffering going on in the world? When no-one else seemed to care as I did? Why did any of this matter? I left, and drove away, wanting to end it all. To just crash into the wall, or something, and pass. I’d had these feelings before, and have had them since, but on this day, I guess I’d lost faith in humanity; not in the way that people say they have when they comment on some sad Facebook post, but truly so. I lost faith in the very thing I’d set up to keep myself going.
But an amazing thing happened as I drove along the motorway, holding the steering wheel, but not letting go as I was afraid I’d hurt someone else. An ambulance’s sirens sounded. And despite it being nearly peak hour, with the whole road packed… everyone moved to the left to let it pass. People DID care, I realised. They really, really did. There will always be good in this world, in peoples’ hearts. And the first thing this inspired me to do was create something that would try and make it easier for people to do that at every single opportunity. A social enterprise called PlayWell, that’s gonna make those billions of hours we “waste” every week online make money for charity. But the second thing this did was make me see that underneath all the systems and techniques to stay happy that we set up for ourselves, you need something that keeps you going. Something that will almost always bring a smile to your face. Something you can fall back on no matter what. For me, that was my favourite fishing spot. Somewhere I could sit and just admire the river, the ways in which that magnificent place just worked; the mangroves providing shelter and food for birds, crabs and fish, and weed beds doing the same for those at the bottom of the river, with the occasional person rowing past. And also, just learning about the world, my place in it, and how people are fixing it.
If there’s one thing that you take away from this, please let it be this: Go away and find that thing for yourself, and take some time out to pursue it. And if you haven’t found that yet, trust me, you will eventually. It could be just around the corner. I’m always here to chat guys. Please feel free to reach me through my blog.
Nikhil Autar, WSU Year 2 MBBS (2016) To hear more from Nikhil about the two sides of his story (as a patient & as a doctor-in-the-making), please check out http://nikhilthegrizzlybear.blogspot.com.au/.