Getting sick in the middle of a clerkship

What happens if I get sick in the middle of my Internal Medicine clerkship? I know that I wasn’t alone among my classmates in worrying about this question as third-year began. We’re expected to work 12+ hours per day, six days per week, and we’re not allowed to have any personal life or suffer any illness that would cause us to miss a day of work. That’s a little melodramatic... but not overly so.

Well, I did get sick: a low-grade fever, chills, sweats, fatigue, and nausea. I didn’t have any upper-respiratory complaints and probably wasn’t contagious, so I showed up at the hospital at the usual time. I mustered enough energy to attend to my patients properly before rounds, but I had to pass on taking a new patient. My resident took note of this because I had been gunning for a new admission the night before.

I almost didn’t make it through rounds. I somehow presented my patients to the team adequately and answered a few pimps, but the rest of the time was a haze. Rather than actively participating in rounds, it was all I could do to save face and act like I wasn’t about to collapse on the ground.

After rounds, my resident told me that I should go home. Can I really? Will my resident think less of me for it, i.e. will this negatively impact his evaluation of me? I felt uncomfortable leaving right after rounds because that meant my intern would have to pick up my slack. “If it’s okay with you, I’d like to stay until I take care of all my patients.” This just meant ordering some labs, following up on some studies, and doing some other miscellaneous tasks that would save my intern some scut.

“Sure, but I don’t want to see you here past 12 noon.”

Deal.

I crashed right when I got home and slept for four hours straight, the kind of hard afternoon sleep that the body demands when it needs to mend itself.

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It seems to me that the personality of the resident greatly determines how the sick-in-the-middle-of-a-clerkship situation plays out. I very easily could have been working with a less sympathetic and understanding resident. Having a nice resident basically bought me the afternoon off when I really needed it.

I can also see how the particular clerkship might matter. Getting sick during an inpatient rotation such as Internal Medicine negatively impacts continuity of care. Even though I did everything I could to tie up loose ends before leaving, I fell behind the ball on the status of my patients by missing a whole afternoon. During an outpatient clerkship like Adult Ambulatory Care, in contrast, patients are seen in discrete 20-30 minute appointments. Missing an afternoon of outpatient care doesn't impact my ability to see new patients the next day. Also, missing any time during a short 2-week rotation might be more problematic.

Here's to hoping that I don't get sick again for the rest of third-year.