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.  

Is this really hypomania?

My mood's bounced back up in style since yesterday.

Once again I'm up good and early and being "productive" (i.e. trying to take on two many activities and getting distracted every ten minutes). The same thing happened three days ago. On that occasion I woke a couple of hours early, made a cup of coffee but forgot to drink it, started cleaning the fridge but couldn't be bothered to finish the job, went online to check out the news, look at pretty dresses, and checked out flights to various European cities. I almost bought a £300 return ticket to Austria on the spur of the moment, but thankfully had the insight to remember I'd have to check with my employer if I could take time off for this trip.

I never know whether to class these kind of episodes as hypomania or not. The only reason I have a diagnosis of bipolar disorder is because of the times I have been supposedly "high". I say supposedly because I still can't make up my mind whether my intermittent bouts of over-activity are pathological or not. My psychiatrists have thought they are - but then it's their business to spot these kind of things. Certainly when I've looked at information leaflets or online about bipolar disorder, I end up thinking Shit, that Sounds Like Me. But then a part of me questions whether perhaps I am just an intrinsically more intelligent, creative and energetic person when healthy and my diagnosis is all wrong. Or whether all of these psychiatric diagnoses are a product of the pharmaceutical industry wanting us to believe we're all sick and need pills to make us better.

DSM-IV states that true hypomanic episodes should last four days or more. I've had a couple of periods in my life when I have been symptomatic for well over four days (once in adolescence and once in my third year of medical school when I went fucking nuts). Each of these episodes were followed by acute crashes into the world of depression. But apart from that I tend to be symptomatic for less than 24 hours, and in all honesty I'm not sure how apparent these episodes are to other people, perhaps because no one tends to be around at 4am, but also because my sensation that my thoughts are racing aren't really visible to the outside world.

My current psychiatrist says that hypomania can last just a few hours at a time and that what I describe to her fits the bill. Which brings me around to the question - should I be concerned when I start to feel this way? Sometimes the sensation that my thoughts are rushing can be very distressing. But at other times I feel great. It's certainly nice to need less sleep. And booking last minute holidays or being extremely sociable and chatty is fun. Then again I don't really achieve much when I'm like this. Sure I can write, but I can't read or study because I get distracted. I don't finish cleaning whatever it is I've started cleaning. And so on.

So lets say I decide when I feel like this it is a bad thing, what am I meant to do about it? For a while I thought you couldn't do anything because I put it down to brain processes that could only be altered through medication (which clearly my medication ain't quite achieving). But then I found this website they other day that has some really sage advice about the importance of nipping hypomanic episodes in the bud and the best ways to do this. The author advises you to Stop, Isolate and Relax. I won't go into the details - check out the site if you want to know more.

That's about all I have to reflect on this morning. But before I stop writing, I just wanted to brag about the fact that my salary is 133% of the UK national average - check out this new BBC tool to see how you fare: http://www.bbc.co.uk/news/magazine-17543356

So much for the European Working Time Directive...

I'm now back at work, albeit without any on-call duties. My main worry about going back was how my friends and colleagues would respond to my absence. Fortunately that hasn't been too bad. My own team are quite understanding and don't ask too many questions. When other people have asked where I've been I've just said I've been unwell and they haven't probed any further. I can't say I'm quite back to my normal social self. I used to enjoy having lunch and chatting to my friends in the doctors' mess. Now it feels noisy to me. I want to escape to the hospital chapel instead.

The thing I am struggling with most is tiredness. Although Occupational Health stipulated that I am not to do any out-of-hours work, the reality is that in medicine or surgery there are no fixed hours. I am supposed to work 8-5pm (which trust me, after a month doing nothing is exhausting enough), but on Monday we finished at 6pm, Tuesday at 6.30pm and yesterday I wasn't done until 7.15pm. That's 4 hours and 45 minutes I've already worked for free this week. I used to joke that I was a full-time doctor, part-time NHS volunteer. I would guess that the extra hours I have worked this year amount to days. So much for the European Working Time Directive!

The long and short of it is that yesterday afternoon I became quite distressed again mentally. I had worked largely on my own in the morning and hadn't had much in terms of a lunch break. My mind drifted to suicidal ideation, as it frequently does when I am unwell and under pressure. I could hear voices telling each other I had jumped under a train. I saw vivid images of myself jumping under a train. I had a strange sensation of being knocked over by a train. Obviously I didn't fall, but the sensation of being hit was there. I rested against the wall, took a few deep breaths and got on with the day with my friends. When I got home I cried. I cried before dinner. After dinner I cried for an hour before bed. I woke up twice in the night, crying. The bedroom is now littered with the toilet paper I was using to mop up my tears.

I loathed myself for doing so, but I decided to text one of my colleagues and say that I wouldn't be in until mid-morning today, rather than 8am. I needed a few hours rest in the morning to collect my thoughts and do some writing. I figured this is the only way I can continue to work – by admitting that I am still unwell and taking small breaks here and there.

That is such a hard admission. I feel weak and pathetic – pathetic because I can see everyone around me “coping” with the hard work and hours, able to come back to work early in the morning after a tough day. But to my knowledge they are not plagued by suicidal thoughts, persistent crying, sleep disturbance or crashing mood swings. Yes I am at work, yes I am now able to work. But my illness is still very much present, and I'll just have to keep judging my ability to function on a daily basis.

On a more positive note, I'm planning to try a new carrot cake recipe on Saturday. Just a day and a half to go...

My favourite cake (thanks Nigella)

Thought I'd lay off the subject off my mental health and get back to baking. I went to see my Grandmother yesterday which gave me the perfect excuse to make a cake. That's the problem when there's only two of you in the house – if you try to eat a whole cake between you either you'll end up fat or the cake will end up stale. My advice: grab every palming-off opportunity that comes your way, be it via family, friends, colleagues or at birthday parties (although of course always retain half the baked good for yourself).

http://www.nigella.com

I decided to make my favourite cake (apart from poppyseed cake which I couldn't be fucked to make at short notice). My boyfriend and I have made it several times this year and everyone who tries it raves about it. The original recipe comes from Nigella Lawson's “How to be a Domestic Goddess”. Despite occasionally being irritating on screen, Nigella's recipes are some of the best I've come across, with this being a classic example. We've altered her recipe by upping the amount of rum that goes in and adding dark chocolate (which, to be fair, she suggests trying in the book). The result is a very moist combination of bananas, rum, walnuts and chocolate. It might sound a bit much, but trust me, you'll love it.

Ingredients 

100mg raisins or sultanas

150ml rum – I used spiced rum on this occasion but any good rum will do

150g plain flour

25g cocoa powder

2 tsp baking powder

½ tsp bicarbonate of soda

½ tsp salt

125g unsalted butter, melted

150g caster sugar

2 large eggs

4 ripe, mashed bananas (Nigella says to use small ones, but I use large ones for extra moisture)

100g dark chocolate, broken up into bite-sized chunks (it's nice to have a variety of sizes)

50-100g walnuts, depending on how nutty you like it (although personally I'd stick to 50g)

1 tsp vanilla extract

You'll also need a large (2L) loaf tin either buttered or lined to stop the cake from sticking.

Before making the cake you'll need to mix the raisins with the rum in a small saucepan, bring to the boil, remove from the heat, cover and let sit for an hour.

1. Preheat the oven to 170 degrees C (sorry, but I don't know what that is in Farenheit. Who the hell uses Farenheit anyway? And apart from My Dad's retro oven I haven't seen many people using Gas Marks lately either)

2. Sift the flour, cocoa powder, baking powder, bicarbonate of soda and salt into a medium bowel and set aside

3. In a large bowel beat together the melted butter and sugar, then beat in the eggs one at a time followed by the bananas

4. Add the walnuts, raisins, left over rum, chocolate and vanilla essence

5. Slowly mix the dry ingredients into the mixture

6. Tip into the loaf tin and bake for 60-75 minutes, or until a tooth pick comes out clean

Technically you're meant to then cool the damn thing, but the smells normally make me so hungry I have a slice while it's still warm and the chocolate is melting. I've also found that several days down the line you can microwave a slice and have it with vanilla ice cream for pudding. The rum taste seems to diminish over a few days, so it may be worth splashing your slice with neat rum if you want more of a boozy kick.  

Enjoy my fellow foodies x

P.S. Despite a possible hypo-manic incident this morning (is waking up at 5am and cleaning the kitchen, studying and researching a last-minute trip abroad before 6am normal?) my mood seems to be holding up okay. Thank the Lord.  First day back to work tomorrow. Fingers crossed it all goes well (for me and my patients!)

Lucky number seven

Number seven showed up in the waiting room yesterday and greeted me with a firm handshake. “I used your first name just there and not your title because I didn't want to give the game away,” he said, with a grin. Give the game away. I am a doctor, a mentally ill doctor sitting in a waiting room of mere patients.

Number seven seems quite fierce, very direct in his questioning technique. Who do you live with? How long have you been with him? (Blimey, eight years? That suggests you're good at maintaining relationships). The man is smart. Not the type of psychiatrist who is easily conned or manipulated. Reminds me of number two...

Number one (my favourite so far) referred me to number two when I was too self-destructive to be managed in the community. Number two wasn't having any of that shit. One week I hoarded the antidepressants the nurses dished out each night and landed myself in hospital on a cardiac monitor after an overdose. Number two went mental. You don't bloody harm yourself with a drug that I prescribed to make you better. Do it again and I'll refuse to see you! So I didn't do it again. Not until I was back under the care of number one.

Number three picked me up at medical school. The man couldn't stand tears. Rang my social worker in a panic when I started crying during his clinic. Number three told me that it wasn't Prozac that was killing my libido, it was the fact that I was a woman. I can see why the man might think that. It's hard to imagine any woman he's ever slept with enjoying herself. Of course, that's not to say I've never fantasised about sleeping with psychiatrists. Just not him.

Number four was private. Cost £100 an hour. It's true – turns out money really doesn't buy you happiness.

Number five just told me to take my medication and stop bloody drinking. So I did. And I got better. Not exactly rocket science is it?

Number six seems okay. So far.

I have both loved, respected and at times loathed, hated and feared my psychiatrists. Funnily enough I often think about becoming a psychiatrist - all I need do is get myself onto a training programme next year and somehow survive within the profession. I can't decide how suitable psychiatry would be for a person like me though. In some respects I think my experiences would make a damn good psychiatrist. But could it end up breaking me? Number six told me to choose which speciality I go into very carefully in light of my illness. Avoid night shifts. Avoid too much hard work... But I want to follow my passions! I can't turn down a speciality for fear of becoming unwell. What if this truly is my last episode? Some people would call that denial. I call it optimism.

Dreaming of aubergines...

I'm beginning to think that being a doctor could be a bonus when it comes to accessing treatment for bipolar disorder (once you are able to get over the trauma of temporarily being a patient, not a doctor). On this occasion I seem to have been fast-tracked through the system. Appointment slots have miraculously appeared for me. My GP made it very clear that I was a doctor during the whole referral process... As a result I got myself onto a CBT programme within a fortnight. Whether it will help God knows, but I've never known the NHS to act so quickly in response to mental illness. I'm being treated almost as well as a cancer patient!

In other news, I've just woken from an extremely vivid dream about giving a presentation at the UK's “National Aubergine Conference”. Nice. An hour before I was lying in bed weeping. I haven't been able to leave the house all day. I checked my email and made myself a fantastic lunch (surprise, surprise), but then froze and started to cry endlessly, mainly worrying about my career. Checking out the aubergines at this conference was a real mood booster though. When I woke up I had all but forgotten my woes and had set my mind to thinking about what I could next cook with an aubergine (when I've thought of something I'll let you know). Is that the sort of experience I need to be talking to my psychiatrist about?

When the other half gets home we've planned to cook another recipe from the Kitchen Shrink - grilled trout and toasted sunflower seeds with leeks. Supposedly the fish oils will do me no end of good. Don't get me wrong, I love fish, but sometimes the thought of deliberately cooking something healthy just makes me crave pizza. And not thin, upmarket pizza. Thick, greasy, cheap, pan-friend pizza of the Pizza Hut variety. With lots of meat. Meat and aubergines.  

Sunshine, bluebells and scrambled eggs...

Life seems to be returning to “normal”. I saw my new psychiatrist this morning who was pleased with my progress and am now hoping to return to work next week. Looking back over the past month it's clear that food has helped somewhat: maple syrup, apple and apricot slices, chocolate cupcakes and home-made king prawn soup have all been key to putting a smile back on my face! Animals, museum exhibitions and a variety of healthcare professionals have also played a role.

This weekend London was blessed with sunshine. We went for a long walk in the park, the longest walk I've managed since becoming depressed again. Bluebells are starting to crop up everywhere, and I enjoyed seeing them. I enjoyed having the sun on my face. We even went shopping and I bought a new dress. I enjoyed clothes shopping! Farewell anhedonia, farewell.

Perhaps I am getting overly excited. I can feel that my mood is still fragile and I need to keep life simple for a few more weeks. I have an appointment with Occupational Health tomorrow and will need to secure their blessing before returning to work. As a doctor my biggest fear is being rejected from my profession on the grounds of mental illness. Of being seen to be unfit to practice. That fear is completely unfounded of course, but it is still there at the back of my head. Patients don't want mad doctors after all. But am I mad? Really?

On a positive note, I've discovered a new edible antidepressant: scrambled eggs. Not just any scrambled eggs. Start by frying up a couple of spring onions and a red chilli in pan with a splash of olive oil (get rid of the seeds if you can't take the heat). Once the onions are soft add a bit of butter and scramble in three eggs. Perfect. Plus, it's not unhealthy like cakes are. I had mine with rye bread, but if you're one of these anti-carbohydrate freaks then it ticks all the boxes – although why anyone would turn down authentic German rye bread is a mystery to me...