by Anu Bajaj, MD
Recently, I’ve had the opportunity to consider this question since I’ve experienced both personal and professional injuries. Physicians usually apply different standards to themselves than they apply to their patients. Everyone else I know, if they are sick or injured takes time off of work – my nurse, my scrub, my husband. But because our job is to care for others, as physicians, we believe ourselves to be invincible.
everyone had his or her own tale of working at all costs – throwing up in the call-room bathroom, working with a high fever, or asking the nurse to start an IV on oneself.
As a resident, regardless of how bad I felt, I always dragged myself into work. When I spoke with my fellow residents or former residents, everyone had his or her own tale of working at all costs – throwing up in the call-room bathroom, working with a high fever, or asking the nurse to start an IV on oneself. During my training, I can recall only one instance when I left the hospital early -- as a fourth-year medical student, I came down with Rotavirus while on my pediatrics rotation and remember having both nausea/vomiting and diarrhea. After spending the entire morning in the bathroom, my chief resident finally sent me home. Similarly, I can recall stories of my father (who is also a surgeon) needing to get breathing treatments between OR cases for his asthma.
In fact I started working with my father when he was injured – he had slipped on the ice and had broken his wrist. He was in a cast for 3 months and was unable to operate during this time. When I joined his practice, I was instantaneously busy since he was unable to work. A year later, I broke my elbow while riding my bike -- I had a non-displaced radial head fracture. My practice was still young so when my orthopedic surgeon advised that I keep my elbow immobilized for 10 days, I reluctantly complied for a week. After further discussion, he conceded that I could do gentle range of motion and start operating on SMALL cases; he even specified, no breast reductions or abdominoplasties or weight bearing for 6 weeks. I did return to work (and followed his instructions).
We were able to find the pieces in the midst of the zucchini, and my father – the hand surgeon – was able to secure them as grafts to my fingertips.
Then three months ago, as I was making zucchini spaghetti on my fancy kitchen mandolin, I sliced off the tips of my thumb and long finger (as a surgeon, I was grateful that it was the radial side of my thumb and my long finger knowing that these areas are less critical for my operating skills). We were able to find the pieces in the midst of the zucchini, and my father – the hand surgeon – was able to secure them as grafts to my fingertips. A typical hand patient would have been told to keep the dressing clean and dry and to elevate the hand; I was not a typical hand patient. Since I didn’t follow instructions, I did have a little graft loss (all eventually healed well). My father told me that I wouldn’t have lost any of the graft if I hadn’t used my hand while it was healing. How does one do that? I’m used to washing my hands umpteen times in a single day.
In the past, I have treated my running and athletic endeavors the same way that I have treated surgery – I have always learned to run through the pain whether it was plantar fasciitis, a strained muscle, or hip pain. I was able to get away with this approach until a few years ago when I had my first stress fracture. At that point, there was no way for me to continue to run through the pain, and I had to take time off from running – 4 weeks after the first stress fracture 6 weeks after the second. I was forced to take time off again following a recent hamstring injury. I injured my hamstring while running – the pain was so severe that initially I had difficulty walking. Nevertheless, as soon as I started to feel better, I started running again – probably too soon and promptly reinjured it. This time, I dutifully rehabbed the injury – took time off from running, then after the pain had disappeared started gentle stretching and cross-training with swimming. I followed instructions so well that I didn’t run for five weeks despite having an upcoming relay race (Hood to Coast in Oregon).
As caregivers, it is difficult to acknowledge our vulnerability – not only for ourselves but also for our patients.
So, why do I have this compulsion to keep working or running despite the effects to my well-being? When we watch professional athletes, many of them will take time off because of an injury – OKC Thunder player Russell Westbrook was sidelined during NBA playoffs for example. Similarly, as a physician, when I discuss upcoming procedures with patients, I routinely advise them how much time they may need to take off of work, how long before they can work out, and how long they may require someone to help them at home. And as they recover from surgery, when they ask about resuming activities, I always urge them to listen to their bodies. They can gradually start to increases activities but should pay attention if “something doesn’t feel right, ” and “listen to your body.” While it may be easy for me to give advice, it is far more difficult for me to follow this advice.
The easy answer is that we are the caregivers. As caregivers, it is difficult to acknowledge our vulnerability – not only for ourselves but also for our patients. Telling a patient that you have to cancel surgery – even if it is because the surgeon is sick or injured still results in disappointment and frustration for the patient. When I broke my elbow many years ago, I had to cancel a bilateral DIEP flap – despite the excellent reason for needing to reschedule, my patient’s initial response was negative. So, I have had it ingrained in me that I don’t cancel patients, ever.
... we are human and not invincible.
The other part of the equation is the guilt I feel for having to cancel on any commitment – whether it’s to myself or to others. With running, I beat myself up if I skip a day – saying that I’m lazy; and I take the same approach if I have to change my work schedule for a personal reason. I have had asthma since childhood. Typically, when I have a severe episode, it will rapidly progress to bronchitis. After having a particularly bad weekend, I spoke to my father on Sunday evening about our DIEP flap for the next day. My dad said, “are you sure that you’re ok for tomorrow?” I responded, “ Of course I am, I’ve never cancelled a surgery before for an asthma attack.” He said, “maybe you should consider it, you don’t have to work if you’re not feeling well.” At that point I realized that I had never had permission to think of myself and how I felt. Now, I had permission to acknowledge that I may not be 100% upto a task.
Usually, when I’ve had an athletic injury severe enough to keep from running, I have been told not to run; when I have a personal illness, as physicians, we rarely obtain “permission” not to work – even on days off, patients still have needs and will still call. Struggling to take care of our patients and ourselves is a balancing act that many of us are still trying to navigate. Nevertheless, we must all admit that we are human and not invincible.