A personal story by Dr Karen Wallace
This year the world has been facing up to an unprecedented crisis due to a virus that is costing the lives of hundreds of thousands of people and applying extreme pressure on health care systems. A lot has been said about health care professionals, who are fighting this new and relatively unknown disease. Many call our frontline healthcare workers “heroes”. I would argue that they have always been heroes, and the agility and reaction of the NHS merely exhibits their constant willingness, bravery, and selflessness to deliver a high standard of care under pressure.
I left the NHS over two years ago after spending eleven years training to be a General Practitioner. I was enthusiastic, passionate, and driven about treating my patients and contributing to the NHS.
When I was in my foundation years, I was involved in an inquest. As a junior doctor, I didn’t really understand what this was or what it entailed. All I felt was blame and guilt. The moment I received the call about the inquest my perspective and enjoyment of my chosen career left me. At the time I had recently moved trusts and had no local support to help me understand the process. I was working as a GPST1 and wanted to continue to make a good impression. I worked day and night, with a smile on my face, pretending everything was normal. Inside, my confidence in my decisions and my ability was questioned by my self-critical anxious mind.
The inquest finally came after many sleepless nights with panic attacks in-between, living with the responsibility that I may have contributed to a patient’s death. Thankfully, the inquest itself was very manageable. I got thanked by the family for the care I gave, and the inquest stated that nothing further could have been done to prevent the patient’s death. I felt very relieved and exhausted, thinking it was all over.
I awoke the next morning with ongoing anxiety. I felt that every patient could lead to an inquest. Any small mistake could result in harm to the patient, a court case and even criminal proceedings. Everything was blown out of proportion. There is a certain pride within the medical field, one where it is hard to exhibit any weakness. I worked in Acute medicine, A&E and on a surgical ward for the next year, every-day ruminating over every decision I made. A year after the inquest I sought support and attended some counselling to see if this would help. I learnt to practice mindfulness. We discussed my childhood, feelings outside work and other areas of my life. My life outside medicine was happy. Medicine appeared to be my only trigger for the flashbacks each night, panic attacks about future mistakes and self-critical attacks on each decision. Nothing was ever good enough. Counselling didn’t help.
Perfectionism at its finest
I continued my GP training, becoming an excellence scholar. I was involved with the CEPN and the local university for teaching and mentoring. However, nothing would allow me to regain any confidence that I was good enough to practice as a doctor. My reviews were very positive, and I had no issues with patient care, yet nothing would stop the anxiety that I was going to make a mistake or harm a patient. With my ongoing rumination about patients, it got to the stage I had to check every detail. I felt I worked all day, and then held a second clinic in my head at night, checking everything. I would make up imaginary patients in my dreams, making myself believe I didn’t document important negatives, or I didn’t check certain observations or drug interactions. I would check bloods at night, and sometimes even call the hospital at 3am to check if I had sent a patient in to ensure I hadn’t killed them.
A Pressure Cooker
Each day was getting harder and harder. I felt nauseous going into work, lost my appetite and would cry at the end of the day. I knew I wouldn’t last much longer but I didn’t want to confide in anyone because of my pride, for then I would have to admit it to myself. After training for so long, and loving what I did, I couldn’t let it destroy me any longer. I discussed my health with a partner in my practice, but I put on a front saying I was a bit anxious and wanted to try something new. I didn’t want to compromise patient care and I agreed to work three weeks’ notice. However, at the start of the third week whilst I had a smile on my face in my morning clinic it was becoming too hard. I closed my door and had a panic attack, crying uncontrollably. A receptionist came into ask me something, who then got the partner. He sent me home, stating he wasn’t aware I was ‘this bad’.
Leaving everything behind
This was my last day in clinical care. My last day managing clinical patients. The last day my anxiety was that severe. For months afterwards, I continued non-clinical work, but still ruminated about patients I had seen months ago. I would phone the practice and see if they would check my notes and see if they were ok. I had Cognitive Behavioural Therapy for Post Traumatic Stress Disorder, but declined medication. I practiced mindfulness, avoided seeing patients as this was my main trigger and exercised. My mental health soon improved, and now after 2 years, my anxiety is gone. I am now in a non-clinical role and I advise on medical matters. I sleep at night, I am healthier and I have restored my self-esteem.
A big decision
The first wave of the COVID-19 pandemic in the spring led the NHS to call for doctors, including retirees, to return to the front line. I agonised over what to do. My company offered temporary redeployment. The decision for me was incredibly difficult. I wanted to help. I wanted to be with my fellow colleagues and fight the great fight together for the nation. I wanted to use my skills and expertise to benefit others. But if I went back, would my mental health deteriorate significantly? The again, if I didn’t go back would the guilt be overwhelming?
I asked myself, what is the duty of a doctor? The will to protect the health of the public? The Hippocratic Oath? Should doctors go above and beyond to deliver their duties at the cost of their own health? How should we act in a crisis knowing that this may compromise our own health?
I did decide to put my name forward to work in a Nightingale Hospital, however I live in the South West which until now has been the least affected, so I wasn’t needed. I also volunteered by helping to support the front line with counselling, coaching and support.
The crisis that is facing us is here and now, but the future cost to the NHS regarding the physical and mental health of the healthcare workers may be significant. Has the weight of COVID - 19 been fully understood and the impact this may have on our current frontline doctors for years to come for both physical and mental health?