By Mark Mikhly
Studying for Step 2, struggling through a set of UWorld questions on a sweltering August afternoon, the answer finally came to me. It was definitely West Nile. 10 minutes of Pubmed and UpToDate later, I had quickly become an expert on the arbovirus. I shifted my focus from diagnosis to management. I was surely going to be encephalitic by the morning – was there anything I could do to stop it?
Yea, I knew I was probably being morbid and slightly irrational. The fevers, myalgias, and rhinorrhea were most likely (definitely) part of a nonspecific viral syndrome. The hours in front of a computer were the reasonable cause of my headache and malaise.
But was it really so irrational? How could I feel so sick with only a simple cold? At this time of year it certainly couldn’t be the flu. My window had been open all week and I’d been swatting at all kinds of bugs; I was now surely suffering the consequences. This was the prodrome of the inevitable syndrome that lay ahead.
As I fell asleep, I fought the nagging thought of how long it would be before someone found my feverish body. I definitely should’ve mentioned something to the dermatologist who’d taken a shave biopsy of my suspicious looking mole earlier that morning.
The next morning I felt fine, if you hadn’t already guessed. Pretty excellent, in fact.
Later that week, the New York Times ran a timely piece that reminded me of the true nature of my problem, one that I’ve struggled with throughout medical school. I was suffering from Medical Student Disease – the commonly reported syndrome of students reporting the symptoms of the disease they were currently studying.
In the piece, the Times quotes studies that describe the prevalence to be as high as 70-80%. One of those studies suggested that student struggles might be a “signal of general emotional distress and conflict.” Another suggested explanation is that the phenomenon may perceptual. Defining an illness and describing its symptomatology primes medical students who respond with heightened corporeal awareness and a tendency to notice bodily sensations consistent with the illness. Newer studies question whether there is actually a higher level of anxiety among medical students, leaving open the question of whether the disease or its proposed etiologic reasons actually exist.
I spoke with some of my fellow students, and found that, just as the Times had suggested, I wasn’t the only one with this terrible “disease”.
Brandon told me about the nightly sweats he’d been suffering through during the year. His B-symptoms of lymphoma turned out to be stress induced.
Victoria told me about the shortness of breath she’d started to notice during long runs during the heart of second year. She’d had a history of Raynaud’s phenomenon and discerned that as a young woman she was probably feeling the effects of pulmonary hypertension secondary to limited scleroderma. After seeing her doctor and going through some tests she came to grips with the most probable reason for her shortness of breath: being out of shape.
At least she’d gotten medical attention. Mark, having had a history of spontaneous pneumothorax, took himself to the Emergency Department with serious chest pain. Once they discovered he was a medical student they refused to do the simple ECG that had previously been ordered. Though the diagnosis of costochondritis was likely real, it is scary to think that he might be treated differently in the ED just for being a medical student.
Another common thread among medical students I spoke with was the sudden realization and fear of latent mental health illness experienced during Psychiatry clerkship. Hearing daily about patients’ tragic stories of sudden decent into psychosis and schizophrenia, it is almost inevitable to imagine yourself in their place. One evening, I remember pondering too deeply on the depths of my mind, nervously considering whether my regular internal dialogue was in fact the beginnings of an aural hallucination. Thankfully, I took my shelf and moved on to less terrifying nosophobias.
Unfortunately, one friend of mine had a worrisome suspicion turn into a reality. Chris had noticed a mass in his testicle. In this case, his elevated level of knowledge betrayed him – he’d known that seminomas, the most common testicular tumor, were not commonly painful. As his mass was in fact painful, he tried to believe that it wasn’t concerning. When it was finally removed and biopsied the result was testicular cancer. Thankfully, after surgery and chemotherapy, his cancer is now in total remission. Its interesting to note that in this case of actual disease, medical training was used to suppress an anxiety rather then to create it.
These stories indicate that just like a “regular” patient, many of us medical students are vexed by symptoms worrisome only to ourselves. Dismissal of a medical student’s concerns, however, is the wrong course. Compassion for their anxiety and understanding of their concerns may help alleviate underlying stress or anxiety. More importantly, staying vigilant may allow the diagnosis of actual disease. For in fact, medical students are people too and get sick at just about the same rate as the rest of the population.
Mark Mikhly is currently a 4th-year medical student at Albert Einstein College of Medicine. Originally from Brooklyn, he has never lived outside New York City. Mark is applying to Emergency Medicine residencies this fall and looks forward to beginning next summer, pending a successful recovery from what is almost certainly Cat Scratch Fever.