by Danielle Ofri
New York Times op-ed
The bottle of Maalox sat perched on the triage desk in the emergency room. It was mint flavor, or maybe lemon — I don’t recall exactly — but it shimmered temptingly. I had just finished with a new admission, and my stomach had been groaning ominously for hours. It was after midnight, the whole night was still ahead of me, and I was getting desperate. I scribbled the last of my medication orders and snagged the Maalox bottle, popping the top and chugging two revolting capfuls on my way to the elevator.
As I rode upstairs, I could feel the intestinal protestations growing. There was going to be an apocalyptic resolution to this. The elevator opened and I burst into the restroom, just in time to disgorge the Maalox and everything else into the toilet, conscientiously keeping my white coat and stethoscope clear of the fray.
I staggered into the call room and flopped onto the couch. My fellow resident listened to my tale of gastrointestinal woe and did what any residency buddy would do: he slid an 18-gauge IV into my antecubital vein and strung up a bag of IV saline. I spent the pre-dawn hours prostrate on the couch doing phone work — renewing medications, answering calls from nurses, ordering labs — while my colleagues did the foot work on the wards and in the emergency room. Together we kept everything running.
After morning rounds, I caught a few hours of sleep at home, showered, and then reported back to the hospital at 10 p.m. for my next shift.
What I didn’t do was call in sick.
It has long been known that doctors make the worst patients. From day one in medical training, the unspoken message is that calling in sick is for wimps. Much of this is logistics. The staff has to scramble to reschedule patients — many of whom have been waiting weeks or months for their appointments. Patients who need medical attention that day are crammed into someone else’s schedule or sent to the emergency room. Your already overworked colleagues are saddled with extra work, and patients usually get the short end of the stick.
So most doctors ignore their symptoms and resist taking the day off unless they are sick enough to be hospitalized in the next bed over.
This, of course, is ridiculous behavior on the part of medical professionals who would never recommend such nonsense to their patients. Medical workers with respiratory infections are contagious. Caregivers with gastrointestinal infections — as I had — can easily infect their patients.
A 2005 outbreak of the norovirus stomach bug in a nursing home highlighted the role of medical personnel in spreading communicable disease. The most disturbing aspect of the case was that medical staff members continued to come to work while ill, well into the outbreak, despite strenuous and public exhortations to stay home. This may have prolonged the outbreak and led to more patients’ falling ill.
A survey of British doctors back in the ’90s found that 87 percent of G.P.’s said they would not call in sick for a severe cold (compared to 32 percent of office workers who were asked the same question). In Norway, a 2001 survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home. Two-thirds of these illnesses were considered contagious.
What explains this toxic brew of denial, ignorance and bravado? Part of it is a professional but often exaggerated sense of responsibility to colleagues and patients. Even if you are sick enough to have an IV running in your arm, you keep doing your job.
But another part is how we see ourselves. Illness is what we do, not who we are. We define ourselves by vanquishing illness, not succumbing to it.
As much as we empathize with our patients, part of protecting our inner core may require drawing an unconscious demarcation between “us” and “them.” I can recall, as a resident, the palpable relief of leaving the hospital at the end of a long night, something I generally thought about in physical terms — getting out of grubby scrubs, the promise of a hot shower and edible food. But it was more than that: There was also the awkward relief of leaving behind the graphic reminder of what could befall my own body. Somewhere, deep down, I needed to convince myself that we doctors were a different species from our patients.
I thought of all this recently, after my daughter woke with a fever, and I had to stay home from the hospital at the last minute. I realized it was my first “sick day” in about 25 years. I was grateful that my colleagues stepped in, but it was a frenetic scramble that inconvenienced everyone, especially my patients.
I wish there were a simple process to make it easier for doctors to call in sick so that it’s not an operational crisis every time. But it isn’t possible to have a pool of substitute doctors the way we have substitute teachers.
What we can do, however, is examine the existential qualms that doctors have about illness. From the beginning of medical school it is important to advance the idea that illness is a part of all of us — doctors and patients alike; that there is very little that separates us from our patients, other than the circumstance of the moment; and, for goodness’ sake, that we need to call in sick when we are sick.