We've all done it at some time or another. We've gone to work sick, when we know we should stay home and do the things we tell our patients to do: get rest, plenty of fluids, sleep, etc. But somehow we think we're different, that we can "handle it" and somehow our bodies don't have the needs that others do. This is interesting considering all the anatomy, physiology, and pathology we've learned.

However, we're trained to believe that unspoken rule, that we are different. Examine the concept of being "on call" and working for 24 to 36 hours at a time. This is not expected of other professions, and if you ask the average citizen if they would work under such conditions, you would hear a resounding negative. But we go on, because we have to. Sick or not. The acute illness has no respect for the call schedule.
I doubt many residents would even dream of calling in sick, worried that it would result in more work for the remaining residents and anger or bitterness towards themselves for being "weak". Nevermind the shame of admitting an illness and the need to provide basic care for oneself. Last year, a resident in my program developed gastroenteritis on call, went to the ED for IV fluids, and continued to work the shift. Many would find that incredible. But some of us, deep down, marvel at how dedicated that particular resident must be and actually wish we could or would do the same.

We are used to delaying gratification, having suffered through four years of medical school in anticipation of residency, and then varying years of residency anticipating the real job, the real money, the real happiness. We are accustomed to being uncomfortable: delaying or skipping meals and sleep entirely, unable to move or pee during a long surgical procedure. The sick thing is that these qualities, more generally the ability to endure, is worn like a badge of pride. War stories can be shared and traded. Instead of making changes to a troubled system, we fuel it by thinking we're somehow better just by having made it through. I've found that pregnant residents will work practicalaly up to the moment of delivery, partly because their schedules insist that they do so, but partly to prove that they are still worthy of the resident title and to avoid causing problems for other resident schedules, and hence, themselves.

My own group of residents has discussed that his practice is silly-if you're sick, then take care of yourself. However, those same residents find themselves febrile and shaking in the call room, unwilling or unable to call for backup.

Maybe it's all just a way to protect ourselves from all those diseases we've learned about. If our bodies do not operate by the same rules, maybe we can't be affected by those same disease processes. And, of course, continuing on that same principle, treatment for us is different. Our bodies should respond faster, and recouperation time is expected to be shorter for us.

We expect these things of ourselves and then wonder why we're burned out, tired, angry, and resentful. What would it take to slow down?

I suggest we all decide to make a change. First of all, we need to develop the ability to ask for help. There is no need to work while ill, and no need to cover up your basic needs. Next, we need to support our colleagues when they ask for help. Even if that means taking an extra call or juggling a schedule or two, understanding that in the future, you may need the same. Third, we should not encourage our mentors to tell their "war stories", to be impressed by them, or to hold ourselves to those standards. Instead we should express our sympathy for those people who worked 48 hours straight, took every other night call for a month, etc. Last, we need to advocate for change. Medicine is not what it was a generation or two ago, and the education system must change with the times. There have been recent policy recommendations and current lawsuits looking at these issues. Rather than sit back and watch what transpires, we should all take an active role in changing things for the better.

Meet Krystal!

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