See One, Do One, Do a Runner: The Journey of a Dyspraxic Doctor
My relationship with anxiety started as a child. I think I may have been born anxious. Within my family as a young child this could be tolerated, but the difficulties increased as I began having to go out into the big world. Looking back, I had some sensory issues. I couldn’t tolerate sitting on the grass. Certain textures and smells dramatically affected my day, and that made me anxious about going anywhere I may encounter them. I struggled to socialise. I wanted to be involved, but I couldn’t follow multiple conversations at once and be also able to participate. My mum used to pick me up from nursery to find I’d spent most of the day sat outside the circle in group games, on a chair, watching. I was taking it in, I could recount to my mum in detail what had happened, but I couldn’t do that whilst also joining in. My ability to process the information had a lag compared to others, which made me socially slow and inappropriate. Something relevant to a previous thread in the conversation would pop in, just as everybody else had moved on. It wasn’t just that my brain was stuck processing previous threads, but I was also noticing way too much around me. I am an absolute fiend for details. I can’t listen to one conversation in a room without also hearing parts of the other ones. It takes effort to shut out non-relevant information. So I stopped contributing, I became a silent listener. That lasted well beyond my childhood.
What also kept me out of those circles, and as I got older held me on the edge of the playground, was my inability to play. I had a fantastic imagination, and I was a fun and playful child. But I struggled to form my thoughts into words other people could understand, trapping me in my own games. I couldn’t co-ordinate myself to join in the ball games, the running and the jumping. Most playground games involve motor activity which I simply couldn’t manage. My mum was called into school when I was six to inform her that I was the only child in the class who couldn’t skip with a skipping rope. Subsequently the class was arranged in a circle around me each break time until I ‘learned to skip’. That important life skill! No wonder I was a child who was fearful about going out to play. I’d rather have stayed in the classroom where my difficulties weren’t on display for all to see. I could sit at my desk and quietly get on with things. Outside of the classroom, my motor skills were terrible in nearly every area. I couldn’t cut my food at lunchtime, and I still recall a teacher impatiently berating me ‘you’re a big girl now so you should be able to do this yourself’. So I didn’t ask again, or mention it as a problem. I’d learnt already it was highly important to hide my difficulties, to mask them, and not to show any signs I was unable to do something. Because if I couldn’t do something, the message I heard loud and clear was ‘it’s your fault’. I was very bright, and so my slowness and inability to learn some things, whilst I picked up others with ease, seemed to others to be laziness or defiance. It was clear I just needed to try harder, be better, grow up. I was also totally disorganised as a child, but unfortunately acutely aware of this fact. I lived in a constant state of fear about the prospect of forgetting my homework, losing my belongings, and not being on time. I dreaded hearing ‘oh no, not again’, to the extent that I would wear my whole school uniform throughout the summer, refusing to take my cardigan or jumper off in case I misplaced it.
As I got older, the difference between my ability in PE lessons and everyone else’s became increasingly apparent. No-one wanted to partner up with me or give me a place on their team because I was an absolute liability. I hid on the outskirts of team games, praying the ball wouldn’t come my way. Inevitably other children picked up on this and it became a joke. Sometimes I was happy to laugh about my difficulties, thinking it was best to fit in, but sometimes it was too much. I was tired, frustrated and fed up of my body never doing what I wanted it to do: repeatedly embarrassing myself in front of my peers. I had no diagnosis back then so no explanation for why I couldn’t manage to use a knife and fork, let alone apply eye make-up. I tried and tried to learn things other people took for granted, spending hours at home as a teenager re-writing my homework so it could at least be read by a teacher, but there were some tasks I never managed to master. This all led to an anxious teenager. I knew I didn’t want to be different, but somehow despite my best attempts, I was stuck in my own world of being different. I couldn’t understand how to get into the other world I wanted to be a part of. The world where people didn’t feel sick for most of a lesson wondering if they might be picked on to answer a question and just gawp at the teacher because their brain was still processing what was being said. The one where other girls could wear shoes that didn’t have insoles and contraptions to try to prevent them from falling over injuring themselves again. The one where other people seemed not to have to live in the chronic fear of their brain or their body letting them down.
Looking back, it’s still a wonder to me that I made it into and through medical school. I left home at 18. I couldn’t manage the day-to-day life of university whilst studying. I didn’t know where I was supposed to be at what time, how to use the washing machine, or how I was supposed to do all of this whilst also learning masses of new academic information. I was permanently on edge that I was going to be discovered. Someone might realise just how hopeless I was at organising myself and practical tasks, then tell me I had no place on this course after all. I struggled to contribute to tutorials and seminars, not because I didn’t have something to say, but because it just went too fast for me. I managed to convince myself that I must, in fact, be stupid. And yet my academic success thus far (I went to Oxford University) said otherwise. I remember struggling to take in a process which had been explained to me verbally, and being told by the tutor ‘come on, a rat can learn 30 new things’. If only I’d known more about myself and my learning style, might things have been different? I learn in pictures and written information suits me best. I can recall with great detail where the information is on a page and what it looks like, but I can’t recall conversations at all if I can’t make notes. Yet unfortunately most information and most meetings are entirely verbally based, all relying exclusively on auditory processing. It’s easy to understand why that might make someone who isn’t really able to take in information that way, very anxious.
As my course got increasingly practical, I developed an increasing fear of performing. At medical school, it’s commonplace for you to practise skills repeatedly in front of a group. Learning the sequence of examining a patient, learning to take blood, learning to present the patient’s history to a senior doctor. You were all shown or told how, then you took it in turns to do (commonly known as ‘see one, do one, teach one’). My panic at this happening unexpectedly and repeatedly throughout the day intensified, to the point where during an A+E placement I became so anxious I couldn’t leave the house. It got to the point where I couldn’t even practise the skills with friends because I was so terrified of looking incapable and stupid. My marks on written papers were well above average, but I scraped through practical exams mainly through spending hours learning the sequences and skills by myself at home.
Once I qualified as a junior doctor, I became acutely aware I had to perform as other people’s lives now depended on me doing so. Quite often on a night shift, I was the only person available to do the job. I had to triage jobs, find my way around a confusing complex of hospital corridors, do the practical tasks, and retain a confident exterior whilst doing so. Oh, and do it all quickly. Having not eaten, drunk, been to the toilet, or had sufficient sleep. It’s no exaggeration to say the first year after I qualified nearly broke me. The whole job was focussed on skills I just found so difficult with dyspraxia. But back then I didn’t have a diagnosis. I wasn’t even aware of dyspraxia, despite being a doctor. So I shouldered the blame for my inadequacies myself. I was constantly anxious and began suffering from panic attacks. I felt trapped in a job I had trained so long for. On the one hand, I knew I could do it – I was academically capable, and I cared profoundly and deeply for every patient I saw – but on the other hand to myself I seemed to be so incapable. I had great feedback from patients and colleagues alike. But I was suffocating from the amount of effort, energy and sacrifice it was taking for me to maintain the same level as my peers.
Making it out of my mandatory years as a hospital doctor, I picked the speciality which suited me best, psychiatry. Here, I had time with patients. I could listen, process, make notes, and check I had understood. In fact, I’d go as far as to say that here, having dyspraxia became an advantage. I could think differently and come up with creative ways to re-frame patients' difficulties and explain concepts. Because I had also struggled with anxiety and by this point a depressive episode too, I knew some of what it was like to struggle. I had lived experience of mental health issues. I had gained wisdom through my experiences. And now I could put that to use. After working in psychiatry for some years, I came to realise that my difficulties were actually not a fault of my own, nor part of normal experience, and that there might be more to it. I also had had so many significant falls and ankle fractures by this point I was desperate to do something about the clumsiness that had plagued me for decades. I had become fearful about walking on uneven ground because I just couldn’t be sure I wouldn’t turn my ankle and end up on crutches for the next month. I needed some answers and some help. I set about finding out what was different about me.
As an adult, the diagnostic services were non-existent, but I thought by this point it was worth paying to have a better understanding of myself to go forward with. So off I went for my assessment, husband in tow. I was terrified about being tested. But the occupational therapist I saw was patient and kind. Even though I was being tested doing things I had long tried to avoid, I didn’t mind. It had a purpose, and this lovely lady was here to help me, not to laugh or expose my inadequacies. After the tests she counselled me on the results and began by saying that my motor skills were in the first percentile of the population i.e. over 99% of people have better motor skills than me. She also told me that a lot of my other non-motor difficulties were consistent with a diagnosis of dyspraxia. I could’ve cried when I realised that this explained my past struggles. She showed me how to use a special knife and fork (I still hadn’t mastered this) and sent me away armed with understanding and knowledge. It took time to sink in, to look back at my past and make sense of it all.
Having an explanation for my differences gave me back some of the self-esteem that had been repeatedly crushed throughout my life. It gave me a way of explaining it to other people. It took the pressure off me. For the first time I could honestly laugh and blame ‘my dyspraxia’ when I couldn’t do something. I could un-link my intelligence and my dyspraxia. If I struggled to understand something, to learn something, or to participate, I could take a deep breath and remind myself that dyspraxia makes it more difficult for me, but that’s ok I will get there eventually. It has totally changed my life.
With the increasing cuts in mental health services, ever growing caseloads and demands, I realised that despite my best efforts a career in the NHS was no longer sustainable for me with dyspraxia. It felt sad to leave, but the system couldn’t fit me and I couldn’t fit it. I tried with and without special equipment, with and without disclosing, with and without adjustments. But it didn’t change the underlying fact that I was different and it wasn’t possible for me to work in a way that was healthy long-term for me. I was tired of feeling like a tolerated inconvenience in an already stretched system, rather than the strengths of my dyspraxia being used. I spent so much energy trying to achieve the basics that I couldn’t excel at the things I was good at anymore. I couldn’t carry on trying to be a square peg in a round hole. I’d spent my life trying to work around my dyspraxia, but now I understood it, I wanted to work with it. So I set up my own business, helping neurodiverse children. Sometimes I still get anxious, when I have lots of things to remember or meet someone for the first time, but I know why. I sometimes get frustrated with myself, but I have the time and space to make things work for me. I can pace and adapt my work to suit me with my dyspraxia, I’m in control and I can make use of my strengths. I am finally happy to be me, with my dyspraxia; so now I can open a whole new chapter of life. A chapter that began with self-understanding.
Dr Emma Tremaine trained as a medical doctor and psychiatrist before starting up a social enterprise specialising in comprehensively supporting adults and young people with Dyspraxia (The Dyspraxic Doctor). She also provides regular emotional and social skills therapy for children and young people who have a neurodevelopmental diagnosis (including Autism/Aspergers and ADHD). Dr Emma has Dyspraxia herself and is a passionate writer and speaker about neurodiversity, mental health and her own experience becoming a doctor with a hidden disability. She also enjoys horse riding, yoga, amateur sewing and making people laugh.