My path to autism diagnosis

I remember spending last year feeling particularly angry, frustrated and with my anxiety levels going through the roof for the first time in my life. I wasn’t really aware of my anxiety until then to be honest. It all started after my ignominious transfer to this small district hospital following the somehow mutilated by the pandemic second half of my colorectal fellowship. I was highly recommended to the surgical department by my highly esteemed ex boss and since they were happy to create a position for me within days I was left with the impression I was going to be invaluable for the department. Highly skilled compared to the junior trainee doctors there and with the potential to be kept there as a consultant within a year or two, I really thought I almost made it. Alas…

To be completely honest, this is not the actual beginning of my problems, but only the peek of them. I had problems at work before but I never noticed a pattern. Having worked in two different countries and cultures it is now clear to me that my problems have been universal. However, over the past couple of years there has been a huge decline in my interest in medicine, something I could not explain. Exhaustion, nerves, outbursts at home and an increasing lack of interest. I sometimes caught myself not caring, not about the patients but about my whole career. I was there, working hard and doing my best for my patients, trainers were happy but I was living on the edge.

After the pandemic was fully installed and our training opportunities gradually decreased, I was feeling quite frustrated, not unlike most of my colleagues. There was little surgery available, no endoscopy training and I often had to do very junior doctor’s work. It was a huge step back. Most of the days I didn’t want to go to the hospital, there was no motivation. On top of these unpleasant situation I also had to deal with the clinical director’s misogyny and gaslighting. He was disrespectful and made it clear to me with his behaviour that he was just looking for another service provider. My seniority was not accepted or respected and I was treated like a very junior doctor although I had 13 years of surgical experience. The issues peeked when amidst the pandemic a few doctors were off sick or away and the rest of us were asked to do their extra hours. I had childcare issues, no one to help but my partner, both working for the NHS, both unsupported after 15:20… But nobody cared, people kept clapping for the NHS… I was angry. My boss didn’t understand and I was getting upsetting messages late in the evening and even phone calls in order to go and do the extra hours although he could have hired extra help for a couple of months. The tension peeked and there were issues between other colleagues in the department as well.

At some point I had a complain from a doctor who was just back after they had serious health issues and potentially not ready to come back to the grim hospital environment of winter 2020. I did not know the doctor and I was certainly not aware of their personal issues. There was an awkward conversation over the phone over a patient that they tried to refer without ever seeing them or presenting them properly. Since they never even introduced themselves over the phone, I had to ask all these questions including their name and role. They never complained on that evening but they sent an email complaining about me grilling them a couple of days later that went around and reached my clinical director. Unfortunately he made a great deal out of it, as if somehow he was looking for an opportunity to make me look bad. The things he wrote to everyone, the things he told me…He wrote to every consultant in the department that there was definitely something wrong with me, he had enough of my behaviour and he couldn’t handle me any more. It was humiliating. He wouldn’t even discuss things with me when after this email I decided to go and confront him in his office. He dismissed me without even listening to my side of the story and suggested to go and talk to the new female consultant, because according to him this was obviously some ‘female’ problem. I told him this has nothing to do with my gender and that I found it more relevant to have the discussion with him. He wouldn’t listen. I was devastated. How could this happening to me? A small hospital, less work but more gossip. Things were said and meant behind my back. Being smart enough I was able to guess afterwards. But I couldn’t read between those lines, I never understood their code. Apparently I had to be nice and servile to male consultants and older nurses but they could be infuriatingly rude and belittling and get away with it! If they didn’t feel you were one of them you were done. And I’ve never belonged anywhere so far.

I was broken that day. I left work and on my way back I started crying. I remember I felt like something in me died. I was trying to figure out what made me such a bad colleague. I was a good doctor and surgeon, I knew it. I had excellent colleague reviews regarding my skills and excellent overall reviews from my patients. While driving back home I received a phone call from the female consultant that hardly knew me or ever worked with me but I was supposed to discuss what were thought to be my ‘female’ problems with. She told me how bad she felt for what happened to me and how she did not agree with how our clinical lead handled (or not) the situation. I went home and cried all night. My partner didn’t know what to do. I felt sick, I wasn’t safe to operate or make any decisions on patients. The next morning I called my doctor and explained everything. She gave me a couple of weeks off and anti-anxiety medications. I wasn’t sure what was happening to me but I knew it was bad and I needed help. The time off helped a lot. I found help from the BMA mental health support service, who offered a few sessions with a psychiatrist. I remember trying to explain to her how besides my other problems I wasn’t sure who I was. I didn’t know who I was and it was frustrating. She didn’t understand. I was diagnosed with work related stress, anxiety and burn out. She was puzzled though because she couldn’t find the cause of the such high anxiety levels. I was given more time off for treatments. During this time and as things settled a little bit over the next few weeks, I started having thoughts about whether I could be autistic.

It kind of started with a Netflix show, called ‘Douglas’ written and presented by the Australian comedian Hannah Gatsby. At some point during the show, she explained her own autistic experiences which although were not the same as mine, her description of how she perceives the world turned a switch on in my troubled head. It was like a light went on. I was not 100% convinced but I decided to complete have a dozen of tests online before I found the nerve to mention anything to my psychiatrist. She was doubtful but couldn’t rule it out. She reluctantly told me that organising a diagnosis could be useful to rule things out. After this discussion I spoke to my GP. She was absolutely negative and did not want to refer me for an autism diagnosis. She reassured me that we are all a little bit autistic and that this is not the route of my problems, although I had previously explained to her my communication issues at work in great detail. ‘No’, she said, ‘there are more serious cases waiting for a psych review’ and she did not want to put strain on the service. The psychiatrist eventually wrote a letter to her with a burn out diagnosis and an official recommendation for a referral to the autism diagnostic service. It was in vain. After a couple of more phone calls with me politely but unsuccessfully trying to convince her that I really need this to go ahead with my life, I started to look elsewhere. The BMA psychiatrist suggested I refer myself to NHS Practitioner Health in case they can organise a diagnosis for me, especially since our financial situation was not that great at that point to look for a private one. Unfortunately Practitioner Health did not offer this service at that point but were happy to take me under their care and refer me for CBT sessions in the meantime. It was the first time I felt supported and reassured.

Time was passing by and I was getting better. After my contract at the hospital ended (and this an entirely different story), I started doing some locum shifts. However, there was fear that if I go back to full employment again the problems would come back. I felt that I needed a diagnosis and I couldn’t wait. I found a private specialist who was initially doubtful, but after filling out a number of forms, multiple choice questionnaires, and spent a few hours at his office answering questions about my past and present, he was more than certain I am on the autism spectrum. ‘You have Asperger’s’, he told me.

Relief, hope, and a sense of a new self and possibly belonging took me over and started to change my life. I cannot say I am a different person, I am the same, but I kind of know who I am now. I often think this diagnosis has somehow connected my childhood self with my present self. It is blurry and confusing in the middle, though. Who was I? I was masking so hard that I fooled everyone. I passed my university exams, I graduated from medical school, got my MD, CCT and PhD without anyone noticing. In the meantime I also had two children. How did I manage all this while being on the spectrum? Is this why I burnt out eventually? Is this why I was not making any progress with my surgical career? I always thought that my main problem was being a foreign woman that was trained in a system outside the UK. But was that all? Has autism been holding me back all these years? I still don’t know the answer these questions and I am still looking hard for answers. And I won’t quit until I know. As an autistic person I am equipped with perseverance and persistence to balance out my shortcomings in connecting with people and reading between the lines and I am planning to use these traits. I will keep you updated.