Carrie Fisher showed the way. I want to acknowledge my own mental struggles | Deborah Orr

Lots of people said Carrie Fisher was wonderful. Lots of them said she was wonderful not because of the achievements in her career, but because she used her fame to talk and campaign about how she managed her bipolar disorder, and about mental illness generally. I agree. Yet, while I’m no Carrie Fisher, all this makes me feel guilty about my own silence. Feelings of guilt are one of my symptoms.

I started being treated in October for a mental illness I hadn’t even heard of: complex post-traumatic stress disorder. I realise now that it’s been there, thickening, worsening, for many years. Essentially, it comes about when you suppress traumas and carry on regardless, failing properly to address emotional distress, which you also suppress.

I have trouble remembering. Even after I’ve looked it up, which I often do, I have trouble remembering the year my father was first diagnosed with cancer, or the year he died; the year I was diagnosed with cancer; the year a huge chunk of masonry fell off our terrace of houses; the year my mother was first diagnosed with cancer, or the second time, or the year she died; the year my first son crashed out of school; the year my second one did; the years when I got them back into education; the year my then-husband was diagnosed with a chronic blood disorder. Basically, I barely remember the last decade. I’d thought my perfidious memory was the result of chemotherapy, or just of ageing. But it’s another symptom.

People tell me I’m “intimidating”. I’ve been told that for all my adult life. I’ve accepted it without understanding it, sometimes explaining what a shy child I was, how endlessly susceptible to bullying, in every context I ever found myself in. I’ve always been too scared really to question how it could be that other people saw me so differently to how I really felt (I even intimidated myself). I told myself it was just because I was someone from a working-class background in an upper-middle-class milieu. Anything to protect me from my secret shame – that I found everything intimidating.

I kept that shame entirely hidden, especially from myself, by pretending that I found nothing intimidating. I even called it “pride”. That “pride” has stopped me throwing up my hands, and truly admitting I’m beaten.

The illness can make you appear to other people as someone who is tough, who can cope with anything. You take on responsibilities you struggle with, and look after other people without looking after yourself. But when you suggest you can’t take it, people often don’t even hear you. They think you’ll cope because you always cope. That’s who you are. That’s what you’re for. Which is not to put blame on others: it’s a natural and rational reaction, the logical thing to say to the person they want to see and think they know.

So you carry on coping, and somehow you get through. You thrum with stress, take your anger out on the random dude who does the tiny thing that makes you crack; or become listless, unable to focus, panicked every time the phone rings, every time a letter arrives, a letter you instantly recognise as pertaining to the hellish, complex negotiation that no one but you knows the intricacies of.

You look like you’re managing things that would floor other people, sensible people. Though nothing could be further from the truth. You become a person for whom it is second nature to find courage or aggression in yourself because you are frightened and vulnerable. Or you resort to passive-aggression, which is often my miserable chosen defence. Anything to avoid addressing the fact that you are terrified.

Generally, the psychological vulnerability starts in childhood, not necessarily with dreadful abuse or neglect. I was not an abused or neglected child except in the usual, Larkinesque way. (My parents were neurotic and moralistic: I think of my childhood as like growing up in a religious cult without the religion.) But I was a sensitive child, in a pretty rough-and-ready, rust-belt culture. Early memories, recounted in therapy, have taken on a significance quite different to the meaning they had for me.

They include seemingly small things, such as being sent out to play on my own for the first time, aged three. A bigger girl asked to see my gold christening bracelet, then ran off with it. When my dad went round to confront her mother and get it back, the woman said the bracelet was her daughter’s and refused to return it. This was my first solo encounter with the outside world, and I see now that, rather than accepting it and learning from it, I defied it, even then.

I stride boldly into situations for which I am ill-prepared. I trust people very easily and very completely. I find it hard to show that I’m hurting. Another memory, aged about seven: I stood on a platform while other kids threw bricks at me. One struck me on the temple, but I wouldn’t show them it hurt. It’s a habit that gets me into trouble, again and again. Anything rather than acknowledge my debilitating fear, of the world and the people in it. I’m an idiot. Or I was.

It’s hard, at 54, to find the time and energy to reassess your whole life, take responsibility for all the mistakes, and still embrace the part of you that did OK, even if it betrayed the part of you that actually needed the attention.

It’s hard to see that you’re interested in, and opinionated about, the world outside yourself because it distracts you from the churning insecurity inside – the anxiety that eventually shoots up and convulses you with the shakes and hammers at your heart, the dissociation that has you stepping out in front of cars – unless you bang your chest to bring yourself back. That, you thought, was normal. Feeling these things is good (kind of). They are manifestations of stuff you didn’t even know was there, because it was all stuffed down so deep inside. They tell you you’re in trouble.

It’s also hard not to start sounding like a victim: and that’s why people such as Carrie Fisher, Ruby Wax or Stephen Fry are so important. They reassure you that you feel worse before you feel better. They help you understand that while all the emotions you suppressed – the fear, the guilt, the grief, the shame, the anger, the self-loathing – now feel overwhelming, this too will pass.

The guilt is especially hard: guilt that you soldiered on and didn’t sort matters out sooner. But with courage you can let it go. Because you still have the courage you always found, even if you acknowledge at last that it always had a lot of competition from other emotions.

For me, I know, 2017 is going to be the most fruitful and honest year I’ve had for a long, long time. I’m going to be spending it getting to know myself at last and maybe even learning that I’m actually not so awful. And I’m going to carry on saying what I feel, and writing about it. I think there are a lot of people out there, struggling with emotional trauma that they don’t acknowledge. England calls it the stiff upper lip. But it’s your whole being that ends up getting stiffed. Enough.

Carrie Fisher showed the way. I want to acknowledge my own mental struggles | Deborah Orr

My Christmas shift showed me the human connection behind medicine

My first medical on-call shift was on the evening of Christmas Day. Wary of what to expect, I joined my family for an early dinner with a cloud of trepidation hanging over it. The post-food cosy daze that everyone has after their traditional meal turned into the pre-work tetchy panic that every doctor has before a night shift.

I arrived at the hospital at 9pm to find remnants of Christmas cheer lingering on every ward. Boxes of half-eaten chocolates, needles starting to drop from Christmas trees, tinsel becoming unstuck and dangling from the walls, and families trickling away from the hospital after spending the day with their loved ones – it’s like you’ve arrived late at a party after everyone has left.

For the first few hours I was strangely enjoying my first medical on-call shift. It was a refreshing break from the daily grind of writing in patients’ notes what my consultant says on ward rounds and typing discharge summaries. I was reviewing and managing unwell patients, which is what I had been trained to do.

Fuelled by adrenaline, excitement, and those half-finished boxes of chocolates on the ward, I was in full flow. Please review this patient who is not producing enough urine: “urine problems – I remember the causes and treatment in a kidney lecture”. Please review this patient who’s got a temperature: “review patient, check the nursing observations, take some bloods, do I need to start some treatment straight away?”. Please review the ECG of this patient who’s developed chest pain: “reading ECGs – let’s decipher these squiggly lines step by step”.

I had just managed to clear the backlog of jobs when my bleeper barked into life: “Cardiac arrest, ward x. Cardiac arrest, ward x”. I immediately got off at the next floor and ran to the arrest call. By the time I got there, CPR had already started and my medical registrar arrived 20 seconds after I did. It was my first arrest call.

I took over doing compressions. Crack, one rib broken. Crack, another rib broken. At least I was doing good compressions. The consultant asked: “Can you get a blood gas from the patient?” Stab, the needle goes into the groin, nothing. Someone else has got it already. He continued: “Can you get the results please?” pH 6.9, lactate 11 – not good. I ran back to find the patient’s heart had successfully restarted.

At this point, a medical TV drama would cut to another scene. In reality, the patient’s heart was restarted but they were intubated and unconscious. The family later arrived and decided it would be in the patient’s best interests not to continue further care. I later certified death, feeling particularly poignant as it was Christmas, a time of celebration for a birth and new life. As I wrote the last entry in the medical notes, I saw the patient’s distraught family walk away from the ward, feeling their sadness as I signed my name and wrote the letters RIP.

With those swirling thoughts, I was no longer a doctor, but a ​person​ mourning the loss of another

Unyielding and relentless, I was bleeped again. My steps towards the next job got slower and slower as my brain swirled with thoughts of that arrest, that patient, and that family. The arrest call itself is a paradox – laid bare it is the most human act done in the most inhumane way. The act of trying to save someone’s life, of you pumping your fellow human’s heart, touches on the very essence of humanity’s common bond. The process, however, is as savage and barbaric as it is life-saving.

As part of the arrest call team, I was focused on my job of restarting the patient’s heart. That focus strips away the humanity of the patient, reducing life to lines on a screen and numbers on a chart. With each passing cycle, the focus intensifies until it changes into a mix of desperation and willpower – willing the tube to go in the lungs, the blood to flash back into the syringe, the pulse to return. And when it’s suddenly over, the humanity returns.

With those swirling thoughts, I was no longer a doctor, but a person mourning the loss of another. I stopped, turned around, sat in a quiet room and had a chat with one of the nurses who was also at the arrest call. We talked about anecdotes from the patient’s stay in hospital and our own lives. It felt refreshing to talk about the life that was lived in the face of the sadness of a life that was just lost.

Mentally and physically exhausted, I was glad to hand over the on-call bleeper at the end of my shift to the next bearer of that cross. As I walked out of the hospital, I reflected on every job I’d had during the night, still wondering how the family of the patient who died was coping and what the diagnosis would be of one patient I asked my registrar to review.

Nights are said to be one of the best learning experiences. At the end of my set of nights, I was comforted not only by the wealth of skills and knowledge I could take into the new year, but by the care I had given to my patients to make their Christmases that little bit better.

Everyone takes something different away from their medical on-call experience. I will always remember that behind every patient and medical diagnosis there lies a human connection that binds us all together.

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My Christmas shift showed me the human connection behind medicine

My colleague"s suicide showed how vulnerable medical professionals can be

I stood in front of the ambulance bay door. My badge clutched in my hand, knuckles white, jaw clenched. I questioned my attempt at returning to work on this day. I stood in front of the doors grappling with a burning feeling in the pit of my stomach. I knew then, right there, that my career in the emergency department was over.

A quiet swollen presence of pain ran down every corridor. The night before, we lost a colleague to suicide. Some of us found the body. Some of us carried out the post mortem care. Some of us stood there as family filed in to the room. Some of us made the calls alerting fellow staff. Some of us, all of us, changed forever that night.

For some vocations, a bad day at the office means: “I dropped a carton of eggs” or “I broke the copier”. Some are more serious of course: “I really messed up a haircut” and the infamous “I crashed the company car”. In medicine, however, a bad day usually means, “We lost a toddler”; “A young family lost their baby”; “She will never walk again”; and “Time of death …”. The list could go on and on; the point is, the magnitude at which we affect the world of each individual person in healthcare is far different than most jobs. We take on the world, we attempt heroic measures, forgetting, we are indeed, so very human.

We study for years, sometimes decades, focusing our skill, perfecting it, to heal, to save, and to comfort. The team we do all these things with becomes a sort of family. You are all present on the worst days together. You share the sorrow, the shock, and the deep regret that everything you have dedicated your life to studying has failed you. You failed together. You failed in the worst way, but you have one another. You can share that dark humour, the memory of this fleeting moment. You can share together the memory of watching the doctor whisper something comforting, or that nurse hold the deceased family member’s hand. Each of you knows what it feels like, to pronounce a patient dead in one room, and in the very next room, moments later, help a three year old change into a hospital gown so that they can be evaluated thoroughly. You do all this with a smile on your face, never for a second letting on that in the next room, a tragedy they can’t imagine has just unfolded.

Eventually, it eats little holes in your soul. Sometimes there are nightmares, other times you stand in a quiet trauma room and feel the presence of every lost soul standing behind you as you scrub down a stretcher. Bigger and bigger it creeps, into you, never though are you afforded the right to go and lament to your friends over drinks, or weep at your place of worship. Never can you post on public media and share your sorrow. Never can you truly convey what it feels like to have dedicated your life to becoming an expert, but when you have a bad day, someone dies. You cannot ever make someone, who isn’t sunken knee deep into the profession, understand what that means.

The kinship you establish with those with whom you share this camaraderie cannot be duplicated. They are a family that knows all your secrets of trauma and sorrow. There is something indescribably comforting in having these people know you at your worst moments, exhausted, angry, and sad.

The secrets within the hospital walls bonding us together are the same web, that when one of us succumbs to the beast of depression, is torn apart forever. None of us knows what cost our colleague and dear friend their life, it was never made clear. But our family, if you will, was severed to the core, doing the thing we did well together, without them, to them.

I still practise, in a different forum. I think of emergency department life every day. Now I realise how human each of us really is, there are no superheroes among us. Now when my team is becoming saturated, I actively seek out ways to alleviate that pressure, for myself, and for my team. On good days someone gets to live another day, but this doesn’t make the really bad days any easier.

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here. If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com. If you’re a healthcare professional affected by the issues raised in this article, help and support is available from Support 4 Doctors.
  

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My colleague"s suicide showed how vulnerable medical professionals can be

The patient who showed me how to be a better doctor and person

The thing that keeps me going in my job as a doctor are the patients. There are days, no matter how dark, where certain ones shine like stars – their strength glows when you least expect it.

These star patients take you by surprise and never leave you. They become your guiding lights through this challenging and rewarding career. Every day a patient moves me. However, there are some extra special ones who stand out, like the teenager who was told she’ll never have children or the man who wasn’t suitable for urgent treatment for his heart attack. I later received a letter of thanks from his bereaved daughters for telling them this difficult news.

Star patients humbly remind you what a privilege it is to do this job

The patient I have been thinking about most recently is one I met while doing an A&E shift. He was an elderly gentleman wearing a pristine, tailored, brown-checked suit with polished brown shoes with leather soles. He wore a shining silk tie and handkerchief bursting like a blossom from his pocket. Beside him was his wife who was as well dressed and stylish. Both were waiting patiently, watching the hustle and bustle around them. Seeping from his brow and smooth grey hair were floods of bright red blood.

I was too busy to pay them any more attention until, by chance, he became my patient. He’d been at a family wedding and was hundreds of miles from home. Bending down in the car park a car had reversed into his head. The couple had driven themselves to hospital, rather than call an ambulance. I completed my assessment, did a neurological exam and he was rushed for an urgent CT scan of his head and neck.

It turned out he was a retired consultant haematologist. While waiting for the scan results he told me about his career and his love of the job. I felt stupid discussing with him the risks of head injuries.

As a young adult he’d been diagnosed with a significant malformation of his brain. His CT scan was one of the most shocking I had seen, huge gaps in places there should have been brain tissue. There was an audible gasp when I had his image up in the doctors’ station.

He later told me: “As a young man I was told I could die at anytime. I’ve lived my life like that and I’m still here. I’m 83 and I’ve had a great, great life. Look at this woman, my wife, my love.”

He told me how he’d enjoyed training doctors and watching them grow and how he as an old man needed these doctors now. He spoke with such truth and honesty, I blinked back the tears. I saw in him my late grandfather whom I loved so dearly. I saw how medicine is a career of sharing knowledge, an apprenticeship and teaching of the next generation. I felt the stories of patients he had cared for, lives this man had touched. I had no doubt that this was one special doctor.

I explained that I would like to keep him in hospital for a period of observation. “Absolutely not,” he told me. “I’m going home. If I die in one hour, one week or one year from now, I’m more than happy to take that chance.” I told him I would have to discharge him against medical advice.

Related: I’ve never felt prouder of the NHS than when my grandmother died

Sometimes we doctors completely understand when people just want to go home against advice. Sometimes no treatment is the best treatment. I completed my capacity assessments, mental state exams and sutured his head. And there he was, gracious, grateful and inspiring. I asked if there was anything else I could do. He said he wanted to see a scan of his brain because he had never seen one. After some organisation I gave him a copy and he was delighted.

I watched he and his wife leave in their blood-stained wedding outfits. He held the door open for her and I saw their love for each other. I was having a bad day until he came into it like a shining light.

These star patients humbly remind you what a privilege it is to do this job. Stories of lives lived, personal experiences. We see lives saved and stars blinking their last light. I hope he is still shining his shoes somewhere, drinking tea with his wife and looking at his scan. I hope to endeavour to be like him as a person and a doctor. Even in his retirement he was a glowing example of how a good person, a good doctor, should be.

Some details have been changed

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The patient who showed me how to be a better doctor and person