Alone Together: The Quiet Fear in Medicine We Don't Talk About Enough

One of the recurring themes that emerged from the Sadness Cloud exercise we ran with the medical students was the word "isolated." And not just once—it came up again and again.

Scribbled quickly on Post-it notes, shorthand for something deeper. It's easy to overlook, to dismiss it as vague or obvious, but the more I've sat with it, the more I think it's actually saying something we're not good at acknowledging: being alone is one of the most quietly terrifying aspects of this job.

Now, let's be clear. In medicine, we're rarely alone in the strictest sense. You're usually surrounded by staff, bleeps, noise, and buzz. But that's not what we mean by isolated. It's not the absence of people—it's the presence of responsibility. It's the knowledge that the decision stops with you, and that even if you reach for help, it's your name on the notes, your voice on the phone, your signature on the form.

The Quiet Dread of Being "The Only One"

Take night shifts. You're the FY1, maybe covering six wards. The handover's a bit patchy, half the jobs are vague, and you're trying to prioritise between "please review this low blood pressure" and "can you just check on this one, I don't like the look of them."

Technically, you're not alone—there's a registrar somewhere, a bleep you can call, a wall you can pull a crash bell from. But functionally? You're walking into those rooms alone. You're the one making the call. You're the one thinking, What happens if this goes sideways?

What no one really says out loud in training is that this isn't rare. It's not some exception. It's baked into the structure. The illusion of support is not the same as the reality of shared responsibility. And the truth is, that can be a very lonely place to live.

Why It Gets to Us

Here's why isolation hits so hard: it chips away at our sense of safety, our sense of control, and our sense of competence—three things the human brain clings to like a koala in a wind tunnel.

Isolation at work isn't just about physical distance. It's about the feeling that you're operating without backup, that the safety net is miles away, and worse—if something goes wrong, it'll be your fault. You'll be the one who "should have known," who "should have escalated," who "shouldn't have panicked."

And that fear? It compounds over time. It builds tension in your chest before a shift, makes you hypervigilant, or paradoxically reckless, and in the worst cases, it's what makes people walk away from the job entirely.

Let's Talk About the Real Fear

The fear isn't the arrest call. It's not the crashing patient. Those are awful, sure—but they're also clear. You know what to do.

The real fear lives in that grey zone: the patient who looks a bit off but isn't technically unwell, the one with vague symptoms and ten pages of notes, the one where something's not quite right but you don't know what. And you're alone in that decision.

That's the fear that keeps doctors up at night. Because there's no algorithm for it. Just instinct. Experience. And your name on the line.

So What Do You Do When You're "It"?

You do what works. You build a process that stops panic in its tracks.

• You start with structure. A to E isn't just a checklist—it's your anchor. It's how you claw back control when chaos starts whispering in your ear.

• You talk to the nurses. Not in a token "teamwork" way, but because they often know what's really going on. They've been there longer. They've seen the shift unfold.

• You own your limits. Saying "I need help" isn't weakness. It's insurance. It's maturity. And ironically, the more confidently you admit when you're out of your depth, the more respect you'll get.

• You ask for priorities. There's no medal for being the most flustered. If the ward list is exploding, you triage it like a resus bay. Sickest first. Everything else slots in after.

And sometimes? You just need a biscuit. You need to sit down, tell someone it's a bit much today, and take five minutes to regroup. It doesn't fix everything, but it keeps the wheels on.

We're All Carrying It—We Just Don't Say It

Here's the paradox. The fear of being alone is universal in medicine—and yet we rarely admit it out loud. We treat it like something to be ashamed of. Something you outgrow.

You don't. Not really. You just learn to manage it. You learn to recognise the signs, build your processes, and forgive yourself when you don't get it perfect.

And the most important thing? You remember that everyone else is carrying it too. That's what the Sadness Cloud showed. People are walking into this job with the same dread in their stomach, the same imposter syndrome whispering in their ear, and the same feeling that maybe, just maybe, they're the only one struggling.

They're not. You're not.

Final Thoughts: If You're Feeling Alone, You're Not Doing It Wrong

You're doing it right. You're feeling what every good clinician has felt. It doesn't mean you're unsafe. It doesn't mean you're failing. It means you give a shit. It means you're self-aware. It means you understand the weight of what you do.

And as isolating as that feels some days, it's also proof that you're not the problem.

The problem is that we don't talk about it enough.

So here's me talking about it. And maybe, just maybe, that's enough to make you feel a little less alone.

Stay Solo

--DW