Five gruelling years as a junior doctor taught novelist Joanna Cannon that compassion and understanding mental health can be a lifesaver – and not just for the patients.
Joanna Cannon – now a bestselling author – was in her 30s when she worked as a junior doctor, before specialising in psychiatry. She found the conditions and long hours so draining that she became ill. However, those years taught her that embracing what makes us human is as crucial as restoring a heartbeat. She reveals here how she survived the unrelenting shifts that nearly broke her.
I had been working in A&E for 12 hours straight without eating or drinking – something that wasn’t considered unusual by anyone in the department. Perhaps through the accumulation of many days like this, I began to feel faint. Waves of nausea tumbled through me. My hands were shaking too much to even write up the notes and I certainly didn’t trust myself to take blood or insert a cannula tube into a vein. It was also affecting my judgment. Extreme tiredness and lack of food have the same effect as being drunk and I was worried that I would make a mistake.
I finished dealing with my patient and looked around for a chance to escape, just for a minute. The department was in chaos. Every bed was occupied and a line of paramedics and their patients snaked down the corridor. The guilt was overwhelming but the need to escape was even more so. I was just about to make a run for it when my consultant appeared and told me which patient to attend to next. I knew that the canteen would be shut in ten minutes. I needed something I could eat while I worked, something to help me function safely.
‘I really need to eat something,’ I told him in a very small voice. He stared at me. ‘There are patients waiting. It’s the patients I’m thinking of.’ The look of disgust on his face was so obvious that I can conjure it up even now.
Over the next few weeks and months I became fixated on the risks of spreading infection. In between patients I would stand at the sink and scrub my hands raw, but still I wouldn’t stop. Soon my knuckles started to crack and bleed. One of the nurses noticed and gave me a pot of Sudocrem, and that small act of kindness in a sea of despair moved me so much I went into the sluice room and sobbed. I barely ate. I hardly slept. I lost vast amounts of weight. My hair was matted and stuck to my skull.
The rest of the hospital seemed able to cope. I watched other doctors march through their work with what seemed like minimal effort. I walked at the edges, treading carefully. My goal each morning was to somehow get to the end of the day without losing my mind.
If you continue to walk at the edges, it doesn’t take long for others to notice. I had a small group of people I could visit whenever I felt unable to cope. Different nurses dotted around the hospital who were exceptionally kind. The bereavement 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 wonderful nurse.
I had arrived on the wards filled with enthusiasm and the desire to be the best doctor I could possibly be. The inadequacies of the system, the lack of funding, the absence of people to provide the necessary care, the misery and the death and the dying had all whittled away at me until there was nothing of that doctor left. Sometimes she felt so far away that I wondered if she had ever existed.
When we visit a hospital we see an army of health professionals and imagine, strangely, that they are invincible. That understanding the mechanism of a disease somehow prevents a person from catching it. Doctors are objective, calm and knowledgeable. Doctors heal people. But the reality is that you spend years at medical school learning how, only to arrive on the wards and discover quickly that there are many things that you will never be able to fix.
Gill was a patient in a side room on Ward Eight. We were the same age almost to the day. 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 did not. On the ward round I would write in the notes as the consultant spoke and think about past birthdays, how we had both assumed the same guarantees in life. As I looked at her it was as if I was staring at a mirror, and the reflection was almost unbearable. I needed to find another difference between us, because if I didn’t, I was worried I would never be able to turn away.
We were now at the point where the only outcome of Gill’s treatment would be to prolong her life a little, where the small amount of life she had left would be ruined by the very same medication that delivered her that time. It’s a decision many patients with incurable diseases face. Quality or quantity. When I walked into Gill’s room late one afternoon in November, I knew that decision had been reached.
I had been called to reinsert a cannula. ‘You don’t need to find a vein,’ she said. Her face was pale. ‘I’ve had enough.’
It was discussed with the consultant and Gill’s elderly parents. There were tears and sadness but also a strange sense of liberation, as if Gill had finally taken back the reins.
I often visited Gill and her parents, who had set up home in her room. Sometimes they had a question about the medication that was keeping Gill comfortable. Sometimes I think they just needed someone else in the room.
One night Gill’s mum ran down the corridor. ‘Could you come now?’ she said. ‘Gill’s breathing has gone funny.’ Gill lay back with her eyes closed and her face was ironed of all the agony she had been through. She was more relaxed than I had ever seen her, and in those moments I saw a glimpse of her before the cancer. When she was just Gill.
‘I don’t think it will be long now.’ I turned to her parents. They looked small and helpless. ‘Would you like me to stay?’ I didn’t for a moment think that 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 put my bleeper on silent and sat on a plastic chair against the far wall.
‘I don’t know what to talk about,’ Gill’s mother said.
‘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 that she will hear will be happy memories.’
For the next few minutes I listened to a life lived parallel to mine even though our paths never crossed. In among the stories, Gill’s breaths became longer and longer. Until.
‘Gill hasn’t taken a breath in a long time, has she?’ her mother said.
‘No, she hasn’t’. I walked over to the bed and held my fingertips against her skin, watching for the slightest flicker of movement. The next sound I heard was Gill’s mother softly crying – a mixture of relief at the end of her suffering and despair at what might have been. Her mother stood up and pointed, ‘Could you straighten her necklace? She hated her necklace being crooked.’ It was a fine chain with an amethyst pendant. Her birthstone. My birthstone. I gently reached back and adjusted it. It was the kind of thing you’d do for a friend or your mum.
‘I’m so sorry.’ I felt the tears overwhelm me. The tears weren’t just for Gill. They were for the elderly couple who had watched their only child take her final breaths. ‘It’s so unprofessional to cry,’ I said. ‘I’m sorry.’
Gill’s mother put her arms around me. ‘You are a human being first and a doctor second, and I can’t tell you what a comfort it is knowing how much Gill meant to you.’
There we stood, in curtained light, all crying for someone who deserved so much more from life. Being with Gill’s parents was a job I had done well. If I helped to make the most traumatic experience of their lives even the slightest bit more bearable, it meant I was learning to be a good doctor after all. Gill’s death was one of the worst days I experienced as a junior doctor but it also reinforced my decision to work in psychiatry. Because those moments reminded me of the kindness one human being can show to another, to a stranger. It’s nothing to do with wearing a uniform or holding a stethoscope, it’s about being human, and in psychiatry I began to witness the very best of humanity.
The most vital thing I learned as a junior doctor was that lives are not only saved on the floor of an A&E department or a surgical theatre, but in quiet corners of a ward or during a conversation in a garden. Lives can be saved by building up so much trust with a patient that they will take a medication even if they think they don’t need it. Lives can be saved by listening to someone who’s never before been heard.
I was reminded of this when I wrote a card for what would be an elderly couple’s last anniversary. When I ran around the hospital hunting down ice for a dying woman who craved cold water. When I smuggled fish and chips on to the ward for an old man who had lost his wife and couldn’t face eating. None of these make me special. Thousands of medics and nurses do things like this every day. It’s what makes us human and sometimes walking across that space towards a patient is the only thing we are able to do for them.
Many times during my training I would say to myself that I wished I had never done this. Now I look back and can’t imagine having done anything else. Working as a psychiatrist saved me. Mending, like breaking, can happen in the unlikeliest places. Breaking is accumulative. We collect small moments of despair and unhappiness. Mending is exactly the same. The small moments of compassion we witness, the more humanity we see, the more likely we are to be able to mend ourselves and the quicker we are able to heal.
This is an edited extract from Breaking & Mending – a Junior Doctor’s Stories of Compassion & Burnout by Joanna Cannon, to be published by Profile Books and Wellcome Collection on 26 September, £12.99. To order a copy with a 20 per cent discount until 22 September 2019, call 0844 571 0640; p&p is free on orders over £15.