Manic episode advice M3

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kinnencan

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I’m definitely looking for some advice here. I recently failed my OB gun rotation because I had a really bad manic episode. I failed due to professionalism. I showed up late to the rotation once and I ended up walking out of the OR a couple times, but came back. I haven’t had any professionalism lapses in my file before this. But I’m really nervous. Because of how my program works, I have to go to the SRP and present my case. They can decide if I need to go higher. This is my first failure in Med School and the only mistake I’ve had. I had one evaluation that is currently pending a title nine I am currently on a leave of absence, but I’m considering coming back . I was just diagnosed with bipolar after the rotation. What are my chances for a dismissal? Does anybody have experience with us at all?

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I'm sorry to hear that. I think if you explain that it was the manic episode of an undiagnosed BPD that you were just diagnosed with, I could see them being understanding. I don't think any sane person would try to punish an unmedicated, unknown mental health disorder.
 
Really sorry you're going through this.

Unfortunately, I don't think any of us can give you solid advice on what your chances of dismissal are. It is likely specific to your school, your school policies, and the timeline of disciplinary action/when you reached out for help. Your best friend or your worst enemy is likely going to be your dean, and they will likely determine if they think you can successfully return to school with appropriate medical treatment and possibly accommodations
 
I’m sorry you’re going through this. I think honesty is the way to go. Your faculty may decide they don’t want someone with bipolar disorder as a physician, but if you try to skate around what happened, they’ll probably just dismiss you because they smell BS.

There are successful physicians who have bipolar disorder and practice. They are treated properly just like any other patient. You also will need to look into going to residency in states that don’t discriminate on the basis of mental health stuff. Pamela Wible, while controversial, has a pretty good and fairly recent list of states.
 
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I’m definitely looking for some advice here. I recently failed my OB gun rotation because I had a really bad manic episode. I failed due to professionalism. I showed up late to the rotation once and I ended up walking out of the OR a couple times, but came back. I haven’t had any professionalism lapses in my file before this. But I’m really nervous. Because of how my program works, I have to go to the SRP and present my case. They can decide if I need to go higher. This is my first failure in Med School and the only mistake I’ve had. I had one evaluation that is currently pending a title nine I am currently on a leave of absence, but I’m considering coming back . I was just diagnosed with bipolar after the rotation. What are my chances for a dismissal? Does anybody have experience with us at all?
I am so sorry to hear you’re going through this. No one is going to be able to provide a professional opinion unless your full case is laid out which I do not recommend here, and I certainly don’t have that professional opinion.

What I’d say is that you seem to have some, but not complete insight into the degree of your transgressions. One manic episode would be an isolated event and wouldn’t explain the persistent behavior that put you in this position.

While I’d be ignorant to say that Bipolar isn’t a significant contributing factor, there are likely other personality traits or deficiencies which may be in your control. Seek care and develop a maintenance plan for your disorder, but also reflect hard and take accountability for and address those. If after doing that you’re unsuccessful, it is what it is and you have to move on.
 
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I am so sorry to hear you’re going through this. No one is going to be able to provide a professional opinion unless your full case is laid out which I do not recommend here, and I certainly don’t have that professional opinion.

What I’d say is that you seem to have some, but not complete insight into the degree of your transgressions. One manic episode would be an isolated event and wouldn’t explain the persistent behavior that put you in this position.

While I’d be ignorant to say that Bipolar isn’t a significant contributing factor, there are likely other personality traits or deficiencies which may be in your control. Seek care and develop a maintenance plan for your disorder, but also reflect hard and take accountability for and address those. If after doing that you’re unsuccessful, it is what it is and you have to move on.
I haven’t had any previous professionalism issues. I did get hospitalized after the event. This is the first I have gotten in trouble besides losing my passport on a school trip. It was weird event, I started talking to myself and became delusional for most of the time. I hate how everything played out. I totally lost myself
 
I haven’t had any previous professionalism issues. I did get hospitalized after the event. This is the first I have gotten in trouble besides losing my passport on a school trip. It was weird event, I started talking to myself and became delusional for most of the time. I hate how everything played out. I totally lost myself
At my school, any clerkship failure automatically gets reviewed by a committee. My dean is trying to delay the process as much as he can but he has to forward it. It’s a messy event and he feels awful for me
 
Very sorry to hear about what you are going through. I went through something similar during M3 year, had severe major depressive episodes and was actively suicidal, I borderline failed 2 clerkships and had several professionalism complaints that I had to present to SRP. After seeking advice from faculty I trust I chose to be forward with everything. My school's admin were sympathetic and supportive, gave me resources to get better treatment. Nothing negative ended up going on my record except for the low clerkship grades (but weren't failures) I am doing ok applying to residencies right now. They did hold me accountable in the sense that if anything else comes up, I have to report to them and potentially face more action.
 
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Very sorry to hear about what you are going through. I went through something similar during M3 year, had severe major depressive episodes and was actively suicidal, I borderline failed 2 clerkships and had several professionalism complaints that I had to present to SRP. After seeking advice from faculty I trust I chose to be forward with everything. My school's admin were sympathetic and supportive, gave me resources to get better treatment. Nothing negative ended up going on my record except for the low clerkship grades (but weren't failures) I am doing ok applying to residencies right now. They did hold me accountable in the sense that if anything else comes up, I have to report to them and potentially face more action.
Thank you for sharing that, this is the first hopeful thing I have heard.
 
Get a lawyer and begin to establish a paper trail. Reach out to your school's disability office and register your disability with the school if they allow you to do so. Keep you head up.
 
As others have mentioned, this is an unfortunate situation and I hope you're doing well now. Your health and well being remain the number one priority.

No one can tell you exactly how this will play out. But I think it's worth thinking about it from a few different angles: legal, academic due process, disability, and social (I'm trying to come up with a better term, this is the best I've got).

Legal issues are complicated because they are very locale oriented -- what's "true" in one jurisdiction may bot be elsewhere. In general, the law protects those with known disabilities and acute illnesses. If you have a known disability you can ask for reasonable accommodations, and assuming that your school finds them reasonable and does not alter their minimum standards they should meet them. This will protect you going forwards, but rarely can you claim disability in retrospect. When you're acutely ill like this, laws can protect your ability to take a medical LOA. However mental health issues are extremely complicated -- as the illness itself usually entails a lack of insight by the patient. Hence you ended up with unprofessional behavior, and no way to extricate yourself from the situation before things escalated. A don't know how much a lawyer can help you at this stage -- if you want to contact one for personal advice, fine. But I would not get them entangled with your school -- that's sure to come across as defensive and that's not a good look for this problem.

Academic due process is going to be your next big hurdle. Your best option IMHO is to be completely honest about the situation - lack of prior episodes, lack of insight while your behavior unraveled, embarrassment and remorse for what happened, and a willingness to make amends. I agree with @Goro's recommendation above to read your student handbook in full and know the process. Whom reviews this, what options do they have, what appeals do you have, what outcomes can you expect. Keep track of whether your school does everything they are supposed to. Don't tell them if they do not -- it becomes a very useful lever if you ultimately lose and they try to dismiss you. The legal system will rarely overturn a profession's well reasoned decision to expel a student But it has no mercy when a school doesn't follow its own written protocol.

Part of academic due process is Title IX, which you mentioned in your post. This unfortunately makes this into a bigger issue that may spiral out of control. This means that your behavior resulted in someone feeling uncomfortable due to gender -- unwanted sexual advances, banter with innuendo, or something along those lines. There is an entirely separate process for addressing Title IX issues, with a separate group of evaluators. Title IX is a huge deal because if someone complains to the Feds that their complaint wasn't taken seriously, the school can lose all federal funding. So schools have a tendency to believe the accuser/victim, and punish the other party. This should also be in your handbook, and will have a completely different process. You will go through both separately, and need to "pass" both reviews to continue.

Regarding disability, as mentioned above this mostly applies moving forward. Remember that disabilities do not "explain away" poor performance. You are expected to ask for accommodations as needed to maintain adequate performance. If you were to have another episode like this, no amount of explaining that it was out of your control would suffice.

Last, social issues. You should probably assume that your story has spread through your school. I'd hope for privacy, but I'm sure your behaviors were relatively public, and people talk. Assuming you're allowed to restart, you'll need to work with these people again and you'll need to be prepared for how you want to address it. You can ignore it and just pretend nothing happened. Or you can be open with people whom you work closely with that they "may have heard stories" and try to clear the air. Neither solution is perfect, you'll need to pick what you want to do. And different environments may need different solutions.

As you go into your reviews, you should also consider what you think a good next step would be. They will likely ask you -- as a way of assessing your introspection. How long should you be stable on meds before you're allowed back in? Should you repeat the entire MS3 starting next year, including clerkships you passed? If you were to return to the same OB site, how would you navigate that? These are all questions to which you should have answers -- and understand that asking for too much too quickly will not be held in your favor.

So, in summary:

Number one priority is getting better. Your school is probably going to want to see a sizable period of stability on medications, could be up to 6 months. Trying to get back in "right away" so you can graduate as quickly as possible is not going to support your assertion that you understand the gravity of the situation.

A lawyer is probably most helpful in navigating the Title IX issues. That's the type of lawyer I'd work with, if you're going to hire one at all. They do not come with you to any hearings, and you don't mention that you have a lawyer to anyone.

Know your academic due process backwards and forwards, same with Title IX. Keep notes on everything - every meeting, whom was there, etc. Make sure that keeping notes is allowed (although it usually should be). Never record anything unless you're certain you have permission, which is very unlikely.

Try to find some local supports / mentors. This is going to be a tough process, you want someone to lean on. These people should be outside the due process envelope. They are not coming to your meetings to support you -- they are there for between meetings and decisions for personal and moral support.

Assuming you are allowed to resume training, consider how that's going to happen and how little/much of this you are willing to share with others, understanding that both over and undersharing can have consequences.

Also, you need a canary. These were bird that coal miners took into the mine shafts to warn them when the air was bad. Sadly, the canaries did that by dying. In your case, you need someone you trust that's close to you to watch your behavior. They are empowered to tell you is you're starting to show manic behavior. And you MUST listen to them. Even if you're certain they are wrong. Because you can't see it. This is really hard, but it's what you need in the short term.
 
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Well that's better than the other way around. But Title IX is a huge pain for schools, and filing one won't make you many friends. Still if it was the right thing to do, then that's what you do. If the event happened when you were manic, that's going to be a harder issue to address.
 
Well that's better than the other way around. But Title IX is a huge pain for schools, and filing one won't make you many friends. Still if it was the right thing to do, then that's what you do. If the event happened when you were manic, that's going to be a harder issue to address.
Do you think I burned bridges by doing this? The person retaliated against and there was a lot of people who were witnesses there.
 
sorry this is coming a little late. I was diagnosed with bipolar I and stabilized on medication many years before medical school. I don’t have manic episodes anymore but get hypomanic every handful of years. It is possible to be a bipolar doctor but you want to be as sure as possible that you’re stable before you put any pressure on yourself. Everyone’s bipolar is different but if this was me, I would try to take a medical leave of absence for at least a year to ensure you are stable and understand triggers and stressors before returning to school.
 
That’s what I am doing now. I extended my leave of absence for a year. I’m just worried I’m not going to be able to explain my action when I was manic
 
That’s what I am doing now. I extended my leave of absence for a year. I’m just worried I’m not going to be able to explain my action when I was manic
You were in a severely decompressed state. You were not well before but you are now well. You have a disability and you have treated your condition.
 
It sounds like the dean is on your side which is a plus. Getting better is top priority. One issue is that sleep deprivation can be a trigger for mania/ hypomania- it’s important to figure out how you’ll deal with this in the future
 
Well that's better than the other way around. But Title IX is a huge pain for schools, and filing one won't make you many friends. Still if it was the right thing to do, then that's what you do. If the event happened when you were manic, that's going to be a harder issue to address.
Do you think I burned a bridge with the school? I filed mine too late to continue with an investigation. I’m worried this will give them the fuel to want me out.
 
Your posts seem to suggest that your school is going to give you another chance next year. You should prep for that as much as possible.

You seem to be perseverating on negatives. This is not healthy. You should talk to your care team about it. This is not medical advice.
 
They are waiting to put me in front of the board. The deans are delaying things but in the end it will be the SPC who will decide if go the APC or not.
 
Psychiatrist here, a few misconceptions to address:

What I’d say is that you seem to have some, but not complete insight into the degree of your transgressions. One manic episode would be an isolated event and wouldn’t explain the persistent behavior that put you in this position.

While I’d be ignorant to say that Bipolar isn’t a significant contributing factor, there are likely other personality traits or deficiencies which may be in your control. Seek care and develop a maintenance plan for your disorder, but also reflect hard and take accountability for and address those. If after doing that you’re unsuccessful, it is what it is and you have to move on.
This doesn't sound like "persistent" behavior in the sense that it's the OP's baseline. It sounds like behavior that occurred over the course of several weeks or a couple of months. That can absolutely be completely due to a manic episode as the average length of an untreated manic episode is somewhere between 2-4 months. It's possible there's other personality or psychological factors, but I would not assume that this situation is not largely or entirely due to acute mania.

When you're acutely ill like this, laws can protect your ability to take a medical LOA. However mental health issues are extremely complicated -- as the illness itself usually entails a lack of insight by the patient.
While this is true for some disorders, many psych patients have excellent insight into their disorders. For bipolar disorder, lack of insight during acute manic or hypomanic episodes is expected, but most patients who are at a stable baseline have very good insight about their condition even if they don't recall large parts of manic episodes. OP sounds like they have at least decent insight, which should be a big plus in this situation.

At my school, any clerkship failure automatically gets reviewed by a committee. My dean is trying to delay the process as much as he can but he has to forward it. It’s a messy event and he feels awful for me
It sounds like your dean is on your side. I would discuss details with him and make sure you are keeping him updated with your situation. Some schools and programs are more forgiving of these situations than others and your dean should be your guide on how to best handle this for your school. Regardless of this, make sure you're staying engaged with your treatment and team and can show that you're staying on top of this to minimize and ideally prevent future problems. Bipolar disorder can be very well-controlled, but only you and your doctors are going to be able to determine what your capabilities will be. I'm sorry to hear you're going through this, but do hope it works out for you, whatever that path may be.
 
Does anybody think I would be better off transferring to the Caribbean or stand trail in front of a committee? I only have one clerkship failure. I am gettting signals. I don’t think I deserve to be a doctor just because of an undiagnosed medical condition that was out of my control.
 

This sounds like a difficult and stressful situation, but the fact that you’re reaching out for advice is already a great step. Medical school can be an immense challenge, and managing mental health during this journey is just as important as academics. Here are a few key things to keep in mind as you navigate this:
- The good news is that it is your first major issue, and one professional lapse does not automatically mean dismissal.
- Also, medical schools usually are supportive if there is a newly diagnosed medical condition.
- Most likely if the review panel is strict then they might ask you to repeat the rotation
- Try to be honest about the whole thing and be professional. If you have started a treatment plan, show the review panel.
- See if you can speak to a school advisor
Good luck!
 
Does anybody think I would be better off transferring to the Caribbean or stand trail in front of a committee? I only have one clerkship failure. I am gettting signals. I don’t think I deserve to be a doctor just because of an undiagnosed medical condition that was out of my control.
can you elaborate on these signals?
 
My dean stated that I have a past of being an introvert. I started going to through a depressive episode in my second year. There was some small group evaluations stating I wasn’t as active in group conversations but engaged. He is worried I am natural introvert or have communication issues.
 
Do you think I should risk the dismissal if I have to step in front of committee or should I withdraw? It doesn’t have to go committee but I’m concerned if it does.
 
You should absolutely not withdraw. Carib schools will not care if you withdraw or are dismissed -- they will consider you either way. Your best outcome is to continue at this school, and that's what you should focus upon. From all that you've written, you should go through whatever process happens -- I'm not sure what SPC and APC mean/are, but it doesn't matter. You go to the SPC. You prepare a presentation that explains that you have newly diagnosed BPD, that the manic episode which caused your unprofessional behavior was your first, that you are getting regular care and now are on a medical regimen that has stabilized. You would like to restart your third year with the next class, to ensure that you have at least 6 months of stability before restarting school. You should ask your psychiatrist for a supporting letter if they are willing. You offer to apologize and make amends with the OB site where you were rotating. You take responsibility for your actions, while pointing out that they were not completely under your control due to your illness. But you have a treatment plan now, and a plan to watch for any further episodes so that should you seem to be worsening, you'll get help before your behavior deteriorates.
 
I agree with @NotAProgDirector . OP, you see super nervous and looking for a reason to avoid standing in front of this committee. However your best path forward is to continue at your current school, so you should do everything you can to avoid being dismissed
 
Thanks for the advice. The SPC is the first committee that reviews my case and decide if need to stand in front of the APC for possible dismissal. Both my pyschologist and pyschatrist are willing to write strong letters for me including a plan going forward to prevent mood flucations and mania. I have a couple faculty that are supporting and writing letters on my behalf as well
 
Just get on some lithium or quetiapine and remediate the rotation. 3rd year rotations are overrated anyway and make sure you clear all the Step 2 stuff needed to get into an actual paying job (aka residency).

One time on my General Surgery rotation i told one of the General Surgery residents who was my preceptor / evaluator to shut the f up and i still turned out decent as an attending physician making 6 figures.
 
Thanks for the advice. The SPC is the first committee that reviews my case and decide if need to stand in front of the APC for possible dismissal. Both my pyschologist and pyschatrist are willing to write strong letters for me including a plan going forward to prevent mood flucations and mania. I have a couple faculty that are supporting and writing letters on my behalf as well
I don't know your school handbook, but it seems to me like you're catastrophizing the outcome of the SPC/APC process. My guess is that it's far more typical for the outcome to be monitored academic status or possibly academic probation for course failure, not outright expulsion, especially since you've been working on a plan for ensuring that you will continue to meet minimum standards in the future (by having your BPAD stably under control for an extended period of time.)
 
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