Long-term sequelae of a life in medicine

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It’s a Friday in January 1997. Another two-week block of nights behind me, 75 hours a week with a weekend off in between. However, working 5 p.m. to 8 a.m. means waking at 4 p.m. to dress, grab 15 hours-worth of food, drive 20 minutes to the parking deck, and run 10 minutes to the reading room by 5 p.m.

As a second-year resident, working alone covering all radiology services for inpatients and emergencies at a tertiary care center seems terribly irresponsible since I’ve only had a year of radiology training. PACS and voice-recognition software haven’t been invented yet. I hang the films on the revolving view boxes to interpret them in the same room where ordering physicians review the images, often requiring me to abandon the case I’m currently reading.

The adrenaline rush is compounded by loneliness. Calling an attending or upper-level resident at home for guidance is “uncool.” The attending’s supposed to arrive at 7 a.m. to over-read my cases but is often late. Having someone critique my work amidst frenzied exhaustion is … difficult, especially if I’ve made a mistake. An acid dump into my stomach is predictable.

If I leave the hospital by 9 a.m., I can unconsciously drive home and pop an Ambien as I walk in the door, so it’ll kick in just after I’ve showered. Falling into bed, white noisemaker humming, daylight peeking through the curtains. Years later, I’ll learn sleep with Ambien isn’t the same as sleep without it. If the night’s been particularly harried, even Ambien won’t be able to slay my cortisol levels, and I’ll start the next shift not having slept at all.

I wish I could be brave like Jane, who leaves at 8 a.m. whether the attending has reviewed her cases or not. She has a baby to see before she goes to bed. The attendings always seem to arrive early when Jane’s working because it’s easier for them to hear Jane’s interpretation directly from her than sign her reports without her. I don’t understand how Jane can do this, but I can’t.

This weekend, my husband and I are driving to Washington, DC, to get reacquainted. All week, I’ve had a strange pressure sensation behind my left eye, not overtly painful, more like a deep, dull, pulsing ache originating behind the globe, escalating to a peak before disappearing altogether, like labor contractions.

In DC, our quaint room in the Kalorama district is charming. Antique furnishings and low-volume classical music from the digital clock radio on the nightstand wash tenderness over me. Such stark contrast to the chaos of my usual life is moving. The sensation in my eye doesn’t keep me from sleeping.

The next day, the sky is overcast. We take the Metro to The Mall, strolling without a sense of time. Free! But when the icy wind blows, I feel a prickly sensation in my left eyebrow, each hair standing alert. With touch, the brow and skin over my left forehead are exquisitely sensitive. I can ignore it until brushing my hair before bed when I trace a tender, slightly raised vertical line from the top of my head terminating behind my ear in a swollen lymph node. I’m stumped. Maybe a spider bit me?

Driving home, my anxiety intensifies with the symptoms. Worried, I report to the emergency department where I’m a known entity. The attending, Dr. Soandso, and I are buddies from my night shifts. After a brief H&P, he says, “You’ve got shingles in the ophthalmic division of your trigeminal nerve. You’re going to erupt in vesicles any minute.”

My thoughts race: Mom said I’d only had 12 vesicles on my body when I had chickenpox as a toddler. Can I have shingles after such a mild case? I’m 27 and healthy. Am I immunocompromised? HIV positive? I can’t work if I have shingles. It’s contagious. I could infect a pregnant woman or those around me who haven’t had varicella since no vaccine yet exists. Who’ll believe I have shingles without a visible rash?

I start to cry. I ask Dr. Soandso how I’m supposed to handle this; I’ve been managing my stress, and Prozac has been helping. He turns cold and silent, then leaves the room. An internal medicine resident enters to console me. I’m sent home with valcyclovir to inform my coworkers.

I’m unable to rest not only for the excruciating pain but from my shame for “screwing over” my now overburdened coresidents. I’m terrified to see any vesicles on my face but find myself actually praying I will, so my colleagues will know I’m not feigning my illness.

I eventually return to work in the nuclear medicine department, where I’ll be fairly isolated from the general public. People move on, right?

Weeks later, I’m back in the ER for another two-week stint, and Dr. Soandso is working. He won’t talk to me, can’t look at me. He never speaks to me again for my remaining three years of training.

It’s 23 years later, and I’ve had post-herpetic neuralgia (PHN) over my left forehead for two days. I get it a few times a year. Is this my fault? Could I have avoided this painful curse if I’d been more competent, laid-back, better at managing stress? Maybe if I hadn’t been so sensitive, I wouldn’t have made myself sick.

The medical system has since placed limits around the frequency and length of shifts for residents and staff. Still, we know those rules are ignored, especially now during the pandemic.

I’m worried about the long-term sequelae of COVID-19. Not just for those who contracted the virus or get the vaccine, but for the medical community once the dust settles.

Our health care system was immunocompromised before coronavirus. Record rates of burnout and suicide weren’t enough to change the paradigm.

Going forward, will we be able to avert or share our own health struggles without being shunned? Be willing to work fewer hours and make less money?

In the aftermath of this crisis, will we show up differently to save ourselves?

Tracey O’Connell is a radiologist and physician coach. She can be reached at her self-titled site, Tracey O’Connell, M.D.

Image credit: Shutterstock.com

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