I’ve really been doing pretty well over lockdown, at least I thought I was. I’m not so sure now, and I’m finding myself wondering what I mean by ‘doing well’. It is with some dismay that I realise that for me this means not relapsing into severe depression, or requiring even more noxious psychotropic drugs, or, worse, ECT. If it’s not that bad, then it must be quite good, realistically rather a dubious point of reference. Maybe I need to rethink things.

I have close colleagues who are, for various reasons, leaving work. There is a commonality though, despite many differences, and that is workload and stress. I think that a tipping point may have been the fact that during the pandemic we have been unable to see each other, and support each other properly. We all work in isolation from each other, but we used to meet up occasionally, and these moments of connection were certainly what kept me going, and gave joy to my job. Zoom and Teams are simply not the same.

I am glad I work part-time, I don’t think I could keep going otherwise. But I’ve taken on a lot of extra responsibilities which keep me busy in my days off, and sometimes I wonder why I can’t work full-time. There is my health, which has been affected by work stress, but what is it that is particularly stressful? It’s difficult to know, because you get so used to working, and so good at dismissing the problems. But I think a very big part is the terrible and tragic stories we hear from many of our patients. I tend to count my blessings – rightly – that my life is easier, but day in, day out, we talk with people whose lives are destroyed by hideous childhood trauma, who have done, and had done to them, things that are unimaginable. Mental illness and addiction are quick to deal out suffering, and vicarious sharing is inevitable. Most doctors will remember a time as a medical student, when they were told something terrible by a patient, something they will never forget. Until then, they had not understood how cruel humans can be. They may have also wondered why their seniors seemed less affected, but you simply can’t remember all the things you hear.

Perhaps all this would be bearable if we were able to change things, but anything we can do almost always only addresses the tip of the iceberg. I am used to anger directed at me, because I cannot cure a patient, or prescribe them that drug that would take the pain away. I know that anger is their fear and suffering, and that it is not really directed at me, but it’s still there. Distress is even harder to tolerate.

Being close to others, who understand, is the one thing that helps. I need to be in the room with them, to talk, touch their hand, exchange that understanding. To talk and plan for ways that we can improve things in our services, to breathe air together. We have none of this anymore. I work in an in-patient unit, so do see some colleagues regularly, and without this I would not have been able to continue. But the colleagues in the same role as me are only seen via a screen, and no-one can tell us for how long this will continue.

There has been a great deal of talk about well-being in healthcare workers, but I’m afraid I’ve seen very little of it. You see adverts for various supports, but the day is too busy, and no-one is going to come in for these on their day off. As someone who has experienced a serious mental illness, I am always alert to potential warning signs – I’m not sure I think very much about my own wellbeing, however, and maintaining this might lower the risk of those warning signs.

But the wellbeing needs to be integral to daily work, and to be part of it, not, for example, a mindfulness class that one attends afterwards. That’s like painting over the wallpaper, rather than changing it.

I have found solace in writing over this time, and perhaps that has been particularly important because of the enforced distance from friends and colleagues. It has kept me going, but it can never replace the casual intimacy that we previously took for granted. And sometimes I wonder the wisdom of keeping going, of telling oneself that everything’s OK, and many people are far worse off. But although this is true, it’s been difficult for everyone, and perhaps we can’t really remember what normal was.

I tend to criticise myself when things get harder; but now I look at my colleagues, and I wonder whether if that’s been very wrong. I wouldn’t criticise them, but perhaps it’s more about what I didn’t do. I should have reached out more to them. The problem in any big organisation is that you can feel that so much is beyond your control, and that has become worse now we all communicate through our little screens at whatever desk we can find.

And, I can’t deny it, a bit of me is envious of those who are managing to walk away. I wonder about it, but I am so accustomed to my work – I love it on many levels, and have been there a long time. I love my colleagues, and feel a bit bewildered. There must be changes. I suspect I speak for many, not just doctors or psychiatrists, when I say that we want to carry on, but we’re no longer quite sure how to do it.

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