It is hard for me to tell this story. A voice in me says, ‘no-one cares’, ‘what would you know anyway’ and ‘you have no right to enter this discussion.’ I am afraid of inciting personal criticism for my flaws and mistakes, of people recognizing me, of being exposed as a failure and blacklisted by potential employers. However, I am sharing my story because I think this is more important. I want to open up the dialogue to people who are struggling in silence, because arguably, these are the people we need to listen to if things are to change.
To introduce myself, I am a female doctor, who works in Sydney and did not grow up here. My social network consists entirely of associates and a few friends, who I see infrequently. There is no-one to whom I tell my secrets, except my psychologist. Through work with my psychologist, I have become conscious of how my negative cognitive style and negative core beliefs influence my experiences. I am also socially anxious and introverted. I struggle with confidence and am not a natural leader. So, stepping up to work as a registrar presented challenges in itself and these factors certainly coloured the experiences that follow.
I started as a registrar in 2015, as a green and optimistic PGY3. My first term was in a tertiary centre and went well. I hadn’t a clue what I was doing, but I felt supported. Second term I was seconded to a rural centre and the story was very different. Three days into the term, one of the trainees had to take time off due to family illness, throwing the roster into chaos. The roster changed five times during the 13 week term and in the end, one of the trainees ended up with mostly days, including a ridiculous number of weekends with no break, whilst I ended up with a disproportionate number of nights. I also worked a run of 11days, alternating 8am to 6pm and 8am to 8pm. Needless to say, I remember reaching shift 8 or 9 in an emotionally labile state. My response to a question about a catheter was bursting into tears! The consultants provided minimal support for us, very junior registrars. I remember one of the registrars was extremely stressed day two of the term, because he didn’t know what to do about a lady with a serious tachyarrhythmia, but his consultant provided no guidance!
Midway during the term, a nurse in the HDU had some difficulty inserting a nasogastric tube, so I tried to advance it further. The NG went through the patient’s diaphragm. Another weekend, a patient died on my shift due to delayed identification of hypoglycemia. Then, being tired after a night shift, I chose an unsatisfactory article for journal club. All in all, I really wasn’t a favorite. A particular consultant felt so anyway when he decided to call the intern for all communications, not me. Then when the intern broke down, I made the mistake of confronting him about it. As a result, he yelled at me and told the supervisor there were serious concerns about my competence, citing incidents above. This led to various meetings, discussing my lack of competence. Then, when I dared to take a patient to the HDU for high flow nasal prongs overnight, because I misinterpreted a multiply corrected advanced care directive I was shamed in front of the department for inappropriate management. The final straw – with a thirty patient list, I was struggling to teach my JMO prioritization skills and because of a delayed consult, another consultant started complaining about my competence. To my face I was told I needed to provide more supervision for my juniors. My end of term feedback was- if you don’t improve dramatically, you should seek a new career.
Shiftwork meant I barely saw the other registrars. I remember feeling very isolated out there, none of those fables where friendly consultants invite you to their homes for dinner or take you to see their farm. I coped, as always, by exercising, listening to audiobooks (particularly the Hitchhiker’s Guide), retail therapy and ranting at my friends over text. But I felt overwhelmed, hopeless and trapped. I didn’t see any future worth having, yet I didn’t want to burden my hard working parents with grief should I die. Instead I took 40x 25mg phenergen so I could sleep for a while and forget. When seeking help from my more senior registrar friends, they nodded knowingly; at least one term like this was to be expected. I didn’t seek help from the program director till quite late in the term. I didn’t trust them and I was ashamed, and when I did, I received no substantive support. Since there was less than a week left, it seemed, there wasn’t much use looking into it, though it took me several months to recover any confidence in my abilities, much longer to recover any self worth and the perpetrators went on to bully many another trainee. In fact, now the main bully has been promoted to director of education at the rural site, despite several complaints, and people wonder why we are cynical and silent? To be fair, the supervisors from my home hospital were kind people, who were more overworked, burnt out and exhausted than me and that is probably a large part of the problem.
Anyway, I managed to get through the following terms through the kindness and patience of my amazing colleagues and consultants back home. I went through several psychologists before finding one I gelled with (and one with flexible appointment times). Through her, I had someone to talk to, to help to process my experiences. I learnt to express myself through painting and writing. I reawakened old hobbies. Further challenges awaited me in the following year. Bullying. Exam stress. Burn out. I still struggle to get up everyday, to see a future, but I am learning to question my pervasive negativity and to seek opportunities, despite potential failure. I hope by sharing this story I am able to help somebody who is feeling alone and unsupported. I also hope that by inspiring others to do the same, we might encourage those in power to embrace the multiplicity of reasons why suicide happens (individual, systematic) instead of looking to a list of two to three tick box solutions before moving on – good, good, got rid of that mandatory reporting, put an exercise program in place etc. Perhaps that way, THIS time, we may achieve change.
