Five debilitating years as a junior doctor taught novelist Joanna Cannon that compassion and understanding of mental health can be a lifesaver – and not just for patients
Joanna Cannon – now a bestseller author – was in her thirties when she worked as a junior doctor before specializing in psychiatry. She found the circumstances and long hours so difficult that she became ill. However, those years taught her that embracing what makes us human is just as crucial as restoring a heartbeat. Here she reveals how she survived the relentless shifts that almost broke her.
I had worked in A&E for 12 consecutive hours without eating or drinking – something that nobody in the ward considered unusual. Perhaps due to the accumulation of many days like this, I started to feel weak. Waves of nausea tumbled through me. My hands were shaking too much to even write down the notes and I certainly didn't trust myself to take blood or to put a cannula tube in a vein. It also influenced my judgment. Extreme fatigue and lack of food have the same effect as being drunk and I was afraid that I would make a mistake.
I finished my patient and looked around for a chance to escape, just for a minute. The department was in chaos. Each bed was occupied and a row of paramedics and their patients scrambled down the hall. The guilt was overwhelming, but the need to escape was even stronger. I just wanted to run when my consultant appeared and told me which patient to go to. I knew the canteen would be closed in ten minutes. I needed something that I could eat while I was working, something to help me function safely.
"I really need something to eat," I said in a very small voice. He was staring at me. "There are patients waiting. It's the patients I'm thinking of. "The expression of disgust on his face was so clear that I can conjure it even now.
In the coming weeks and months I became fixated on the risks of spreading infections. In between the patients I would stand by the sink and scrub my hands raw, but I would not stop. Soon my knuckles started to crack and bleed. One of the nurses noticed it and gave me a jar of Sudocrem, and that little act of kindness in a sea of despair moved me so much that I entered the lock room and sobbed. I hardly ate. I barely slept. I lost huge amounts of weight. My hair was matted and stuck to my skull.
The rest of the hospital seemed to be able to handle it. I saw other doctors marching through their work with what seemed like minimal effort. I carefully walked along the edges. My goal was to reach the end of the day somehow without losing my mind.
If you keep walking along the edges, it won't take long for others to notice. I had a small group of people that I could visit when I felt unable to handle it. Several nurses throughout the hospital who were exceptionally friendly. The mourning officer – one of the most compassionate people I have ever met. The sister on Ward Four who made my day by telling me that I would have been a great nurse.
I had arrived at the departments full of enthusiasm and the desire to be the best doctor I could be. The shortcomings of the system, the lack of funding, the absence of people to provide the necessary care, the misery and death and the dying were all driven away until nothing was left of that doctor. Sometimes she felt so far away that I wondered if she had ever existed.
Joanna worked as a junior doctor until 2015
When we visit a hospital, we see an army of health workers and weirdly imagine that they are invincible. That understanding of the mechanism of an illness somehow prevents someone from contracting it. Doctors are objective, calm and knowledgeable. Doctors heal people. But the reality is that you spend years in medical school learning how, just to get to the departments and quickly discover that there are many things that you will never be able to fix.
Gill was a patient in a side room at Ward Eight. We were almost the same day old. As children, we had watched the same television shows and saved our pocket money to buy the same records. Our only difference was that Gill had metastatic breast cancer and I didn't.
On the ward round, I wrote in the notes while the consultant spoke and thought of birthdays from the past, how we had both assumed the same guarantees in life. As I watched her, I was staring at a mirror and the reflection was almost unbearable. I had to find another difference between us, because if I didn't do that, I was afraid that I could never turn away.
We were now at the point where Gill's treatment would be the only way to extend her life a little, where the small amount of life she had left would be ruined by the same medication that gave her that time. It is a decision that many patients are confronted with incurable diseases. Quality or quantity. When I entered Gill & # 39; s room late in the afternoon in November, I knew that decision had been made.
I was called to reinsert a cannula. & # 39; You don't have to find a vein, & # 39; she said. Her face was pale. & # 39; I've had enough. & # 39;
It was discussed with the consultant and Gill's older parents. There were tears and sadness, but also a strange feeling of liberation, as if Gill had finally taken back the reins. I often visited Gill and her parents, who had settled in her room. Sometimes they had a question about the drugs that kept Gill comfortable. Sometimes I think they just needed someone else in the room.
One night Gill's mother ran down the hall. & # 39; Could you come now? & # 39; She said. "Gill & # 39; s breathing has become funny." Gill lay back with her eyes closed and her face was covered with all the pain she had endured. She was more relaxed than I had ever seen her and at those moments I saw a glimpse of her before the cancer. When she was just Gill.
"I don't think it will take long now." I turned to her parents. They looked small and helpless. "Do you want me to stay?" I never thought they would say yes. "If you don't mind?" Of course I didn't mind. Her parents sat on either side of the bed. I stopped my beeper and sat down on a plastic chair against the far wall.
"I don't know what to talk about," said Gill's mother.
"Why don't you talk about her life before the illness – things that made her laugh, adventures that you had together? Then the last thing she will hear is happy memories. & # 39;
For the next few minutes I listened to a life that lived parallel to mine, even though our ways never crossed. Between the stories, Gill & # 39; s breath became longer and longer. Until.
& # 39; Gill has not had a breath for a long time, has he? & # 39; Said her mother.
You discover very quickly that there are many things that you can never solve
& # 39; No, she doesn't & # 39 ;. I went to the bed and held my fingertips against her skin and looked forward to the slightest movement. The next sound I heard was Gill's mother gently crying – a mixture of relief at the end of her suffering and despair about what could have been. Her mother stood up and pointed: & # 39; Could you stretch her necklace? She hated her necklace being crooked. "It was a nice necklace with an amethyst pendant. Her birthstone. My birthstone. I gently reached back and adjusted it. It was the kind of thing you would do for a friend or your mother.
"I am so sorry." I felt the tears overwhelm me. The tears were not only for Gill. They were for the older couple who had seen their only child blowing out their last breath. "It's so unprofessional to cry," I said. & # 39; My apologies. & # 39;
Gill's mother put her arms around me.
& # 39; You are first a human being and secondly a doctor, and I cannot tell you what a comfort it is to know how much Gill meant to you. & # 39;
There we stood, in curtain light, all crying for someone who earned so much more from life. Being with Gill's parents was a job I had done well. If I helped make the most traumatic experience of their lives even the smallest bit more bearable, it meant that I was learning a good doctor anyway. Gill & # 39; s death was one of the worst days I have experienced as a junior doctor, but it has also strengthened my decision to work in psychiatry. Because those moments reminded me of the kindness that one person can show to another, to a stranger. It has nothing to do with wearing a uniform or holding a stethoscope, it's about being human, and in psychiatry I started to witness the very best of humanity.
The most important thing I learned as a junior doctor was that lives are not only saved on the floor of an emergency department or operating room, but in quiet corners of a ward or during a conversation in a garden. Lives can be saved by building up so much trust in a patient that they take medication even if they think they don't need it. Lives can be saved by listening to someone who has never been heard before.
I was reminded of this when I wrote a card for the last anniversary of an older couple. When I ran through the hospital looking for ice for a dying woman who was craving cold water. When I smuggled fish and chips to the ward for an old man who had lost his wife and couldn't eat. None of these things make me special. Thousands of doctors and nurses do this every day. It is what makes us human and sometimes walking through that room to a patient is all we can do for them.
Many times during my training I told myself that I wish I had never done this before. Now I look back and I cannot imagine that I have done anything else. Working as a psychiatrist saved me. Recovery, such as breaking, can happen in the most unlikely places. Breaking is accumulative. We collect small moments of despair and misfortune. Repairing is exactly the same. The small moments of compassion that we see, the more humanity we see, the greater the chance that we can restore ourselves and the sooner we can heal.
- This is an edited extract from Breaking & Mending – the stories of a junior doctor about compassion and burnout from Joanna Cannon, will be published by Profile Books and Wellcome Collection on September 26, £ 12.99. Call 0844 571 0640 to order a copy with a 20 percent discount until 22 September 2019; p & p is free for orders over £ 15
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