A junior doctor has bravely spoken out about being signed off with depression and anxiety at the beginning of last year due to the pressures of work and family life, in the hope of helping others suffering silently within the NHS.
This week an inquest opened into the death of Rebecca Ovenden, a junior doctor from Plymouth who worked with Devon Air Ambulance. She was found dead in her bedroom by her husband Paul on March 28.
She is the third female junior doctor to have gone missing or be found dead in Devon in just over a year.
Dr Lauren Phillips, whose car was found abandoned in Devon, has now been missing for more than five weeks.
The mounting pressures junior doctors are under is a feeling known all too well by mum-of-three Caroline Booth who is training to work in geriatric medicine at the RD&E in Exeter. Her husband is a junior doctor in Plymouth.
The 40-year-old, who is known in a work capacity as Dr Killy Pinckney Booth, is currently on maternity leave after giving birth three months ago.
She was signed off with depression and anxiety in January 2016 and is planning to return to work later this year.
Dr Killy Pinckney Booth and her family
"It is so stressful working as a junior doctor because you have so many balls to keep up in the air, and that's even without children," Caroline told DevonLive.
"It's depressing finishing late all the time. It's depressing rotating departments all the time. It's exhausting having to build relationships with new consultants and it's depressing doing exams, which you have to fund yourself.
"It can feel very isolating being a junior doctor when your bleep (pager) is going off all the time and you can't think straight to prioritise. It can feel relentless and asking for help is a skill you acquire.
"It can also be difficult to switch off and when you're in bed at night you can experience crushing anxiety about whether you did this or that right.
"When I took time off for my depression last January ago I had a baby who was not sleeping, I was in a department rotation I was finding difficult, I felt I was not catching up on my studying and I had exams coming up.
"I found work was good respite and my focus was still very sharp, but by the time I got home I'd even struggle to remember what my name was.
"The wheels came off and it was horrible"
"If you don't sit an exam you've enrolled for you lose the money so I sat it unprepared and failed. The wheels came off and it was horrible.
"Luckily I have a tremendously supportive partner and family. I have also suffered depression before when I had four miscarriages so my husband and I were able to recognise the symptoms had come back.
"My consultant referred me for support from RD&E occupational health who were brilliant and they organised some free counselling sessions for me very quickly. My GP was also brilliant because he understands the pressures junior doctors are under.
"I was able to pull myself out of it. A lot of people don't know how to ask for help and that's one of the problems with depression, especially early on. You often don't realise you're feeling quite as bad as you are until you get better and look back.
"It can also be very difficult to admit to a consultant you're not coping, but the support is there, especially at the RD&E. It can make the difference between going back or not."
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Dr Lauren Phillips has been missing for five weeks.
Since the death of Rose Polge - a junior doctor who worked at Torbay Hospital and killed herself at the height of the dispute between the Government and NHS workers and had voiced serious concerns about remaining in the profession in the hours before she died - Caroline says support for junior doctors has improved.
"There are online support groups which have been set up among junior doctors encouraging people to speak up and look out for each other," she said. "It has been quite a positive offshoot of what tragically happened.
"I'm quite open about the fact I was depressed and had time off for it in the hope that if someone needs someone to talk to I am available to them.
"Depression is very real and very frightening and it shouldn't be a taboo subject. It's not contagious or anything to be ashamed of, but unfortunately some of the symptoms you feel are guilt and shame."
Police searching for Rose Polge
Medicine is a second career for Caroline. The former events manager, nanny and writer decided to retrain when she was 28-years-old after reading that medicine had opened up to non-science graduates.
After passing tough entrance exams she began a five-year medical degree course at Exeter's Peninsula Medical School in 2006. On the first day she met her now husband Sam who has opted to specialise in Obstetrics and Gynaecology, while Caroline chose medicine.
As part of her training, Caroline is required to rotate working in a different department every four months. She has negotiated part-time hours working three days a week but does far beyond her contracted hours.
Her husband is also a junior doctor working in Plymouth, and his working pattern means he usually leaves the house early before their children - aged five, two and three-months-old - have woken up and often returns home at around 9pm when the children are in bed.
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Caroline said: "In theory I should work 9am to 5pm, but in practice I get to work earlier because you have to be ready for the ward rounds.
"A patient may become sick late in the day needing urgent attention, handing over to the night team half way through sorting them out is often difficult, and before you know it the time is 6pm.
"When you say you have to leave at 5pm it does not go down well sometimes with colleagues who might not know your situation.
"You shouldn't feel bad for leaving on time but you do. It is also very difficult to leave the team when they are dealing with urgent sick patients. I feel like I am letting down patients or my children all of the time.
"There is a creche on site at the hospital which is great, but it closes at 6pm. You can negotiate an extension to 7pm but most nurseries charge upwards of £10 for every 10 minutes beyond 6pm. If you are not there by 7pm they call social services.
"It's an enormous amount of stress on childcare. I often found myself needing a jet pack if I had any hope of getting to the creche and then pick up my eldest from after school club.
"My days don't end when I leave the hospital because I have to put the children to bed and then next thing you know it's 9pm and you've then got to start studying."
Dr Killy Pinckney Booth
Caroline said procedures are trying to be put in place to give junior doctors more time for training and to be able to leave on time. However, she says staff shortages at the RD&E and across the NHS nationally are unlikely to see it achieved.
She said: "All the business with the strikes and change of contacts put junior doctors under even more pressure.
"People are falling out of love with medicine. We are not seeing recruits coming through for training like we used to. People just don't want to be taken for a ride anymore.
"At no point during the strikes did people say they wanted more pay. They wanted working anti-social hours to be recognised as such, and at the time we were already being asked to do more for no more pay.
"To have more staff would be amazing and more money for staff to make the job more attractive.
"But at the moment it means junior doctors are being asked to performs things they are not confident to do or they don't have the supervision."
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Caroline is planning to possibly return back to work in August and now employs a full-time nanny and is considering increasing her hours to full-time to catch up on her training.
However, she admits she is worried about her depression returning.
"It's a very real concern it will come back," she said. "I started my maternity leave in a stressed state and now I feel much better but I do think, will it set me back when I'm back at work?
"It's terrifying as I will be juggling a lot. When you have two doctors in the same family, childcare becomes a very real and expensive problem, and I do still want to see my children."
If she can continue to work full-time it will still take at least another eight years before Caroline finishes her training, but she says she is more determined than ever to stay in the profession.
"I love medicine," she said. "You meet extraordinary people amongst all the grot that goes with it. At the end of the day it's about people and patients and that's what I love and it's what makes me keep going back."
Reporting by DevonLive