The benign symptoms
Unintentional weight loss, weeks of night sweats, sharp decline in exercise tolerance. If a patient told you that they had this, you would most likely urge them to seek investigations to exclude the scary thing that starts with C.
The exception to this of course is if you are treating yourself, and then the differentials list quickly changes. The top differential is missed lunches, followed by lack of gym, normal aging or a broken scale. And of course, stress from preparing for the most intense exam of your life must be considered. After all, how could a doctor get sick?
Unfortunately, that was me. I had those symptoms for weeks without thinking once that maybe I should go see a doctor. It wasn’t until developing persistent chest pain which finally made it difficult for me to find a benign explanation. Admittedly, I did tolerate it for a week, thinking it must be of a musculoskeletal origin stemming from a recent chest workout at the gym. It was not until my significant other became concerned that she wasn’t strong enough to perform CPR on me that I finally went to see a GP.
The GP I saw I must say was brilliant, and while the initial diagnosis was pericarditis and even costochondritis, she was sufficiently and genuinely worried that she performed a set of routine blood tests.
The bad news
“You have to come back to the clinic today so we can talk about your results, and I think you should bring family or a friend with you”
Two days later the GP called with this.
It was not difficult to think of the worst case, and the most likely scenario. How can one be so certain of a serious medical condition from a routine blood test. But I tried not to think about it. The wait until the appointment was certainly uneasy, everything started to feel more real. Maybe it’s because everything else I had in mind like the upcoming exams, starting a week of night shifts, how to get the next trainee job, all of this didn’t seem to matter anymore. It was just me, my surroundings, and the bad news to come.
After a few hours wait I was in front of the GP. Very empathetically she started the consultation with,
“I know you came in two days ago for chest pain, but we have the results and it is not something we expected”
Knowing I could comprehend the results, she handed me a printout of my haematology results – WCC 265. Hb 87. Plt 560. “Marked leukaemoid leucocytosis suggestive of Chronic Myeloid Leukaemia”
Well, at least my cholesterol and BSLs were within normal range.
“Phew, at least it is treatable” was my first response. At the same time, a part of me was actually amused by these results, particularly at the amazing white cell count. That was probably what my doctor brain was speaking, not connecting with the fact that these were my results.
After being hospitalised, there was plenty of activity (hours of leukapheresis, driving around to attend investigations and appointments, and the countless visit from colleagues and friends which I am eternally grateful for) over the next couple of days to keep me from truly absorbing the reality of my condition.
The gravity of the situation did not actually hit me until a few days after the diagnosis. This was facilitated by a colleague, friend and one of my treating doctors who probably thought I was going through a doctor’s version of denial.
“Has it sunk in yet?” He said.
I felt I skipped most of the bargaining phase straight to depression. It was also difficult to direct any anger at anyone, except myself for ignoring previous parental advice for me to go see a GP for my weight loss. But ultimately none of these thoughts made sense. All that was left was for me to face the diagnosis and all its possible outcomes.
There were certainly tears, severe lethargy, lack of motivation, low appetite and difficulty enjoying certain activities (e.g. Netflix). Navigating through this depressed mood required the usual humanly strategies, such as philosophy, religion, friends and family.
“Try to be a patient, and stay away from uptodate and do not access your own results” was previously advised by the GP.
Despite this warning, I mostly sought solace in Pubmed and Medline. I probably spent the next two weeks looking into all the landmark trials, including the subanalyses of those patients in my age group and ethnic background. I finally understood why it’s important to apply research to the individual patient in front of you.
The ability to understand my disease and its treatment was probably a gift and a curse. It was difficult not to “over research”, particularly the worst case scenarios and the concerning case reports. I could not appreciate the reassurance offered by my treating team as I became aware of all other possibilities. Many times I challenged my team regarding whether I truly only had a mildly enlarged spleen (surely, I must have significant splenomegaly!). A Basic Physician Trainee, two Advanced Trainees, and the consultant’s correlating finding did not settle my concern.
After a period of time dealing with it did get easier, especially when I got out of the hospital. I started to get out of the house, walk the dog, see friends and family, and eventually went back to work. There were many hurdles preventing me from getting back to normal, especially the loss of confidence, confused identity (am I a doctor or a patient?), and having to make plans around medical appointments, but it eventually all worked out. Maybe that journey is a story for another time.
But so far, it has been exactly a year. I have survived, and I am well. While what I have cannot be cured in the traditional sense, I feel almost normal. I have my significant other, family and friends to thank for being there for me. Real support is not something I experienced until I truly needed it and it felt amazing. I guess you never really appreciate the pillars of your life until the roof over you is threatened to come crashing down. So, make sure you know what your pillars are and keep them strong around you.
Concluding thoughts
Thanks for reading up to here. You might as well hear what lessons I have to share from this experience, so here they are.
First, it is difficult to look after yourself as a doctor. The crazy overtime and expectation to study/do extracurricular activities make a strong deterrent for going to see the GP. Additionally, it is not easy to find a GP you can trust and regularly access. That is why I suggest finding and establishing a relationship with a GP you can call by their first name, know when they work, and what sort of dog they have at home. Go see them annually and do this before you get seriously sick.
Second, do not self-diagnose. We all know the mantra taught in medical school that you should never be your own doctor, but I realise now that you do this subconsciously. Ultimately this can be solved by seeing a doctor regularly which may be difficult due to the points above. I think another way around this is regularly voicing your own symptoms or medical concerns to non-medical friends and family. Then take their concerns seriously, and do not personally analyse it further.
Third, ambition has a cost. I am not advocating for people to not be ambitious. I was ambitious, and I do hope I can find that ambition again over time. But know that every inch you gain achieving your goal comes with a cost. Maybe that cost is spending time with family, doing a hobby you once had and enjoy unreservedly, or your health. The important thing is be aware of what you are sacrificing and be ready to not regret it later. You may do this by periodically writing down what you are sacrificing because it is not easy to recognise.
A few words on how you can help
Register Your Bone Marrow
For many people with haematological conditions, there is no breakthrough medications, or they fail to work. The only hope of long-term survival is an allogeneic bone marrow transplant. For many people without siblings or those with matching genetics, they rely on having a match from someone unrelated. Your registration increases the chance someone out there in the world of having a second chance in life. To register check this out:
https://www.donateblood.com.au/learn/bone-marrow-donation
Do this and I will treat you to a coffee (at where I work of course).
