Sick Days

This is getting ridiculous.

No sooner have I recovered from the URTI from hell (that's 'Upper Respiratory Tract Infection' for all you non-medicos), here comes the gastroenteritis.

The plague never ends.

The good news is that I'm currently rostered on 4 days off after a 6-day stretch.

The bad news is that I'm meant to be attending classes for these next 4 days, before going back to work on a 10-day stretch.

The bottom line is... I'm far too busy to be unwell!!! 😫

But it is how it is. Willing myself not to fall sick does not unfortunately make it so.

Despite all my efforts with hand hygiene, protective gloves and face masks, the bugs still get me. Partly due to my crappy immune system, partly due to the sheer volume of exposure.

And, yet... I doubt it's just me, but it's incredibly hard to take sick days when you're a doctor. Even when you're entitled to it; even when you need it; even when it's the right thing to do. It's really hard.

For starters, sick or not, if you don't show up to work, there's no one to do your job. Guess what happens then? Your colleagues are asked to not only manage their unmanageable workload, but also yours as well.

Another side of it is, nobody really cares about doctors being unwell. Especially other doctors. They just want you to be at work because hey, they're also sick and they're at work! Why shouldn't you be?

In any other profession, you'd call that sadistic. In medicine though, it's just the culture.

Puking your guts out? Take a chill pill and some metoclopramide. Bloody diarrhoea? Here's a cup of concrete, you'll be alright. (Disclaimer: That was sarcasm, not a prescription...)

We all know the rules with gastro. If a hospital worker gets gastro, they're meant to stay home until 48-hours post the last episode to minimise the risk of transmission to others (colleagues and patients alike).

Realistically though, I know a doctor who once had an acute gastro attack on his shift and rightfully informed the senior doctor of this. The senior doctor then said, 'No big deal. Just push on, it's all good.'

You might be thinking, 'I'm sorry, but I don't think it's right for doctors to be treating patient when they're sick, particularly not when they're infectious.'

My response to that is, 'Congratulations! Right answer. And while I whole heartedly agree with you, medicine can be a really cruel and thoughtless profession sometimes.'

I find this particularly true when it concerns the intraprofessional expectations of fellow doctors.

A nurse once said to me, 'Medicine is the only profession I know of where they eat their young.'

Young or old, I think doctors do tend to have very little compassion for other doctors. And that's a terrible shame.

According to Beyond Blue's 2013 'National Mental Health Survey of Doctors and Medical Students', 40% of medical professionals perceived their fellow doctors to be less competent if they have had a history of mental illness and 59% felt that being a patient results in embarrassment for the doctor. Sad to say, stigma within the medical profession is alive and well.

If you've ever wondered why there are so many doctors out there who seem tactless and uncaring and appear to lack compassion, it's because to a certain extent, the profession breeds them. The perception is that it's the 'tough' doctors that survive the decades of rigorous training, ragging and gruelling hours. The profession prides itself on being resilient; on rising above the decades of physical, mental and emotional torture and abuse that is perceived to only make us stronger.

And often it does. But amidst all the success stories, you can't look away from the other side of the truth.

We don't all escape the trauma of self-neglect unscathed.

Mirrors and Walls

I was on Day 3 as a resident.

I was in a new department, working with new people, fulfilling a new role in a new rotation.

Even on Day 3, I still felt completely lost.

She was on Day 3 at her new job.

She was in a new town, working with new people, fulfilling a new role in a new and unfamiliar field.

And on Day 3, she was stretched to her limits.

We spoke about the stressors of her new work and life, the guilt that comes with putting herself above a commitment that she's made, and the feelings of uncertainty and inadequacy that she felt in her new role. We talked about the difficulties she was facing and discussed options that could assist with making things better.

Even today, I'm not sure if the nature of the discussion we had was part of my role as an ED resident, but I stuck with it because it was what needed to be discussed. If not now, then when, and if not me, then who?

As I worked within the limits of our professional relationship to defuse some of her fears and anxiety, I had to make a conscious effort to go against some of my own natural responses that were driven by my instincts of compassion and empathy and this was a real challenge.

Medicine is a paradox of incredible proportions. Isn't it funny how the exact qualities that draw individuals into the profession, the very fundamental values that we seek to instill in our doctors and the ones that we identify present in good doctors, are the ones that they are often required to silence in order to appropriately fulfil their roles?

I have no doubt that she will be okay. All that she really needs is time to prove to herself that she, in the words of Christopher Robin, is "braver than she believes, stronger than she thinks, smarter than she thinks", and that there are always options in her favour. And in the time that she is discovering that, all she needs is someone to be kind to her on days when she hasn't got the ability to be kind to herself.

In retrospect, I wonder if some would have thought that I had spent to much time with her in that consult. The truth was that I took as much time as I needed to get the work done. 

I gave her the time she deserved, the time that she needed and the time that I secretly wished I could give to myself for the same purpose.

In the end though, I think what matters most is that we ended the consultation with her stating, "I don't feel sick anymore".

Amidst all my doubt about whether I'm following all the rules, fulfilling all the criteria and being and doing my best, I can't help but be extremely comforted by her parting statement.

After all, if my patients can honestly say that they feel better after a consult, surely I must be doing something right.

Isn't that what I'm ultimately here for?