Life is a Balance: July 31st, 2022

I rarely speak about my work: not about the impact of being a physician on this journey, but about my actual job. I work as a clinician specialist and sub-specialist at a large academic hospital, which shall remain nameless for now. I wish I could tell you about how I am accommodated at my institution. About how I am valued, not despite my life experiences and disability but rather because of them; that it is widely recognized how I am able to provide patients with illness-informed, unrushed and as a result, arguably better care. But this is not the case. I no longer fit the collective definition of what it means to be a ‘good’ doctor, and have felt shame in not fitting into this too-small box of self-sacrifice, efficiency and, well, able-ness.

One would think that doctors, being in the business of illness, would be an enlightened bunch. But it turns out that we physicians actually hold a lot of ableist opinions, fuelled by governments, systems and hospitals that have little if any policies in place to encourage change. Oh, it’s fine if you are a physician with a disability. But you have to also be superhuman. Because if your disability requires any kind of accommodation — if you require someone else’s help to obtain patients’ weights and heights in the cramped space reserved for these measurements, if you can no longer do overnight shifts, or especially if your productivity is impacted in any way — it’s no longer fine. You are now a liability, and it would just be easiest for everyone if you walked away from your job, your livelihood, your professional identity. In Ontario, physicians are not employees, and are therefore not entitled to the legal protection afforded to practically anyone else hired by the hospital. And if your disability was acquired, you’d also better hope you purchased private long-term disability insurance back when you were well (thank you endlessly for this, Danielle Martin).

I am anxious to give too many examples here that relate to me specifically, even though there have been some pretty egregious ones I’ve experienced in the past year, and more in the way of microaggressions during the eleven years prior; I still plan to return to work at my hospital (or at least try). And I have certainly had some wins, although I wouldn’t call them kindnesses. But these do not balance out the words and actions at work that overwhelmingly convey to me that I am not valued. That I am a burden to be tolerated.

I remember a conversation that took place around a large conference room table back when I was training as an Internist, before I had an intimate relationship with chronic illness. It was led by a kind and well-respected physician, who asked us residents if we believed that someone unable to do overnight call should be accepted into our postgraduate program. Many of us felt strongly that call was an integral part of residency, that it fostered growth and independence in a way that having access to an in-house staff physician during daytime hours never could. Truthfully, I believe for some of us, it was as much about it all feeling somehow unfair: all of us were exhausted, and many of us also suffered from burnout. But then we learned that the resident in question was on home hemodialysis, twelve hours per night, seven days per week, for end-stage kidney disease that had developed during medical school. This treatment was literally life-saving. We were silent and ashamed: who else would we turn away in the name of equality instead of equity?

Until there is more compassion and humility in this world — in my world — I can only control my response to the ableism and injustice I have personally experienced. I’ve joined the University’s working group for disability justice, and signed up as a mentor for students with disabilities. I am holding tightly to that part of my work that I love, and continuing to push for the accommodations that I need and deserve. And sometimes…I am letting go. I plan to walk away from the area of my work that is the most physically challenging and also where I feel least valued, and to fill my time instead with this beautiful gift that MS and my stem cell transplant have given me: a return to writing.

This is not the path I envisioned when I signed that hospital contract back in 2009. But this might be the most interesting — and meaningful — career move I could ever possibly make.