Dr Barkas is a consultant old age psychiatrist at Tees, Esk and Wear Valleys NHS Foundation Trust. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Note: please be aware that in this narrative Kim bravely shares details that could be sensitive for readers who have experienced pregnancy loss or child bereavement.
Dr Barkas' story
After my foundation training I did not think I would become a psychiatrist at all. I was on a different specialty training scheme but realised that the patients I really enjoyed working with were those with mental health difficulties, particularly older adults. This, as well as reassessing my approach to work life balance following the birth of my first child and feeling unsupported in training made me take the jump to core psychiatry training in 2013. I knew then that I wanted to work with older adults and was (and still am!) fascinated about the complex interplay between physical, mental health and social factors for this population. I also felt such a privilege to work with people with such rich stories to tell. Moving to psychiatry was a different way of working and thinking for me, but I felt so welcomed and at home during training.
One thing I have always been very passionate about is the wellbeing and mental health of medical staff. I personally had felt that I wasn’t seen as an individual in my previous training, just a cog in a machine, and I found that hugely draining and unfulfilling. I was burnt out. I wanted to do what I could to make sure that other junior medics didn’t feel like that. I became a representative locally for core trainees and subsequently specialty trainees, as well as on the RCPsych Psychiatric Trainees’ Committee, looking at ways to improve experiences of training and support.
During the transition between my core and older adult psychiatry specialty training, there was the review of junior doctor contracts; this was a particularly turbulent time for juniors and I aimed to be supportive of my colleagues and advocate for our concerns. The feedback I received from trainees was that it was reassuring to have someone they could go to with worries and concerns. I personally felt empowered to be involved in such discussions rather than feeling helpless with all the changes from outside. During my training, I serendipitously became a team member of a national educational project about delirium that won several awards – it started as a local intervention teaching acute hospital staff but has since had 4 national conferences and developed a huge social media presence. I felt so proud to be involved in such an important project. I felt I had definitely found the right career for me in Old Age Psychiatry.
In 2018, I had just started my final year of specialist training, when everything changed for me.
I was pregnant with identical twin boys. At my 20-week scan, a rare and dangerous complication called twin-to-twin transfusion syndrome was picked up. It meant one of my boys, the larger twin, had too much fluid and blood flow, and his brother had too little. It progressed very rapidly to a severe stage and I was admitted to a hospital 200 miles away for emergency in utero surgery. The following morning I was told the larger of my twins had died and though the smaller twin was still alive, there was not much evidence of outcomes for such babies. I came home, on the train, on my own, still pregnant but with only one of my boys alive.
I became incredibly anxious; I could not focus on anything apart from grief and negative thoughts about myself letting my babies down. My life was governed by feeling my surviving twin’s heartbeat. I could not concentrate.
Six weeks later, both boys were born. My survivor weighed less than 2lb and was rushed to the neonatal intensive care unit. The neonatal unit were incredible, but it was a very traumatic experience as a parent. He was there for over 100 days. I began to develop flashbacks whenever I heard buzzers or alarms. I had other symptoms of PTSD and struggled with grief. I had therapy, but I was not sure if I could come back to work at all.
My surviving twin is now two years old; he has severe global developmental delay and cerebral palsy. He is happy, but I have had to learn how to be his carer alongside being his mum. I had always respected unpaid carers looking after loved ones, but I didn’t realise how difficult it could be until I became one myself.
I came back to work to finish my specialty training in 2019. It was a difficult transition. I worried about how I would juggle my work-life balance and how I could emotionally be ready to return and support my patients and their families. I also put pressure on myself to return as my Certificate of Completion of Training felt so close. I received some excellent support in discussing these concerns and working through them, and how I could make training work. It sounds like a small thing, but accepting that my training and career could take its own journey and didn’t have to be linear really helped me feel better about returning. Another thing for me personally was being honest about expectations from others and for myself. I was able to have frank conversations with colleagues about working more flexibly and maintaining boundaries, which took a lot of pressure off me. I had a great deal of support from colleagues when I returned - it was good to be back doing a job I love and feeling a sense of purpose again.
I presented locally to medics about recognising burnout and mental health in doctors and hope to continue to offer and expand this. It is more relevant than ever during the Covid-19 pandemic. I have presented information about the mental health of parents and carers of babies on neonatal units, to boost awareness of this amongst psychiatrists.
I found that I had to really look at my work-life balance and I feel I am much better at recognising when this is off-kilter – I was able to use my experiences to speak about this as a strength in my consultant interview. I feel that this balance is the best it’s ever been, despite the difficulties family life throws at us sometimes. I began working as a consultant on an organic Mental Health Services for Older People ward, with a fantastic team, in May 2020. As someone who has complex caring responsibilities I am much more aware of how difficult healthcare systems can be to navigate, how important it is that professionals of all disciplines work together and how vital it is to have good working relationships with our patients’ families and carers.
In the future, I would like to expand on my role as a mentor and supervisor for trainees and students. I hope to continue to raise awareness of mental health issues in doctors through teaching sessions and even more formal roles. I felt welcomed and supported throughout my time as a psychiatry trainee, especially when I needed it most. I want other trainees and junior doctors to feel welcome and supported too.