I was diagnosed with anorexia nervosa when I was 19 and in my second year of medical school in England. My difficulties with eating had started the year before when I first came to university – I was fresh out of school, had never been away from home for more than a week, was surrounded by hundreds of people I didn’t know and suddenly had this huge workload that seemed impossible to keep up with (to my standards, anyway).
All in all it was a perfect storm and controlling my eating was the (maladaptive) strategy that I unconsciously found to help me cope with the chaos that I found myself in. But in hindsight, I can see that I wasn’t coping. I was miserable. The anorexia was slowly but surely eating away at my personality, isolating me from my peers, feeding me lies that I wasn’t good enough, that I wasn’t doing well enough, that I was a failure. And it promised to cure all these things for me (spoiler alert: it didn’t).
At first, I didn’t believe I had a problem - I still ate, I never became extremely underweight, my friends hadn’t noticed anything was awry and I was doing well in medical school. But my family were becoming increasingly concerned and, not long later, I found myself in a psychiatrist’s office being told that I had anorexia.
Taking a year out
I powered on through another year of medical school and then came to Edinburgh to complete my intercalated degree. I was half-heartedly engaging with treatment but was still struggling. I didn’t feel ready to recover – I didn’t feel ‘ill enough’. Gradually, however, I became more and more fed up with how this illness was affecting mine and my family’s life and, with the support of my family and doctor, I made the hard decision to take a year out of medical school to try and focus on recovering. That year was tough, and I did not, as I had imagined, come out of it completely cured. I had, however, made enough progress to see that I needed to change university and how I approached medical school if I had a chance of completing my degree and making it as a doctor.
I was lucky enough to be able to return to Edinburgh University as a medical student and repeated a year to ensure I had time to re-adjust. There are many aspects of medical school (and working as an FY1) that are particularly challenging for those with an eating disorder. The hours are long and meal breaks are not always natural and one often has to grab food when one gets the chance. It’s difficult to keep up with perfectionistic standards when working in medicine and it can be difficult to find a good work-life balance. It is a job where making mistakes can have big consequences and therefore feel terrifying and feed in to feelings of failure. Slowly but surely, however, I made progress.
Through medical school and out the other side
I found a group of people who accepted me for me. I prioritised self-care. I forced myself to strive for ‘good enough’, not perfection, in my work. I spoke to student wellbeing regularly, who were instrumental in helping me cope with the demands of medical school and making reasonable adjustments where appropriate. I went to therapy – LOTS of therapy! I tried different therapists until I found one with whom I really clicked. I took (and still do take) medication to help my mental health. I used a meal delivery service to take the pressure and control out of cooking every day and made sure I had quick, nutritious snacks that I could eat quickly if time was short. All these things helped me to navigate my way through medical school and out the other side, whilst forging ahead in my recovery.
Now I find myself working as an FY1 and am almost totally free of anorexia. There were certainly times at which I didn’t think it would be possible for me to recover and I wasn’t sure whether I’d make it through medical school and actually get to work as a doctor. But here I am! I still have to remain vigilant to not let it return during times of stress, however. I plan my meals and snacks in advance and always ensure I have enough food for the day. I still prioritise self-care and keep an open dialogue with my supervisors and occupational health, as I’ve learnt that asking for and accepting help and support early is the best thing to do.
Navigating medical school whilst battling an eating disorder is physically, mentally and emotionally exhausting. My best advice is to admit to yourself and those you love that you are struggling, ask for and utilise support where needed and take time to get yourself better – medicine is not a race. Keep pushing yourself towards full recovery and one day you’ll get there. And I promise it’s worth it.
Dr Olivia Impey, FY1 and Edinburgh Medical School graduate.
