When can a doctor call in sick?

I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.

It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one was really bad as it hit me on top of my undertreated seasonal allergies and having a 9 month old who doesn’t sleep through the night. (I’m just not getting to the Neti pot.)

So no surprise that after a week of this virus, I started to get an earache. Within an hour the earache went from kind of annoying to consistently throbbing. I had a colleague look at my ear to confirm that there was a dull, red, bulging TM there. By the time I got to the pharmacy to pick up my antibiotics, it was screaming, pulsing, popping. I kept putting my hand to the canal expecting to feel pus and blood.

This is on top of a toddler and a 9-month old with copious nasal discharge and coughing. The baby hates having her nose aspirated, but is used to sucking her binky as she falls asleep. With all the green mucous, she can’t suck the binky and breathe at the same time. Thus, misery, for her and us. It’s been over a week with this struggle to clear her little nasal passages so she can soothe to sleep.

Our toddler is a bit better off, but still cranky, clingy, picking at meals, whining. And waking up during the night coughing. A cup of juice and some quiet rocking lulls him back to dreams, but meantime, either me or hubby is up, again.

Night before last, it was midnight, and neither child had been able to fall asleep yet for more than a few minutes. Stuffy snotty noses, coughing, diarrhea, fevers … we had spent hours trying all the tricks. Steamy shower, nasal aspirator, saline wipes, Tylenol, juice, singing, reading, cuddling, cartoons.

And I had to be up at 5:15am for a 7:40am start time in clinic.

I admit that I kind of lost it. I was personally miserable with my own symptoms, exhausted from several nights in a row of this sort of shenanigans, and I knew I would have only a few hours’ poor sleep before I had to truck it to the city and take care of people.

“You have to call in sick,” insisted my husband.

“I can’t,” I insisted.

And I didn’t. The kids eventually drifted into snoring/coughing but sustained slumber. My alarm went off at dawn. I hauled my sorry drugged-up ass into the shower, and made it to work alive. I popped phenylephrine, chugged dextromethorphan, snorted Afrin, gulped a whole lot of coffee, and tucked a full bag of Ricola into my white coat pocket. I saw my full panel of patients. I got some looks from people, colleagues and patients alike, for my red, swollen, flaky nose, and this wet cough. I kept assuring people, “I’m at the tail end of a cold, I doubt I’m contagious. It’s my own misery.”

I’ve commiserated with colleagues. Everyone’s been through this before. But we all agree. You should call in sick for this stuff. But we all feel like we can’t call in sick for this stuff.

So when can the doctor call in sick?

I remember as an intern on a busy overnight call, one of the senior residents started the evening with GI bug symptoms. It was severe, coming out both ends. By 1am, he was laid out in the call room, and the nurses hooked him up to IVs. Still, we interns were coming to him for all the usual overnight precepting: running admits by him, reviewing labs, discussing cases. There was no question of, “Could he go home sick?”

We knew that he was febrile and dehydrated and not thinking straight, but there was no choice. And in the morning, the attendings heralded him as a hero for sucking it up and holding down the fort, despite having active nausea, vomiting and diarrhea … that was contagious. That left a strong impression on me. Today, I think that was insane.

More recently, I had to fight with a patient of mine who also happened to be a surgeon. She had developed flu symptoms and wanted Tamiflu, but didn’t want me to test and confirm flu, so she wouldn’t have to call out sick, as is mandated by occupational health.

“I’m on the schedule, I have to operate,” she explained.

Those are extremes. More common, I think, is our family’s situation. We’re all miserable, but can’t justify calling out.

What would you do?

“Genmedmom” is an internal medicine physician who blogs at Mothers in Medicine.

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