It’s apparently a uniquely North American phenomenon that, when meeting someone new, one of the first questions we ask is: “What do you do?” The roles we assume become a shorthand for who we are and what we stand for, and no role, it seems, is more telling than our occupation.
I have always been proud to call myself a physician, though long ago I chose to follow a different career trajectory than that of my peers in academic medicine. In 2011, after a particularly nasty MS relapse that kept me off work for four months with debilitating vertigo and ataxia, my doctor recommended that I return to work on a part-time basis. Maintaining a full-time practice while living with my particular MS was unsustainable, she told me. There were other rheumatologists who could look after patients, but I was the only mother my children had, the only wife my husband had married. It was sage advice, and I took it readily. Working part-time allowed me to be a better mother, wife, and friend. And it still allowed me to be a doctor.
This arrangement worked for a long time - until I contracted Covid, in fact. But over the past two years, as everything has changed, I’ve struggled to redefine myself in the context of my increasingly imperfect and demanding body. Some roles have been easier to negotiate than others. I know, for example, that my worth as a mother isn’t dictated by how well my legs work, nor is my value as a wife and partner determined by whether I can drive my fair share of carpools. Don’t get me wrong: I wish I didn’t have these limitations, but I know that the people who love me don’t think less of me because of them.
But then there is the matter of my identity as a physician. As my recovery reaches - maybe has already reached - a plateau, I am forced to confront the unlikelihood of being able to return to my previous medical practice. If I can’t go back, what will my future career look like? Can I still be a doctor? And what does that even mean to me?
Last night, I joined nine other storytellers at the Temerty Faculty of Medicine’s Story Slam, each of us speaking in turn to an auditorium of our peers. This medical humanities event celebrates the power of story to educate, to effect change, and to heal. Here is the story I told:
I Used To Be a Doctor
My son Judah tells me that I used to be a doctor.
If you ask him, he’d say I stopped being a doctor in September 2020, six months after the pandemic began. He had returned to middle school, and all the grown-ups in his life were returning to their workplaces. Meanwhile, I was still practicing tele-medicine from my house. My immune system was suppressed by the disease modifying drug I was taking for multiple sclerosis, and I was at increased risk of severe Covid. I was still looking after my patients, but a real doctor would have gone back to work at the hospital.
If you asked my neurologist when I stopped being a doctor, she’d say it was on December 9th, 2020, when we spoke on the phone, weighing the pros and cons of continuing ocrelizumab. If I deferred my next dose, I could get my Covid vaccine as soon as one became available, and thus go back to work in person. The problem was, nobody knew when that would be, and the longer I delayed my next dose, the greater the risk of reactivating my disease. When ultimately I chose to receive my infusion, I prioritized my own needs above those of my patients, who would have to keep waiting to see their doctor in person. A real doctor would have made that sacrifice.
If you asked my colleagues when I stopped being a doctor, they’d say it was on March 24th, 2021, my last day of virtual clinic. My husband had caught Covid at work a few days earlier, and I tested positive that afternoon. I developed a severe case, and ended up being admitted to hospital. Once I started improving, I assumed I’d be ready to return to work in a few weeks. But the virus had caused a recurrence of all my old MS symptoms, and even as the rest of me was getting better, my old relapses persisted. I remained on medical leave. A real doctor wouldn’t have so burdened their colleagues.
If you asked my old division director when I stopped being a doctor, she’d say it was on July 23rd, 2021, the day she called to ask me when I’d be back to work. When I said I wasn’t sure, she informed me she’d be transitioning my patients over to my colleagues, permanently. I had cared for some of my patients for as long as I’d been a rheumatologist: I knew about their marriages and divorces, about new babies and family deaths. I knew their children’s names. But none of it mattered, because I had broken an implicit rule to rebound quickly after illness. A real doctor doesn’t get sick.
If you asked my Physician in Chief when I stopped being a doctor, she’d say it was on November 9th, 2021. On that day, she received a letter from the comprehensive rehab clinic I’d attended, with recommendations for my return to work: starting back slowly, being offered an exam room close to the waiting room, and having assistance to measure my patients’ heights and weights. I didn’t hear back from her for five months. A real doctor isn’t disabled.
On April 12th, 2022, twelve days after I finally received my return-to-work plan, I was approved for a myeloablative autologous hematopoietic stem cell transplant for MS. My transplant was on June 9th of last year, and I’m still on medical leave; recovery can take at least a year, and even then, I still have MS.
It feels like a long time since I’ve been a real doctor: over two years since I last consulted on a patient, and more than three since I last walked into my hospital as a physician. And although I’ve failed to uphold nearly every expectation our medical culture has of how a doctor who’s also a patient should behave, that self-identity remains. I may not know what my future holds, but if you ask me, I’ll never stop being a doctor.
- Erin