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Internist
Sees Her Own Chronic Illness
as Strength in her Work
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More on:
Medical
Professions
Physical
Disabilities
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Medical
School residency programs are known for requiring residents
to pull exhaustive multi-day shifts and to almost always
be on call. What if a resident had a chronic health condition
that required numerous hospitalizations, absences, and
medications that caused drowsiness?
If that resident were like Margot Kushel, M.D., she would
have become a successful internist at the University of
California at San Francisco. Kushel has ankylosing spondylitis,
a form of arthritis that affected her ability to walk,
her manual dexterity, and her attendance in medical school
due to flare-ups, medication side effects and surgeries.
In fact, she was so unwell at her admissions interview
at Yale University Medical School that she feared she
would not be able to get up out of her chair at the end
of the meeting.
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Despite
the fact that she was hospitalized the day after this
interview and had to cancel others, she was accepted to
Yale. Yale was a good experience for her mainly because
of the flexibility of their program for all students.
Tests were not required and were easy to reschedule. She
says that Yale "is a little bit quirky and prides
itself on its quirkiness. They really don't follow traditional
medical school rules." She attributes part of her
successful experience at Yale to "just a few people
in key positions that recognized that [my disability]
wasn't a problem. The Dean of Students was very supportive." |
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Everything
was not always smooth sailing for Kushel in medical school.
During her second year, both of her legs were in casts.
After being hospitalized during her surgery rotation,
she took some time off and returned using a motorized
scooter. Although she was determined to finish the surgical
rotation, the Dean at Yale encouraged her not to do so.
The Dean understood that Kushel did not intend to go into
a surgical specialty because she could not stand for the
long periods required in surgery and did not have the
manual dexterity. Kushel was clear about what her goals
were and were not, and the faculty helped her develop
her training around those goals. "They understood
that you did not have to know how to do absolutely everything
to be a good doctor." |
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After
Kushel returned to school in a scooter, she had to deal
with accessibility challenges. In particular, one of the
hospitals to which she was assigned to work had inaccessible
architecture and elevators which made it difficult to
get around in her scooter. |
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Reliability
during clinical rotations was also something Kushel had
to work around. Her co-residents were always extremely
gracious about covering for her when she was ill, which
at first made her feel guilty. However, when Kushel was
selected to be one of the chief residents, she was responsible
for calling in residents to cover for others due to sickness
or family emergency. Doing this, she realized that many
of the residents needed to be covered at different times,
not just the few with chronic illnesses. |
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A
struggle that Kushel shared that was unique to her situation
as a person with a chronic illness in the medical field
was when her colleagues would make judgements about her
disability. There were occasions when she would be in
a class studying her own disease. Professors and classmates
would try to give her advice, such as "you should
be sitting up straight!" Kushel found this to be
out of the boundaries of class discussion. On another
occasion, she took a medication that made her nauseous.
When she excused herself during rounds, a colleague told
her that this particular medication didn't make patient's
nauseous. "Oh," thought Kushel to this absurd
comment, "I'm sorry, I got the answer wrong!" |
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Having
first hand knowledge and experiences with disability and
chronic disease is a great strength to Kushel in her work
as a doctor. She has seen that everyone has strengths
and areas where they need improvement. "My disability
is that I can't walk far…that I didn't have fine
movements with my hands. There are plenty of people in
medicine who can run really far, have great movement with
their hands, and have a disability of having no empathy,
or a disability of having no concept of what it is to
tell someone they have a chronic illness that will never
go away." Kushel related a story of a time when she
suggested ordering a pregnancy test for a woman in a wheelchair.
The doctor she was supervising hadn't ordered it because
he assumed that because the patient used a wheelchair,
she was not sexually active. "That made me think,
who has the real disability, here?" she mused. |
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Today,
Kushel works as an assistant professor of Medicine at
the University of California-San Francisco. She divides
her time among teaching, seeing patients, and doing research
on homelessness, violence, and disability. |
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After medical
school she participated in a new drug trial which led
to a remission of her disease. She still values her
time and struggles in medical school. She says "I
remain grateful for both my chair and for the flexibility
and insight of the people who supervised me during my
training, both of which allowed me to continue to do
something that I love to do. I certainly hope I can
return the favor for other students and trainees who
have special needs as they go through training."
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