Career focus: Doctors who have a chronic illness

Susannah Baron and colleagues share their experiences of chronic illness and give some tips for those who might find themselves in a similar position

Non-Hodgkin's lymphoma

Illness seems to be a dirty word among doctors. Why do professionals whose vocation is caring for the sick find it so difficult to care for themselves and each other? It is almost as though once you are ill you have deserted and joined the ranks of the "sick others." Is it because ill colleagues remind doctors of their own mortality?

True to form, I ignoredmy symptoms for at least six months. I put the chronic cough, drenching night sweats, swinging temperatures, severe chest pain, and constant fatigue down to flu and the usual problems of uprooting and starting a new job in a city where I knewno one. Even I couldn't ignore a large lump inmyneck, but I was told it was probably tuberculosis. Six weeks later I turned into a walking MRCP short case as my large B cell non-Hodgkin's tumour decided to occlude my left subclavian vein and cause mediastinal shift (first time I've ever felt a properly deviated trachea).

It is truly frightening to suddenly become a patient: you tend to know the worst possible scenarios and want to know everything. I just wanted to be treated like a normal patient, but some doctors couldn't see past the fact that I "used to be" one of them. Junior doctors would avoid me (too close for comfort), and I became used to the pitying, written-off look in people's eyes. Surprisingly, the nursing staff had no problems treating me as a regular person and were immensely kind and supportive, giving me all the information about chemotherapy that many of the doctors mistakenly assumed I would know.

I think it's imperative in all forms of illness to remain positive and truly believe that you will get through. One problem, however, is that, as a doctor, you sort of want to know all the statistics, but really you want to hear only the good ones. So how do you stay positive in the face of negativity and feeling lousy? This is where I found complementary medicine an essential part of my treatment. In contrast with chemotherapy and radiotherapy, it makes you feel good. It can be difficult to choose a particular treatment as there are so many to pick from and so many practitioners out there, but it's simply a case of deciding what suits you best. This is the one time in your life you are entitled to be completely and utterly selfish.

I didn't fancy a diet of raw vegetables and daily enemas so, in an effort to improve my spinal headaches from the intrathecal methotrexate, I found an aromatherapy masseuse, and she turned out to be a spiritual healer.Well why not? It wasn't a time to be fussy, and, despite being Jewish, I was happy for any help from any denomination. Complementary practitioners have the time to listen to you and treat you as if your wellbeing were important to them. You feel empowered if you can control symptoms such as nausea with hypnotherapy. Anything that makes you feel better and more positive is bound to help you to get well.

Ulcerative colitis

I had felt tired and had had a change of bowel habit for more than a year before I decided that it wasn't normal and set off in search of an answer. A few weeks and a colonoscopy later, and I had a diagnosis of ulcerative colitis. That was three years ago, and I am now in the middle of a six month "break," during which I hope to finally give my health the time I should have given it long ago.

At the time of diagnosis I could not believe that I had something wrong with me that would probably require treatment for the rest of my life. So I carried on with the tablets but continued to ignore the symptoms throughout a two year surgical rotation. Setting my alarm early so that I could spend an hour on the toilet and still get to work on time; always carrying spare knickers and trousers, followed by excuses as to why I'd changed into themduring the day; having to leave theatre at speed during operations to make it to the toilet: these all became part of my "normal" way of life.

In August, however, it became too much. I'd had enough. Surgery wasn't the career formefor many reasons, but it was clear that spending long periods standing in theatre and having to cope with a chronic disease that by its nature means sudden and unexpected visits to the toilet didn't go together.

So I have done locum work intermittently to pay the bills, have joined a gym in an effort to combat the osteoporotic effect of the corticosteroids, have decided on general practice as my future career, have secured an obstetric and gynaecology job, and incidentally feel a lot better.

Chronic fatigue syndrome

After many years of good health, enjoying medical work and family life, it has been hard to be struck by ill health in my 40s. I have had chronic fatigue syndrome for the past five years, and the nature of my illness makes planning for the future very difficult. Fortunately, Iam only moderately affected and seem, to the rest of the world, to function fairly normally, but this is only because Ihave learnt to manage my life very carefully, with all the frustrations that this brings.

From a work point of view, however, my difficulty in reading and writing, coordination problems, and memory lapses have made it impossible for me to continue in my specialty of geriatrics, and I stopped work fairly early on in my illness.

Hepatitis B

I had been working as a staff-grade orthopaedic surgeon for four years when I was struck down with liver cirrhosis secondary to hepatitis B and C (antigen e negative) and had to have a liver transplant in April 1999. Since the transplant, I have not been able to go back to work as I feel very weak and tired and am easily exhausted. Climbing stairs and doing any strenuous job tires me very quickly.

I feel that, with my knowledge and experience, I could contribute a lot to outpatient clinics and perhaps perform minor surgery and also take part in teaching rounds to juniors. I might not be able to take full responsibility as a "surgeon on call" or deal with major accidents and emergency because of my general weakness and easy fatigability. As there are no such job opportunities in the NHS, I feel that my talents are decaying.

Mononeuritis multiplex

A little over three years ago I developed mononeuritis multiplex. Six months after its onset, as I gradually became more unwell, it became clear that I had a connective tissue disease with a vasculitis as the underlying cause. After about five months and treatment with high dose corticosteroids and other immunosuppressants, I returned to work much improved but still functioning well below my "healthy" level. It is only in the past six months that I have been able to function at anything approaching my normal level, and the relief at not finding everything Ido an effort is enormous.

Perhaps the hardest aspect of work has been looking fine while feeling awful-the "hidden disability" phenomenon. My not wanting to admit how Ife ltmeant that some colleagues did not realise how ill Iwas and askedme to take on more than Icould cope with. However, my reticence was the only way Icould deal with my illness-constantly talking about how you feel soon becomes both boring and exhausting. Such problems were balanced by the endless support Ire ceived from several colleagues who are close friends and a sensitive and protective secretary. The two colleagues on the same specialist rota asme did a "1 in 2" for a year without a single word of complaint as Idid no on call duty for a year.Without their support, Iwould have struggled to remain at work, yet my work was a lifeline-it allowed me to maintain some sense of normality when Iwas forced to give up so many other activities that Ihad previously loved, in particular sports.

Susannah Baron, specialist registrar in dermatology, Leeds
Email: Zannerzu@aol.com

The other authors wish to remain anonymous

studentBMJ 2001;09:171-216 June ISSN 0966-6494