Facing bereavement, money problems and exam stress, Ayesha Shahid’s answer when asked how she was coping was always the same – I’m OK. She wasn’t, and, in a piece which was a runner-up in this year’s BMA writing competition, she makes an impassioned plea for doctors to seek out the help they need
If I could change one thing, it would be a small thing. So insignificant, one would hardly think it needed to change. My small change would be to answer the question ‘how are you?’ truthfully.
For you to understand this request, I must tell you my story from the start. At medical school I was a self-funding student without financial support from family and being a graduate meant paying my own fees. I was committed and driven but I was keeping afloat. Yes, my boat had leaks but they were small. So, when anyone asked, ‘how are you?’ my response was always ‘OK’.
Then a storm struck in the winter of my third year. My youngest and most beloved sister died. It was a shock and after six weeks in ITU she lost the fight. I didn’t cry. I didn’t break my resolve. Every family has its issues and mine is no exception. I needed to be a pillar of strength for them. My leaky boat had taken on water but I survived. When my mother asked, ‘how are you?’ I answered ‘OK’.
‘I started to drink. That summer was spent in a stupor. When medical school restarted I couldn’t stop drinking’
I continued medical school but all was not well. I struggled to earn money and my focus was gone. I followed the GMC Good Medical Practice and sought help from my GP who supplied me with beta blockers for anxiety. I wanted to tell him how I felt, I really did, but I was afraid of being seen as weak, unable to cope with the pressures of medical school. Worried somebody would find out. My boat had gone under but I was keeping afloat. So, when he asked, ‘how are you?’ I just said, ‘OK’.
The medical school noted my attendance was dropping and called a meeting. I met with the dean who suggested I ‘take time out’ for the remainder of the year. I tried to explain that money was a problem but it didn’t seem to register. My options were to drop out and face financial difficulty or complete the end-of-year exams without submitting extenuating circumstances. What could I do? I continued to tread water just about coping. When the dean asked, ‘how are you?’ I said ‘OK’.
I started to drink. It felt good. At university everyone drinks so no one noticed. That summer was spent in a stupor. When medical school restarted I couldn’t stop drinking. The next two years were spent pretending everything was OK. I hadn’t dealt with my sister’s death, I had money problems, I had exams and the only coping mechanism I had was alcohol. I was beginning to tire but there was some hope. I met my husband. Together we made it through medical school. When he asked, ‘how are you?’, I said, ‘OK’.
‘I rejected the offer against everyone’s advice. I started seeing a therapist’
On graduation my husband and I got jobs in different deaneries. My only support was taken from me. Although I passed my exams, I didn’t make it through medical school. I was drowning. I tried to move jobs to be closer to my husband, but I did not meet inter-deanery transfer requirements. So, I commuted two hours each way, so we could live together. Needless to say, it took a toll on our relationship. I wasn’t sure we would survive. Work was hard. Home life was harder. I was unhappy, lonely, angry, irritable. I was drowning, yet I never took a day off work. No one knew. When my colleagues asked, ‘how are you?’ I knew no other answer apart from ‘OK’.
I was offered a core medical training post but it meant long commutes for another two years. I was starting to unravel but finally did something. I rejected the offer against everyone’s advice. I started seeing a therapist. I took a trust-grade job and started to evaluate my options. All of this was a little too late. I had had enough. I had the intention of ending my life. I just couldn’t cope any more. No one knew, and when any one asked ‘how are you?’ I just said, ‘OK’.
I got lucky. My trust-grade job was a wonderfully supportive environment. My supervisor was more like a mentor. He spent time with me. Made it clear my needs are important. When he asked me ‘how are you?’ The truth came out. For the first time in a long time I could breathe.
Like me, I know there are many in the medical profession who feel they must be invincible, who do not get the right help at the right time, who live away from their support networks because of the nature of the job. Those who know me will not believe this is my story, but I share it because being vulnerable is not a flaw. Saying you are not OK, is OK.
Ayesha Shahid is a staff grade in general medicine and dermatology in Surrey. She was one of three runners-up in this year’s BMA writing competition
Find out more about the BMA writing competition