In my final blog post for the ‘Surviving at the Frontline’ series, I wish to talk about contradictions.
As I navigate the transitional space between my individual and group identity – the dance that we perform between our independence and interdependence; our belonging and othering; our need to be loved, and the stark denial of this – makes me dizzy.
How long can we flit between these polarities, trapped in fear? Is it possible to hold space for two contradictory truths? I owe it to myself, and to you, to share the joy as well as pain I’ve experienced on this path, thus far.
Three months ago, I handed in my resignation. It took 18 months of rumination, panic and one attempt at return to work, interrupted by my body screaming ‘No’!
I was in the middle of my first clinic after several months off when the abdominal pain started. I still shiver at my desperation to complete the clinic; to not let my patients and colleagues down; to maintain my scarred omnipotence, which is an almost mandatory part of our ‘doctor’ identity.
I didn’t wish to show any more signs of being human, of feeling pain. It had been deeply ingrained into our identities that these aspects of ourselves would not be ‘helpful’ to our patients. But as they say, ‘your body keeps the score’. When one doesn’t listen to their body, it stops listening to them. I was blue-lighted to A&E.
As I lay on a stretcher in A&E for nine hours, in pain, I experienced the good, the bad and the ugly sides of the NHS as a patient. It’s not that I had never been a patient before, but on this occasion, the timing was symbolic. Roles were reversed. I had little control. I was vulnerable. Although this is true for all of us throughout our lives, as healthcare professionals we tend to deny our vulnerability by hiding behind our roles, status, egos and the delusion of power and control.
Instead, here I was, stripped naked without any access to those defences. It felt like an experience that was necessary at this point – being transported back to basics. Life is not a gentle teacher because it has to cut through the years of brainwashing defences steeped in pain and its expression viewed as weakness.
I decided not to disclose that I was a doctor, perhaps due to the imagined embarrassment of being seen as expecting preferential treatment. Also, on a deeper level, I was learning to let go of the false control that my identity might afford to me in such situations. I let myself be vulnerable and uncertain to fully experience all that was happening to me.
This was a very difficult process in the face of excruciating physical pain, especially when the only relief was a morphine injection. I did wonder what part of the pain was physical and what part was emotional.
The A&E nurse, starting her shift, told me off for requesting intravenous (i.v) morphine. My apprehension of the pain triggered my controlling behaviours. Partly due to its addictive potential, asking for i.v morphine is responded to in a highly suspicious manner within hospitals. It took me back to my clinical work where we are quick to pigeonhole any request for sleeping pills as ‘drug-seeking behaviour’.
A reminder that the starting point of getting to know our patients is often from a place of mistrust, unless proven otherwise. I felt the burden of having to prove my innocence.
As my irritability at the nurse’s admonishment arose, I heard her fighting my corner with the surgeons who were reluctant to accept me under their care because my scans and blood results were normal. Was she fighting for me or trying to get rid of me? Did the surgeons not wish to ‘accept’ me because they were overworked, under-resourced and gatekeeping?
The line between the care being good or poor was frequently blurred, and my judgement challenged. The experience of being at the mercy of opposing mental states, such as abandonment and acceptance, evoked anxiety and left me feeling like a child.
Meanwhile, junior doctors discussed their night out and I felt a murderous rage, until one of them wrote me up for analgesia and all was forgiven. I remembered being a junior doctor, planning the next party while writing up medication charts. I wondered if this is how intolerable I was for my patients.
Seeing both sides of the coin, and holding the contradictions at the same time, leaves one feeling confused and at a loss for a blameable object. The latter urges us to be accountable for our part in the story. Melanie Klein refers to this dynamic of seeing and accepting the ‘whole’ person/ situation as the ‘depressive position’.
Even though there is discomfort in accepting the ‘whole’, it is developmentally more progressive than splitting off the bad from the good in people and things in order to tolerate them and those darker parts of ourselves (the schizoid-paranoid position).
I returned home after an appendectomy, and it felt like the fog had been lifted. I started to re-examine my needs, wants and ultimately my purpose. It was clear that a new direction was required. In the space of three days the gold of the daffodils and the silver of the snow drops had filled my garden. It was evidence that my soil was fertile, and it gave me confidence that change for the better could be cultivated.
The cognitive and moral dissonance I had felt meant that my mind, and later my body, had decided, on my behalf, that returning to work was impossible. I was stunned that I had let it come to this. What keeps us locked into our jobs and careers as healthcare professionals, especially as doctors, when it works against our wellbeing?
We wear this identity with such attachment that it becomes part of our bodies: the stethoscope around our necks, the white coat that has been replaced in Covid times with scrubs, the bleep tracking our move and making us operate like machines at its mercy. We even adopt the title ‘Dr’ before we say our names. These narcissistic tendencies are honed and refined throughout our medical training. We are taught to ignore our own needs and ‘care’ for others’.
This becomes rather a convenient way to stoke our egos and repress the cries of our own unmet needs. This sense of omnipotence is best afforded to and displayed by privileged folk who stand tall and stubborn as the ‘snowy white peaks of the NHS’.
But imagine the shock when one tries to shrug off this cloak, only to realise that they too were encased in this narcissistic skin. Ah, the pain of peeling off the layers; the shame of the raw, red skin being exposed, recalling the battles where these scars were hard won.
I am left with loss and grief, perhaps most at letting myself get choked in an identity cloak that wasn’t for me, or even mine. There is pain in learning how to walk again, with one hypertrophied limb, at the expense of the other three atrophied ones. My balance is gone, my skin, red. But we must face that which we wish to change.
As part of my recovery, I have started with a black therapist. It feels like home. I am better able to accept her interpretations of my defences of splitting, idealisation and denigration. Until recently, this had been the bread and butter of my clinical work for my ‘patients’. Now that I was doing this inner work for myself, I realised how far away my ‘autopilot’ mode had driven me from my own body and mind.
My therapist provides context. She believes me when I tell her that structural oppression exists but urges me ‘to try slowly but surely to relinquish my part within the re-enactment and reclaim the joy that I inherently deserve in life’.
I joined a group ‘Reimagining healthcare beyond institutional trauma’. We start each session with embodiment practise and grounding. We discuss ‘shame’ and ‘boundaries’ and what ‘interdependence’ means for community mental health.
I have been part of an anti-racism reflections group since last year. It’s not until I reluctantly attended the last NHS leadership module that I realised how much my newly found groups have fed and nurtured me when my NHS groups disappeared.
The facilitator at the NHS leaders group applauds me for my wisdom. He refers to my convincing, yet compassionate, articulation of the theoretical and experiential aspects of racism. The pull back onto my narcissistic pedestal, is tempting but this time not having hustled for it, it’s easier to identify and not fall into that trap. It feels like a pleasant ‘take it or leave it’ event, rather than the fulfilment of an insatiable need.
I have restarted my Hindustani classical singing lessons. I am learning to relate to the land by cultivating blossoms of hope. I write poetry, journal, listen to music and connect, and attend to those small, stunted limbs that have been neglected for so long. My connection to my ‘Indian-ness’ (and what that means for me) has helped my roots take hold in the ground.
My winged dreams of living amid the Himalayan Mountains give me hope and a bird’s eye view of the world and my place in it. I want to fly free again.
The momentum of years of conditioning raises its panicked head frequently, but I tell myself that my wounds are all mine. They will have their own place to heal. They will be accepted while the fear curls up like a black fluffy kitten at my feet.
I am resting my feet now, after walking out to walk on. My path, My life, My purpose.