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Humans of Medicine 2017

Home > Humans of Medicine 2017

At the beginning of the year I sat down at my dinner table with a new group of housemates and a close friend and we completed a ‘getting to know you’ questionnaire. One of the questions was ‘Do you have a secret hunch on how you will die?’. For most, this question is probably relatively innocent but for me it touched my deepest fear. I eventually told my friends that I thought I would die by suicide.

I first became acquainted with the complexities of mental illness and the reality of suicide at quite a young age. At the time I didn’t have the maturity or comprehension to see it for what it was, a combination of genetics, past trauma and environment. Intellectually, I hope to use this to one day work in mental health and to provide truly empathetic care to my patients. Personally, it has also left me fearful. I fear that my genetics and the trauma I have experienced may predispose me to one day developing severe mental illness.

I’ve always had a great support network – faith, family, friends. Now I have strategies too. Good study breaks, journaling, prayer, exercise, hobbies, mindfulness. Some of the ways I think and act are still far from healthy, but I’m glad to be heading in the right direction.
The advice I wish I was receptive to in my worst times is this: don’t wait until things get out of control to seek help. There’s nothing heroic about bad self-care and stubbornness.

I’ve been ashamed about achieving well but also about not being perfect. I’ve been ashamed about being well enough to function, but not well enough to be free. I’ve been ashamed about accepting my illness, but also denying it. I’ve been ashamed about seeking help and taking medication, but ashamed that I can survive without it (albeit not as well). I’ve been ashamed about being ashamed, and not being ashamed. I am ashamed that I haven’t been more explicit, but also that I’ve shared anything at all. I am ashamed that I feel like I am attention seeking, but also ashamed that I immediately feel like seeking attention is a negative thing.
Shame controls too much of my life and too much of what I do and don’t feel. It controls too much of what I do and don’t do. Inevitably, shame fuels my illness(es). However, listening to the shame and holding this inside hasn’t done me any good, so I guess I’ll try something different and speak out for once.

For many months, I experienced traumatic flashbacks. I was in shock; it took a long time to understand what had happened to me was sexual assault, rape. I couldn’t bring myself to tell my mum. This burden shared is not halved, it grows.
The symptoms of PTSD continue to plague my days at university. I experience panic attacks at the sight of him, the smell of his cologne, begin to shake merely at the sound of his voice. In a small and unified cohort of medical students, there is no escape. Sometimes people notice. I am well acquainted with the bathroom stalls, where I can hyperventilate privately.
By October of that year, I began to open up to my close friends. The overwhelming love and support I received was life changing. If any of my friends are reading this, thank you to the ends of the earth for all you do for me, I love you.To anyone struggling with this, I highly specialised services (1800RESPECT, VIC CASA, NSW & QLD Sexual Assault Services, WA Sexual Assault Resource Centre).

For me, it was easier to confide in a stranger than it was to my friends. It took all the courage I had to approach my extremely empathetic GP tutor after one class and say ‘I’ve been feeling really low lately, and I don’t think I’m coping. Do you know anyone that can help me?’ This tutor was beyond incredible in the way that they sat me down with tissues and just listened, before recommending a psychologist that I still see years later.
When I got home that day, I made the decision to call my closest friend, which involved going through the terrifying ritual of talking about what I’d been feeling yet again. Talking about depression and the thoughts I’d been having made them feel more real – and having suicidal thoughts felt extremely abnormal, scary and out of my control. Her response was everything I needed – she listened, cried with me, said how much she loved me and promised that we’d get through this together – and to this day, we have.

In June this year on my way to my general practice placement I had a serious car accident which was entirely my fault. While I wasn’t injured the effect on my confidence was shattering. Everyone told me I was lucky but I didn’t feel it and threw myself back into uni hoping I could forget what had happened. Little did I know I was plunging into a deep depression that would leave me almost unable to function. I stopped studying, I struggled with attendance, started taking unnecessary risks and withdrew from most of my friends. I made mistakes and alienated some people, things I couldn’t take back and only served to deepen my depression. It wasn’t until I saw a fantastic psychologist that I realised I couldn’t cope with all of this myself and that’s perhaps the most important lesson I’ve learnt. As doctors we aren’t infallible even though we try to convince ourselves we are. I was at rock bottom but still I threw myself into my work thinking I could do it all and it was to my detriment- it’s so important to know your limits and take a break when you need it.

Rock bottom is not a pretty place. Failing that exam felt like personifying failure rather than simply failing a task. Having spent many years feeling worthless as a person due to insecurity about my appearance and personality, I attached my self-worth to succeeding in academic pursuits. I had metaphorically put all the eggs into one basket, and failing the exam stole that basket away from me.
Before this incident occurred, I was so scared of other people’s judgement that I did everything in my power to make sure no one found out about how I was feeling. Hitting rock bottom meant that stigma was something that no longer scared me. That’s why I publicly acknowledged my struggles with mental illness – to do what I can to fight the stigma of mental illness.

“I had a friend who saw the signs and pushed me to get help. I appreciated it a lot. He’d had experience with mental illness so I trusted his judgment. My GP suggested that I start medication but my friend was really against it. He said they made you clouded and that they didn’t work. Because of what he said I wasn’t compliant with my medication and it took much longer for me to start managing my mental illnesses properly. I never had the courage to tell him he was wrong and what hadn’t worked for him had worked for me. I guess my point is, do what you need to in order to get better. You are not alone, but your journey will be different. Keep trying until something works.”

I’m very conscious that if I tell people I have bipolar, they might think that I’m unstable and crazy. I am perpetually worried that the people who do know about my disorder will treat me differently to how they did before they knew. I am no different after I disclose my bipolar to how I was before. I’ve indirectly experienced stigma and misconceptions from other med students who don’t understand mood disorders. And I worry that if I disclose my disorder, these people might change how they treat me (or others) in the workplace, or in my personal life.

It wasn’t until I burst into tears in the car because I couldn’t bear the thought of going into hospital that I realised I had been having panic attacks. I was catastrophising about the state of my physical health, and my worthiness in the face of barrier exams. I was paralysed with fear that I would not be good enough as a doctor, then I felt incredibly guilty about feeling this way. It was a horrible cycle of unhelpful thinking. This time, I invested in my wellbeing and got a mental health care plan with my GP.

Eventually things started to change. I didn’t want to go to lectures (compulsory classes saved me – they forced me to get out and about and not isolate myself), and I wouldn’t just feel so overwhelmed that I would burst out crying for no reason. I finally spilled everything to my mum and after sobbing for hours, she dragged me to the G.P. the next day.
Luckily, he knew about everything that was going on at home from my mum’s visits and knew that I was doing med. He diagnosed me anxiety, prescribed diazepam and offered to refer me to a psychologist. I declined the referral and said I would see the uni counsellor instead – my G.P made me promise that I would come back if things got worse. Even though I never went to the counsellor or took the meds, checking in with him really helped. He asks me how everything’s going each time a see him – even just to get the flushot. I’ve become more aware of my anxiety and have learnt how to control it – venting to everyone about exams really helps.
Taking that step forward made me feel empowered and in control (and was less scary than I expected).

I don’t think I can describe how broken I felt at the time, partly because I had no idea why this was happening again and partly because pain dulls with time. There were no warning signs or emotional triggers like the previous episodes, and yet I suddenly felt like I was drowning and barely being kept alive.
The first month was like purgatory. Every single morning I opened my eyes, I had a few seconds of ignorance before I was drowning again. I did not have the energy or motivation to leave for placement. I woke up feeling paralysed by my lack of being, returned to sleep and waking up covered in guilty and self-deprecation. I started avoiding my roommates so I didn’t have to admit I’d skipped another day. Sometimes I even lied and collected the lies in my stomach like acid. I felt ashamed when I saw an email from my clinical supervisor questioning my attendance, and thus questioned my own ability to become a doctor. After five years of enduring this unwanted guest in my mind, I was finally desperate enough to commence my first anti-depressant.

Not surprisingly, I failed the next course which meant that I had to take an additional year compared to my peers. I sought help from my school’s clinical psychologist and was referred to CAPS. However, the feelings of desperation kept coming back.
Later that year, I was diagnosed with papillary thyroid carcinoma while doing my last course for first year. It was difficult telling my parents , they didn’t believe me and were in denial. I was crushed and just wanted to end it all. Wondering: what is my purpose? Why do I have to be such a burden?
I failed my last course and applied for special consideration. I felt ashamed applying for special consideration for my mental health issues. Cancer seemed a better ‘excuse’. I had a total thyroidectomy and radiation at the start of this year. Coming back to Sydney, I struggled telling my friends why my voice changed and that I had cancer. I was afraid of being judged and pitied. I still continue with my consultations at CAPS and that provided me with the tools to help with feeling low.

It was uncertain whether I’d ever be able to attend university, and as a very academic person, this completely tore my self-worth to shreds. I hold myself to extremely high standards (traits of maladaptive perfectionism), and I couldn’t understand why my brain was letting me down. I went from being extremely outgoing to incredibly reserved, and I felt like I was defined by the new label that had been stuck on me – severe anxiety disorder.

Unfortunately second year meant moving back home (away from my previous supports as we’d moved about 3 hrs away) to what can only be described as hell. During second and third year I never knew what I was coming home to. I would have constant panic attacks on the train/in the car knowing I was going home to arguments, not knowing if the police were going to be called that night. I was required to go to court more than once for intervention orders. I definitely found rock bottom last year. People might ask why I didn’t just move out, but it’s never that simple.

The majority of last year I was convinced I was never going to be able to pass as I couldn’t study, and when I could it was impossible to focus. To this day I am still surprised I passed. Part of it is due to my stubbornness and unwillingness to give up, but most of it was due to the amazing support I received from friends, faculty and medical professionals.

Losing your health is losing almost everything. It stripped my life to bare essentials and taught me just what is important in life; love and people and, in essence- relationships. Being in chronic pain and suffering draws on an inner strength you don’t even know you possess, until there’s no other option. Naturally, chronic pain often causes depression as you spend days in bed, grieving the loss of your former self. Not being able to live life fully can be overwhelming at times. My love for my beautiful son got me through, along with receiving love and kindness from my family and close friends. I was fortunate.

These events and their effects will shape you. These events will fuel you. They will push you into Medicine. They will push you to try and help people. They will push you to seek out every bit of evil that feels familiar and fight it. You will do good things.

But it will not come without cost.

Depression does not make you weak. In fact, admitting that you are depressed and seeking support actually makes you incredibly strong. It makes you believe that you are suffering from an illness that can be overcome and that you are worthy of the help. And that when you do get through it, you will be kinder, wiser and more resilient person.

If I was to give one piece of advice to anyone who are struggling with depression it would be to lean on your loved ones and seek professional help when you are ready. Hopefully, like me, your journey will teach you a lot about the world, yourself and how many people care about you.

I guess that’s what has made this long battle so hard, essentially being controlled by two Chloes. On one hand, there’s the “intellect” who’s educated about mental health, who works with patients with mental health problems and who will drive home the importance of recognising symptoms early and speaking freely about them. And then there’s the Chloe that experiences the dark, lonely, scary and toxic places depression and anxiety can take someone and I felt guilty that I couldn’t will myself out of it.

When I first started to recognise symptoms of mental illness in myself, I didnt want to talk to my friends about it. I knew they would care, and really that was the problem. I thought it was selfish to put my stuff onto them- just one more thing to worry about when I knew they were already stressed.

I got to a point where I just felt like there was no point trying to get help. I came to the conclusion that mental illness was just a part of medicine, and the crossroad I was at was whether I was willing to suffer with it, or change career. When I look back now, I realise how wrong I was, but I wish someone had slapped some sense into me then. While mental illness is common, it is not something we just need to accept. There is help and there is recovery. Talk to your friends, or your GP, or headspace, or whoever it is- keep talking and get help. You’ve got this.

Sure, there are people that question the legitimacy of my problems. They tell me to “stop worrying” and “it’s not that bad”. In some ways they’re right, most of our marks don’t matter and actually, I am lucky enough to have quite a few friends. But they’re also wrong. In a certain state of mind I am incapable of believing myself, let alone them. It’s important to understand that just because someone’s problems may seem trivial to you, doesn’t mean that they’re trivial to them.

Over the last year my life has become about positive coping strategies and rational decision-making. Things that many people take for granted. Things that I really have to work at. I still struggle to admit when I’m not coping but every time it gets easier.

Personally, I see my anxiety as an advantage. When I have things under control, it pushes me to do better in every aspect of my life. When I need a break, I know how to properly look after my mental health.

I’ve always been a fiercely independent person (read: stubborn). Convinced that I could overcome any obstacle on my own, I took the same approach to the management of my anxiety. I didn’t talk to anyone, I didn’t go to the doctor and I certainly didn’t talk to any family or friends about it. I watched a youtube video and read a self-help book and believed if I did yoga once a week that everything would be peachy. My belief was that this was “working” for many years, and by this, I mean that I was somewhat holding it together enough to not have panic attacks in public. The cumulative effect of anxiety slowly took its toll. I became warn out, got sick all the time, and felt constantly nauseous.After years of coping on my own, the straw (an issue with my honours project) broke the camel’s back (my mental health).

Any time I left the house for more than 24 hours I’d convince myself that I’d forgot to lock the door, or that I’d left the hotplate on, even if I hadn’t used it in days, resulting in me vividly imagining what I’d do if the apartment burnt down and how I’d replace all my belongings. I would convince myself that the 1.5cm lymph node in my neck was metastatic cancer and I’d start contemplating how I’d tell my family I was dying. I believed the itchy freckle on my arm was most definitely a melanoma, and that maybe the muscle fasciculations I would get after a long day at uni in combination with slightly brisk reflexes meant I certainly had ALS.

Hallmarks of severity scare me: I always feel that mental illness is okay, as long as you can show you are only getting better. But the reality is that there is a monster in my brain that I have been fighting for years. Today, it is lying weakly in a small cage in a corner of my brain I don’t explore anymore. I have fought it with all the ammunition I have. But it doesn’t ever really go away, and sometimes it gets stronger, and bad days still happen, but I’m still here, fighting, and I always will be.

My point is this: whatever help you need, whatever ammunition you require, it’s all okay. Whether it’s your first GP appointment, your tenth medication, a new type of therapy, a visit or admission to hospital, a year of intermission: there is no shame in reaching out. We fight the good fight so tomorrow we might be better. And that, to me, is everything.