The Threat of Funemployment

In final year, we thought that getting an internship post at our desired hospital was the hardest – and most coveted – thing.

Two years later, we all tried to find a community service posting that would give us a foot into the door to our future specialties.

But we didn’t know that those were the easy parts. Then, we still pretty much had guaranteed employment (most of us, at least).

Then came the end of Community Service, and reality hit us in the face: we were on our own.

* * *

That’s where I am now. The government no longer “owes” me a job, and unless I find one, I’ll be unemployed come January 2018. People used to say, “There’s no such thing as an unemployed doctor.” These days, there are plenty of them, because freezing posts is a done thing.

Applying for my first post-comserve job is a bit like the whole “what do I want to do when I grow up” crisis all over again. Because I want to work with children, but how many paediatrics posts are available? Not many. And paeds has seen an upsurge in popularity, so the available posts are highly sought-after.

So what other jobs would I like to do? Jobs that could teach me something before I go back to working with children. But if something happens and I end up stuck in that job for a long time, will I be okay with it?

Looking for a job is an exercise in self-reproach. Why didn’t I do more courses this year? Why didn’t I write that diploma? Why didn’t I participate in more research? Why didn’t I suck up a little more, make sure people knew my name? Look at what everyone else has achieved. Why haven’t I?

It’s an opportunity to be kind to myself. I’ve had a big year.

I started therapy and finally found the right combination of meds.

I ended a long-term relationship.

I stayed on my own for the first time. The past few years were just adulting-lite. This year I had to learn the real art of adulting.

I finally started making friends.

As I explored this new city, I also explored myself.

I found parts that I hate. I found parts that I love.

I stepped out of my comfort zone, and as usual, it was rewarding.

Finding a post-comserve job is probably the scariest part of my medical career so far. I know I must not compare myself to others, but I also know that an interview panel will do exactly that. (By the way, I screwed up my most important interview. I got total stage-fright.)

This is also a time of great promise. It reminds me of everything I can do with this degree. It reminds me that I can stretch my wings. It reminds me that I am not captive. I am free.

 * * *

Sorry if you came here looking for some inspiration. I had to type because my nails were already bitten to the quick. Find me a job, and maybe I’ll be able to get back to the usual stuff.

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Can I Be A Depressed Doctor?

Ever since I wrote about how going for therapy was my biggest gift to myself*, I’ve met with a few medical students to talk about the topic of mental health. Many of them were worried about their ability to make it through med school with their illness. Many were worried about the viability of a career in medicine with depression.

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When I was a student, there was a rumour that students with mental illness would be excluded from the course. We were informed by our senior students, and they by theirs, and thus the rumour was propagated.

This may well have been one of the biggest reasons, besides financial accessibility, that I took so long to get help for my depression. (In case you’re still wondering, the rumour is false, as rumours are wont to be.)

The reality is that depressed medical students are often high functioning in nature. It’s the reason they get away without help for so long. It’s the reason their colleagues will say, “But we never knew.”

I got through most of medical school without therapy or medication. But I didn’t get through it happily, and I wish I had found help earlier. I’m still not sure if my brain has recovered from the years of deprivation.

Now that I am more open about my mental illness, I have met more doctors – young and old – who are open about theirs. We don’t advertise it, but if it comes up, we don’t shy away from it. So I can confidently tell my young friends that yes, you can be a depressed doctor. But try to be a depressed doctor in remission.

For medical students (and doctors!) with mental illness, I recommend finding a treatment team sooner rather than later.

Find a good psychiatrist – even if, for financial reasons, it means you find a government psychiatrist. Or maybe a really good family physician. If they suggest medication, take them religiously. Don’t be the stereotypical non-compliant doctor-patient. And, as hard as it may be, try to accept your role as a patient when you step into your psychiatrist’s office. Maintain involvement in your own treatment, but put some trust in the expertise of your doctor.

I don’t advocate pharmacological therapy on its own to my patients, and so I don’t recommend it to my friends. Therapy is another costly but valuable part of managing mental illness, and one I have found to be invaluable. Once you are a doctor, you’ll be able to afford it. As a student, you may need to pull some strings, put your name on a waiting list, or open up to your parents for funding.

As a doctor with depression, I have days that I can’t get myself out of bed. I have relapses. I have colleagues I trust, but I have days that I second-guess that trust, and days that I feel alone. I have days that I can’t connect with my patients, and days where the connection is too intense and I just want to cry.

I have not yet had days where my patient-care was compromised. But I am always on the lookout. And I know that my psychiatrist and therapist will step in if they think that is the case. This is also why I told my HoD – not for sympathy, but because it is important for her to know. Just as we know about our colleague with diabetes, in case he has a hypo and collapses at work.

I also know that I will never sign up for shift-based work like in the ER, because I don’t think my neurochemistry will be able to handle that. Being on call is hard enough. Some of my colleagues accept multiple shifts in a weekend so that they can have a greater total of uninterrupted weekends. I know that I can’t do this, because I know that my mood takes a dip.

Managing mental illness as a doctor has been challenging. Sometimes I stumble. Sometimes I fall. Sometimes I lie in the dust awhile before I get up. Sometimes, someone helps me up. But the more I strengthen my support systems, the less frequent the falls become.

We are not cookie-cutters. I cannot say that some doctors/medical students will not decide to leave the profession because they feel it is incompatible with their illness. But that is a decision that should only be made after careful thought. Probably also a decision that should not be made while experiencing a major episode.

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Whatever you decide, don’t be driven by internalised stigma. And remember: you are not as alone as you feel.

*Strangely enough, the post in question has disappeared from my blog. A few of my posts mysteriously disappeared a few months ago. Quite annoying. 

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”

The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why

If you’ve been paying attention, working hours of doctors (especially junior doctors) have been getting some good airtime over the past few months. The Province of the Western Cape has committed to actively reducing maximum continuous working hours for doctors to twenty-four, the HPCSA has promised to “look into it” (not that we have too much confidence there), and our biggest representative, SAMA (South African Medical Association) has come out in our support.

One of the things to come from all this is the launching of an armband campaign. This has its origins, I believe, from a similar campaign in the UK – although I have not been able to find any source to this link.

608772084 Continue reading “The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why”

A Key To Disillusionment In Work And Play

disillusionment2The phenomenon of disillusionment is well-discussed in the world of medicine. Roundabout third year of medical school, students begin to realise that the medical world simply does not live up to what they envisioned.

It is easy to say, “Just don’t have such high expectations,” but in reality a doctor without vision becomes a mindless drone. Disillusionment is discussed so widely because even though by definition it seems simple, its origins and characteristics are complex.

Funnily enough, I began to really understand disillusionment when I started club-running. Don’t be mistaken: joining a club was the best decision I could have made. It introduced me to many like-minded people and provided ample opportunity to amp my mileage.

I joined a club because I felt that I loved running enough to do so, but not long after joining I started experiencing an emotion I recognised from the medical world. I was feeling disillusioned. Continue reading “A Key To Disillusionment In Work And Play”

[Guest Post] From Nursing to Medicine

While the best-known route to medical school in South Africa is the “conventional”: finish high school and enter med school the next January, it is by far not the only route followed by medical students here.

The journeys are numerous, like Tash’s journey of an older medical student, which she graciously shared here.

nurse to med school

Today, Roxanne shares her journey from nursing to medical school. Roxanne is a fourth year medical student at the University of Stellenbosch. We lived across from each other when she was a first year and I in my fifth. She impressed me from the beginning, with her humility, passion and eagerness to learn. This is her story: Continue reading “[Guest Post] From Nursing to Medicine”

Dear Medical Student: Med School Is Not Worth Your Self-Harm

[TRIGGER WARNING]

A while ago this secret appeared on PostSecret:

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“Medical School made me self harm. It better be worth it.”

Continue reading “Dear Medical Student: Med School Is Not Worth Your Self-Harm”