In my previous articles I have talked at length about how as doctors we must let go of our own judgements to fully understand the significance of disease to a patient and their journey. I ask you now to turn the diagnostic eye inward and realise how, when properly tempered, our own disease experience can help us to understand others, gain strength, and be better advocates for our patients.
I suffer from bouts of severe depression. I have been told to tell my trusts, the GMC and my supervisors about it. I am aware of the societal stigma. I am aware that as a doctor I have to be at the best I can be to help my patients, and that in a midst of a severe bout have to be responsible enough to take a step back. I have had to do this before. I have had to deal with both support and stigma, in and outside of work. I am proud to carry on in spite of it.
If anyone wants a simple and powerful analogy of depression, Google 'the black dog', or think of JK Rowling's 'Dementors'. I personally love how the patronus is made powerful by happy memories and takes the form of such. I know the form mine would take.
I find it best to describe depression as an old friend to be welcomed and forgiven. He or she acts with the best intention, and needs to be treated with care. In darker times I lament him/her, but realise that he or she is just a sad and lonely being hoping for attention. In the end they only want to be seen. I have depression, but I am not defined by it. It is a wave I must ride on occasion and is completely unpredictable, and may disappear as quickly as it came. Either way, I am learning to manage this condition, temper it and own it. Turn it from an enemy to a friend, or at least a guide. Remember Harry following his patronus in the Forbidden Forest.
I have found that the periods of illness that I have had have allowed me time for deep reflection. A large number of my articles were written during, or in response to, depressive episodes and the musings I would have. This musing has led to an exploration of physics, philosophy, science, poetry, music and art and taken me as far as Vienna. I would wholly recommend Vienna, but not Nietzsche. I would also recommend delving into classical fiction; authors know pain very well.
One particular focus that I think is worth building on is the idea of disease identification and auto pathology, ie telling the story of a disease to learn new strengths. I have decided to use my dark times to learn what it is to be bright. To re-evaluate what is important. To learn from my struggles to help others in theirs. My conclusion is that what people care most about is their connections, be them to people, to love, or to things they hold as purposeful above and beyond the simple day to day. People wish to transcend.
Disease, be it mental, physical or a combination of the two, takes away this purpose and these connections. It may leave you bedridden, without a voice, without use of a limb or without time. People want to fly; disease provides an anchor.
When I talk to a patient my immediate goal (other than making sure they aren't about to keel over) is to ascertain what in their life has gone amiss and how I may help them. No one particularly cares why their appendix hurts, just that it does and they can't be them for a bit. My job is as much to understand and diagnose disease as it is to understand my patient. This approach has often been met with surprise, but also commendation: 'Finally, someone who understands'.
For someone with severe depression, sometimes this is a rocky path. Having a map of this path means that my connections with people are often deep from the outset. I have found that by building on this shared experience of disease the connection made between doctor and patient is much stronger. I do not believe that for one moment any patient would hold any reason for me to understand their plight in any way as reason to switch to another doctor. One caveat is that this deep empathy is a hard cross to bear at times.
So what does this mean for other medical professionals? What is my advice (if you so choose to take it)? Make friends with your particular beasts; find connections from your experience to better understand your patients' plights. It may not help you form a diagnosis, but it will definitely help you to form a trust that leads to better-quality healthcare. Remember, physician heal thyself, but do not forget the pain. Learn from it. Use it to understand the elderly lady or young man in front of you who is scared to lose who they are. Pain is a universal language, but so is love and compassion.
Remember Harry's patronus.