Death is hardest to deal with when it hits close to your heart.

It seems death has been a predominant theme for 2016. I'll go into celebrity deaths and the rest in a later entry.

In the early hours of Sunday 24th April 2016, my friend Aaron died. His death affected me in more ways than one.

Aaron and I have never met face to face. We come to know each because we enjoy the same radio programme, "Fighting Talk" on BBC Radio 5 Live. We have been friends for about two years, finding out that we have much in common. We both reminisce about the 1980s, especially about TV shows. He was great to engage online, chatting on music and movies. He loved quizzes and he got me playing "QuizUp" on my smartphone. He had a similar sense of wicked humour to mine.

The similarities don't end there. We both suffer from depression. We both been through trying out different anti-depressants to see which would fit us the best. We both had our up and downs. We both expressed our depression to our online friends without being afraid of what people think, that we were not afraid to ask for help. We both conversed with each privately about our depression, supporting each other through the rough patches.

Ultimately it was his depression that killed him. Although the details have been sketchy, primarily because the news I have been hearing has been delivered by proxy. Aaron had been going through a bout of depression in March. I had noticed it and had been conversing with him during this period. There was some time he was not online, around three weeks. I didn't notice, maybe because I was dealing with my own troubles with depression and work, and had gone on holiday. Only in mid April did I hear the news from a common friend that Aaron had been admitted to ICU for alcoholic necrotising pancreatitis. Apparently he had tried to commit suicide by consuming a copious amount of alcohol. This didn't kill him but caused the pancreatitis I mentioned before plus multi-organ failure. Most of his online friends thought he was pulling through, being on the mend. In the end, it seemed the damage was too much.

This is the second friend who has died at a young age. My friend from secondary school, Theola, died of complications of IgA nephropathy (a kidney disease) in early December 2014. I had written an entry into blog at that time. For some reason, I didn't post it. Both died in their 30s - Theola at 32 years old, Aaron at 36 years old. Both had died from complications of their primary disease. Their deaths had come our of the blue. I was chatting to Theola on Facebook only two weeks prior to her death, planning to meet up and crash at her place. We were joking I had to share a bed with her two cats if I was going to stay overnight at her home. I'm going to miss conversations like those. With Aaron, he had already been ICU for a few weeks. He had been planned for surgery, with family and friends visiting him.

As a doctor, I always feel I could have done more. For Theola, she was diagnosed four months prior to her death. She traveled back to Hong Kong to see if an expert nephrologist could do anything to help her but to no avail. With Aaron, the guilt is more so. As a friend, I could always talk to him and give my support, even though I was thousands of kilometres away. As a fellow depressive patient, I know the struggles he was going through. As a doctor, the guilt is even worse. I should have noticed Aaron had disappeared off online. I should have recognised the signs, since he was putting up posts on his Facebook wall of being down in the dumps. Other friends have said we have done everything possible and he would still have killed himself. Apart from being attached to Aaron, 24 hours and 7 days a week, we couldn't have prevented this but the guilt is still there.

Don't get me wrong, it's a tragedy more for his family, his closer friends and everybody around him. For Theola's death, it was horrific for her parents, her younger brother (who was going to be married a month after her death) and her husband (they had been married for less than two years).

With Aaron, there is always something I identify in his situation and always thinking, "that could be me". In the past, it would have been - I've lost the number of times I have tried to commit suicide or the number of times I have been hospitalised for my depression. Nowadays I know there is an alternative. I can always quit my job. I could always go back to England or go to Australia. I could always go into research or switch to public health. I've got enough money in the bank to last a few years (as long as my mum doesn't kick me out of the house).

As we grow older it will be inevitable we have to be more accustomed to death. It's not easy to deal with - it never is - but with the support of family and friends, it will get easier.

The lack of drive

I touched upon the subject of my lack of drive in a previous post back in August 2015. I thought the situation would change but the lack of drive continues to persist. Even trying to sum up the will to write this post took several months. Only because I want to write about another subject that I have to write about the lack of drive so that the next post makes any sense.

I looked back at my previous post and found nothing has really changed. My reasons for the lack of drive is the same. I still haven't done what I am supposed to do for my higher training: my consultation videos, my notes for the practice assessment, my clinical audit. Even the fear of being left behind, having fellow doctor friends or doctors who are younger than me being resident specialists, associate consultants or consultants, doesn't motivate me into trying. Here I am, still pondering about emigrating to another country or planning my epic months-long holiday (I've added a cross country trip of Japan into the lexicon, either as a rail journey or a road trip). I've excluded my ambition to join MSF as I know my depression will get in the way. When I'm really unmotivated to do anything, I become very obsessive-compulsive about doing meaningless tasks, i.e. planning my epic North American / European / Japanese trips, despite them being at least 2.5 years away. I watch / listen to TV/radio programmes I have watched / listened to before, instead of engaging into new stuff.

I've tried to find other reasons why I'm not motivated. Is it the fear of the stress that will be entailed if I do my Exit Examination? I've seen other doctors go through the endeavour and the whole process frightens me. I fear of relapsing into a major depressive state, something I never want to happen again. There have been many senior colleagues who have said the Exit Examination isn't hard but they didn't rule out the process will be stressful. I have learned I cannot handle stress well (hence why I won't be apply for MSF). One recent event has made me quite sombre lately (which I will write about later).

So what am I doing to help my motivation. I've agreed to participate in a clinical trial, to see if repetitive transcranial magnetic stimulation will help. Basically it is using a device to produce magnetic waves so it will stimulate my brain into being happier and more motivated. I'm in week 3 of 4 into the treatment and I don't think anything has changed. I know with this method of treatment that the results may not be seen immediately.

However in the end I know most of the motivation has to come within. But how do I motivate myself to become motivated?