Leave of Absence (LOA) or fail a class?

[carfunkle1990]

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Five years ago, I had a crazy virus that resulted in an acute leukopenia (WBC was .8, SED levels elevated, low platelets, petechiae) hit me my sophomore year of high school. I was sleeping 20 hours a day for a month straight. I improved somewhat, but was experiencing excessive daytime sleepiness (EDC), needing to fall asleep every 3-4 hours a day and sleeping 10-16 hours a day. At any rate, I was diagnosed with Chronic Fatigue Syndrome (CFS) by several doctors and after years of trying all sorts of medication and alternative therapies with little improvement. However, I've managed to get through undergrad and into med school. As you can imagine though, sleeping as much as I do makes it extremely difficult, especially combating fibromyalgia like pain and splitting migraines hurt studies. I finally underwent a sleep study, and found to have primary hypersomnia additionally, but this was only a couple of days before my second test. I have done poorly on the first two and only and one test left for this module to pass, but I don't think I could realistically score high enough to do so, but then again I finally have found a medication that will allow me to study. Still, that puts me a year behind. I have people listing reasons I should fail and forge ahead (such as my leadership positions, opportunity to remediate in the summer and keep pace, honors in other classes, etc) and why I should take a LOA (learn better for my patients, not have the fail on my record, attempt to get headaches and body pain under control etc.) and try again. I need to decide soon. I want to become a hematologist and do research and direct patient care. I know this is my decision ultimately, but any insight would be appreciated. Additionally, I know taking a LOA can be made into a positive such as doing research, but I was considering taking some post grad classes (I had never had anatomy before and since I've never had immunology or physiology, figured it might help with future classes although my peers don't seem to think it helped them). Any thoughts on that? Thanks in advance!

 

[EagerToBeMD]

If you take a LOA, you need to rest and get yourself better. Forget taking classes or research or whatever else. A LOA will only be for 6 months anyway, right? In that time, you need to figure out how to deal with your condition since it's chronic and is bound to give you trouble in the future.

As to failing versus not, that really does have to be your decision. If you think you can forge ahead, then don't take a LOA. If you think you may have trouble again next block, then I'd urge you to take the LOA.

 

[carfunkle1990]

So either way with residency, a LOA is just as bad as failing a class?

 

[GAgrl]

I would speak to your advisor and be very open about your concerns with residency. I would be worried about explaining either honestly because I think many residency programs will be worried about someone that hassuch chronic health issues that could interfere with the long hours they willneed/want you to work. What type of residency are you interested in? Do you think that you will be able to find a way to control/cure the symptoms if youtook a LOA? If you do then I would do the LOA because you can explain the need for the LOA, If not then what is the point? You might as well just do the best you can because things wont change right so it would just be a waste of time?

 

[qmcat]

+1 with what the other posters have said.

Failing 1 pre-clinical course is bad, but not the end of the world. It will be much worse if you continue failing courses.

If you think that you have your condition under control now and will not fail any future courses after the current one, then it might be worth it to move on. If you feel like you cannot have a clean record from here on out, then it'll probably be better to take a LOA to get your condition under control before coming back.

Residency programs will care about a LOA or failing a class because they want to make sure you can put in good work during residency and won't quit or take a leave half-way through and dump your work on other people in the program. Be prepared to explain why you took a LOA or failed when you are applying and interviewing in the future.

 

[carfunkle1990]

I have talked to many people, including advisors and professors of my predicament. Energy levels I feel I have under control with this medication however headaches and body pain are issues. I don't know if I will be able to get these under control. I don't know if it's enough to do well in my other classes. To do hematology eventually, I would need to do an internal medicine residency. It's times like these I wish I had a crystal ball... Thanks again for everyone's input; I really appreciate it.

 

[HumbleMD]

I have talked to many people, including advisors and professors of my predicament. Energy levels I feel I have under control with this medication however headaches and body pain are issues. I don't know if I will be able to get these under control. I don't know if it's enough to do well in my other classes. To do hematology eventually, I would need to do an internal medicine residency. It's times like these I wish I had a crystal ball... Thanks again for everyone's input; I really appreciate it.

An LOA for anything other than a research fellowship or advanced degree is usually a red flag that will need to be explained, and could certainly look worse than a fail and succesfull remediation. You clearly have an explanation, but as a heads up, there are a lot of MDs out there who would roll their eyes and interpret diagnoses of CFS/fibromyalgia and primary hypersomnia as "whiney pain in the ass" and "sleepy" - these are both idiopathic catch-all diagnoses. Ironically, medicine is one of the most unforgiving professions for those with disabilities or medical illness.

Personally, successful Onc fellowship is the least of your worries. If you forge forward without getting your health straightened out, how are you going to survive your clinical rotations? On surgery for instance, you'll likely be operating on 5 hours of sleep or less, and on your feet in the OR standing or retracting in very uncomfortable positions for hours at a time. Do you see yourself capable of doing this in your current state? What about as a busy medicine intern in 3 years? I personally think the LOA is in order to get yourself to a place where you can perform the duties a doctor has to perform.

PS, have you thought about PM&R for residency?

 

[carfunkle1990]

Yeah, regrettably, but I can personally attest it is very real. I did decide to turn in the forms to take a LOA. Hopefully it won't be a waste on progress of health. I still have every intention to review as much of the material as I can. I'm not worried about an onc fellowship, although I would not object to heme/onc. but focused myself on hematology due to the opportunity to do research and direct patient care (~80% of hematologists practice and research and because this is lifelong, hate to say, they can set hours...) I have not done much research on PM & R but it certainly should be something I look into. Why do you think it would be a good choice?

 

[HumbleMD]

Yeah, regrettably, but I can personally attest it is very real. I did decide to turn in the forms to take a LOA. Hopefully it won't be a waste on progress of health. I still have every intention to review as much of the material as I can. I'm not worried about an onc fellowship, although I would not object to heme/onc. but focused myself on hematology due to the opportunity to do research and direct patient care (~80% of hematologists practice and research and because this is lifelong, hate to say, they can set hours...) I have not done much research on PM & R but it certainly should be something I look into. Why do you think it would be a good choice?

As a heads up, you could turn almost any field into an 80% research field, save for maybe Surgery or OB-GYN.

Also, I'm not passing judgement, I just wanted to let you know that you'll run into some docs who are less than understanding when it comes to complex pain syndromes.

Physical Medicine and Rehab, like psychiatry and probably peds, is one of the more understanding fields, which I think would be good for someone who will be dealing with medical issues throughout their career. You'd be dealing with patients who are disabled or requiring physical therapy, which I would guess you could empathize with. PM&R also has the advantage of being less competitive, especially if you have some low grades. Also, it's underresearched, so you'd have a wide open research career ahead of you.