When you realise that your best isn’t good enough

Update: I am still alive but the medical school dream may be over.

Turns out that despite being academically successful and with  decent results in the basic clinical skills, I may not be fit for medicine. I am mentally fucked. So yeah, life can be a shit place when the thing that you wanted most is so close yet just out of reach. The goal and reality of becoming a medical student drew me out of my first deep, dark hole. It was the threat of being deemed not medically fit to study that drew me into my subsequent descents into darkness. Being a medical student had become an identity that I stole and wore, covering my fears, insecurities and the fact that I didn’t know who the fuck I was. I am vulnerable without that extra skin.

I even tried to mask my slowly disintegrating medical-student identity with alcohol, cutting and an increasingly passionate love-affair with the toilet (aka. bastardly bulimia). The medical community refer to my pattern of behaviour as a delicious combination of social anxiety, depression, alcohol misuse, self-harm, bulimia and suspected emotionally unstable personality disorder. It just roles off the tongue *note sarcasm*. I have reached out for help but, when you are so raw and vulnerable, the lost referrals, chasing-up professionals and being turned away by services, that you are told to turn to, hurts. That belief that you are unworthy of help is repeatedly reinforced. It shoves you in the small of your back so that your descent is accelerated and more withdrawn from people around you, because as you’ve learnt, they only let you down.

It’s easy to support someone with mental health issues on a good day because that support is mostly in the form of promises that they will be with you in the days that aren’t so good. People don’t often follow through with those promises.

At the moment I am lost.

Without that medical-student identity, all I have are my defects: dinking, bulimia, cutting. I desperately want to put the brakes on my self-destruction and so a few months ago (after waiting lists, being turned away, lost referrals) I found myself at my first appointment at a specialist personality disorder service. Three months on, I have relocated to be closer, tumbled out of medical school and put all of my hope of a future into the help that this service could provide. They had acknowledged that I drank heavily and relied on disordered eating and self harm. Last week at a second meeting, they informed me that in order to access help from them, I had to be first referred on to a separate eating disorder service and that they would likely not accept that referral given my drinking. I don’t think disappointed quite covers how I felt.

I don’t know where my brain is at this moment in time. I don’t know where my future is either. I have congratulated friends on graduating from University, making successes in their jobs that they started when they left school and on anniversaries of getting together with their partners. It stings when at 22, I can look at the last few years and see nothing to show for it: limited friendships, no romantic relations and a family who sees me as more of a burden than a person.

Anyway, that was an insight into an insignificant life.

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Uncomfortable Situations

I have recently found myself doing a two week slot of dissection. I thoroughly enjoyed myself and I greatly appreciate the value of that experience. Not all medical schools provide this opportunity for medical students to learn first hand from dissection.

Whilst doing these dissections I chose to roll up the sleeves of my lab coat. This was not mandatory but I felt more comfortable doing so. It was a room of 100 students and up to 10 lecturers and technicians whom I see during the anatomy practicals and in the lecture theatre. I have followed this blogger for a while and she recently posted a video that describes more about my complicated, ambiguous relationship with my self harm scars and relapses into old behaviours.

 

Failure is not so bad

I had my second medical school exam last Friday. It was tough and I didn’t prepare in a way that was any good for my mental health. Excess caffeine, lack of sleep and panic prevented me from doing my best, but part of this situation was as a result of knowing that there was a lot of content that I needed to know which I just didn’t. Anyone familiar with how Medical School works will know that there is always something more that you could learn, something that you don’t know the answer to. Perfectionists are often drawn into becoming medical students and this can become problematic. You only need to get 50% to pass. But to know 50% of the shear amount of content that they throw at you can be overwhelming. School taught you that there were things that you needed to know and things that you didn’t. Those limitations don’t apply in this world. Before Medical School you are used to aiming for 100% or close to it. Regardless of whether or not I get 50% or over in this exam, I can’t help but feel that I failed.

It’s ridiculous and irrational. I feel embarrassed and ashamed that there was so much that I didn’t know. But what I am proud of is the fact that I am still going. I am using the feeling of failure to encourage me to study harder and make sure that I can be the best that I can be. I know that I am no longer the girl that gets 100%, but I can be the best me that I can be.

I am now also regularly wearing shorter sleeves and exposing my scarred arms. I do feel ‘other’ in the Medical School sphere but I am embracing it. I may not be typical, but at least I am me; whoever that may be!

WHY MEDICINE? – IN 10 WORDS

Thank you Musamah for inviting me to take part in this. It has been great to read some of the other bloggers’ responses.

 

Life of a Medic

Why Medicine?

One of the truths about choosing do study Medicine is that, from the moment you decide to go down that road, you are bombarded with the same question. Why Medicine? You’d think that once you get into the medical school, you’ll never be asked that question ever again, but you are, and many times over and over. And this is such a long question to answer, because I know my reasons required 4,000 characters in my personal statement. So, that gave me the idea, is it possible for it to be answered in just 10 words or less?

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Looking Forward is Terrifying

The reason I have not been writing is partly because I’m busy, but also because I didn’t want to face the possibility of having to write about me dropping out. Just to be clear, I am NOT dropping out of Medical School, although at times I struggled to keep my head above water. Despite this, I have passed my first exam well; really bloody well and I am preparing for my second which will be in little over three week’s time.

Looking forward is inevitable and necessary. I have started to enquire about accommodation and have found this amazing opportunity to live in subsidised student accommodation, guaranteed for the remainder of my studies, in exchange for an hour or more out of my week to get to know an elderly resident and organise an event every-other month for the care home. It is perfect and understandably, highly competitive. I worked in a Nursing Home and Dementia Unit for two years whilst studying for my A-Levels and I am currently volunteering on the phones of a listening service overnight. I feel as if I have the skills to get a lot out of this experience. Yesterday I went along to volunteer at one of the events that they were holding and some older Medical students introduced themselves to me. It dawned on me that what they were seeing was a me as a medical student that would be a doctor in five or so years. I understood that this would mean a commitment to myself and others to complete this. I am trying to look at it as encouraging rather than overwhelming. I AM going to commit to a future that is longer than six months ahead. When I know that illness can strike at any point, it is daunting.

I am also planning on going travelling this summer! I have never done anything like this and it will be an opportunity to make memories and grab as much of life as I can. I was invited to go with a friend who I met last year and is now in second year. It made me so ridiculously happy that they wanted to do something like this with ME. I have money from the my ‘gap’ years in between study when I have been ill so this is the perfect opportunity to make the most of it. I want to feel normal and experience everything life has to offer.

It is strange that I am looking so far into the future and making plans. It is just as terrifying as it is exciting. It has given me motivation and hope. And yet there is this nagging doubt that sits on my shoulders telling myself that if I spend so much time with one person, they will realise who I am.

I am not a complete person. I am flawed. I am ambivalent. It has highlighted that I have lost a year. It is a year that no one will know about in the future and might as well have never happened. I have met so many new people that have no idea that my body is littered in scars. I am experiencing a split in my identity as the medical/ academic student is trying to detach from my past.

I still experience this bizarre sense that my identity is fragmented. Who will I be whilst travelling? We went to a travel agents yesterday afternoon and all this guy would say was “It was just so cool, I found myself, I made friends for life!”

His selling technique would have been great, but he was pitching to the wrong people. I highly doubt that this trip will cure me of my lack of identity. I want to experience life, taken back to just what I have on my back and not entirely sure what I am going to see on the way.

After the appointment, the two of us went to the main Medical School building after hours. It was beautiful. All the anxiety that I experience when everyone is there during the day dissipated so that I could finally take it all in: A high ceiling with a large central staircase spiralling the course of three floors stood and waited patiently, the ornate banisters perched on top, unused, and the large canvases holding esteemed alumni didn’t look threatening anymore. Silence.

Trying to be New

I have always loved the idea of the New Year and becoming a new person. Cutting out alcohol, eating my five-a-day, running, starting a new health kick and a magical turn to happiness. Well that gnawing depression screwed with that plan. Like most people, I couldn’t suddenly drop the emotional baggage, shed my skin and become a new person at the turn of the year. I should have anticipated it but it still comes as a disappointment during the dark months of January each year. The Christmas break wasn’t an overly happy time for me. As it creeped towards the New Year, all I was reminded of was the time that had been taken from me. I had wasted a year of being ill. Nobody wants that.

I am doing well enough at the moment. I was discharged from services in my home town over Christmas and it’s now strange to think that I will be going it alone. The Med School has requested that I am under a Community Mental Health Team in the city I am studying in and if that doesn’t happen it will become a “fitness to practice” issue. I find this separate world bizarre. This world of medicine appreciates that it is a challenging environment and in an attempt to support those who are more vulnerable, it chooses to flex it’s muscles. It sees that I am well enough to study but still wants more; as if I haven’t been actively seeking better health over the course of the 6 years that I was under mental health services. I have found it amusing how the University have been so taken aback by the lack of miraculous recovery from last year. They seem completely unaware that some of my residual issues are coming up to 10 years old, they are independent individuals who if they were human would be soon moving on to secondary school!

Despite all of this I have achieved a lot, even since I last posted back in December. I have had my arms out in two Clinical Skills classes and dealt with the strange reactions from my peers. Most have been brilliant and have acknowledged them and not changed how they are towards me. But one student in particular surprised me with his lack of tact and immaturity. He volunteered to be a ‘patient’ and I was in the middle of a basic respiratory exam when a Doctor/ lecturer walked in. There was a group of around 10 students at this time all watching me and waiting for their turn to perform the exam. The lecturer commented that I should be bare below the elbows and so I apologised, pulled up my sleeves for the first time and turned to continue with the examination. I was met with wide-eyes, finger pointed and an exclamation of “Oh my word, what happened to your arms?”.

I surprised my self by how cool and collected I was. I looked at my arm and said “It isn’t a very exciting story, can I carry on examining you?”

Where the hell did this blasé girl with her shit together come from?! I stayed for the rest of the session and then went on with my business as if nothing had happened.

I am writing about this because it feels like such a monumental step for me to take. My classmates now know some of my history- it was literally all over my arms. The guy who had questioned me so publicly didn’t do so maliciously, it was his lack of awareness. It scared me that someone who didn’t pause, even for a second, to think of the consequences of his words is training to become a doctor. The words didn’t affect me, but they might have if they were towards a vulnerable patient. This is why things need to change, and hopefully I can help to show that illness and strength and are not mutually exclusive.

Now I am the girl with the scars because I do have scars, but they will not be the only thing that I hope to be remembered for.

Split in two..

I am loving being back at medical school but it has been hard. The work load has been intense and still the best. I am enjoying putting my brain back in gear and challenging myself again. I have presented a scientific poster, sat my exam and completed my first PBL write-up/ essay. I have achieved so much more than I could have imagined and it is scary to look back and see how different last year was; but there is still a part of me that is stuck in time. That part of me is dragging me into self-destruction every time I drink and it is becoming larger now that Christmas is looming. I hate it.

I feel so different and detached from everyone when that part of me is present. It tells me that I am not good enough and that I am a fraud. I know that ‘imposter syndrome’ is common amongst the population, particularly in med-students, but it does have a way of making you feel so alone. That separate part of me also associates itself with my times of ill-health, and when I have been at my lowest ebb. It is bizarre as when I am like that, my whole reality switches. I’m not sure how to cling on to the reality that most people live in where I am a successful woman at medical school who has a lot to live for. Some people would say that what I am describing is depression; I guess that they may be right.

And yet I don’t find labels useful. Most people want to feel as if they are complex and that there is more to them; I know that I do. I am aware that we are living in a mild-delusion pretending that there is more to us when we are fundamentally simpler than we choose to see. That’s why I reject labels, because I like to think that there is more to me than depression, anxiety, bulimia and whatever else is running through my head. I want to think that there is some abstract cause for this rather than mental illness because mental illness is ugly and there is no prancing around that.

 

It has only been in the last few weeks (actually more like days) that I have accepted that I am bulimic. In truth, I have probably hit the criteria for bulimia for about 9 years. It is a lot of time wasted. I have not had a diagnosis of bulimia because I have denied it to healthcare professionals and they haven’t seen it because I’m not underweight or physically suffering.

 

To deal with this, I have created this persona around university where I am who I know that I’ve always wanted to be; confident, clever and sociable. That persona has split from the one who I have to spend time with when I am alone in my room or in the library, the one with one that is scared. I dread the two of them joining, when my classmates see who I am from the scars on my arms, the bruised knuckles and bloodshot eyes. It will have to happen at some point.

Something did make me chuckle the other day though. The PBL group that I am in started talking on the topic of psychiatry and inpatient psychiatric units. One person in particular mentioned how it would be scary and violent and that they wouldn’t want to work in that environment. I think that they genuinely believed that people who were mentally-ill were violent. I knew some people still had that view, but was shocked that they would so blatantly air it in front of others. They then went on to talk about suicidal people and how they could not relate and wouldn’t know how to talk to them. It made me realise the vastly different experiences that I have lived and made me value the bizarrely-acquired skill set from my own ill-health. It made me feel as if I was some sort of undercover agent.

 

I do want to make something great from my past and yet I know that I still haven’t fully dealt with it. It was only the other night, when I had a few beers and this anger that I haven’t felt in so long just emerged from somewhere inside me. It was furious and mad. It wrapped around my chest until I exploded into a scream and threw some punches at wall. It terrified me. There is something still not right and alcohol somehow brings everything up. The easy answer would be to avoid drinking (which I am still trying to do) but I want to address this pile of shit that occasionally bursts over. Even writing about it is making my hands shake.

I am trying my best to deal with it. I tried signing myself up for CBT (cognitive behavioural therapy) at the Advice and Counselling Service at my uni. I to an initial appointment and it went something like this: “I don’t believe that we can achieve anything meaningful within the four to five sessions that we would be able to offer you. I don’t think that we are the right service for you”. Well that was me told. Too fucked up for them and too well-functioning to get anything on the NHS.

 

I am thinking about investing some of my savings into seeing someone privately. I want to find the right person though and I am not sure where to start. The big, wide world is scary at the best of times but it is even worse when you feel as if you are wearing your heart on your sleeve. Asking for help is a hell of a lot harder than I thought.

I am sorry for the long post and the lack of posts recently. I want to make it clear that I am so grateful for this second chance at uni, this amazing opportunity that so few people have access to. This is why I am desperate to make the most of it and not fuck it up again. One of these days I’ll write when things are going brilliantly so you won’t have to read a whiney post but for now it is the same old me…..

A People Problem

I am not shy. If you met me you would most likely think that I was an overconfident prick. I dominate social situations, I am loud and energetic. I react widely to things and people find me entertaining.

The thing is, in social situations I need control or else I am lost. I drown in social etiquette, in-jokes and knowing where all these damn lines are which dictate whether or not things, said or done, are acceptable. I think I missed that in growing up where I learnt how to fit in; to walk and talk with the rest. That’s why I fear most people getting attached to me. I don’t want people to discover what I actually am. That I don’t understand people; that I hate texting because it just makes it so much worse and that most of all I don’t want the nagging voice in my head to become louder and louder and louder until I scream.

That’s why I sit by myself in lecture theatres despite being so vivacious in seminars. I don’t do friends. I have too much to hide and too much that I am ashamed of. I dread that day when we will be asked to be bare below the elbow and in that split second, I become that girl with the scars.

I hear the whispers of judgement from others already. They don’t know yet. All they know is that I am odd, eccentric. I feel stuck in a world of people.

Life as a not-so-sane Med Student

So yeh, I got cleared to go back to study. I was a bag of every emotion going and increasingly stressed by the phone-calls and emails that I had to send to sort out my return. Turns out that administration and organisation is not my Uni’s strong point. I was actually relieved by the time I had packed my bags and we were half way down the M5!

I love my flat. I love my halls and room. I have enjoyed the last four days and have felt great. But…

and yes there is a but….

One of our induction lectures was called: “Resilience and Mindfulness in Medicine”. Sounds great right?!

So in the lecture theatre, with three-hundred other students, I participated in a guided body scan. For those of you who do not know, a body scan is a mindfulness meditation were you pay attention to each part of your body, noticing tension or any other sensation without judgment. It took 15 minutes in total with our eyes closed, sat on green, squishy seats.

So rather than relax as my body and mind was intended to do, my chest tightened, heart pounded, palms turned sweaty and I struggled to catch my breath. I tried to stop it. I couldn’t even rationalise it as the anxiety was purely physical and my body was quaking. The worst of it only lasted around 20 minutes and it wasn’t obvious to anyone near that anything was wrong. I’m still shakey now.

I have found mindfulness techniques useful in the past so I guess that I am just surprised and shocked that that lecture would have bought on such bleuuughghhh. This isn’t going to affect my studies. I have met some great guys on my course and in my halls. This year will be great even if I have to have the odd anxiety attack!

Killing Time

I’m sat in Victoria Station’s Costa waiting for the dreaded final meeting with Occupational Health. I’m not feeling any nerves which is bizarre especially three coffees into the day- I have a love, hate, dependent kind of relationship with caffeine. My meeting is at four and I am writing this at just past one…

It is blowing my brains out how different this evening could pan out dependent on the outcome of this meeting (I bought in some emergency supplies of Estrella and gin incase it goes sour). I might be back at medical school in no less than 11 days time or I could be on the job hunt, applying for HCA roles in local hospitals. I unfortunately couldn’t get time off work tomorrow as we are short of too many staff so as a compromise, my boss is ok with me coming into work somewhat hungover and an emotional wreck.

Oh and it is my birthday on the 17th, my 21st. I tried to spread the word that I wasn’t going to ‘have a birthday’ this year but it has been tricky as a I have a party-loving, extrovert as a twin sister. What is so great about 21 though? I guess it is a mile-stone of maturity. Dam, I might still be living at home at 21. I thought that I would have flown the nest, found a partner and a secure plan for the future by now. My Mum was married at 19, my Dad had got onto the property market at 20. I’m behind in this absurd rat race, tripping over all the shit left behind. I am one of those slow people, dragging their knuckles along the ground, head bowed so far down that they walk into lamp posts.

Ahhhh.

I know that life isn’t a race but by god is it easier to say that than actually believe it.

And I do want to explain why it is such a big deal as to whether I go to Uni this year. To some, it may seem ridiculous that I would be so devastated if I am delayed a year as I still have a place to take up, but this is a Medical Degree my friends. Not only is it long (five years min), but University policy dictates that should I take a year or more out from study, then I should be referred to the Professional Capability Committee. They could stop me from continuing with the course.

Talking with my psychologist a couple of weeks ago, we went through the classic negative thought patterns- the paranoid thinking style being one of them. I tried to explain to her why it is so hard to think that people aren’t going to put you down and work against you when experience, past and present, demonstrate that they do.

In all honesty, I am tired. So fucking tired.