In 1999 I was a junior doctor, and I was drowning.

Not in the way anyone around me could see. I still turned up. I still did the ward round, wrote the notes, made the jokes in the tearoom. But if you'd looked in my fridge at home, you'd have found it bare but for the shrivelled remains of a single capsicum. That's not a metaphor. That's just what apathy looks like when it moves into your house.

I'm telling you this now because it's nearly R U OK Day, and every year the campaign asks the same question of the person next to you: are you okay?

Every day we ask our patients how they are doing, but I want you to flip it today and ask a colleague, "How are you doing?"

That's not a normal way for a DFTB newsletter to open.

We're usually the place for papers, pearls, and practical paediatrics.
But R U OK Day isn't really about our patients at all.
It's about us - the people looking after them, at 3 am, in a resus bay, on our fifth night shift in a row, telling ourselves we're fine because everyone else seems to be managing.

I wasn't fine in 1999.
I attempted to end my life.
I've written about it before, in a piece called The Road... Not Taken, and I still find it strange to type that sentence in a newsletter that mostly talks about bronchiolitis and blood gases.

But strange or not, it's true, and it matters more than most of what I write here.

The numbers on doctors and depression are worth sitting with for a second. Roughly one in five doctors report having been diagnosed with, or treated for, depression. Almost a quarter have had suicidal thoughts in the past year. Two in a hundred have attempted suicide. If that were any other statistic in medicine - a complication rate, a readmission rate - we would call it a crisis and build a task force. Instead we mostly just don't talk about it.

Part of that is stigma.
There is an undeniable stigma attached to mental illness in medicine, and it is precisely the thing that stops people asking for help.
Part of it is culture.

We are trained, from our very first day on the wards, to equate coping with competence. Admitting you're struggling can feel like admitting you're not cut out for this.

But here's the thing I've come to believe, slowly, over twenty-odd years: you don't tell the doctor working in an abusive environment to toughen up, to be more resilient. You try to fix the system.

Resilience training has its place, but it can quietly become a way of asking individuals to absorb the cost of a workplace that should be absorbing it instead.

There is nothing wrong with admitting you have a problem and need help. The thing that actually needs to change is the system, and the way we treat each other inside it.

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If you only do one thing with this newsletter, watch that. It says the things this piece is trying to say, but better, and out loud.
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Why this matters for the person next to you, too

R U OK Day works because it's built on a small, almost embarrassingly simple idea: that asking someone if they're okay, and meaning it, and staying for the answer, can change what happens next.
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Not fix everything.
Just change what happens next.
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In paediatric and emergency medicine specifically, we carry things that don't always show up on a debrief form.

​Vicarious trauma is real, and it accumulates quietly - every non-accidental injury, every resuscitation that doesn't go the way we needed it to, every family's worst day that becomes another Tuesday for us. You don't need to have been the one holding the airway to be carrying something afterwards.

We've also written about what it takes to build psychological safety after a paediatric cardiac arrest - the idea that a team that can speak up, admit uncertainty, and check on each other afterwards performs better and, just as importantly, survives longer in this job. Psychological safety isn't a soft add-on to good clinical care. It's part of it.
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And it isn't only about the acute moment.

​Staff retention in the ED is, underneath the workforce-planning language, a wellbeing story. People don't leave emergency medicine because the medicine got harder. They leave because nobody asked them how they were doing for long enough, often enough, and meant it.

What I'm actually asking you to do

Not a wellness webinar. Not a mindfulness app. Not a poster in the tearoom that nobody reads twice.

Just this: pick one person you work with. Someone who's been a bit quiet, or a bit sharp, or a bit too fine lately. Ask them properly - not "you good?" tossed over your shoulder on the way to resus, but a real question, somewhere you can both actually stop and listen to the answer. Ask it twice if the first answer is "yeah, fine."
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If you're not sure how to have that conversation, R U OK? 's own resources are genuinely good on this — practical, non-preachy, and built for exactly this situation. You can find them at ruok.org.au.
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And if you're the one who isn't fine: I'm not going to tell you it gets better on a schedule, because it doesn't always, and platitudes are their own kind of unhelpful.

What I will tell you is that admitting it is not the failure. The system that made you feel like admitting it would be a failure - that's the failure. You're allowed to need help. I did. I got it. I'm still here, twenty-seven years later, writing you a newsletter about bubbles and children's health, which is a better outcome than I would have predicted for myself in 1999.

That's the hope part. It's a real one.

Systems can change, slowly, when enough of us say the quiet part out loud. Conversations can change things faster than we expect. And sometimes the whole thing turns on one person asking one honest question, at the right moment, and being willing to sit with whatever answer comes back.

So: are you okay? And - properly, this time - is the person next to you?