Posts Tagged ‘alcohol’

First off, my ‘date’ yesterday afternoon was really rather nice. I think I’d like to see him again.  I’ll stop before this gets too schmalzy.

Some things this week have been tough, though. I know I am prone to a lot of introspection, but I think that this week with all the other things going on (job application: finally submitted!) has led to me thinking more than ever about mental health, and my own path through it. More specifically, after seeing pretty quickly that 30% of beds on accident/emergency are perpetually filled by overdoses, self-injurers and suicide attempts, it’s made me question what made me, to put it bluntly, manage to hold on when I was at my lowest. I don’t always know the answer to that. I don’t know what separates me, from the people who come in to the ER and sadly never leave. I don’t know why I was brought out, and they were not. I do not know. Sometimes, I think it’s mostly because I was too scared that if I tried anything, I’d end up being treated in this same ER, with my peers on placement peeking at me round a curtain. It was the potential for shame, that kept me alive.

But on the other hand, I’m kind of struggling with having a flatmate (and best friend) who is now being started on treatment for mid-grade depression. I encouraged her to go back to the doctor’s this week for follow-up and afterwards,  and was trying to explain that she shouldn’t assume that her medication won’t work just because mine didn’t, but just ended up frustrated. I think part of it is that when I really really needed someone to hold my hand through things, there was no one quite up to the job. I know I asked her, at one point, to phone and make an appointment with the psychiatrist I’d been referred to for me, as I just couldn’t face it, and I needed her to go and fetch the number, and do it, there and then and take that task from me. I needed her to do it and give me a date and a time, and make sure I went. I couldn’t face it myself. No one rang for me, and so I never went. No one encouraged me to go back and see another doctor, or keep taking medication. With depression, you sometimes need someone to take charge and just force your hand; I think they were unsure or afraid or doing that; perhaps it seemed too difficult. I fought my way out of last year without medication or psychiatric input, or anything much, really, and am still reeling from it. I’m still not back to where I was. I don’t know if I’ll ever get there.

And I want so badly for this first, low dose to work for her. I want her to be one of the ‘miracle cures’. I’m praying for it. But I also am just so bogged down with wondering why it did not work for me, why I was less worthy, or deserving, or able of mending myself. I ended up on three times the starting dose, and it was never right. I’m helping guide her through it, but that small part of me is angry that I had no-one who knew enough, or was confident enough, to tell me, show me, how to get through depression. My flatmates were not medical and did not know. I know it doesn’t mean at all that they didn’t care – but sometimes, caring isn’t quite enough. Sometimes you need action and motion. It’s hard. Sometimes, I feel like I’m always leading the way or teaching from my experiences, but having to learn the hard way myself – and I know that’s partly because I hardly make things easy, but by the same token, last year, there were all these people I was having to go and talk to, and to be honest, none of them really did much for me. They didn’t return my emails, or check in. They didn’t chase me up or ask my tutors to keep an eye out. They just looked awkward when I cried at them and promptly forgot me.

And it makes me angry when she says things about counselling not ‘being for her’, as though you have to be a bit self-indulgent or attention-seeking to benefit from it. It makes me feel fobbed off – I’m not sure anyone who has not ‘done counselling’ knows how hard it is, or how much effort and courage it takes to go, every single week. I’m not sure she realises that it’s no easy option. It’s been the most painful experience of my life. Perhaps it’s my fault for never telling anyone that I get there fifteen minutes early so I have time to coax myself through the door, or that it still makes me cry myself to sleep every single week, and leaves me drained – but I don’t appreciate feeling as though I’m a weakling for trying it. I’m a stoic, in many ways. Counselling has gone against all of my instincts and taken away any feeling of safety and privacy I had. It’s not for the faint-hearted.

I guess, in ‘mental health’ terms, this week has just been ‘extremely triggering’. I’m not sure I’d really appreciated stuff like triggers before. I’m on the nightshift this weekend, and spending twelve hours at a time surrounded by drunk people, is wearing me down. However, this time in a week I will have a week’s holiday to look forward to, and I really can’t wait to have a few days away from the city and medicine, where I don’t have to think about all of this.

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I’ve got a few posts kicking around in my head but thought I’d start with a more personal, less gungo-ho theology one for now. I headed home for a visit this weekend as it’s unlikely I’ll be back before Christmas, to collect my winter coat and check in with my parents and brother. It’s been a really busy week on my attachment, with a lot of 12 hour days without breaks- but also really good and I’ve learned a lot, and have got to scrub in on a lot of surgeries too, which is always fun – but I was pretty knackered by the time I was on the four hour journey South.

Home as always, is strange. There is so much that my family don’t know about me, that sometimes it really does feel like I’m playing to the crowds, and after a fairly painful discussion about family stuff in counselling last week (is it ever, not painful?), I was dreading it and feeling pretty vulnerable. On Friday night once everyone had gone to bed, I was in my childhood bedroom, looking out at the night sky from a darkened room, as I did so often when I was younger, wondering how it was that the sky was so peaceful, when inside our walls, everything was chaotically falling to pieces. I feel so empty, so two-dimensional, when I am here. My old room in many ways is a catalogue of who I was – the list of grades needed for every medical school in the UK, which I pinned up three years in advance to spur me on, is still there, and now, a year from qualifying, it’s odd to look and realise that I’m so close to my childhood dream. The photos of the first learning disabilities respite camp I worked, age 16, are still there – and I’m still involved with similar things. The stack of thank-you cards from the Brownie unit I helped to lead, and used as an escape, is still there. The photos from the sixthform ball, me awkward in a balldress and heels, are there, despite the fact that the evening ended in tears when I ended up, as usual, being the ‘responsible’ one calling the parents of people who drank too much and were sick in the floor, further fuelling a complete fear of alcohol that would tar the future years with uncertainty and mistrust. The books on the shelf suggest that even then, I was painfully searching for answers, something to explain what I was seeing and thinking and feeling, something to help me get over and get through. Jostein Gaarder, my fifteen-year-old self owes you a debt. My old room almost feels as though it’s in mourning for something I can’t quite place.  Being back reminds me of how much I hated those last years at home, of how desperate I was, for such a long time. It reminds me of how young, and vulnerable, and afraid I was, how lost and alone and bruised, I was and to some extent, still am.

It’s pretty much five years to the day since I moved up to University and every year around this time, I think back to what that meant. For me, the thought of escaping and starting over, was intoxicating. I’d been ticking off the months till I was predicted to leave, for three years. I couldn’t wait to get away from it and find people ‘like me’ who wanted to change the world and change it whilst sober. The reality was a little different; my first week in medical school landed me in a horrific tutorial on alcoholism met with (probably fairly typical) bad attitudes from the other students and I literally was like a rabbit in the headlights, running away, so needing to find somewhere, anywhere, that alcohol and its damage couldn’t get me. I was so upset I ended up catching the first train I could, regardless of destination, and spent a day wandering around a city I didn’t know, just trying to get some peace and sort my head out before realising that I was truly on my own, not knowing anyone, and that I had no choice but to pull myself together and head back. I returned, headed out with a group from my halls, and churlishly drank more than I ever had (not hard, as I’d not really touched it at all before then), and ever will, to try and push through. If you can’t beat them, join them, after all. It was awful. My medical career did not get off to a sparkling start. Fortunately, it got better.

Now, I am five years on, stronger, older, wiser, though often, it doesn’t really seem that way. I don’t want the next decade to be as hard as this one has been. I don’t want to lose more time. I don’t want to still feel so caught and tethered by the things that bring me down. At twenty-three, there is still plenty of room for life to throw things at me that will knock and hurt me; if I’m going to manage, I want to be free of the weights my family life hung about my shoulders. Going home still wears me down and makes me feel fainter about the edges, as though if I’m not careful, I’ll fade into the wallpaper and cease to exist. It still makes me feel masked and costumed, concealed and false. When I was eighteen, the thought of being stuck in a room talking about my issues scared the daylights out of me. It still does, but I do it.I’m learning. I just hope that I’m learning enough.

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I’m on a general surgery attachment this month, and am with the emergency team this week so have been spending long days clerking patients and following surgeons as they charge round the hospital. As ever, I’ve had a high volume of patients with serious problems induced by alcohol, which longterm readers will know is something I struggle a lot with. This time, however, I’ve literally been the first person to assess them before I’ve handed over to my seniors, and there’s a responsibility, and opportunity, that comes with that.

Something I’ve noticed is that ‘problem drinkers’ tend to fall into one of two categories; they either are completely adament that they are ‘not an alcoholic‘, that they can stop when they want, and that this somehow makes them ‘better’ than others they see labelled in that way – or, as soon as you meet them, they tell you that they are an alcoholic, in this defeated way that suggests that they kind of know that not much is going to be done, aside from patching them up and shipping them home again. It’s as though the second group think that if they own up, we’ll tar them with a coat of hopelessness, and give up on them. We won’t fight for them. We’ll leave them be to carry on, which is probably a lot easier and less scary, than sorting their problems out. Sadly, this is often what happens; most healthcare workers only see the problem of the ‘revolving door’ patient, who comes in again and again, and never seems to change, regardless of whether it’s an issue of access to help, or ability to ask for it. I want to be someone who has time.

The interesting thing is that often these patients, in either group, don’t have the right label for themselves, at all – dependancy, afterall, is a syndrome, characterised by both physical (such as withdrawal symptoms) and more psychological aspects (such as narrowed repertoire, and salience of alcohol over other substances and past-times). I ended up having a long conversations with two of my patients, one of which lead to him realising that he does in fact have a dependancy on alcohol, and is quite a long way past the ‘social drinker’ he had classed himself as – and the other with someone who is a longstanding ‘known alcoholic’, trying to get to the bottom of what else could be done to help, and work out why it is that he’s got such a poor view of himself that he didn’t think anyone would bother to help him sort his drinking out in the first place. I guess a learning point here is that often we don’t have accurate views of ourselves, whether by lack of awareness, denial, or selfloathing. We sometimes need another perspective to get things straight. We all do this to some extent.

As always, I found talking to these patients hard to do, – and as always, every time I speak with a person with substance misuse issues, I think of my dad, and the years we all lost to his drinking, and all the hang-ups I’ve garnered from them – but I was also glad to be there, as someone  supernummary who has a bit of extra time to spend with patients, and doesn’t just fob them off as a no-hope case. I was glad to be there, getting the story out in the open, listening to the reasons they had drank more than usual, and being able to answer honestly, about what they were doing to their health. I was glad to be there to stick up for them when I reported back, as I like to think someone might have stuck up for my dad when he was at his illest, and not just stuck him in a corner to sober up. If we don’t stick up for them, they will never get the help they need. If we don’t stick up for them, they’ll keep that revolving door swinging until one day, they die before their time. I know that it’s so easy to get ‘compassion fatigue’ when you’re working in a busy unit with a high turnover, and are always on the go, but I want to help combat this.  My dad probably wouldn’t be alive today, if someone hadn’t help us get him into rehab, when they did. He’s alive because someone had the time to help and the time to care. I don’t want to find one day that I have someone’s blood on my hands (figuratively, but possibly literally given my line of work) – because I didn’t care enough. I want to make sure other people get another chance. As a Christian, I’m only too aware of how much we all need second chances. The God I follow, is a God of second, and third, and seventy-seventh chances. If I’m going to follow, I need to be a person who gives these chances too, as well as receiving them.

I know that it’s likely I may always have shaky moments when I’m managing these sorts of patients. I know that sometimes, when I’m already fraught and tired and emotional, it may break me a little, for a while, and make me cry in a corner somewhere, for a while. It’s one of my struggles, one of my wounds. We all have them. It reminded me of this post here. But I also know that I’m learning, all the time. I’m learning. And sometimes, I think that’s the best we can hope for, the best we can aim for. As long as I keep learning, I’ll be fine.

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It’s not been a good day. I was in clinic this morning and was already feeling cross as the junior doctor I was sitting in with didn’t seem to think it was important to tackle the fact that one of the patients was drinking 16 units a day, and had what his GP called ‘unexplained stomach trouble’. You don’t need a medical degree to join the dots, sometimes. It needed sorting out. It’s tough, asking about drinking, especially as ‘problem drinkers’ don’t exactly respond well – but at the end of the day, it’s in the job description. Sort. It. Out.

At lunchtime my current hospital had a talk scheduled from.  one of the mid-grade doctors who was speaking on ‘how health professionals can stay healthy’. Most of it centred on his battle with dependancy on alcohol, prescription opiates, and non-prescription drugs. Let me be clear that I’m so impressed that he’s now off everything, giving back to the abstinence programme he went through, getting his career on track, and is brave enough to stand up and say what he did in front of colleagues – it’s brilliant.

However, what is not brilliant is being taken aside at the end and told I didn’t look as though I was engaging with his talk, and was it because I have the mistaken view that addiction is not a disease, and certainly not one doctors get? Because, you know, it could happen to me too….

Excuse me, for getting angry when he said that although he has not used since the birth of his son, that his son is not why he abstains – his own self-love, is. Excuse me for not wanting to look in depth at his AA keyrings (which are given at certain time points of abstinence – a month/two months etc) when I’ve seen my dad come back with them enough times, and when he falls off the wagon, start over. Those keyrings represent a lot of achievement, but they also represent a family who are waiting on eggshells for someone to start again, at the beginning, and plunge everything back to uncertainty. They represent months of children being neglected as they are less important than sobriety, which is  just one more thing they love more that you.

I’m sorry, but I believe that when you chose to bring a child into this world and raise them, they should be your first priority. Call me an idealist, call me old fashioned, but if you don’t want to do that, give that child to someone who will. Parents should be staying sober for them, over themselves. They should be protecting them. My father loved his whiskey more than he loved us. My mother loved our reputation as a clean living, achieving family, more than she loved us. Yes, you get sober – but the first reason should be for your children and spouse, who’s lives you have turned upside down. Otherwise, you’re just chosing yourself again, as always. This doctor said he stayed sober for himself, not his young son. I have an issue with that.

I know that substance use, misuse and dependancy is something I struggle with, and I have worked to tackle this head on by doing placements, projects and assignments within the field of substance misuse medicine. I do not bury my head in the sand. I tackle my issues head on. Sometimes I learn a valuable lesson. Other times, like today, I get completely incinerated. I don’t need some evangelist for recovery telling me about the difficulties he’s had; I’ve seen it. I’ve come through it. I remember it, every time I see someone drink more than they should, every time I have a sip of wine, and every time I don’t, because I know that it will be too much, too painful for me. Coming off alcohol and other drugs is so difficult. I have a lot of respect for those who manage it, including my dad, and I will correct anyone who claims otherwise, who claims that it’s just a weakness of will, and that  people chose a life of dependancy. Just don’t expect me to congratulate anyone for sorting their life out and leaving their family in the lurch. My dad is sober at the moment, yet I am in recovery from depression not entirely unconnected to his prior habits and am still tethered to counselling. His drinking has left me scarred and scared. His addiction has painted me black, too. It, among with other things along the way, broke me and I still don’t know if I’ll ever achieve that elusive ‘wholeness’. I don’t know if I’ll ever stop bleeding out and hurting. The effects don’t stop when someone puts down a glass for the (yet another) final time. The damage grows and continues. It continues to infect and supporates in quiet corners, in quiet people.

So – I’m feeling pretty fragile today. Strangely enough, this time I didn’t seek it out, the pain just found me. It’s never far away. I know that recovery from depression is a tale of hills and valleys, a trail that we follow for months – but I was hoping for just a few more days in a row without crying. I was hoping for a few less reasons to feel that once again, I just can’t handle parts of this world we’re in. I’m trapped again. I hate that out of nowhere, my issues with drinking spring up and crowd me out. I was upset enough that I left the ward early. I never do that. It got the better of me. It beat me. I can’t, can never, let it beat me.

The odd thing is that the other day, I was back in counselling after a month off and we were talking about drinking, and L (counsellor) asked if I would seek a medical specialty that didn’t have a large number of patients with substance issues – and I said, and stick by it, that although I wouldn’t dedicate myself to it, I want to be part of the solution to this. I want to give something positive back. I want to help people get clean. I want to stop the cycles and the sickness that flows through families. I will not bury my head in the sand. I tackle my issues head on.

Today, though, it was a bit much and I could do with a hug but am home alone.

God, how long is this going to be too much? How long?

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