The Anxious Doctor – Welcome

I’m an anxious person. Always have been, always will, but hopefully to a progressively lesser degree as time goes on. Throughout my life I’ve worried about the tiniest things, far more than I know I should, but I couldn’t help it, it just happened. While others around me would seemingly sail blissfully through their day, my brain would churn relentlessly, analysing everything and anything that might possibly go wrong that I would then have to deal with or be chastised for, working myself up into a shaking nervous wreck that could hardly think straight. This got bad enough that as a medical student and foundation doctor I was frequently waking up in drenching sweats at night, panicking about the decisions I’d made during the day, absolutely convinced that I’d killed someone with my spectacular ineptitude as a medical professional. Not exactly a recipe for a successful career as a doctor is it?

Well the good news is I’m now a few years further down the line and in a much better place, progressing through my training programme as an anaesthetist and really, genuinely enjoying my day-to-day work, and most importantly – hardly ever worrying even close to the same amount as I was before. So I thought I’d try and share all the things that I feel have helped me through the really rough patches – a letter to my previous self – and hopefully it might bring other people some reassurance or guidance along the way.

This introductory post is here to give a bit of back story, partly as a cathartic brain dump on my part, but also to give you a bit of an idea of what I went through to see if the subsequent posts are likely to be relevant to you. so here goes.

It started with horrible social anxiety as a teenager.

Like many medical students and doctors, I’d always been a ‘good kid’ who did well at school, was mostly polite and generally ticked the boxes that the average well-wishing middle class parents would associate with a ‘successful’ child. I was a bit weird, to be fair, with quirky interests and a proper nerd vibe going on, but I somehow had enough friends to avoid being a complete loner and didn’t struggle too much with normal social interaction. As a result it wasn’t until I was about seventeen that I realised there was a big problem.

What had been creeping up on me over the preceding years without me realising, was the fact that my entire self worth, and every ounce of my rather lacking self-esteem, relied utterly on what other people thought of me. It makes sense, looking back, since up until this point my life had been a steady compilation of working to achieve the right grades, performing well at interviews to get into good schools, impressing the right people to win the right opportunities, and so I had gradually inflated the importance of others’ opinions of my success and personality to such an extent that I had literally no idea who I was.

And guess what – I was a bit of a twat.

With no endogenous sense of my own worth, so began an ever spiralling vortex of trying to impress people, in order to reassure myself that I was in fact, doing okay. This works well in interviews and exams, where the entire point of the exercise is to make the person in front of you think you’re absolutely marvellous. It works remarkably less well in general social situations where, unlike Miss Higgins from primary school who definitely wants to see just how splendid your handwriting is today, people are trying to relax and just ‘be’, and you’re there on full parade showing off everything you’ve got like an overachieving puppy dancing for treats.

You can see the feedback loop starting to form here:

Rely entirely on other people’s opinion -> perform for approval -> piss off people who don’t care and just want to chill out -> convince yourself they don’t like you as an individual -> fail to justify why this is, given this tactic has worked impeccably for your whole life until now -> perform harder for approval…

BOOM – anxiety

This continued throughout school well into some frankly pretty dark university years, alienating myself from friends and generally making my own world a rather miserable place to be. My relationships with other people became superficial and meaningless as I sought ever harder that addictive hit of ‘impressing’ people for some sense of self-value, and I became progressively more lonely and unhappy. It started to improve somewhat when I got properly into cycling competitively for the university team, because it involved spending lots of time riding next to people who enjoy the same sport, who want you to do well (because you’re on their team), and will quite happily be verbally assaulted with tales of just how well you did in the race last Sunday, because they’re about to do exactly the same to you. This provided a bit of emotional stability in rather desperate times, but didn’t actually address the underlying issue at hand: I was still devoid of any genuine sense of self-worth and precariously danced from one moderately positive interaction to the next, just about maintaining some semantic appreciation that I wasn’t a complete balls-up.

The 3am-drenching-sweats worry properly started once I was a clinical medical student in my penultimate year. The realisation that I was soon going to have to bear the enormous responsibility of looking after vulnerable people who needed professional help resulted in such catastrophic imposter syndrome on my part that I genuinely questioned whether people believed I was a real medical student at all. This left my already self-destructive brain with a very sinister default assumption whenever I did anything remotely clinically important:

I must have screwed something up

Whatever I did, however minor or insignificant, my brain would assume that I had someway screwed it up, and there was absolutely no conceivable universe in which it all went fine and I didn’t need to stress out about it. Even in situations where I knew unequivocally that I had got it right, Mr Frontal Cortex and Captain Amygdala would sit there smiling cynically at me muttering, “You sure about that?”

To give you an apt example, I once put in a cannula as a fourth year that went perfectly. Textbook. The patient even said thank you! My insane wad of grey matter however was inclined to disagree, and tried to convince me I’d stuck it in her brachial artery. I knew I hadn’t. I’d palpated the vein, knew the artery was a fair way further round the arm, and I’d only stuck the needle in a short way under the skin – no way could it be in the artery. So my brain played the ultimate check-mate anxiety move that can never be defeated:

But what if you did…?

Shit, what if I did? What if the nurse comes in, injects a medication into this poor woman’s artery, it clots and her arm goes ischaemic, and she has to have an amputation, all because I screwed up a cannula… cue panic.

Pro-Tip: It’s usually blindingly obvious if your needle is in an artery, but if you’re worried about – take a blood gas sample and compare the saturations to their sats probe. Venous blood is usually around 75% saturated.

As a junior doctor this trend continued, and every prescription I wrote, every procedure I performed, no matter how much I checked and double-checked, I would always be awake at night fretting that I’d done something wrong. As you might imagine, all of this unnecessary stress meant I seriously did not look forward to going to work in the morning, and I was reaching the point where I was genuinely wondering whether this was the career for me…

So you’re essentially up to date, and throughout this blog I hope to convey the sorts of things I went through, and the tips and tricks I picked up along the way to help put this anxiety to rest.

To try and convince you that it’s going to be okay, and to give you an idea of how far I’ve come in just a couple of years – I’m now a moderately competent, albeit very junior, anaesthetic trainee. Every day I put in cannulas, administer potentially lethal medications to render previously well people unconscious and unable to breathe, then try and intubate them before keeping them asleep but alive through an operation and then waking them up at the end without breaking them. Furthermore, not only do I no longer lose sleep over my work, I actually enjoy it!

So if you’re in a similar position to me, struggling with imposter syndrome and a paralysing fear about making mistakes or harming someone, then have a look through some of the posts to come, and hopefully you’ll find something that helps, or at least reassures you that there is light at the end of the tunnel.