Time moves forward like a spider spinning its web: quietly, imperceptibly in the night, until suddenly something new appears with dawn. My summer has slipped by this way, the days overall happy and satisfying, the occasional punctuation of some frustration or another nonetheless failing to interrupt its rhythms. In many ways, this summer has been the same as last, the same sudoku puzzles, the same lounging on the couch at my cottage with the breeze coming in through the open windows. It’s easy some moments to forget the very real differences between this year and last. Gone is the struggle to swallow solid food, the heavy labor of propelling my left side forward, the discomfort of sleeping propped on a wedge pillow to manage my esophagitis, the weight of a constant blanket of fatigue. This year I can more often predict the ebb and flow of my energy and attention span. Coffee tastes good this summer, friends can come up to visit, and breakfast with Larry is all pleasure.
This summer has been one of reinvention. I’m in the process of retiring from clinical practice, which may sound like a fait accompli when you consider that I haven’t seen a patient in over two years. But now it’s official, having informed the hospital I can no longer manage the hours, the commute, the commitment, the mental load of providing good quality, ongoing patient care. In the culture of medicine, this feels like failure, as if this part of my identity has been rescinded.
For years I wondered why there weren’t any options for doctors like me to keep working in academic medicine, why no policies existed for accommodations or part-time work, why my value was being measured only by my productivity. Hadn’t there been others with life-altering illnesses who had come before me? But I’ve come to realize that no one stays precisely because such pathways don’t exist. There are neither the resources nor the cultural will to keep us, and so we hand back our University appointments along with our hospital ID badges and office keys. Because who wants to work somewhere they aren’t wanted? Who has the time or energy to fight a system that excludes us, when we don’t even have the energy to get through our day?
Yet, stubbornly, I'm not willing to leave. I want to stay to advocate for equity for physicians and medical learners living with disability. I want to coach students and colleagues to use reflective practices in their medical training, and I want to continue to mentor and teach. My lived experience has value. And medicine brings me joy.
This past year, I participated in the Diversity Mentorship Program in the Faculty of Medicine; I was matched with a first year medical student on the basis of our shared experience of living with chronic illness. Learning that Sophie had disclosed this fact in her med school application felt both inspiring and terrifying. I was heartened to learn that the university was admitting people with disability, in an effort to train doctors who better reflect the diversity of our population. And yet I worried, knowing the supports that students like her need were insufficient, effectively forcing them to become their own advocates as they move through a system ill-designed to educate them.
In the culture of medicine, a good doctor puts the needs of their patients above their own, theirs always the last oxygen mask that is donned. It sounds like altruism, but in our current medical system it is unsustainable, even for those who do not live with disability. But this next generation of doctors is going to be better: they value diversity and believe in setting boundaries, and they aren’t afraid to question the hierarchy. It is this generation who will change things for the better. They will do it with or without me. But I feel like I owe it to Sophie to stick around and cheer her on, and to let her know she isn’t alone.