I am just over three months into my first year of medical school. I love it, really, I do. Every day is different and a new kind of challenge, causing me to both embrace and restrict change as I become and remember who I am.
Of course, one contributing factor to who I am is my ulcerative colitis. It rarely feels like a Disease, with a capital D. It is less of a dinosaur than a dandelion these days. Usually barely noticeable but ubiquitous in my fields of thought. But then, the slightest trigger of an associated idea or memory creates a flurry of emotion I can’t help but acknowledge.
Sometimes it’s fear I won’t make it through. Sometimes it’s worry that my status as a patient-provider will disadvantage me because I choose to disclose it. Sometimes it’s confusion over not really knowing what that title means, or what it should mean, or what it could mean. Sometimes it’s awe that seven years have passed since I sat in a hospital bed and wondered if I could make something out of this D-thing.
I used to wonder how they did it, the clinicians who were also patients. I knew from growing up with a life-threatening food allergy that the disclosure of a disability is not always met with kindness or fairness. I recently met with a mentor and commented offhandedly how I was nervous when disclosing my disease in my medical school applications that I would be seen as a liability by admissions committees. Any of my peers could endure an unexpected hardship at any time that could challenge their ability to practice medicine, but this possibility is realer when it comes to me. Mine comes with a name and a history.
I knew I had to prudently disclose my disease in my applications in order to honestly present my candidacy, give context for the discussion of some of my accomplishments, and stay true to my belief that it is not a fault. However, having now matriculated, part of me wistfully hoped my nervousness was merely paranoia. Instead my mentor looked me in the eye and confirmed my worst fear to me. It happens, present tense. It may have already happened to me. It could still happen to me. By being brave and honest about who I am, I risk losing opportunities I will never know I lost. I used to want to know how these patient-providers kept their two parts, patient and clinician, separate. How they protected themselves.
Recently, though, I’ve lost interest in that question, because I realize I don’t care to be someone who does. That is not to say I necessarily want my future colleagues and patients to know or that I’ll necessarily disclose it at all except in select circumstances. I’m not interested in understanding the patient-provider dyad as a means of learning how to protect myself. I am who I am, and I trust myself to make the right choices in any relevant situations that may arise. It is to say I want to know how I can be the best patient-provider I can be. How I can not just be both, separately, but best allow each of these two small but critical aspects of my identity to complement each other.
Being here in medical school now, I realize that I don’t have a dramatic moment of transformation into someone different when I put on my white coat. What is different is my cognition and interpretation of my education and experiences. Rounding in the hospital, I wonder whether I will ever come through as a patient. Writing chart notes in clinic, I meticulously choose my words, thinking of those indelible inside mine I may never read. When a twinge of pain strikes me during a run, my first thought is never of a simple runner’s cramp. The nearer I get to my next set of blood draws, the more I encounter the same terrible and pervasive thought that can interrupt the moments when my mind finally settles down for the night: Will this be the one that changes everything?
My disease is an emotion. Like joy, sadness, and the rest of the gang, I wish sometimes to disown it, I wish at other times for it to lead. At the end of the day, I can step away from my education and my work. But I can never take a break from being a young adult with a chronic illness, even when my disease is at rest. I do not pity myself or bemoan the responsibility, but I acknowledge it in the hope to channel the emotion of my disease into something good. I want a child just being diagnosed with IBD to know that her disease will not be a liability but can be her ally in success. It is her story to write, her identity to create, and her opportunity to lead. It is her emotion, and I hope she will feel it with pride.