I am a doctor. I spend all day diagnosing patients. So how could I not diagnose myself?
I had been at work since 7.30am. It was 8pm. I was the only one left in the building, the cleaners long since finished. I was still ringing back patients from that days' on-call triage list. I had almost finished, knowing that once I had, I then needed to turn to the mountain of paperwork and blood results still waiting for me. My children were asleep, I had missed bedtime by a long way. I had just spoken to a patient who needed an emergency assessment. I knew the nearby hospital had a day unit open 8am-8pm. I rang them.
The staff nurse was professional and polite. She was sorry but they had just accepted the last referral of the day. The patient would have to wait till Monday or be admitted to the general ward.
And my response? I started sobbing. I couldn't stop. I sobbed and sobbed down the phone at the poor nurse who was utterly bewildered. In one short sentence, she had added at least another half an hour, probably longer, onto the time that I would eventually be able to go home and crawl into bed, exhausted. I had nothing left. No reserves. No empathy. It wasn't her fault; I knew it was likely they were closed. But I had to try because I couldn't face another minute.
I hung up and sat crying in my room. When I eventually composed myself, I rang my husband to tell him I would be later still. That set me off again, as did his anxious voice. And I thought - I can't do this anymore.
This wasn't a single shitty day. This was the culmination of months of pressure. Spending days off that I should have been playing with my children fixed to my e-mail trying to solve practice problems from afar. Fielding phone-calls when yet another GP rang in sick - no I couldn't come in to work, I had two small children to look after. But I would offer to try and triage from home on the remote access while frantically running round after my kids. When the children were in bed, I logged on again, and would spend 4 or 5 hours each night trying to clear the blood results and scans from that day, to give my colleagues who were there again in the morning a fighting chance.
The days I was officially at work always started early. I tried to keep on top of my paperwork, but every day brought 80-100 scans, and at least 60 blood results. Fully booked clinics with extras slotted in, 4 or 5 visits each, no breaks, no lunch. Covering for colleagues off sick with stress, or those we hadn't been able to replace. I always finished late. It was usually after 9pm by the time I got home. The on-calls were the worst. If you haven't read my first blog, then please do to understand what it was like.
I stopped sleeping. I existed on junk food and coffee. I ached all over. I felt physically unwell. I convinced myself I must have something wrong with me. I knew I should go to my own GP. Except I never had the time.
My husband was stoic in his support. My parents watched me anxiously each time they saw me. "You look tired - are you alright?" But I couldn't tell them I was failing at the job I loved.
It got worse and worse. I thought maybe I was depressed. I couldn't see the wood for the trees and realise now that, for the first time in my career, I was suffering from burnout. All of us were. And that was part of the problem. Because every single person at the practice was working to the same intensity as me, there was nothing left. There was no support. No one who could take up the slack if I was having a difficult day. We were all flat-out and burnt out.
I began to dread going into work. I'd wake up in the night to settle one of my children, and for a brief blissful moment, think the morning would bring a day I wasn't at work. Then I'd remember and lie awake all night. Dreading it all over again. It sounds so stupid now, so obvious. I had had an incredible GP trainer who had dedicated time to talking to me about the dangers of getting burnout. How to avoid it, how to recognise it. How to ensure the slippery slope of relaxing with a glass of wine didn't lead to something more.
I started to resent my patients. Every appointment, every home visit request, every extra person on the triage list. They made me want to crawl under my desk and hide. I knew my notes weren't as good as they should be, always rushed. I was requesting more and more tests, because I couldn't trust my clinical judgement in my exhausted state.
I have worked in A&E, dealing with life and death every day. I never felt like this. I have worked in paediatrics and child safeguarding, coping with desperately sick and abused children. I never felt like this. I have delivered babies, been there when a stillbirth happens, tried in vain to resuscitate a child who did not have a chance at life while their parents looked on. I never felt like this. I have cared for stroke patients, cancer patients, sat and held hands as some died. I never felt like this. I have failed in this, my chosen career.
So my choice was made. I suddenly realised I couldn't carry on. Either I left, and made a new start caring for patients in a different way. Or I left full stop and was no longer a GP.
I know there will be people reading this who know me personally or professionally. And they will not recognise the doctor I have described above. I don't want sympathy. I am a better doctor for having gone through this. But I want any other GP or doctor reading this who identifies with it to stop. Look at yourself - for just a second - as a patient. What would your diagnosis be Doctor? And can you care for patients, when you are beyond caring about yourself?