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Why do we, as physicians, feel let down when we get sick? Do we expect that we are somehow immune from something as universal as illness? Striving constantly for perfection, do we feel abandoned by our bodies when we become ill? I'm not sure what bothers us more — the feeling of vulnerability or dispensability.
During my combined infectious disease and critical care fellowship, I recently became ill with influenza and had to face my own vulnerability and dysfunctional need to feel indispensable as a physician. As a result of my illness, I have a renewed respect for influenza and am more convinced than ever that health care workers should receive influenza vaccination — not only to protect their patients but to spare them an experience similar to mine.
The Infectious Disease Service was busy as usual at the large inner city teaching hospital where I was working. There were many consults and no junior house staff, making for hectic days. I was on call over the weekend when I was informed about a possible influenza outbreak on a ward. A patient had tested positive for influenza and had likely exposed 3 roommates, one of whom was already symptomatic. I saw all 3 patients, suggested isolation and appropriate treatment, and left a message for Infection Control to follow up on Monday. I continued seeing consults until late in the day, finishing up in the evening. That was Sunday.
Monday was a long day but uneventful. By Tuesday night I was feeling unusually tired but thought it was because I had worked through the weekend. I convinced myself that a run would make me feel better and headed out on my favourite route. My usual run, however, was anything but usual — I was exhausted, my legs felt weak, and my body was sore. I barely made it home. I had to walk up the last long hill, out of breath, my spirit broken. I was so dizzy that I had to stop to sit on the side of the road to recoup.
That night my muscles ached. I had a hard time holding onto the belief that my run was the sole culprit. I went to bed hoping that I would feel better in the morning, that the aching would pass and be quickly forgotten. I awoke, however, to intensifying muscle pains. I ignored the soreness in my throat and continued to deny the obvious connection to the patients I had seen over the weekend. I went to work as usual — denial must be ingrained in us. By mid-morning I could no longer discount the chills, the screaming pain in my throat, and the severe headache impairing my concentration.
My staff-person sent me home. I tossed and turned in bed that afternoon, evening and night, but I couldn't sleep. The fever started that night, raising my discomfort to anguish. My hair, pyjamas and bed sheets were soaked with sweat. The rigors were unsettling. After a sleepless night, I called in sick the next morning — something I'd never done in residency. I stayed in bed with my cough drops and syrup. My ribs were sore from the constant coughing.
Only at the insistence of colleagues, and in spite of the strength of my denial, did I agree to start taking oseltamivir after about 36 hours of illness. I made the trip into the hospital to collect a nasopharyngeal swab for testing and to pick up my medication. My symptoms slowly eased, and by the fourth day, I felt well enough to go back to work. The results of my swab were not back yet, but I was convinced that I wasn't a risk to my patients because I was taking medication. You would think a physician would know better.
Work was draining. In the afternoon the laboratory called to let me know that my swab was positive for influenza A. Finally I realized some common sense, and although it took some scrambling to find a colleague to cover for me, I decided to go home. Even though I was taking oseltamivir, I was probably still shedding virus, and to be looking after patients was not in anyone's best interest. I felt guilty for passing my work onto colleagues.
My weekend off-call was spent sleeping, drinking fluids and consuming more cough drops. My cough still turned heads in the grocery store, but my ribs were healing. I settled back into my routine.
As I started to feel better, I began to feel cheated, realizing that I had contracted influenza despite being vaccinated the previous fall. The laboratory confirmed that my strain was included in the vaccine. With the vaccine having over 80% effectiveness, I was miffed at being a vaccine failure. Me, a doctor, a vaccine failure — how was that possible? You would think physicians would understand that nothing in medicine is 100%, but this doesn't seem good enough, even for us. I suppose I might have been much sicker without the vaccine — something I should remind myself, a small consolation nonetheless.
Weeks have now passed, and this experience has provided a valuable opportunity for introspection. Not without irony, becoming ill helped me to understand better the concept of illness. Being a patient is a scary experience; the “other side” is not one I'd like to stay on. And although as physicians we have the ability to treat and cure disease, we are still vulnerable to illness ourselves. We are not indispensable, and illness is not a sign of weakness. I have also acquired a renewed respect for the influenza virus. And despite being a vaccine failure, I'll be lining up for my vaccination next fall — 80% protection is a lot better than none. A repeat of this illness is not welcome.