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Life as a medical student can be hard work. The long hours and massive amounts of factual information to be learnt make it difficult to handle for even the most dedicated student. What happens, however, when things start to go really wrong? I am not the only student to have had doubts about life as a doctor, but my confusion and self doubt led me to start drinking.

I arrived at university straight from school excited about being at medical school. I was eager to meet new people and to have a good time, as I had been quite introverted at school. I had no experience of going to the pub or clubbing, and the opposite sex was a mystery to me - I couldn't wait to discover these attractions.

The first year was fun. I made lots of friends and passed all of my exams first time around. After the summer holidays I began my second year with similar zest and vitality. The thrill of clinical work was only just around the corner. However, things did not seem rosy for long.

It was at Easter, with degree exams looming, that I first noticed that something was wrong. I was reduced to tears by the sight of a physiology textbook and was not sure what was happening to me. I started to doubt my abilities and sense of direction, and the work was getting on top of me - I failed three out of four exams.

After a summer revising I managed to pass the resits. As I moved on to the third year, the doubts I had about myself and my direction in life had by now taken root and exacerbated my lack of self esteem. I wished with alarming frequency for a life doing something other than medicine. I often missed lectures, and despite the approach of summer exams, I only procrastinated about doing the work I needed to catch up. My apathy resulted in doing too little, too late, and I failed all three exams. A second summer holiday in a row was spent working for an exam I should have passed first time. Again I managed to pass the August resits.

In my fourth year the fairly abrupt change to clinical teaching in the wards did not suit my book based style of learning. Despondency and clinical teaching did not mix well either. While I considered my direction in life, I missed more teaching blocks. On days when I did go in to the wards, I was shouted at by consultants wanting to know who I was or where I had been. It was a downward spiral - being told off made me resent the course so I attended less and my problems got worse.

Friends listened to me moan endlessly about my "evil teachers." I was unaware of how much time I was spending in the pub, where I would always find one or two mates to chat over my problems. I soon discovered where to get cheap drink five nights a week, and then, well hey, it was the weekend.

I convinced myself that my surgical block was irretrievable as I thought I had missed too much to be allowed to pass the exam even if I sat it. It was easier to ignore the problem than go into the ward and make amends. My days descended into a routine of waking up late, feeling hung over, spending the afternoon in front of the television, later buying a bottle of spirits, and going out for yet another night's drinking.

Christmas came and went, and the new term started with an end of block exam in surgery. Distressingly I realised how scared I was about going into the hospital to face the music. I avoided the exam. As I heard nothing for a couple of weeks I thought I was in the clear. I believed I had been given an opportunity to put the whole experience behind me and sort out my life. I was wrong; my problems were far from over as I was still drinking too much - a fact which became obvious at the medical ball. Blind drunk, I lost my head and was billed for £280 worth of damage. It was money I could ill afford.

Eventually I was summoned to see the faculty dean, who exploded with rage. I sat terrified as my catalogue of academic failures and shortcomings was recounted to me, and I had difficulty in speaking. I was asked to explain my behaviour; I was silent. I was asked why I should be given a second chance and how I was going to make amends; I stayed silent. I had no answer, only feelings of persecution and anger. I agreed to keep a personal register to be signed by each lecturer and to present this to the dean in a few months. It was humiliating to have to get each of these doctors to sign my book - they took one look at it and treated me with disdain.

It was during my psychiatry block that I learnt about alcohol abuse. The final pieces of the puzzle started to fit together as I realised I had a serious drinking problem. Although friends had told me to cut down on my drinking, I felt angry at being told what to do, guilty about how much I drank, but still needed a drink to get me going in the morning. I had missed work, been hung over most mornings, and had lost my self control. I was filled with a sense of dread at the undeniable evidence that I was an alcoholic.

It wasn't easy coming to this conclusion. I still tried to deny that I fitted the criteria of alcohol addiction, and argued that I didn't drink on my own, or drink methylated spirits, so how could I have a drink problem? Friends told me otherwise. I began to be really angry with myself. How could I have let myself go like this? I decided to pick myself up and began studying with renewed determination. It was too late to catch up on the clinical experience I had missed and I failed the exams. This time I had to convince the dean that it was worth letting me resit the year.

As I told my story to the dean I saw a different person from the horrible ogre I encountered before; he now seemed a genuinely concerned and caring person. The dean allowed me to resit the year without any problems. Finally, I realised that the faculty was not something against which I had to struggle to achieve my degree, but which was there to help and guide me.

I spent the last summer doing locum work, which rekindled my passion for a career in medicine. I regained control over my life and am now in my final year. It has not been easy, resulting in missed work and avoidance of the hospital, and on two or three occasions the frightening consideration of suicide as a way out. Despite feeling lower than ever and coming close to quitting medicine, I recognised the signs and sought help from my friends and tutors. They were all supportive, helped me sort through the problems that arose from missing work, and helped me to get my act together again.

Contact addresses

	The BMA's confidential counselling service Tel: 0645 200 169
	Drink line - a telephone counselling service, open Mon to Fri 11am to 11pmTel: 0345 320202
	The Doctors and Dentists Group c/o Medical Council on Alcoholism Tel 0171 487 4445

Books

	Stress Survival Guide. Caron Grainger.London: BMJ Publishing Group, 1994
	A Survivor's Guide to Alcohol. Jonathan Chick. London: Family Doctor Series, in Association with the British Medical Association, 1997
	I'm O.K. - You're O.K. Thomas Harris. London: Pan Books, 1973
	Your Erroneous Zones. Wayne Dyer. London: Warner Books, 1992