230 Being a Doctor After Being a Patient
came in with active TB, and coughed over everybody. Six of my coworkers converted their TB skin tests, and patients in the waiting room got infected. My husband said,‘‘ This is enough. The last thing you need is to get TB!’’ I continued consulting and lecturing. I have thought about going back into practice because I miss it. But my physician said,‘‘ You really can’ t go back there’’— because of the TB.
Jennifer saw a continuum of risk, and drew a line, initially accepting some danger, but not too much.
Even if one is not immunocompromised, infectious risks may be widespread. For example, physicians and trainees have acquired hepatitis B from patients. Where he trained as a surgeon, Jerry said:
During the five-year residency, a third of the residents acquired hepatitis B from intraoperative needle sticks. I worked in a major trauma center, so we would do thirty- or forty-pint blood cases a night on bleeding cirrhotics and a lot of esophogeal variceal bleeds. I had hepatitis B, and was out for three months.
Fears of dementia prompted retirement, too. Loss of cognitive capacity, or fear of such loss, marked particular milestones. Generally, these physicians thought they should and would stop work if and when they began to demonstrate cognitive decline. But such a point was hard to gauge. Charles, the underground researcher with HIV, said,‘‘ It scares me if I walk into a room and forget why. I have to give myself a little lecture: I used to do that. But when I’ m down, these fears close in.’’ As mentioned earlier, as a defense, Stuart and others asked colleagues to observe them for any such mental slippage.
Retirement also resulted from concerns about how patients might react if they learned of their physician’ s illness. With an infectious disease, guilt over continuing to work without disclosing one’ s illness to patients could prompt retirement. Those with HIV all quickly restricted their practices or range of procedures to ensure they were in no danger of exposing any patients to the virus.
Trainees confronted particularly difficult questions of whether, given their illness, even to continue in the profession. As a resident, Pascal wondered,‘‘ Why should I go through with residency, and put myself through all that?’’