Coping with change... Again

It's been so long since I've written anything. Except drug charts and stuff.

Normally that's a good sign – the amount I write seems to be inversely correlated to my mood. The lower I go the more words pour out of me.

My mental stability is undergoing serious challenges this week: I'm moving house (which will involve negotiating my way through London during the Olympics); and I'm starting a new job. I'm having to say goodbye to all of my friends in London and, perhaps more importantly, people involved in my mental health care.

There is no way out of this chopping and changing as a junior doctor. I'll have another job in four months time and again four months after that. I will no doubt be having to move to a different part of the country next summer depending on the location of whatever training programme is mad enough to accept me.

I think it's hard enough for a healthy person, but when you have an underlying mental illness such as bipolar disorder moving so frequently can be very de-stabilising. I'm having to make sure I have a good GP to access and that Occupational Health at my new hospital are aware of my condition. I have to weigh up the pros and cons of letting my next supervisor know. And I guess in the short-term I need to be very vigilant about monitoring my mood and intervening early if things start to slip. So far there's no evidence of that that's happening. Not in a serious way. I felt really down this afternoon after a seagull shat on me (this isn't a joke), but come on... Isn't that a healthy emotional response?

I do wonder sometimes whether the UK medical training system couldn't be better at helping some doctors stay within a smaller geographical area. There are special circumstances that can allow a trainee to request to stay in a certain area, such as having children or requiring regular medical treatment that couldn't be accessed elsewhere. However I think it would be hard for me to make such a request on the grounds that moving house “may” destabilise my mood, especially as staying sane could well be seen as my responsibility, nor theirs. I don't begrudge them this particularly. I suspect such requests are rarely made on the grounds of embarrassment. But it's something to think about in future I suppose...   

Perfectionism

I've been going for CBT for three weeks now, and I have to say that day by day I am getting better at challenging my negative thoughts. Whether that is due to the CBT, medication or other factors such as being back at work I will never know.

Keeping my little thought diary has shown me how desperate I am to please others and how much I fear criticism or punishment. Yesterday my therapist pointed out that this tendency has its benefits. It drove me to succeed through A-levels and medical school. I have managed to command a lot of respect over the years from people around me. I've won prizes. I have a great CV. But then there's the flip side. The moment when failing to achieve my goals becomes intolerable to me and I give up altogether. Many people with depression and bipolar disorder are very talented and successful when well. Is this why? Are talented people prone to depression when the praise dries up?

I've received so much praise in my life. From the age of five I was reading and writing better than anyone in my class. I was way ahead when it came to maths and languages. OK, so sport was never my strong point, but you can't have everything. The point is – I was constantly told I was clever by both teachers and a pair of loving parents. So when I moved to a bigger school with pupils as clever as me it was a shock. I managed to get over it and climb my way back up the academic ladder. Yet by the time I hit medical school I was definitely mediocre. Indeed, in my current friendship circles I still am mediocre.

My default mindset seems to be that I am a) stupid, b) fat, and c) unpopular. Luckily this mindset tends to be challenged on a daily basis unknowingly by others. I might get good feedback from a senior doctor; I might squeeze in to a small dress and note the fact that my BMI is only 21; I might find myself surrounded by friends and having a good time. When I am well I can get away with the odd reminder that I'm not as bad as I think I am. But when I am unwell I need constant praise and signals from others to stop me from sinking... And life's just not like that is it?  

Bad news for patients...

So my union has decided to go on strike...

Two weeks ago when the BMA asked if I would be willing to take part in industrial action over threats to my pension I firmly said “no”. Today I found out I am in a minority. An overwhelming 92% of the junior doctors who responded to the ballot favoured taking part in a strike over this issue.

Now all routine GP appointments, hospital clinics and operations will be cancelled on 21st June. Supposedly this won't harm patients. What the hell? What about the elderly woman living off a state pension – a fraction of the pension her consultant will eventually live off – who has to endure another week or so of pain because her hip replacement is cancelled? Or the patient with worsening COPD whose chest clinic appointment (and subsequent clinical intervention) is postponed? Will their lungs appreciate that? Not to mention hundreds of psychiatric patients who won't get to see their psychiatrists that day...

There's no way around it – this strike will affect patients. 

My view remains that if doctors are so unhappy about their NHS pension they don't have to take up the offer of one; they can pay in to a private pension instead. But they know that private pensions are crap by comparison. Most of my friends outside of medicine work in the private sector. I currently have a fairer salary and fairer pension than any of them, even if proposed public sector pension reforms go ahead. Sure, unlike them my job involves sticking fingers up peoples arses, but we all have to make sacrifices in life...

On an entirely different note, it's my birthday this week. I have already opened my presents from my mother – a cheque for £125 (much appreciated) and two books on bipolar disorder, one entitled “The Bipolar Disorder Survival Guide”... Gee mum, thanks. Thanks for rubbing it in.

Having got over my initial annoyance I reflected on the fact that she's only buying these books out of love (and perhaps a little desperation). Both books look fairly good. I just wish my illness weren't the main topic of conversation between myself and my family members at the moment.

Depressingly I didn't have time to make carrot cake last weekend (the heat made it unbearable to turn the oven on), so I bought one from M&S instead. Not a patch on what mine would have been. But then I didn't exactly get a birthday cake this year, so it was nice to have something sweet and manufactured in the fridge to comfort myself with.