The ethics of staying home while sick

By Chaya Murali, MS4

I get sick frequently. This has been true about me since childhood, when it seemed like I had a runny nose or hacking cough at least once a month.

Having been sick so frequently as a kid, I’ve learned to go to school even while ill. Because when you’re sick several times a semester, and you’re trying not to rack up a huge list of absences, ain’t nobody got time to stay home when you have a little runny nose.

I’ve carried this general attitude of work-through-the-illness into adulthood. This presents a unique conundrum, when my “work” is interacting with hospitalized patients on a daily basis, some of whom are immunocompromised (ie, their immune systems are less capable of fending off illness than the immune systems of typical people). I’ve also learned that the more rest I allow myself during illnesses, the better.

After all, when I have muscle aches and a fuzzy head and a fever, I’m not a very useful member of a patient care team.

So this Monday, when I began to feel a little fuzzy-headed and muscle-achey, I decided to go to my assigned night shift, since a part of me wasn’t sure if my symptoms were due to sleep deprivation or a true illness–though a couple of sneezes from earlier that morning should have told me it was clearly the latter.

Of course, I got to work and scrubbed into a surgery, only to find myself getting uncomfortably light-headed and feeling my bowels go into disarray. I ended up scrubbed out, on a stool in a corner of the OR, with my head between my knees and a juice cup in my hand.

Since this week’s rotation involves delivering babies, my resident and my attending decided I should stay away from newborns with whatever virus was afflicting me, and I was sent home early, with assurances that no one would fault me for doing so, and that I should take the next night off too, if I was still feeling bad.

I was really grateful for my team’s incredibly healthy attitude toward illness. As one of my residents said, as a medical student, I should take advantage of being able to take time off when I’m sick, because most residents have precious little opportunity to do that.

Since Monday night, I’ve also ended up staying home from work on Tuesday and Wednesday night, because my symptoms have steadily worsened into a garden-variety upper respiratory illness–one that rendered me unsafe to practice any kind of medicine, especially medicine involving newborns who are literally entering the world into my germ-ridden hands.

The frustrating thing is that, in the time since I was sent home by my team on Monday night, I’ve gotten steadily more and more signs that people seem to think I’m stretching my sick leave a little longer than I should be.

My residents have asked whether I’ve told the clerkship director about my absences. My dad keeps talking about how I should be sure not to miss too many “credits,” and is expressing concern that I’ll never learn how to deliver a baby (a skill that, while important for any physician to know, likely won’t be of great use to me as a pediatric geneticist).

And this brings me to the point I’m trying to make with this post: When is it okay to prioritize my health above other factors? Granted, I’m not suffering from Yellow Fever or something, and this URI certainly isn’t going to kill me. But it will make me uncomfortable and inefficient at work, and it will make me a hazard to the patients I encounter.

Isn’t it right to take off as much time as I need to get over this illness, or at the very least to get over the phase of the illness during which I feel like I’m actively shedding germs from every pore of my body? Or is it more important to fulfill my duties as a student? If I still don’t feel 100 percent tomorrow, should I go to work anyway, lest I exceed the allowed number of days off from my rotation, and end up having to do makeup days?

Perhaps a more pressing line of questioning is, How will all of this play out when I’m a resident, and later an attending physician? When my contribution to the medical care team is no longer negligible, when my notes in the medical record carry actual legal weight, when my patients won’t have a doctor if I don’t come to work?

I’m not sure what the right answer is. I suppose it’s something I’ll have to wrestle with in the future. For now, I will content myself with being grateful that, as a student, I can still take time off when my body needs me to.