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On the meaning of sickness

I was sick last week.

In my medical opinion, my illness was among the worst colds ever suffered. It was a cold so brutal and suffocating that Coach K might want to use it to guard Harrison Barnes. If the terrorists knew this cold existed, they’d use it as a biological weapon. It was the swine flu of colds.

At least, that’s how it seemed to me.

Because the truth is, now that I’m on the mend, it was only a cold. Even when I was sick, I had no doubt that I’d get better in a matter of days. While some of my patients’ illnesses carry mortality rates approaching 100 percent, I knew that there was an approximately 0 percent chance that my condition would kill me. And still, it was pretty awful.

I couldn’t go work in the hospital. I couldn’t go to parties with my friends. I couldn’t play intramural sports. I couldn’t cook, or clean up after myself or do much of anything besides lie around on my couch and feel sorry for myself.

But the unexpected break from my regularly-scheduled life gave me time to think, for the first time in a while, about what being sick meant. And, even though my own illness could never be considered serious, it gave me more of an insiders’ view on sickness than I’ve had in a while.

Medical students don’t take much time to think about what being sick means. Being sick is for patients, not for us. Doctors—and med students—don’t have time to be sick. In fact, a recent survey of medical residents showed that nearly 60 percent showed up for work when sick at least once in the preceding year. Last Thursday, the day before I stayed home from work with my cold, I took a DayQuil and attempted to ignore my burning eyes, running nose and pounding headache. One of my patients, when I told her I hoped she felt better soon, responded, “I hope you feel better soon.”

But the pressure to show up for work when sick isn’t external; rather, it’s internal. And it has a lot to do with what sickness means, and what health means and how we, as physicians and trainee physicians, define our identity.

Sickness and health are somewhat slippery terms. It’s intuitively obvious that the two are opposites: Sickness is the absence of health; health is the absence of sickness.

Friday, when I missed work, I was sick. Today, I’m at work and I’ll go to the Duke-Clemson basketball game; I’m healthy.

The World Health Organization defines health as “a state of complete physical, mental and social well-being.” Further efforts to define health have focused on quality of life, since mere duration of life seems inadequate to capture “complete physical, mental and social well-being.”

The University of Toronto defines quality of life as comprising the areas of being, belonging and becoming—very loosely, who you are, who you hang out with and what you do. For medical students and trainee physicians, all of these areas seem to converge at the hospital. We are the caretakers of the sick; we hang out with other caretakers of the sick at the hospital; we help take care of sick people. For us, illness strikes at all phases of our identity—if we ourselves are sick, then we cannot be caretakers of the sick, cannot hang out with caretakers of the sick, cannot take care of sick people.

So we resist the label. We show up for work when we’re ill, ignoring the danger in which we put ourselves and our patients.

Our patients’ illnesses pose a similar threat to their being, belonging and becoming. No matter whom they hang out with or what they do, serious illness prevents them from leading their daily lives. The threat of death is a literal threat to one’s being. And, unlike my own minor illness, most of my patients have chronic illnesses. Even if they recover, they will never be quite whole again.

In comparison, my cold seems like no big deal. Maybe I should’ve shown up for work.

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