You can make it back after burning out. I should know, I’ve done it
Dr Robin Moore’s life fell apart two years ago and here he describes the long road back to practising as a GP
In early 2013 I was set a task. I was given paper and a pen, and told to write a two-word statement with the title ‘I am’. This was intended to be a self-esteem building exercise, and those around me spent the next 15 minutes filling their page with lines such as ‘loving father’, ‘Rangers supporter’, ‘coffee drinker’.
I stared at my paper and couldn’t write anything.
There were lots of things I had been, but I wasn’t any of them now. I was nothing. An empty shell. In hindsight, that’s what I should have written, but I didn’t. I went back to my room on the NHS psychiatric ward where I was an inpatient.
In 2012, I had my annus horribilis. The blame was squarely on my shoulders. I know I’d used the phrase ‘burning out’ a few times. I said it to my own GP in November 2011 when he started me on antidepressants for generalised anxiety. I said it to my partner in the practice when I cut my hours to part time. I said it to the appraisals lead when I postponed again because of ill-health.
I broke my ankle in January 2012 in the snow. That sounds so innocent, doesn’t it? I slipped while putting an empty vodka bottle in the recycling bin at 11am on a Sunday morning. I picked myself up, made sure the bottle was hidden by cans, as was my usual practice. I filled a bag with snow to pack around my ankle, and went back indoors to the drink I’d just poured. That afternoon, when my wife returned with the kids, I persuaded her, citing Ottawa rules, that it was a sprain. After four days at work as usual, I got an X-ray. It was a Weber B fracture that needed pinning and plating. The orthopaedic surgeon gave me a six-week sicknote. I didn’t use it. I had to keep going.
Five weeks later I just couldn’t.
I was unsafe to be in the family home
The week before the plaster was to come off my wife asked me to leave the family home. She’d found me passed out after she’d put the kids to bed. It wasn’t the first time. I was supposed to be cooking dinner. It was in the oven and I was unconscious. I was unsafe to be in the family home. My brother-in-law drove down from Scotland to Manchester to collect me. I removed the plaster myself in the garage with a pair of scissors and a kitchen knife while I was waiting for him. I stayed with them for a few days, then went back down south to fix everything. A week later the locks were changed.
Things spiralled. At the practice, I wasn’t seeing patients but was still trying to maintain a partnership role and going to meetings. The partners always opened a window as I walked in but I didn’t get the hint. They gave me an ultimatum - either I could self-report to the GMC or they would report me. I said go ahead. I wasn’t capable of dealing with that - or anything.
I isolated and hid. I didn’t answer the door or the phone. I drank when I could. The only time when I was vaguely straight was when I was with my kids. Between those times I was suicidal.
I developed symptoms of a colovesical fistula and ignored them for two months. On the morning of my daughter’s first day at primary school I was at the family home. The kids were playing with their mum’s forehead thermometer and found my temperature was 39. I could barely walk up the hill from the school after we dropped my little girl off. Two days later I finally went to A&E - at the hospital where I’d done my JHO year and GP training. I was in for six weeks, had emergency surgery with colostomy formation for severe diverticulitis, then a revision of the stoma and ITU stay. On discharge I was collected by my sister for another stay in her spare room in Scotland.
My sister’s doorbell rang on 31 December and divorce papers were served - a fitting end to the year. Despite agreeing to not drink when staying with my sister it had been Christmas, and we’d been seeing family so I was well into a binge. I woke up in a sorry state on New Year’s Day. The district nurse who had come to dress my non-healing post-op wounds didn’t look impressed. Something had to change.
On 2 January I phoned the Sick Doctor’s Trust. I told my story. The lady on the phone said ‘gosh, you’ve had a really hard time haven’t you?’ Then she said: ‘Do you think alcohol might have played a part?’
One of my partners, in an email as part of the GMC bumpf that I’d avoided, had suggested I ‘seemed like an alcoholic’. I’d not liked that. I asserted that I could stop drinking abruptly without any problems. The lady arranged for me to get Librium for a home detox after I’d phoned Alcoholics Anonymous.
I turned to everyone and said: ‘My name’s Robin and I’m an alcoholic’
AA surprised me. A guy turned up on the doorstep later that day and took me to a meeting just down the road. I’m ashamed at my lack of knowledge of recovery. I’d assumed it was like Weight Watchers - a meeting every few weeks to discuss how miserable or happy everyone was and compare how we were doing with cutting down. I didn’t expect to see folk who were sober and had been for some time. And I knew I belonged there. I turned to everyone and said: ‘My name’s Robin and I’m an alcoholic’.
My memory after that meeting goes fuzzy. I know I was taken to another meeting the next night but I don’t remember much of it. The day after that I have a patchy memory of being in a police van. It was taking me to hospital – only I didn’t understand where I was until two weeks later. I have patchy recollections of my delirium tremens, and I try not to revisit it.
And so I found myself in the group session at the start of this account.
On discharge, I presented as homeless to the local council, and was put in a hostel. The first weekend there I took an overdose of various things, including a dose of dosulepin that I shouldn’t have woken from. But I did. I had sworn I would never drink again; but the next weekend I did.
That was my last drink, on 23rd February 2013.
Early the next week I saw a doctor at the community alcohol and drug service. He told me his story of addiction and recovery, and how despite getting to rock bottom he was back in work and doing well. He suggested I get back to AA. When I saw him the following week I’d done that and things had already improved. The council had found me a flat in a rural village where I knew I would struggle to hide being an active alcoholic. My recovery was gaining momentum. All I had to do was ‘keep coming back’ and ‘stay away from the first drink’.
I went to a British Doctors and Dentists Group meeting in early March and got more hope, but I didn’t think I’d ever practise again. I had started to engage with the GMC, though. With a clearing head and a support network, the enormity of things seemed to diminish. I discovered I wasn’t the only one who had ever been in this position, and that folk had got through it. I contacted my defence union and it provided representation throughout.
My Fitness to Practise panel was scheduled for July 2013. After a submission outlining my insight, ongoing sobriety, engagement in AA and recovery progress, the panel was cancelled and the GMC instead imposed health-related undertakings on my registration.
Getting back to a position where I could work again took time and effort. But I had time, and my life was empty as I’d lost everything. All I could do was engage in recovery activity through AA and BDDG. As I did the right things, the right opportunities arose. A BDDG friend knew a GP who let me observe at his practice, and got me opportunities to observe elsewhere. I went to CPD meetings. I read a lot. I got physically stronger. My GMC-appointed psychiatrist reckoned I was ready to look for work so applications went out, but with my situation it didn’t look promising. I was also struggling to put myself on the local performers list despite the GMC’s position that I could work in a post appropriate to my undertakings.
I was on Jobseekers Allowance, signing on and attending a local work programme. One day my job adviser showed me an advert for a part-time long-term locum GP in a practice in Lanarkshire. I wasn’t confident when I sent my CV but they offered me the job. That strengthened my performers list application but it wasn’t a clean run. For my first few weeks I had to prove my competence with video consultation assessment.
That’s water under the bridge. In April 2014, after two years away, I was a GP again, working two days a week. In October I was offered a part-time job with the possibility of branching into addictions work. From then until July 2015 I was working five days a week. In August my ex-wife brought the children up for a week to stay with me. From October I’ll be doing four days as an addictions specialty doctor and one day in general practice.
I’m managing better today. I’m not where I expected to be but I’m not in a bad place and things are working through. There is hope. I’m in recovery.
Dr Robin Moore is a GP in the Forth Valley, Scotland