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On the Brain
November 1, 2021

Full Circle

Author Affiliations
  • 1Division of Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
JAMA Neurol. 2021;78(12):1441-1442. doi:10.1001/jamaneurol.2021.3909

I began experiencing symptoms of autoimmune encephalitis during my third year of obstetrics and gynecology residency. Before I became sick, the rhythm of my life had been marked by the cycles of medical training: clinical rotations; standardized tests; and graduations and orientations. These rhythms broke down when I started having daily headaches and intermittent low-grade fevers, which remained unexplained after 2 trips to urgent care and a normal head computed tomography scan. Commensurate with my identity as an adaptable, hard-working resident, I forged ahead with rotations while taking an abundance of ibuprofen. The next month I had a seizure while on an elective rotation in Kenya and was placed on medical leave until I returned to the United States. I remember feeling frustrated that my elective had been disrupted instead of being concerned for my own health.

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1 Comment for this article
Learning from the circle
Daniel Krell, M.D. | Retired PCP
The loss of "that sense of peace" is certainly understandable and expected, given the Dr. Ho Kay’s and others' experiences with such life-altering events, whether transient or permanent. That sense typically starts in youth, with the perception that one is invincible and will stay fully healthy and functional throughout life and (initially) not even die, one day; disability and prolonged or chronic illness are for other people. That sense of peace is more fragile and more valuable than people realize, until they lose it. I would often admonish my patients to consider themselves “temporarily abled,” and hope they only become “disabled” some 30-60 seconds before they die. By the time I completed residency, I had had six surgeries (two at age 11, followed by an iatrogenic hip fracture) and well over a year on crutches, part of that time during residency. A fellow resident had a heart transplant during residency, having contracted viral myocarditis while on peds rotation. These experiences make us better doctors. I started med school at age 28, finding myself with fellow students, most of whom had had charmed lives without any significant medical events, and often cringed at how they treated and spoke about some patients. We treasure moments of health and full functionality, and are able to more deeply empathize with our patients and their families.