Sick Doctors

I remember once during my massage years seeing one of my regulars who was an ophthalmologist (eye doctor) and asking how he had been since his last massage. He reported that he was very very sick, sicker than he had been in many years. I asked him if he took any time off work, to which he smiled and said "Doctors don't take time off when they are sick," which I figured at the time was just a representation of his generation. He was an older man, near retirement himself after a life of giving up his time to medicine, and had that "old school" mentality where it is expected for doctors to work over 100 hours a week, and work when sick, all without complaint. After just two weeks working in the hospital with internal medicine residents, I've realized that the expectation for doctors to work when they are sick is still very much alive.

Take the intern for example. Last week while giving presentations out in the hallways he would have to take a break to wipe his eyes, and the sweat off his brow. While in the rooms leaning over patients to listen to their hearts, he would tip his head way back, and deeply sniff, so that he didn't drip any of his nasal secretions on the patient. After the heart exam he would quickly go over to the sink, blow his nose, then wash his hands, and return to the work at hand, until his secretions sent him to the sink again. We watched him suffer for many days with his illness, all the while being slammed with the work of an intern (something I am NOT looking forward to). He would be sitting at the computer in the call room, with blood shot eyes from being up all night, and a sweaty brow from his fever, with runny nose and eyes, trying desperately to keep up with the relentless incoming pages from nurses about medications or symptoms of his patients. You see when on overnight call, the intern is not only responsible for the ten patients that we have on our team, but is also responsible for what is called "cross cover" - he is also responsible for all the other internal medicine patients in the hospital (because the other interns are home sleeping). My heart broke for him, and I wish that we could have helped him, but unfortunately medical students don't yet have what it takes to do intern level responsibilities.

If that wasn't enough to believe that this whole working while sick thing in medicine is utterly ridiculous, I have been fortunate enough to experience it myself, so that I can know for SURE, that it's absurd. Last week, just days after the intern's snivels started to abate, I started with the infamous sore throat, that soon led to a dry hacking cough. After several days I just started wearing a mask, because more of my time was spent coughing than not. I drank cough syrup like it was candy, and went though a whole bag of cough drops in one day. Thursday was the worst day, as it was long call day, which meant an overnight shift. Thankfully my resident sent me home to do my work, as she was probably sick of hearing me cough in the workroom. So after examining my patient, I went home to spend hours writing my history and physical exam, assessment and plan, and slept a few hours sitting upright on the couch. I returned for rounds early the next morning at 6 am, and spent the next 4 hours in uncontrolled coughing spasms in the hallways of our medicine ward. My eyes watered, I slugged another few doses of cough syrup, and prayed to at least stop coughing long enough to give my presentation to the attending. 3 hours later, after listening to the other medical students give their presentation, as well as the intern discuss the other patients, I finally got to my 10 minutes of "fame" which of course, was interrupted by racking spasms of coughs.

Now what is most disturbing to me about this whole thing, other than the obvious fact that I did NOT belong in a hospital, around patients much sicker than I, who definitely couldn't afford to get my illness on top of theirs, was the fact that we all pretended it was completely normal for me to be at work while sick. I'm looking into the resident's eyes, telling her between coughs what I think we should do for my patient, and it's like a HUGE elephant in the room, my sickness, that is completely ignored. Oh sure, I know that everyone on my team was aware of my sickness, just like we were all aware (and feeling bad about) the intern's sickness the day before. But no one can say anything about it, because like my massage client/eye surgeon told me years ago, "Doctors work when they are sick."

That is one of just many things in the medical profession that is totally insane, from so many points of view. First, there's the possibility of infecting the patients; then there's the idea that when a doctor is sick, they are probably not thinking very clearly (not to mention when combined with the drugs taken to help control the symptoms);and how about being a part of a profession that takes the oath "first do no harm?" Could one argue that going to work sick is not only harmful to one's self (should be at home healing), but also possibly harming a patient?

These are all things that I have thought a lot about this past weekend, as I laid on the couch, coughing up my lungs. As I coughed like crazy this morning, I thought about calling in sick, as I knew that I really need more time to heal (2 days just isn't enough). But here's the thing: I realized that to miss a day of work means that I have to make up this day, and when would I make this day up? I only have one day off a week anyway, and I certainly don't want to come in on a weekend day to make it up. And I imagine the reason doctors go to work sick is the same - when will they make up the work? If they have a whole day of patients, or several surgeries scheduled, when will there be time to fit all those people in? Sure, maybe you would be lucky enough to have another physician pick up your patients for you, but most likely, they are also overworked and have no immediate openings in their schedule. So imagine that a patient has waited three months for an office visit to see their doctor to follow up on some lab results, and the doctor has to cancel because they are sick, and you have to wait another three months. Wouldn't you rather just listen to him or her cough behind a mask, rather than wait? Most of us would probably admit that we wouldn't want to wait, and alas, that is why doctors go to work sick. While I don't have any patients that wouldn't be taken care of in my absence as a medical student, I certainly don't want to spend any more days in this hospital than I have to. So here I am at work, cough, cough, cough.