I've had an annoying, nagging cough for the last couple of weeks. I never got really sick, but I'm sure taking my time getting better... Before leaving medicine, I would have ignored it and plowed ahead with my busy life. Now, I wonder what my body is trying to tell me... Sometimes a cough is just a cough, but let's back up here to a little object lesson in psychosomatics...
I felt like I was sick all the time in residency. I had been ill here and there in medical school – the worst was on my Pediatrics rotation. All those little kids sucking on your stethoscope and coughing in your face will give you the flu like nobody’s business, I don’t care how many flu shots you get. But in residency it got truly ridiculous. Serotonin levels were down and cortisol was through the roof! I was always getting the cold-of-the-moment, and when I wasn’t sick, I was feeling ill. I often had stomach upset and general malaise. Occasionally, more concrete abdominal pain. Too bad I couldn’t see that it was probably psychic, not physical. My body knew I was on the wrong path, even if my consciousness hadn't yet gotten the message. But I didn’t pay attention, and continued on to graduation. No surprise, it continued after I finished residency and began practicing out in the real world. Yes, of course, when you see sick people for a living, you’re bound to get sick once in a while. All the hand-washing in the world can’t save you from that cold or flu virus when it’s all over the hospital or your office. But it’s not just that. Working crazy hours compromises the immune system and raises cortisol levels. The body is so stressed, it can’t muster the energy to fight off anything else, so you get sick. But it's not just that, either.
When you’ve stuffed down all of the emotions and inner voices that are crying out at you to make a change (you must suppress these in order to do what you do), they're going to come out physically. That's what psychosomatic means, although any good physician knows that only happens to other people, right? I saw patients all the time who would come into the OB triage unit with vague complaints of dizziness or non-specific abdominal pain. Often, there was something going on at home – either domestic violence or just being ignored on a Friday night. They wanted a little attention, and a physical complaint was a "valid" way to get it. I could recognize it in my patients, but couldn’t see my own “I don’t feel well” status as Red Flag #256. Zero Insight Girl, that was me!
By the last year I was practicing, I was breaking out in angry, painful red welts under my arms each time I had a call shift. I thought it must be the surgical scrubs, so I would take hospital scrubs home to launder them in my own detergent. I saw my dermatologist who tested for allergies - all negative. It took seven courses of antibiotics and a few rounds of topical steroids to calm my skin before my wedding day. I also took six weeks off work before the wedding, both allowing my skin to heal and because I felt I needed that time off to be a sane person on my wedding day (Red Flag #257, there you go! If you need that much time off to feel and look like a normal person, something is wrong with your working situation). Maybe it truly was a bacterial infection, but I think it had not a little to do with stress and something in me screaming out to be heard – if you won’t listen to me, I’ll give you physical symptoms so you have to pay attention!
The thing is, that only works if you are tuned into it. Otherwise it just leads to more denial, and an outward focus on the physical symptoms. They at least detract your attention from the inner turmoil, and give you something upon which to blame your misery. They will only heal, however, if you learn to dig out the real issues and deal with them. Since this is both difficult and scary, most people choose never to go there. I was not exactly raised to embrace my emotions, so allowing myself to feel them was terrifying, and it took a few years - this is certainly not something that happened overnight. Once I started paying attention, however, there was no going back. Luckily, by the time the outbreaks started, I already knew I was on my way out of medicine. That didn't stop my body from trying to reinforce the message. "What do you mean, you're giving six months notice? Are you crazy? You need to get out now!"
And since I quit? Clear skin and clear skies... except for that stupid cough.
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