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It’s 9:45 am and there’s already a packed waiting room in the paediatric outpatient department. I can hear children enjoying the array of toys in the play area while their parents sit patiently waiting to be called. Nurses trundle through with bundles of notes and there is a background hubbub of ringing phones and chatter.
I’m in the only available toilet in the department, my face unnervingly close to the toilet seat while I eject this morning’s breakfast and multivitamins into the toilet. I feel terrible, have done for weeks, months actually.
‘It’s only morning sickness’ I tell myself and wipe my eyes and nose. I peevishly emerge to a collection of sympathetic, if not moderately revulsed, faces and make my way to my clinic room.
I have to hurriedly run out of several consultations mid-sentence throughout the day to return to my familiar spot hunched over the toilet trying to further evacuate my already thoroughly emptied stomach. I have hyperemesis gravidarum and I’m too unwell to work. If ketones weren’t swilling around my pre-frontal cortex I’m sure this would be blindingly obvious, and I would arrange to meet the consultant and rota coordinator, who know of my pregnancy, and explain the situation with clarity; but I don’t.
I’ve been getting gradually more unwell for weeks, my weight has dropped, my mood deteriorated. I’ve become irritable with colleagues, I frequently disappear in the middle of ward rounds and am struggling to get into the hospital on time. When I finally collapse during an on-call and am shipped off to the maternity ward the inevitable comment from my seniors was, ‘you should have said something!’
From angina to malignancy we often marvel at how severe patients have allowed their symptoms to get before presenting to us. But the truth is it’s hard to sense small changes in our bodies from day to day. What’s more, sickness makes us universally poorer communicators.
Pain, nausea, sleep deprivation and anxiety all change the way we think, and hence the way we communicate. Who hasn’t been frustrated by the incoherent mumbling of a patient trying to explain their inner sensorium when you have very clearly asked whether what they are feeling is ‘burning, aching or stabbing’?
What we must remember is that those who are unwell are often trying to reach through the fog of a disordered symptom-riddled cognitive state, to us, a comfortable clear-headed professional, for help.
They may not realise the severity of their symptoms, they may not be able to explain them to you, and they may not be able to make logical decisions like whether to take the day off or seek medical advice. When we ourselves are affected by illness we too have to accept our limitations and ask for help, even if the request comes a little late or less coherently than others would like. And above all we must remember to look out for one another.
Be considerate of the colleague who seems ‘a bit off’, be prepared to offer them an ear or even a shoulder, and perhaps be prepared to act on their behalf if it looks like they need it. Maybe one day they’ll be able to do the same for you.
Maria Kiesler is a junior doctor in Manchester. She writes under a pseudonym
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