Sleep, survival & surrender…

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5th October 2020

So here I am, 10 and a half months post diagnosis, and 2 and a half months since my last blog post.  I returned to work. 

It was great to be back with my incredibly supportive colleagues and to be part of the team once again.  As much as I have loved being with my family throughout treatment and then lockdown, it was wonderful to be engaging with other people.  It was great while it lasted.

Work wasn’t the problem.  Perhaps it was tempting fate to have mentioned in my last post how much benefit I had derived from having had more sleep. 

I understand now why sleep deprivation is such an effective form of torture.  Sleep is so vital to our very existence.  After a month of averaging 3 hours sleep a night, I felt neither safe to work, nor drive the round trip from Sheffield to Doncaster.  The abilities to think clearly, act rationally and respond with some semblance of emotional balance gradually deserted me over those 4 weeks. 

Despite starting, and subsequently increasing, sertraline (an antidepressant medication), and use of zopiclone (a sleeping tablet), the situation failed to improve.  If anything it got worse.  Sleep initiation was never the problem.  Despite getting off to sleep fine, I would wake routinely at 2.30am.  I would lie in bed, with my eyes still shut but suddenly conscious.  I would play a quick mental game of “guess the time”, before rolling over to check the clock, always disappointed with my unfortunately accurate prediction. 

In the early days of my insomnia, I would lie in misguided hope that I would miraculously get back to sleep.  No such luck.  Some friends suggested starting my day earlier.  I did a couple of 5.30am runs, but it just didn’t seem practical to be starting my day in the middle of the night.  In the end, when I woke, I would either read or head downstairs to watch TV. 

As a GP we always advocate good sleep hygiene, and I was desperately trying to follow that advice.  I eliminated alcohol (not that I was drinking much), and caffeine.  I switched my phone off in an evening. The bedroom was dark and comfortable temperature wise.  I was exercising most days. No matter how hard I tried, I just couldn’t prevent the early morning waking.

I guess I hadn’t wanted to accept that the poor sleep was likely symptomatic of a bigger problem. 

Depression.  

I certainly hadn’t wanted to entertain the idea I might need anti-depressants.  I genuinely thought I could run and cycle my way out of this.  Seemingly, however, you reach a point where no matter how much you exercise, the release of endorphins just isn’t enough. 

I find the concept of describing what I have been experiencing as “depression” strange.  A big black cloud hasn’t been hovering over my head.  I have had purpose, and continued to experience joy in various facets of my life.  I have never wanted to “end it all” and I have never wanted to just not wake up in the morning – there is far too much to live for.  But… I have felt increasingly fed up with the situation and I have been so utterly, utterly exhausted. Baby number 3 left me feeling pretty broken with lack of sleep and the need to care, not just for her, but our older two children as well.  But I could always snatch sleep when given the opportunity, and returning to sleep after a middle-of-the-night feed was never an issue.  This has been a completely different kettle of fish.

My counsellor has suggested that the depression has been masked by my stamina.  I suspect she’s right.  I think being a doctor has only made things worse. 

Throughout our education and training, the quest for excellence is drilled into us.  We are immersed in a “striving” culture – constantly fed a notion that success will only come by trying harder, going further, working longer hours…  Be the best.  Good enough isn’t really an option.   “I must…”, “… should…”, “…have to…”.  

I’ve had no reason to question if this is the only way to achieve my goals…until this year.   I kept going, pushing myself harder and harder to maintain the “standard”, which was increasingly difficult to achieve on ever diminishing reserves, but I did it (mostly!).  I look back over the last couple of years and realise now that I have been surviving rather than thriving. 

One of the greatest challenges since diagnosis has been finding that my expectations of self-performance are now so far adrift from reality.  I have fallen short of the goals I have set myself along my (non-physical) recovery journey, time and time again.  They never seemed unrealistic to me, because until not so long ago, they were all achievable.  By my reckoning, I should have been back to work successfully, long before now.  I should have been more resilient.  But there goes that “striving” talk again.

Surgery, as mentioned previously, was the easy part.  Physical recovery was relative plain sailing.  I was back to running, swimming and cycling within a couple of months and soon performing better than I had done in years.  This only reinforced my misguided notion that I was superhuman and that the rest of recovery would be a doddle.  I was so naïve in underestimating its complexity. The emotional recovery has been so much harder, and I’m still not there.  I’m not “sorted” by a long stretch.  

I would never dream of talking to a patient the way I talk to myself and it is not that I lack sincerity in my approach to patients suffering with anxiety and depression – I just still can’t view myself as a patient.  From discussions in a forum with other doctors who have had cancer, I know that I am not alone in this inability to exercise the kindness we show to our patients, to ourselves.  A different, totally unrealistic, set of standards, (entirely self-imposed) apply to me.  It’s a miracle that I have, largely, managed to live up to them up to now.

Finally, over these last few weeks, I have been forced to surrender.  To abandon all those falsely held beliefs about my own capabilities.  I have had absolutely nothing left in the armoury.

Imagine a full money box, ready to be taken to the bank.  However, just before setting off to the bank, the fund starts to be depleted, bit by bit, in order to maintain life as I knew it.  Not mere existence, but a pretty full life.  One that was becoming harder and harder to maintain on the ever diminishing funds.  Having been completely plundered, as a final insult, that now empty money box is smashed from a great height.   

I have been completely broken down. 

It seems, however, that on further inspection, there is, in fact, one item left in the armoury, overlooked at first glance… a supersized tube of superglue. 

A total of nine truly awful weeks of insomnia are hopefully now behind me.  Thanks to a switch in antidepressant medication to mirtazapine and (hopefully one-off use) of temazepam (9 solid hours of sleep!), the time has come to start to rebuild.  Slowly and painstakingly, piece by tiny piece. 

I think I am starting to feel better.  I just need to make sure that I construct the Claire model mark 2.0 with a little more self-kindness built in.