The Doctor Calls In Sick

Jenny Blair, M.D.
April 17, 2005

It started with a sore throat. I've had plenty of those. I felt miserable but came to work, and it wore off within a few days except for a dry cough. A couple of weeks later, I awoke with a funny sensation in my chest, the feeling I get if I forget to use my inhaler before a jog, or walk into a room full of cats. The nasty feeling blossomed; the dry little cough deepened and grew painful. That week, I alternated between calling in sick and forcing myself to show up.

After a few days of this, while eating lunch in the break room, I was seized with a coughing fit like none I had ever had. It went on and on. I gasped for breath in a high-pitched, strangled moan. I went to the wastebasket, leaned my hands on the edge and coughed till the base of my tongue hurt, till I vomited. When it was over, I repaired to the bathroom, rinsed my mouth, and stared at my eyes, which looked as red as if I had been wandering in a cloud of poison gas.

The paroxysms and vomiting recurred that night, and the exaggerated, high-pitched dragging in of air sounded awfully like a whoop. Whooping cough, or pertussis, is making a comeback. Vaccinations often wear off by adulthood. My symptoms were highly suggestive. The next day, though I was feeling better, I wore a mask to work. I called my doctor; he agreed it might be pertussis and prescribed antibiotics.

Knowing this was a contagious disease, I checked in with the hospital's infection-control clinic. When they heard my symptoms, they poked a thin tube deep into my nose to sample the secretions, then bundled me unceremoniously out of the hospital in the middle of a work day. I was advised to stay five feet away from other people. This was, in effect, quarantine. Whether or not the bacterial cultures came back positive, I would require five days of antibiotics before I could return to human society. The intensive-care unit, where I was working that month, would have to manage without me.

Calling in sick was one of the harder messages I've had to deliver. My residency director received the news with grim taciturnity. So did the other residents on my ICU team, who would now have to take care of my patients themselves. The culture results would take a few days. I slept, cleaned house, read medical journals, took azithromycin every morning, and waited.

Many sick doctors have a hero complex: They go to work when they ought to stay home. Residents often react to a colleague's illness by recalling when they were so sick they came in for their shift early and got "a couple of liters" of saline run into their arm by a sympathetic nurse. The not-so-subtle point is that you may be too sick to stand, but you work your shift nonetheless. "If you're going to call in sick," goes the warning, "you'd better call in your ventilator settings."

A close friend who is an economist assures me that more productivity is lost when employees work while ill - infecting colleagues or making themselves worse - than when healthy ones call in sick. Yet the culture of medicine tacitly expects sick residents to stop complaining, take ibuprofen and work. It is this culture that can schedule residents to work 7 a.m. to 7 p.m. one day, then 7 p.m. to 7 a.m. the next. It is this culture that expects us to show up for a five-hour didactic conference the morning after a night shift. All of this is well within the realm of the ordinary in a medical residency, but, as the overwrought copy on the back of my shampoo bottle puts it, "wildly exciting is our normal."

That is why I felt anguish in addition to joy at being sent home. There were stacks of articles I needed to read, and a few to write, too. There were dozens of e-mails to return and new books to read. The thought of getting to wake up at 7 or 8, as opposed to 5, was bliss. But none of the many people to whom I reported my impending absence assured me that I'd done the right thing by reporting my symptoms. None, that is, except for the infection-control people, who were incensed that I hadn't called in sooner. ("You've been coughing ... on the unit ... for a week?!")

By now I have finished my antibiotics and can start a new rotation. There is still no word on the culture results. If Bordetella pertussis grows, my protracted absence will be justified. If the bacterium does not grow - and it is a fastidious organism that often fails to take root on culture plates - we won't know for certain whether I had pertussis or a mundane virus.

I worry that if there is no evidence of pertussis, I'll lose face among fellow doctors, who might see me as lazy or a malingerer. I would almost rather it were proven I coughed pertussis germs throughout the hospital in my determination to soldier on. I'm afraid to think I would want to be that kind of hero.