October 2021: Women, Mothers and Others as medics

I had my first baby at medical school. I had learnt through my childhood that complaining didn’t do any good and so during the constant nausea of the pregnancy, I carried on.

It was 1982 and even though our medical school had more women than most, being pregnant was not playing by the book. For the most part, it was ignored. As I came up to term, I was on a surgical firm. We were doing a ward round on a female ward and came across an empty child’s cot. The consultant surgeon I was training under, looked straight at me and said “I can see we are prepared for all eventualities.” That was the only acknowledgement of my condition.

I went into labour while assisting in the operating theatre. I bore the contractions silently and timed them on the theatre wall clock. I managed to get to the end of the operating list without letting on and went from there straight to the labour ward.

I had no official time off for the birth of our daughter. My husband was working and we had no family to help. I did have a childminder arranged but I hadn’t expected to be overwhelmed with maternal feelings. I wanted more than anything to be with my baby and by the end of the year and my qualification as a doctor, I knew that I could not leave her for the minimum 80 hour average week of pre-registration house jobs.

Almost 8 years and 4 children later, I started my surgical house job. I knew that I had to do well, extraordinarily well. Two consultants had interviewed me; it was after they told me that I had not got the job, having been out of medicine too long that they asked me what I was going to do – my answer changed their minds and they decided to give me a chance.

I set out to be the best. I put up with the snide remarks and the gendered references – once in theatre, I was left holding a bowl filled with the contents of an obstructed bowel. The consultant surgeon was laughing at me, asking whether this was better than changing nappies.

However at the end of the 6 months I was rewarded – both of the two consultants who interviewed me also paid me the compliment, that I was the best houseman they’d ever had. In retrospect, the consequences weren’t quite as positive as I thought they were at the time.

I had created a situation where I expected perfection from myself at work and also back at home; I tried so hard to be a really good mother to my 4 children and make up for the time when I was away at work. I moved on from house-jobs; the plan was to become a GP, then at least I could be part time.

 On my first day in paediatrics, I was left to resuscitate a neonate without assistance when the consultant mistook the fast bleep as a ‘test’ bleep. As an A&E SHO, the only doctor in the department at a peripheral hospital, I found myself dealing with a 4 year old child in cardiac arrest all on my own – these situations are unthinkable today. There was no debrief, no counselling, I just carried on working; but it hit me hard -perhaps more so, since I had young children.

Despite or maybe because of the way I had handled the paediatric arrest, I was encouraged to pursue A&E as a career and I did really enjoy the speciality -it all seemed to being going well;  flexible training was on the horizon and so it seemed that my working life would improve considerably with a reduction in hours.

I was lucky in that my husband and I had role-swapped when I went to work – it seemed the only choice when I was doing the average 80 hour week, 1 in 4 and he adapted well. He was unusual at that time, which meant that there were few people he could relate to and he was not readily accepted by other ‘stay at home’ women, who were also caring for young children. The attitudes of other men also changed towards him. In social situations, when he told them he was looking after our children – they would turn away disinterested…..

But I felt his rejection – it reflected on me. I was the cause of the trouble. I internalised my feelings. I was also getting tired. Everyone else’s needs came before my own and the stress and vicarious traumas from work, began to take their toll. Then a situation arose in our family that provoked memories of my own traumatic childhood and finally I had an emotional crisis. My repressed emotions came to the surface and once activated, it seemed that that nothing would stop them. There’s a long story in the years that followed the diagnosis of depression……

Eventually I returned to work where I had left off, this time as a flexible SHO in Emergency Medicine. I completed my Membership exams (now titled MRCEM) and was now set to apply for SpR posts. Candidates were expected to visit the A&Es where I would potentially work on the rotation.  One of those visits was particularly memorable. The consultant I met, a man, spelt it out to me. Even though, I was not going to go off and have more babies, I was too old for the job. I would not give back enough years to the NHS, so it was not worth while training me.

I was shocked, but there was more to come. I was told something similar by one of the powerful male consultants in the A&E where I was currently working. He did however, assure me, that if I wanted a permanent staff grade job there, the door was open.

I was infuriated and also determined. Thankfully I did well in the competitive interview and was given a training number on the rotation.

If only fate hadn’t intervened……my children were teenagers now and two required funding for university, my husband was back working. We were dependent on both our incomes and then suddenly, without warning, his company was taken over and he was made redundant. He tried to get another job locally but without success. After much thought, we decided to be positive and move to an area where housing was cheaper and decrease our outgoings. Naturally I was limited to areas where I could get an inter-deanery transfer.

I made enquiries. Initially I was told that ‘economic migration’ was not a good enough reason to move but then my husband found a job. An inter-deanery transfer was agreed for that area.

I flew up to Scotland to visit the new A&E department where I would be working. It turned out that the flexible training dean was also one of the A&E consultants. I sat in his office and discovered the harsh reality of joining this particular deanery, where they had not agreed to the EWTD. (European Working Time Directive which limited average working week to 48 hours.) Even though I remained a flexible trainee, my new part-time hours were to be 39 per week without any increase in my pay. (The full timers worked 65 hours). In addition to this, I was to be expected to do the full 7 night-shifts in a row. I would be required to be resident for 18 months at another hospital over 100 miles away as part of the rotation, never mind the fact that I would be separated from my family. I couldn’t believe what I was hearing – none of it made sense. I knew what I was required to achieve to satisfy the A&E curriculum and it wasn’t necessary for me to go to yet another hospital. I explained why I found working more than 4 nights so difficult since the illness and the fact that I was a flexible trainee to protect my health. But he was insistent-none of this was negotiable. One of the existing SpRs showed me round the department.  He also explained the ‘culture’ of this particular A&E to me – it was supposed to be reassuring to know that this consultant, the flexible training dean, whose office I had just left, would pick on me and make my life miserable until I swore at him in public. The SpR told me not to mind – “it is nothing personal, he does it to every new SpR.”

I decided I couldn’t work under such conditions and resigned my training number. I thought I was fortunate to get another post, working in Psychiatry as a staff grade. There were no anti-social hours at least. But I was a fish out of water and soon realised I had made a terrible mistake.

I went back to the flexible training dean, humiliated, defeated and asked if there was any way I could come back to A&E. I said I was willing to be an SHO again, or a staff grade. He was incredibly rude and he brought up the subject of my mental health and used this against me. His final words were that he would never let me work in A&E either at this hospital or anywhere in the region.

I reported him. He had broken every rule under the sun. I did not know where to turn. Even the BMA were little help. Occupational health were no help either – they told me, I should never have taken the job in psychiatry……….. Once again, my world was crumbling. I didn’t know what to do; the crisis earned me a diagnosis of ‘relapse’ – I thought they must be right. I went off sick.

The Trust (hospital) Medical Director agreed that we should meet – just the 3 of us. It was my word against that of the flexible training dean – he denied everything. I couldn’t help myself and broke down in tears. I knew that I would not get work as a doctor where we lived, I had burnt my bridges.  After the meeting was over the Medical Director validated what I had reported to him – “I believe you” is what he said. But without evidence, there was little anyone could do, so I didn’t work again until we moved back to England.

Yet another gap in my career and this time, it was not my own children I was caring for but a baby grandchild…….but I wanted to go back to work in A&E. There was no such thing as a ‘return to work’ scheme, so I did it myself -I was an ‘observer’ on an unpaid honorary contract but after a day, I became part of the work force, just making sure that I presented every patient to a senior. Thankfully before too long, the department offered  me an ST3- LAS and then I became a ‘trust registrar’.  However the possibility of career progression to Associate Specialist had gone – the 2008 contract put paid to that.

I wanted to return to training. There was a glimmer of hope, when a scheme called DRE-EM arose. On closer scrutiny, it was little different to starting all over again as a CT1 and once again, there would be an impossible commute – this time I would have to work at the base hospital for 18 months, including twilight shifts finishing at 2 am. It seemed like the gods were against me, yet, I couldn’t envisage being stuck at the top of the trust registrar pay grade where I had landed and keep going without any potential for growth.

I was acutely aware that there was little respect for me or my opinion within the medical profession, once my job title was known. I had also witnessed how derogatory others were towards SAS doctors in general. How could I have let myself get to this? I spoke about the possibility of the DRE-EM training to one of the consultants I knew and respected in my department. I was completely shocked by his advice. He told me he thought I was capable and could pass the final exams (FRCEM) but he also told me that I was not the ‘type’ to become a consultant – I was the ‘wrong’ sort of personality. I was not aggressive enough, not loud enough. I was a good follower, but not a leader. He advised me to forget it.

Opportunity arose for us to get a green card and emigrate to the USA. It seemed the answer -I studied and passed USMLE and was given the golden certificate – the ECFMG – the Eligibility Certificate for Foreign Medical Graduates, granting me the right to apply on the computerised matching scheme for residency programmes………..Finally I would be able to complete my training in Emergency Medicine.

 Filling out the on-line applications for ‘the match’ was arduous, requiring considerable detail. It was costly too. There was a fee to pay for each programme you applied to. Finally -press submit – it kept pinging back. I couldn’t understand what the problem was.  

My heart sank when I found the reason…….all residency programmes for every speciality in Colorado, where I now lived, required that your primary medical school qualification had to be within the last 5 years – if this stipulation was not met, your application was automatically rejected. I looked through every document I had been sent, every relevant email, there was nothing about this anywhere. I searched through all the advice sent to International medical graduates……no mention and yet, I could not find a single residency program in the USA for Emergency Medicine to which I could apply. I tried other specialties in Colorado but to no avail. I met with University of Colorado medics. I was given contacts and had meetings with numerous people. It was hopeless. Nobody could help me. My dream had come to an end -I gave up medicine- this time for ever.

Here I was a bona fide resident (green card holder) in the United States and none of my British qualifications including my BSc were recognised – the best I could hope for, was a job which only required  high school graduation. I earned $11 an hour when I worked at a charity for the homeless. It was tough, but I enjoyed it, until I was subject to an unprovoked assault. Once I recovered, I realised that it really was too late in life to start an alternative career and living in the USA without a steady and at least moderate income was not likely to end well. We were living below the federal poverty line, yet, unable to get any state benefits because we were immigrants who had not been in the country for more than 7 years. Time to move on.

It was hard returning to the UK, leaving friends and family behind. But at least I found it relatively easy to slot back into Emergency Medicine, once I overcame the initial anxiety. But I suppose I am a veteran at ‘return to work’ and this time, there was proper support. It felt like riding a bicycle and here I am, this time for life, a SAS doctor back in Emergency Medicine.

I am strong. I am a survivor. I am a woman who has battled against the odds in a world where I was discriminated against firstly because of my gender and then because I had been ill. I have learned that though I have made mistakes in my career, I have also been the first to recognise and rectify them. I should not have been treated the way I was and I hope very much that others do not have to go through similar ordeals. The hierarchy within medicine is breaking down because there are more women within the system, however we must make sure that the fight we have gone through to get to our positions, does not harden our own abilities to be supportive and empathic towards others who come after us.

I am happy to still be working when most of my medical school peers are entering retirement. I can look back at my life and wish it had gone more smoothly and that I had attained my career goal to become a consultant in Emergency Medicine. However, I am where I am and not a lesser person because of it. I have proved that a neat, straight line, career trajectory can be broken, not just once, but a number of times and still lead to a fulfilling life and provide a service to our patients. Those who say otherwise are merely reflecting their own limitations.

February 2021

Life this year is stressful the world over, but more so for those who are caught up in the various political and economic fiascos resulting from the pandemic.

I want to step away from that subject right now as I am starting an ambitious writing project. I promised myself a few years ago, that I would set the record straight about what I believe really happened to me back in 1994 at the start of the period when I was first given a diagnosis of depression. The sequelae from then on are all too easy to understand given the psychiatry paradigm that has been around since the publication of the first edition of the American DSM (Diagnostic and statistical manual), which made the American Psychiatric Association millions of dollars.

I had no idea of the falsehoods that were presented to us as research, defining mental illness diagnoses and the treatments, which were supposedly evidence based. There is plenty of argument to be had to this day and of course it will be a battle to convince the majority mainstream psychiatric profession to change their views, particularly if it means doing themselves out of a job.

The current situation is that there is more and more hype with regard to the rising numbers of people suffering with traditional mental health diagnoses like anxiety and depression and therefore the perceived need for increasing the mental health workforce.

I completely agree that there are many people suffering from emotional or mental distress at the present time. There are many who have been recently bereaved or have suffered in all too familiar ways as a result of being ill themselves or knowing those close to them who have been seriously unwell with covid. I believe the mistake is in medicalising the normal response to difficulty and suffering. Not only that, there is also the worrying trend for people to be prescribed medication for these normal reactions and those very same drugs have a complex and bewildering effect on the way our brains function.

I have been there. Yet I also know how hard it is when you have desperate people in severe emotional distress begging for some kind of relief and you as a doctor are so unable to give them the necessary time to really listen and understand what is going on. However, knowing what I do now, I would be extremely reluctant to go down that path.

 Our culture is such that we have developed a very low tolerance for suffering and we have lost the ability to discriminate what is normal from what is pathological. Yet we are the same human species that has been on this planet from time immemorial and managed our societies with varying degrees of kindness and compassion for one another. If we have learned anything, then surely it is that accepting our differences and managing our expectations of one another with as much tolerance as possible, is a healthy way to live.

In some ways, the anti-stigma campaign that I fought so hard to promote has made things worse. More and more of our children and young people are being diagnoses with a mental illness and their behaviours labelled as abnormal. It’s only a few years ago, the very same youngsters may well have been dismissed as just manifesting a stage in growing up. The truth is, that the latter is much more healthy for all of us. But it is hard when social media has become so dominant and learning dysfunctional behaviour from others is easy.

When I was at school, I never heard of anybody hurting themselves. I did not know anyone who had completed suicide. Of course these things were not talked about because there was a general feeling that to do such a thing was selfish and weak. Families were ashamed and it was not long ago that a suicide attempt was a criminal act. I am glad I did not know that I could have used a variety of behaviours to draw attention to my plight.

I was an unhappy child for many reasons, but despite the misery, I made it. I came through and got myself to university. I know how things could have been better for me, but also I believe that if I had been a child in today’s world, it would have been a whole lot worse and I very much doubt I would have arrived at medical school before my 18th birthday as I did then.

I can easily see the connection between what happened during my childhood and  the crisis I experienced later in my life when I was diagnosed as being depressed. I saw it then but was told I was wrong. If they had maintained an open mind and the connection recognised as significant by the psychiatric community, then it is highly likely that my symptoms could have been seen as normal.

Normal doesn’t exclude support or help. I am not suggesting that I could have carried on with the life I had as a junior doctor then, without being able to replenish my energy and strengthen my inner being or that I could have made it without psychological support. But I know that being given a label of major depression and being told I was seriously ill opened the gateway to the acceptance of treatment. I wanted to get better. I was treated with drugs that changed the way I could respond to psychotherapy, as well as gave me terrible side effects, which the doctors told me were further evidence of the depression; drugs which were likely responsible for my suicidality. I had numerous ECT treatments and finally irreversible brain surgery. It was not just me who was harmed, so was my family. We continue to pay the costs to this day, almost 30 years later.

I have no wish for others to have their lives ruined by the same lies that caused my well- intentioned doctors to give me such treatments without any credible evidence base behind them. It is about time that the real story was told and I am currently writing a new book to correct the fallacies which I had accepted to be true, at the time I wrote ‘Life After Darkness; a doctor’s journey through severe depression’. I was duped by so called experts, just like millions of others the world over. Unless we do something now, there will be many more casualties. Our time has come, the bastion of traditional psychiatry must fall beneath our scrutiny.

November 2020 – renewed perspectives

I decided a few months ago that I would re-write my first book ‘Life After Darkness; a doctor’s journey through severe depression.’ It’s not that my story is inaccurate but if I had received a different response on the first occasion I asked for help, I believe I would have avoided the 7 year nightmare that followed.

  Of course, life has moved on; it’s almost 20 years ago since my sudden and inexplicable recovery from an illness where I gained the diagnostic label of ‘treatment resistant depression’. So why would I want or need to write any further about this?

Sadly it has taken me a long time to unpick what happened to me and to discover the truth about the erroneous diagnosis, the well intentioned but completely wrong treatments I endured and the pseudo-science that led me to believe that I was in the safe hands of psychiatry. It was a shock when I first met somebody who challenged the diagnosis of depression. Yet once I was able to allow myself to contemplate that these learned, highly trained professors of psychiatry could simply put, be wrong, I felt as though my experience started to make sense.

The paradigm that I had had a severe, serious and prolonged depression which had not been amenable to standard treatment, which could relapse in the same way had a profound and lasting hold on my life. I found it difficult to be confident when I started to break away from the advice that my esteemed doctors had given me. It was very scary and anxiety provoking. But the rewards have been considerable.

I started to feel alive again after almost 25 years of high dose antidepressants but more importantly I am no longer afraid. I can be myself, free from worry about losing my foothold on life, free from the concern that I might once again be forced into hospital or given drugs or even ECT against my will. I can relish the fact that I survived and that I can work as a doctor and know that I am not a poor, vulnerable individual who is likely to succumb once the pressure gets too much.

I never was that person originally, though I became so when I was made a psychiatric patient. The label follows me on my medical record but I delight in defying the trajectory that the cynical and pessimistic mental health profession, unwittingly lays out for their patients.

 I have been fighting against the stigma of mental health problems since 2001 and now I wonder whether that has been the right battle to engage with. I do not want others to medicalise their traumas in the way I did and to look to doctors for answers. I know that it did me a great disservice and even today, the potential for harm is great.

Instead I would rather focus my efforts to encourage individuals who have had particularly difficult or traumatic encounters, especially as children to see themselves in the context of their experiences.

We are not weak when we have emotional turmoil. Our requests for help in processing the past are indicators of the strength of our purpose. We are survivors and we will be strengthened through compassionate understanding and in this way we can be those who break the cycle of dysfunction that only too often has the potential to repeat itself in future generations. For this very reason, I have to be grateful to be where I am today.

My family did suffer and I cannot speak for them. I can only hope that in time, there will be a realisation that I would have done anything to avoid that. Yes, I was a victim but thankfully, I passed from that passive state to one where I was able to take back control of my own destiny.

The challenge I have today, in my working life is to re-empower those who have lost their ability to determine their own future. Clearly this is never going to be absolute, but to live life to the full, self determination without prejudice or judgement will enable the best chance of recovery. Medics like myself have to give up on the idea that we are there to fix peoples’ lives and then, maybe our patients may start to view us as fellows who inhabit the same human struggles as everyone else. That should not take us away from the ability to be compassionate helpers when the ‘chips are down’, rather we must hold on to the hope, that each person will have the strength to survive the darkest night and awaken to the opportunity of a new day.

June 2020

I’ve been back in the UK for over a year. So much has changed and I am not just referring to the Covid pandemic. It seems as though we can talk about nothing else and it dominates every aspect of our lives. There has been talk of war on the virus, conquer and defeat, but with little regard to the actual facts of the matter.

Viruses aren’t at war in the classic sense; they just use other living creatures to propagate and survive. True parasites, they do invade our cells and it is not the politicians who fight them, rather our bodies; unfortunately, it is our immune systems responding to the alien, that causes reactions so severe that will for some, make us very ill. Viruses are a highly successful species in evolutionary terms, adapting themselves to suit their ongoing transmission.We are unwilling victims of course and there are many who have succumbed. Yet life goes on and how quickly we accept the situation, if it is not us who are mourning the death of a loved one.

As I write, a member of my wider family is still struggling between life and death after 2 months in intensive care, separated from his loved ones. A personal encounter of this sort, takes all levity out of the situation. An unpredictable danger, a threat to be taken seriously.

Of course there are positives to the pandemic . Our unstable world, which has been ravished by man’s selfish and thoughtless use of its resources, has a chance to recover, just a little. And many of us as individuals have been stopped in our tracks and made to think about what exactly is important to us.

It is heartening to discover how many people are enjoying the freedom that restriction brings. An oxymoron if ever there was one. The musts and oughts have had to take a break and with it, comes time; time for reflection, time to read, time to write.

Not true for everyone of course. Mindful that my job as an Emergency doctor here in the UK, is very different from what some of my international counterparts are experiencing. I am grateful that doctors in the UK do get time off; fortunate too that we have not experienced the overwhelming intensity of some hospitals in Europe, China and the States have encountered. Some flooded with seriously ill patients suffering with covid, that has happened in too many places the world over.

I am not saying that working life has been easy. It was extremely stressful as we prepared, not knowing how exactly the pandemic would ‘hit’. But, when it did, facing our fears brought a modicum of relief, though not of course for the patients and families who needed our services.

Many troubling events the world over. Institutional racism, homophobia, fascism, religious bigotry, communism and many other unnamed injustices. I just don’t know how to navigate through the overwhelming news of atrocity after atrocity. I feel intensely for a while, whether it is anger or sadness or the hopelessness of it all. But I cannot carry it, and I turn away, forget and move on. I cannot change the world, I am no god. So where is the line between apathy and responsibility?

Sitting in the sunshine, watching birds at our feeders, loving the blue skies and the spring flowers. I know that I am lucky; one of the wealthy few in world terms, I have a garden and a house, food on the table and a job to go to. Is it enough to be grateful, I ask myself and sigh, because I have no answers.

Hello, my name is Cathy

I am Cathy Wield, but who am I exactly and what makes me tick. Now redefining my occupation as a writer, the world suddenly takes on new challenges. My passions remain similar and I still want to fight the stigma of mental illness but there are new horizons. I have learnt so much more about myself since emigrating to the United States.

The books I have written are not the whole story or at least not the completed story. The historical events are indisputable, but I have more insight about my early life and how it affected me so profoundly in adulthood. I have experienced healing of some very painful memories for the first time which is exciting, although I am fully aware that this is a process and it may take a while.

I am a woman of faith, but further definitions in this category may draw some near but also push many away. So I would rather leave it at that for now. I have so much compassion for those who suffer from all walks of life whatever belief system they have chosen. My desire is to be authentic about myself but I know there are many pitfalls and though I abhor hypocrisy, I am just as likely as anyone to possess this trait. So this comes with a warning: I am far from perfect and may unwittingly offend, although it is certainly not my intention to do so. May I ask for your patience and tolerance because I am a work in progress and I will make mistakes?

I spent most of my working life as an Emergency Physician, but I did have a couple of significant periods where well….. the politically correct phrase is, I took ‘a career break’. It makes my profile potentially more colorful than most: Dr Crazy Wield specializes in every emergency related to depression, self-harm and suicide, but lives to tell the tale. Well able to sympathize with unwanted effects for many medications; personal experience of overdose, ECT, suturing and surgery. Excellent communication skills after 7 years of face to face counseling and psychotherapy. She’s not so bad at other aspects of Emergency Medicine either………..Suffice it to say, I can call myself a thriving survivor and I have a unique perspective having played both the roles of doctor & patient.

My plans to continue practicing as a doctor were thwarted when I arrived here in the USA. Despite passing the rigorous USMLE – US medical licensing exams, I hadn’t seen the small print which meant that in order to apply for the necessary clinical experience as a hospital resident, I would need to have qualified from medical school within the last 5 years – that counts me out. I am rather more experienced than that. Nevertheless, nothing is wasted, but my career is clearly not going to be as a clinician.

This is liberating in many ways, set free to pursue other avenues. My first attempt at a job here was working with the homeless, though it has to be said that the reason I resigned following an unprovoked assault, had more to do with the response of the institution than the actual injuries. I admit a little reluctantly that I suffered from PTSD following the assault, but on the positive side, I have another string to my bow in the understanding of mental health conditions – there’s nothing quite like ‘lived experience’!
My assailant was arrested but unable to stand trial ‘by reason of insanity’. I was horrified to hear that she was released back to the streets without any treatment. I had hoped that some good would come from this incident and that she would get the help that she so desperately needed. I was told, that it’s ‘too expensive’ to offer her treatment…………

As usual, it is those who have no voice who lose out the most – in this instance, the homeless, the mentally ill and the addicted. I feel right at home among them, but I need to step up, step out and speak out as I doubt many others will.

Please join me – there is a battle in progress. We will win it one day – injustice will be defeated.

To quote a famous book – “the wolf and the lamb shall graze together; the lion shall eat straw like the ox, and the dust shall be the serpent’s food. They shall not hurt or destroy in all my holy mountain.”

Hasten the day!