Quoted: Sick in school

[Doodledog]

For SDN membership to respond to.

Hi all. I realize that you probably can't answer this definitively for me but I'd appreciate your opinions and/or suggestions.

In January last year I was diagnosed with a glioblastoma after a few simple partial seizures. The tumor's in my left insula, is pretty big, and we've decided not to resect because the area of my brain is definitely eloquent. I'm young, neurologically intact, and the seizures are under control. All those things help my prognosis significantly, but it's still pretty dismal.

When I was diagnosed, I was a second year medical student (25 y/o) and had passed all of my classes first semester that year. The last seven months, I had to take off for radiation and chemo. Thus, I'll have to take second year over again, auditing first semester. Second semester, I'll take for real. Clearly I've grown close to my physicians, who are also my professors, and both they and the school have been phenominally supportive of me.

I have a couple of questions/thoughts to which you can respond. First, I still am on chemo for the forseeable future, which I take in 4 week cycles. Everytime I take it I am more exhausted than usual for at least 2 weeks. That's half of my time I'm worthless. Auditing these classes that isn't a big deal, but I'm pretty worried about next semester... boards... clerkships... and on and on. I'm worried that me out half the time will affect my preparedness for being a physician.

In addition to the exhaustion, the obvious problem is that I could become congnitively impaired and not know it. It could happen either suddenly or as a drawn out progression. I've tried to set up weekly meetings and regularly stay in touch with my mentors at school, but that can only go so far. Again, this potential for impairment isn't aweful pre-clinically, all I'll do is flunk, but I question the risk I could put patients in in yrs 3 & 4 & beyond. Would you want a student or physician with my seizure history in the operating room working on your kid or a slipping mind trying to make a diagnosis on your spouse?

Can I, should I continue with med school? Perhaps you can talk about older physicians and how do they know when the time has come for them to retire. I know there are hospital policies in place, but I also know they don't work until too many patients have been hurt.

I have considered leaving school, but I don't know what I'd do. My best idea is to go to my folks house and do woodworking. I can make a heck of a bowl. But that sounds like I'm just biding my time till I die... and I definitely don't want to do that. Not to mention I'd just be bored all the time.

And I love med school. Sorry for the long post and for the rambling... just thought I'd toss it out for you guys to chew on.

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[Doodledog]

First of all, I'm certain I speak for the SDN volunteer staff in saying that we are wishing you a complete recovery and are glad you felt comfortable enough with SDN to post this question.

Over the years, I have known a number of medical students and residents in a similar circumstance as yours. There are three issues to consider. First is whether your illness or its treatment poses a risk to your patients, the second is whether medical education poses a risk to your health and recovery and the third is whether this is how you wish to spend your time.

With regard to the first, I am doubtful you will pose a significant risk to your patients as a medical student. Certainly you can discuss this with the deans at your school, but I think this is unlikely to be a major concern if you are not having uncontrolled seizures. A medical student is not generally providing the type of care that your condition or its treatment would likely cause concern. In terms of residency and beyond, I think there are numerous career options that would make your illness unlikely to pose a serious risk to your patients. I would not "give up" for this reason unless your physician or your deans feel it is necessary for the safety of your patients.

The second is a bit more difficult. Assuming you are not immunocompromised during your therapy, then the biggest concern might be the effect of the medical school lifestyle on your fatigue and your ability to tolerate chemotherapy. Others who have been through this can comment better, but my guess is that if you enjoy what you are doing, it is worth a try. Certainly discuss this as well with your school leadership, but it is not unreasonable to think that some accommodation can be made to help you in this.

The most difficult issue, and the one that truly only you can decide, is whether this is what you want to be doing with your time. Although it would not surprise me to see some folks tell you that medicine isn't worth it and that you should be at the beach or whatever, I don't necessarily agree. I know many attendings faced with serious or life-threatening illnesses who chose to continue to work at their jobs because it was what they liked doing. Medical education isn't necessarily "fun", but it is what you've chosen and it is not necessarily the case that you would be happier giving it up. Hopefully, as you recover strength and health, you'll move to advanced training and find a field that you wish to work in that fits your health needs.

If not, or if it does not appear as though you can continue, then certainly you can stop or take a more extended leave of absence. But, I would encourage you to make your own decision based on how you feel about what you are doing, not the view of others who may not share your desire to continue in your career path.

Above all, again our thoughts and prayers are with you. Good luck with your decisions.