The rollercoaster ride of being a doctor means that your high moments are a rush of adrenaline, and yet your lowest moments can be rock bottom. There is nothing like being a part of a resuscitation. Everyone is gathered around one patient in organised chaos. It’s a high stress situation, with pressure to get vascular and airway access fast. You go into an almost flow state, and can feel a huge sense of satisfaction when you nail that arterial line in the midst of the pandemonium. And yet, the lows. The lows are so low that you may lose sleep for weeks. Avoidable patient deaths, stillbirths, sick infants, and just an overarching sense of exhaustion. Sometimes the lows are so low you feel like you can’t bear it any longer.

Such is the life of a doctor.

The depth of the lows is the price you pay for the height of the highs

Adam Kay This is going to hurt

Lately in the emergency department I’ve been experiencing quite a few highs. Medical conditions that often have immediate fixes, with instant gratification. Long gone are the general medicine days where we have centenarians that seem to be crumbling in every possible way.

My recent term has been quite fulfilling at times, and even an adrenaline rush. Reducing a pulled elbow of a toddler, stitching wounds back together, properly diagnosing and treating patients in one go. My previous intensive care term was equally satisfying at times, when I could glide in central and arterial lines.

Yet there is always this small feeling of fear in the back of my mind, with any procedure. You must know the risks and the possible complications.

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The fear of complications

My first central line, I was incredibly scared. It went super smoothly luckily, with no issues, however I was so concerned there would be a problem. The jugular vein is so close to important structures, and you hear of all the horror stories.

Someone getting the artery and not noticing, so the patient had an air embolism to the brain. This led to permanent disability in an otherwise well person.

A resident hitting the lung, leading to a large pneumothorax, subcutaneous emphysema and respiratory distress.

Patients who have a cardiac arrest when the wire goes too close to their heart. Or doctors who inadvertently forget the wire, and leave it inside the patient, requiring removal.

There have even been cases of cardiac perforation from central lines.

The night after inserting the CVC, I spent it researching every scary complication. I could barely sleep, worrying that I had somehow hit their lung. I came back to work the next day to see the chest xray as before. Perfectly placed, no issues.

Compared to other medics, I probably worry too much. But I can’t help remembering all the possible risks in anything I do with a patient, and can agonise over harming anyone.

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The Low Point

Yes, there are highs in this career. However, as ex-doctor Kay says “the depths of the lows is the price you pay for the height of the highs”.

The buzz of a successful procedure wears off fast when you’re faced with terrible situations. A type of situation where someone loses their life or has a life-long disability from either a disease you could not fight, a missed diagnosis or an error.

Is there anything sadder than that? In other professions, your worst mistake may cost money or time. But rarely do mistakes cost a person’s life or lead to permanent injury.

When these lows happen, and it happens to every single doctor, it can be difficult to process and recover.

You carry a weight of grief around with you, and are expected to continue work as usual. Even if you ask for help and time off, it can’t be done. There is just not enough staff to cover for when doctors need time to mourn.

In the end, doctors are not infallible robots, they are human beings with real emotions. No one can continue unaffected when they are dealing with problems as weighted as this.

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The real world effects

An emotionally loaded profession such as medicine is bound to cause stress. Dealing with death daily is distressing. Doctors not only have to manage this, but also navigate understaffing and long hours. Constantly over-stretching yourself to the point of physical and emotional exhaustion is not sustainable.

There is a reason why one doctor commits suicide in the U.S. every day — the highest suicide rate of any profession. And the number of doctor suicides — 28 to 40 per 100,000 — is more than twice that of the general population, new research shows (1).

In England, four hundred and thirty health professionals died by suicide between 2011 and 2015. The equivalent of almost 2 healthcare professionals a week.

Australia’s Beyond Blue found that young doctors in particular experience levels of psychological distress that are significantly higher than in the general population, and thoughts of suicide are twice as prevalent (2).

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What can we do?

How can we make it better? We should normalise speaking up about our negative experiences in medicine. There should be no stigma around doctors discussing their mental health, and everyone should recognise that there are ‘bad days’ in medicine.

More staff would change things drastically, to reduce the stress and work load on everyone. Sustainable hours would reduce exhaustion, burnout and medical errors.

A process of debriefing, a readily available counsellor and the ability to take leave after emotionally distressing situations should be widely accessible.

Maybe one day it will change, until then doctors need to protect themselves as you can’t care for patients if you’re unwell or struggling.

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References

(1) Doctors’ Suicide Rate Highest of Any Profession, Pauline Anderson 2018, Web MD.

(2) National Mental Health Survey of Doctors and Medical Students, Beyond Blue, 2013.