Most of my job is wrapped around the idea of understanding. And it’s a funny thing, really, because there is almost always more understanding to be had, no matter how wise you are or how many questions you ask. The first time you are a medical student with plenty of time and all your important questions written down and you take detailed notes…to a patient with pneumonia “ma’am do you have any exposure to birds?” Patient: “What? No?” Then the attending comes in after your confident presentation, asks a few questions in a slightly different manner and turns out patient has a bespoke mountain partridge aviary, and they caught their pneumonia from the sick bird they took to the vet on Saturday. The type of pneumonia is important because if its from a bird you use different meds to treat it.
Sometimes if you stare directly at a thing it never comes into focus.
I’ve always been a stoic. Mostly because it never really felt worth the effort to express or share my pain because who cares anyway, the energy is better spent in other places. Very few people in my life know that I was so sick for 3 years. Some of you might be finding out reading this, though friends and family often don’t read your books or blog, so I’m probably safe.
After year one of the fevers for a few weeks every season I got sicker. The fevers lasted for more weeks, the recovery afterwards took me more time to get back to normal, and the respites were shorter. In year one we didn’t make extensive plans because there was a pandemic and no one was doing much. We met a butterfly enthusiast and saw the American side of Niagara Falls. Nothing that took a lot of energy.
In year two I started back to seeing patients in person and I started to have to call people who might be planning to come in person because I had a fever…I had my yearly physical and everything was fine, but I didn’t tell her about the fevers because I hadn’t quite figured out how much they were ruining my life, and if you tell your doctor something is wrong in your yearly preventative physical under American health care rules you have to pay for it instead of your insurance paying. It’s only $250 or whatever but we already pay $20,000 for coverage…it’s the principle of the thing.
A few days after my physical my fevers came back and I finally decided to try to figure out what was wrong. Denial ain’t just a river in Egypt they say, and 18 months of on and off fevers finally decided me. I thought I knew the answer, though, because my family is chock full of autoimmune disease. When I eat too much of the wrong thing (gluten, okay, don’t judge) I tend to get a malar (or butterfly) rash on my face. My eyebrows aren’t very robust, another sign of autoimmune disease. I googled the most likely lab abnormalities to expect and during the fever I ordered some labs and made another appointment with my PCP, this time with the chief complaint of “I think I have an autoimmune disease” (for real, we have to type it in).
A man who is his own lawyer has a fool for a client…this also holds true for medicine. The advantage of being a doctor is we can drill down on the important questions and no one will dare to tell me to my face that my illness is imagined or whatever horrible things the general public has to deal with my profession on a regular basis. Or maybe some doctors and other medical people have to deal with this, but I have not. This is important because honestly the most likely response to my little fever problem once all the labs turned out okay was to ask me about my spirits or depression or whatever. And my labs were fine, legit normal.
Whenever I see my PCP I ask her how she is doing and make her cry (it’s really hard to turn off the psych ninja skills when I’m in a clinical situation) so she doesn’t ask me about all my emotional stuff. Am I tremendously “defended” as the therapists would say? Sure. Was it causing my fevers? No.
All the asides aside…during a fever I ordered my labs drawn that should have detected autoimmune disease if I had it, and everything was normal. My PCP ordered them again, normal. I came to my PCP for my fever appointment with a list of referral possibilities and one of them was the unexplained fever clinic at the major Harvard hospital she was affiliated with. She happily made the referral and I got an appointment 5 months later.
In the mean time my life kept getting smaller. My energy was entirely devoted to work and the essential things I had to do for my family. Other hours existed to rest and recover. Vacations and visits and family and work obligations were a major toll, and I didn’t make any extra plans, not to see museums or new restaurants or a fun weekend day trip or anything. One of the doctors who worked for me told me she had to leave, it was time to go back to her family in Florida. I didn’t have the energy to replace her and no one else would either. Without her I was the major money engine paying for the office and manager with our practice.
It’s probably easier to see in retrospect but I was literally hiding at home in my bed a lot of this time just to get the energy to deal with all the problems that came up.
I’m not a person that spends much time in regret. Things happen, we make choices. Was I absolutely done with my job as it was and being a supervisor and shepherd to younger or less experienced doctors…I’d taught the introduction to psychiatric interviewing class at Harvard Medical School for 18 years (without being paid) because I wanted to help and I believed in the class. After a few years of fever exhaustion I couldn’t do it anymore.
Why does Harvard with the largest endowment (in the billions) of any school in the United States rely on volunteers to teach their highly selected medical students…well…
Sometimes stoicism is helpful in life.
“In the mean time my life kept getting smaller.“
So frustrating!
How much did you share of this with anyone else? Aside from your doctors, were you getting emotional support (or social support maybe from a friend) during all of this?
I’m glad I’m not stoic.