Learn from me: speak out, seek help, get treatment
This article was written by Dr Steve Robinson, published online MJA Insight on 22/10/2018.
I discovered CrazySocks4Docs Day held annually on 1 June, only this year. The day aims to ‘encourage conversations about mental health and help reduce the stigma for doctors experiencing mental illness’. When I discovered the day thanks to my burgeoning Twitter obsession, I experienced an incredible and overwhelming reaction.
Almost exactly 30 years before, as an intern in the central Queensland city of Rockhampton, I had tried to kill myself. Three decades later, I am now President of a specialist college, but I had kept the entire episode to myself and tried to forget it. I am deeply ashamed of not learning from my own experience and using it to help others. I hope it isn’t too late.
Perhaps by fate I was introduced to cardiologist Dr Geoff Toogood, the incredible and inspiring founder of CrazySocks4Docs, at a College meeting a couple of weeks ago. The meeting was so unexpected and so overwhelming I choked and could barely speak, but it made me determined to take something positive from my own experience all those years ago. Hence this article.
I have a strong feeling that my own experience mirrors that of many doctors around the country, but it is worth explaining. I hope it will help others understand why I have been silent and have not taken the actions I should have. When I heard that Rockhampton junior doctor Frith Footitt had taken his own life on New Year’s Day this year, I could not bring myself to read any of the details. The tragic outcome could easily have befallen me.
My internship was a very bad year. I had found medical school difficult – I was not a natural academic like so many others in my year – but hoped that my intern year might prove better. I was wrong.
Halfway through 1988, it seemed clear to me that I was making even more of a hash of internship than I had of many subjects back at university. To make matters worse, Rockhampton was a long way from my family and my junior doctor colleagues all seemed to be more capable and were thriving.
As I reached the halfway point in my internship, I felt overwhelmed with inadequacy. I had a patient die and felt responsible. My ward work was just barely adequate. My consultants and registrars were not exactly glowing in their feedback.
I had an all-pervasive sense of failure, that so many years of struggle at medical school had been a complete waste and that I was little short of dangerous. I could see no way out.
So, one night, I made careful plans to kill myself. I won’t go into detail but suffice to say that I wanted the end to be painless and clean. I stole some supplies from the wards – standards of security were much slacker 30 years ago – and set about writing letters. Luckily, I had few personal affairs to put in order.
Incredibly, a work colleague arrived unexpectedly and began knocking on the door of my small hospital unit. That person – I won’t reveal the gender – knew I was in because my car was parked just outside. There were knocks and calls, “I know you’re in there …”
I will never know what made this person visit me unexpectedly. Perhaps my emotional state wasn’t as well disguised as I thought. Perhaps it was just plain good luck. Perhaps it was something else.
I spent quite a while talking to the person, though not about my plans for the night. Enough, however, to make me take a step back from the brink. To reconsider. To think about other options. Looking back, that person probably had an inkling that I was about to do something dramatic. That impromptu visit saved my life.
I won’t pretend that I had an epiphany or that I suddenly was better. I did seek help, although I didn’t completely disclose just how close I was to suicide. Rather than put my career, for what it was worth then, further in jeopardy by talking to one of my hospital colleagues, I made an appointment with a GP in town. I started in a roundabout way, and ultimately confessed that I had made elaborate plans for kill myself.
To this day, I can remember the GP’s advice. Under no circumstances tell anybody or see a psychiatrist (I only knew of one in Rockhampton at the time, and was about to become his intern for a 3-month term!). If I had a record of suicidality or mental illness, I would never be able to buy income protection or life insurance, and I would probably never get a good job. Indeed, don’t tell anyone…
I was bonded to the Royal Australian Navy, with the hope of spending time as a seagoing medical officer. The advice I had received was startling – what if I was rejected from serving and had to pay back my return-of-service instead? I couldn’t afford it. There was no way I was going to risk my Navy job – what if they were so worried about me jumping overboard that I was banned from the fleet?
I elected to try antidepressant treatment, but I remember it being very unpleasant. The options were more limited 30 years ago. The GP warned me that if anyone found out about prescriptions for antidepressants, I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself.
The episode left me with two key messages, both of them very wrong. This first was that not thriving as an intern (or being “a-copic”, as one of my registrars disparagingly put it) meant I would never be appointed to a training program. The second was that seeking help was a sign of weakness, something to be ashamed of and hidden.
Today, I am President of my College. I have had a good career and, on balance, have done more good than harm to the patients I care for. In the end, there was some light at the end of the long, dark tunnel. I just couldn’t see it at the time.
Why shine a light on my own past, 30 years later? Why speak about this so publicly? I have had a good career and achieved most of the things I had hoped to. Why rake up the past? Why not stay silent as I have for three decades?
If a person who has reached the highest point in their specialty still feels ashamed of events 30 years ago, and is reluctant to admit it, how must those who are going through things and feeling disempowered now feel? I am determined to use my own example to point out that mental health problems are nothing to be ashamed of.
Today, I am not ashamed of how I felt or what I did 30 years ago. I am ashamed and disappointed in myself that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. I am ashamed that I was embarrassed and ashamed.
Doctors commonly are under pressure, are more prone to mental health problems, and often have access to the means of killing themselves. These are occupational hazards. In the same way that pilots are exposed to simulated decompression and hypoxia so they recognise the warning signs, we should recognise the warning signs and the debilitating and potentially lethal effects of psychological decompression.
When trainees of the College of which I am President took their own lives, I stayed silent. When a junior doctor took his life while working at the same hospital that I did when I tried the same thing, I stayed silent. When I met Geoff Toogood, I stayed silent. Even after the shock realisation that CrazySocks4Docs day was almost exactly 30 years after I tried to kill myself as an intern, I stayed silent.
It is absolutely vital that each and every one of us is honest and acknowledges the pressures and strains of our profession; that we see mental health issues not as sources of shame, but as potential occupational hazards that put not only ourselves at risk, but the patients we care for.
I should have spoken up sooner. For every doctor, especially our juniors, it is important to understand that mental health and emotional issues are nothing to be embarrassed about or ashamed of. They are important and need acknowledgement and treatment. We need to support each other and make this message abundantly clear.
If I had not been interrupted, I would have died 30 years ago. Luckily for me, that didn’t happen. Now I find myself a College President. If you feel now the way I did 30 years ago, seek help and support as soon as you can. Speak out. Who knows where you might end up.
Kate Tree wrote a comment in response to Steve’s story:
Dear, dear Steve,
As one of the very small group of interns working with you in 1988 at Rockhampton, I read your brave and eloquent story. I wept, I could not sleep, and I feel I must respond.
Oh Steve, I had no idea until reading your article that for 30 years you thought it was “just plain good luck” that you were visited at home and interrupted before you could commit suicide. Your “hospital supplies” had indeed been glimpsed, a small number of us were terrified about what your intentions might be, and there was a desperately staged intervention.
If you had not opened the door then you would have had visitors climbing through your window or kicking the door down. It was not an impromptu visit. It was not “plain good luck”. We cared about you, Steve.
We were unskilled, untrained, perhaps totally unhelpful, but we cared and we tried to help. Please accept my apologies for all the ways in which we let you down. Please accept my sincere and profound apologies that for the past 30 years, you have lived with the belief that no-one cared enough to try to stop your suicide.
Perhaps we could have helped you more without that “code of silence”, and what I heard described recently as “the manbox” – the cultural assumptions as to how a man is supposed to act, the box into which a man is supposed to fit. I was a girl, but I was not your girlfriend, so of course you could not be expected to talk to me about your feelings – in 1988 that was not how a man was “supposed” to behave. If I asked “how are you”, or “are you OK”?, and you looked awful but said you were fine, in 1988 I am afraid that I did not have any effective strategy to turn to next. I hope I would do better now.
All the promises of silence, which was most definitely the prevailing culture of the day, were well-meant and were intended to help you, and yet created a complex web to trap us all.
At the start of 1988, you were so ebulliently effervescently positive and extroverted. You always had a cheerful smile, you would stand and salute when women entered the room – you said you were practicing for being a naval officer, but you always made me laugh!
You gave roses to all the female doctors for Valentine’s Day – initially anonymously, until your cover was broken. I still have some photos of you happy and laughing, including up on our roof – because the roof was the best place for a party on a hot night in Rockhampton.
And I still remember that my first ever out-of-hospital cardiac arrest came in when you and I were the only two doctors in Casualty, or indeed the entire Rockhampton Base Hospital. You intubated, I did the IV cannula. This was the world before manikins, we only could learn on real people, I had never intubated anyone but you could already do it – I was so impressed. I wanted to be capable, like you were. You seemed so confident and competent, and you helped me so many times when we had a shift in Casualty together on an evening or weekend – I remember showing you all the ECGs because I was terrified of missing something crucial.
You projected such outward confidence, which I saw – yet it seems you skillfully concealed your inner harsh self-criticism, in which we were no doubt alike.
As the year progressed, you became quieter, more serious, more withdrawn, and we saw less of you – in retrospect, that would have been the depression starting, but we were young and ignorant and all struggling to cope in our own ways with our own challenges. I would not have recognised social withdrawal as a sign of depression. We were all overwhelmed by the hours, the workload, the responsibility of being the one and only doctor on site overnight in the entire Base Hospital, under constant social pressure to NOT ask for help and to NOT call anyone overnight, by working as interns with sometimes no registrar and sometimes no consultant, if there was anyone more senior they were often only 2nd year out themselves. The interns in Brisbane were paid less than us, but we were working far more hours and scarcely had any supervision or training. Plus the charming culture of bullying and sexual harassment in the surgical department by “Sir”, but let’s not go into that here…
I was not surprised to read in your article that you had obtained supplies from the hospital with intent to kill yourself – because, you see, I knew about that, way back in 1988. You had not hidden your supplies well enough, someone glimpsed them and leapt to the obvious conclusion. I was told in horror; there was great concern for you and for your well-being. The strategic mission to get into your flat succeeded, but we remained tense that you would try again another time. Later, I was told (“confidentially”, of course) that you were seeing a doctor and being treated, but you did not want anyone to know, so we were never to mention it.
We did as we were told and we kept your silence for you.
I was told that your projection of confidence was bravado and a mask, hiding your inner self-criticism, that you judged yourself far more harshly than any of us would. And I was told all these things, but I was told that I had to keep this information silent and confidential. So much silence, to help you save face, to help you stay registered, to help you get to naval officer training after your internship; we kept your silence, and we did not share our own distress.
Steve, for all these past 30 years, I have kept your silence, until you have broken it yourself and bravely made this public knowledge. So now, I have printed out your article, I have shown it to my husband and said, read this, I was there, this was part of my life-story and lived experience too; and I have given a copy to my medical student to read.
Sadly, you were not the only medical colleague of mine to have attempted suicide – just the first. I have been to the funeral of a colleague, and I have also helped resuscitate a colleague, when I brought my friend intubated into an intensive care unit with the tears still running down my face. And I have also had male colleagues cry on my shoulder in the workplace, because the 1988-style masks are slipping, the “manbox” is changing, and even well-meant silence is not always constructive, positive or helpful.
Please accept my congratulations, Steve, on having achieved such success in your professional and academic career. I hope that your personal life is filled with contentment and joy. I am deeply sorry that as a 23 year old intern, I did not have either the skills or the knowledge to have been more help to you, and that I contributed to letting you be caged by the silence.
Professor Steve Robson is President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and is a member of the Australian Medical Association Federal Council.