My “aha” moment wouldn’t come at the signing of my leave of absence contract. Nor would it awaken me at night with the chair-gripping dizziness I had come to expect.
When the vertigo started in early December during my third block of clerkship, I chalked the symptoms up to stress.
Over the December break, I met with my family doctor and casually recounted my symptoms. The vertigo had worsened, and seemed questionably sound-induced. The quiet noises became louder. The louder noises became unbearable. And the loudest noises set off nystagmus.
Handing me a pile of differentials and a wealth of associated requisites, what she didn’t account for was the weight of what I was being handed.
Gradually, the privilege of medical jargon and access to semi-exclusive texts divided my mindful self and left me consumed with the fears of all that could be. I spent hours dissecting my symptomology, absorbing every resource avail to me through my hospital account and MD library. I honed in on specific signs and began to see myself among the pages, certain that the descriptions coincided with my presentation.
Over the second week of break, I visited the ER several times and was referred to dozens of specialists. Words like multiple sclerosis, optic neuritis, ocular myasthenia gravis, vestibular neuritis, and Lyme disease were thrown at me from multiple directions. Words that represented the body of knowledge I had passionately spent the past few years absorbing. Words of disease, of uncertainty, of panic.
Returning to my clinical duties in the New Year, my level of functioning went from that of a dedicated clerk to one of poor attendance and performance, booking my weekends and evenings with the mandatory tests my physicians had arranged: MRIs, CT scans, PCRs, electronystagmograms, visual field testing.
On a good day, I made it to the hospital an hour early. The oscillation was inevitable, but the triggers were blended. Was it loud music? Fluorescent lights? The stop-and-go traffic of the morning commute? I couldn’t risk the onset, so I left for work as soon as I woke up.
By noon, I was gripping my seat and praying my breakfast wouldn’t make a re-appearance. My preceptor would glance over at me, kind as he was, and ask if I needed to leave. But I had four more patients to see, and with my exam coming up I knew best to stay put and get the most out of a day’s learning. I would jokingly deny it at first, but by 5 o’clock, I would lose my footing in the elevator riding down to the main floor.
But those were good days. And they were becoming few and far between.
Eventually, I got caught.
My ambition to adhere to presumed professional standards drove me to simultaneously undermine the possibility of taking time off. The medical rite of passage to belittle one’s primary instincts of eating, voiding, and sleeping meant my desperate attempts to prevent disappointing the community I longed to join were laughable, at best.
An outlier, they called me.
Defeated, I put myself on medical leave. My spirit for medicine had faltered, and all I could do was condemn myself for not being a “strong enough” medical student in the eyes of my institutional predecessors. I boarded a plane and returned to my parents’ the following day, tearfully leaving my studies, my partner, our dog, and the life we had proudly made for ourselves behind.
Derailed from the medical community, my only connection became one of a patient. Over the next four months, I underwent a battery of tests and heard dozens more diagnoses resembling only those words familiar to the specialists mouthing them.
I ceased to care about my future and accepted myself as a failure. I spent my days lying in bed, waiting for answers that I feared would never come. I watched my colleagues celebrate their clerkships successes from afar, as I answered well-intentioned, yet alienating, text messages from classmates I barely knew. Zofran became a daily certainty, and even still I could not guarantee that a meal could be kept down. I folded my white coat into a drawer, believing I may never wear it again.
“We found a lot of abnormalities,” the neurologist said, holding a stack of data collected from five hours of audiology testing and a high-resolution CT scan. “You are likely going to need surgery; it seems you have bilateral perilymphatic fistulae.”
Superior canal dehiscence. Diagnosed. And treatable.
My face lit up as I accepted the road ahead and acknowledged the impact of the past five months. The importance of an answer, irrespective of the treatment plan, was imperative to my feeling whole. Suddenly, and all at once, I was human again.
My real “aha” moment came at the decision to return to school the following year to join a later cohort. I accepted that I wasn’t taking time off, but really, taking time on. When I reflect on my year, I see now that I was initially complacent with an outdated concept of physician-patient detachment. A moment in time captured not by self-awareness, but by a fear of failure in the face of evaluators and supposed standards of professional poise. Support for medical student self-care is not only crucial to reconstructing the stigmatized labels of “failure,” but is ultimately an essential component to the teachings of resiliency, empathy, and compassion.
I am thankful for the opportunity to see the examination room from the other side, and to learn first-hand that the bedside is not a unilateral experience. I know of no other means to master empathy than accepting the vulnerability, uncertainty, and fear that comes with donning a patient gown. My love for medicine returned, stronger than ever, in the form of the patient experience; and it has taught me more about medicine than any lecture, textbook, or case history ever could. After all, what is medicine but taking off our white coats and embracing shared humanity.
Kayla A. Simms is a medical student.
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