I realised I was stressed, maybe even a little anxious, when I was having palpitations in the middle of the night in the lead up to exams (1).

I then wondered if there was a problem when I was physically unable to get myself off the sofa the moment I walked into the house from a nine to five in the hospital followed by a few hours of study. 

I then realised I really was quite stressed when I found out my aunt unexpectedly died about half an hour before said exam and had to fight off the tears as I tried to interpret ECGs.

My body then went into high-stress mode and was running on adrenaline/cortisol.

The consequence: within hours, I was struck down with the worst cold I had in years.

Then when they say, 'all bad things come in threes', my stepfather had the worst flare-up of his Crohn’s that he’d ever had in his life a couple of days into said 'worst cold I had in years' and rushed into emergency care.

It was only until all these things happened, that I decided I maybe needed a day or two to take a breather and recover from all these things (2).

It took a friend to point out that I was ‘anxious’ when I was unable to make a decision on what flavour squash I wanted. Actually, when I really thought about it, I didn’t realise maybe I had been anxious for a really long time.

I took a step back and reviewed how much I did in a day.
Usually, I wake up early, attempt breakfast and meditation (3), complete a nine to five on placement (4), then pick between studying or going to the gym (5) for a few hours and finally arrive home to cook/fall asleep on the sofa watching Selling Sunset (6). In between, there’s extra-curriculum activities that boost one’s CV, the part-time job I have to keep myself afloat (7), life-admin that most normal people have and maintaining a healthy social life.

1. Exam stress: due to medical school exams contributing to your decile; which contributes to your EPM; which determines where you’ll be in the country; and during a stressful plunge into the deep end, I’d really like to be near my family. Which just so happens to be North East London. Also, the most competitive place in the country.
2. Spoiler; I didn’t
3. Because this is what is meant to be good for you
4. Which could involve intense grilling from a consultant at any given time
5. Usually pick going to the gym, because on top of studying for one of the hardest professions that ever existed, you also have to keep up with society’s expectations to be ‘healthy’ (a whole other set of problems)
6. Don’t judge me
7. Because my loan and NHS bursary barely makes a dent in my car insurance

I then looked around me… majority of my friends and colleagues are in very similar boats; we’re all trying to literally do it all. Most of us don’t even realise we’re anxious. So I thought I’d make a quick guide to how to spot anxiety in the high-functioning who are able to hold it together even when everything is falling apart.

1. Sleep. You are unable to get to sleep because you are thinking [8] of things in the past or the future; wake up in the night with palpitations; wake up feeling exhausted.

2. Food. You often forget to eat; you’re always hungry; you lose your appetite; you’re too tired to cook; you can’t decide what to eat; you end up eating all the wrong foods that make you feel more tired; you eat out all the time. Tread with caution here: eating disorders such as anorexia and bulimia still exist, even if you are a medical student/doctor. You are still human.

3. Life events. Contrary to popular stereotype of the 'privileged, middle-classed, wealthy' doctors-to-be, most people I know becoming doctors don’t have much money and have had huge life events such as deaths, illnesses, abuse and suffering in their pasts. As much as we have learnt not to answer 'why did you become a doctor' with 'because I want to help people', most of us have actually had to deal with some horrible things in our pasts and actually genuinely do just want to help people. Just because you have been able to 'hold it together' during massive life events, get into medicine and continue with about 2,892,480 things, doesn’t mean you’re immune to anxiety and depression. You might even need some kind of therapy. You are still human.

4. Social life. A lot of us also want to maintain our friendships and social lives (9). But sometimes you might find yourself unable to say no to things when really what you probably need is a bath and rest. You might also just actually find it hard to say no to people… because you’re used to accommodating others and don’t want to miss out.

5. You’re too good at everything you do. Right, this isn’t a problem- it can be a good thing. Most my friends are not only medical students, but they can dive, surf, bake, cook, draw, have part-time businesses, care for family members with learning difficulties and then knock out a campaign to stop racism… but it can become a problem when you realise you actually are good at everything you put your mind to and want to do it all and probably can’t say no. This is called spreading yourself too thin and leads to burn out.

6. You can’t sit still. You’re good at everything you put your mind to. So you do. Because maybe when you stop, you have to think about the patient who cried to you during your mandatory clerking about losing their daughter and then being diagnosed with end-stage lung cancer. Maybe you have to think about something that happened last week that really bothered you- because it wasn’t up to your usual standards of perfection. Or maybe, you’re blocking out thoughts on the relationship you have that’s going wrong or went wrong; the body image that you’re trying to work on; the things that happened to you as a child that are now coming to haunt you. These are all normal things that bother people. But a lot of us are able to stamp on those thoughts and drown them out by working on poster presentations, working evenings in a bar then submitting that poster presentation to an international conference (10).

I’m still learning how to manage all these things. All I know is it’s ok to take a breath. It might be ok to take a day off. Do you know what, it might even be ok to take two days off.

Khadija Stone is a BMA medical students committee rep in  Swansea

8. Also known as worrying

9) A very normal thing to want

10) Give me those application points

The Self Care Forum promotes Self Care Week (16 – 22 November) as an annual national awareness week that focuses on embedding support for self care across communities, families and generations.

The initiative is a reminder to NHS doctors and staff to take better care of their own health and wellbeing generally, particularly at a uniquely challenging time for the NHS.