What a mess...should I take time off from my fellowship?

[Janedoedoctor]

Hello everyone,
I'd like your take on my situation and advice on how to proceed from here. My troubles, as I see them, are:

1. I think I might be depressed. The trigger is a miscarriage I had weeks ago. The pregnancy was very much wanted and anticipated for years. I've had several weeks of sick leave due to complications. In spite of the time that has passed, I still feel miserable. I can't sleep at night, and I hardly eat. I still cry daily and I do not feel up to going back to my highly competitive work environment. My relationship with my husband is strained by all this grief, both his and mine.

2. As you could read in my previous thread, http://forums.studentdoctor.net/showthread.php?t=800260&highlight=janedoedoctor, things were already not going swimmingly in my professional life. The atmosphere at work had improved a little since I wrote that post.
However, I had not yet told anyone that I was pregnant, because of the negative attitude towards women in general and pregnant women in particular. I was coming to a point where hiding my belly was becoming impossible, so I made an appointment with the PD to break the news to him. Unfortunately, I miscarried while rounding in the ICU, hours before that conversation was to take place. It created quite a scene. Everyone was very nice to me at that moment but I really don't know how they will react once I get back.

3. I have postponed working on several publications and research projects because of what happened. When i go back i'll have to catch up with everything. One big piece that I did manage to send in was rejected by the journal. I will probably get it published somewhere else but it's very demotivating and just adds to my gloomy mood.

So... would you guys take more time off if you were in my shoes, or do I need to go back and grit my teeth? I'm not sure I can manage that second option. I've always considered myself a very strong person who could keep het private and professional lives separated, but all this just might be too much.

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[shopsteward]

You are grieving the loss of your child. You are physically ill. You are in a toxic environment at work. I don't think you are depressed (from your posts you are coping remarkably well with everything which is being thrown at you), but you have a lot to be sad about.

I tend to think that western society doesn't know how to handle grief any more. It takes time, and peace and quiet, to process a big loss in one's life. In the days when people wore mourning clothes, they could be given the space they needed, but now we are expected to pick ourselves up and carry on as normal within a few days. I'd tell you to give yourself more time now, and you will be better able to deal with the loss in the longer-term.

Your husband is grieving too. After the loss of a child, a very high proportion of marriages break up. Again I think this is because the effect of such a loss on the individual can be underestimated, and with both of you grieving the person each of you most naturally turns to for support is themself in need of support. If you know this is the problem, though, you can work together to find ways to deal with it.

As for your fellowship, while you are still physically ill, you need to be on medical leave. Do you know what your fellowship conditions say about paid/unpaid medical leave, and how you stand in relation to them? Does the length of your fellowship get extended after medical leave to make up the time lost?

If you come to the end of the period of paid/unpaid medical leave which you can take and you still feel you don't want to go back, I think you should look at what your fellowship says about taking a leave of absence. A leave of absence would give you the time and space you need to recover and to work out your plan for how you want your working life to go when you go back to it. When you do go back, go with a plan and a timetable for dealing with all the obligations you will be picking up on: if you have that plan and feel confident you can implement it, then you are fit to go back to work.

I'm sorry for your loss, and wish you well.

 

[Janedoedoctor]

Thanks for your kind words.
Perhaps I should have been more clear that my feeling bad at this time is not because of physical illness. I have made a slow but steady recovery in that department. From a strictly physical point of view there is no impediment to starting work on monday.
The length of my fellowship WILL be extended by too much medical leave. However, their definition of 'too much' is rather generous and at this time I'm not in danger of exceeding it.

I've been thinking about a leave of absence. I have no experience with the concept and I don't know anyone who's had one. How long are they typically?
How much impact would the gap in my CV have on future applications for subspecialty fellowships?

 

[shopsteward]

A leave of absence isn't a gap in your CV as long as you have an explanation for it, which you do. (As far as I am concerned, a gap in a CV is something which isn't accounted for or explained.)

It's difficult to say what is typical for a leave of absence. The most generous employment contract provision that I've seen is for an unpaid leave of absence/career break for family reasons of up to five years and for other reasons of up to one year. Contracts also sometimes specify limited amounts of paid and unpaid leave for particular reasons other than medical ones, such as bereavement, jury duty, and so on. Maternity leave sometimes applies in cases of miscarriage.

Check what your contract says. It will set out what, if anything, you are entitled to. There is no reason why you need to be limited to what is in your contract, though. You and your program administration/PD can agree whatever you like. (If what you agree is outside what is already in your contract, then it is an agreed variation of that contract.) So sort out in your mind what period you want and what your arguments for it are, and then discuss it with whoever has the power to make the decision. Make sure that the terms for your return are fully understood by both of you, and get it all set out in writing. Good luck.

 

[twentyone]

Thanks for your kind words.
Perhaps I should have been more clear that my feeling bad at this time is not because of physical illness. I have made a slow but steady recovery in that department. From a strictly physical point of view there is no impediment to starting work on monday.
The length of my fellowship WILL be extended by too much medical leave. However, their definition of 'too much' is rather generous and at this time I'm not in danger of exceeding it.

I've been thinking about a leave of absence. I have no experience with the concept and I don't know anyone who's had one. How long are they typically?
How much impact would the gap in my CV have on future applications for subspecialty fellowships?

Only go back if you're ready to be at your best. Going back and doing it half assed will not help anyone. I think this is exceptionally true in your fellowship situation. I had a similar issue and was in a completely understanding and supportive environment, and I took extra time off. I got off cycle, finished late, and had a "gap" in my CV. None of it mattered. If you feel you need more time off and are offered it, take it and go back when you're ready. The gap will be explainable to any licensing board (all you have to do is say "reproductive issues" and that's all they usually want to hear).

ETA: That was literally the worst time in my marriage, and was almost 10 years ago now (we're still married). Give it some time and maybe even counseling.

 

[NotAProgDirector]

Another way to look at it is like this: Will going back to work help you feel better, or make you feel worse? Sometimes, the best way to put a personal tragedy behind you (after some grieving time) is to get back to work to take your mind off of it -- this works if you like your job and have a supportive work environment. From your posts, I think it's pretty clear that going back to work is likely to make things worse.

 

[Mattchiavelli]

I would also recommend seeing what mental health services are available to you through your program and look into seeing someone because you have an acute-on-chronic stress situation combined with being postpartum, which is really about as bio-psycho-social of a trigger as it gets. Going and seeking help you have relatively little to lose but if you don't this could snowball and become a mess of a situation. It sounds like your daily activities are impaired so I think this is reasonable. Take care of yourself so you can take care of others... and best of luck to ya

 

[cpants]

Another way to look at it is like this: Will going back to work help you feel better, or make you feel worse? Sometimes, the best way to put a personal tragedy behind you (after some grieving time) is to get back to work to take your mind off of it -- this works if you like your job and have a supportive work environment. From your posts, I think it's pretty clear that going back to work is likely to make things worse.

Agree with this. You have to think about how going back will change your scenario and whether it will be for the better or worse. What would you do during that leave? Sitting at home thinking about stuff can make things a lot worse. At least you will have some positives in your day if you are at the hospital making things better for some patients.

 

[nitemagi]

I agree with much of what has been posted. And in some ways this thread borders on psychiatric advice really, since at minimum you may be having a postpartum blues + adjustment problems, if not major depression, and big issues shouldn't be decided anonymously over the internet. Talk with a professional (psychiatrist or at least a psychologist), talk with your PD. You're suffering one way or another, however people want to explain it.

 

[dragonfly99]

You need to see a good clinical psychologist or psychiatrist. I think
you should see if you can get a leave of abscence for a month or two. Most programs would probably give it to you, even if they are a bit malignant. Is your program so understaffed that someone being gone for a couple of months is THAT big of a deal?

 

[thisiswilde]

I just want to say that I hope things look up for you. You should focus on yourself first and your mental health.

 

[heretics]

Find a great therapist and take the full amount of leave allowed by the Family & Medical Leave act. I believe this will allow your health insurance to continue.
Write in a journal.

 

[PharmaTope]

Hello everyone,
I'd like your take on my situation and advice on how to proceed from here. My troubles, as I see them, are:

1. I think I might be depressed. The trigger is a miscarriage I had weeks ago. The pregnancy was very much wanted and anticipated for years. I've had several weeks of sick leave due to complications. In spite of the time that has passed, I still feel miserable. I can't sleep at night, and I hardly eat. I still cry daily and I do not feel up to going back to my highly competitive work environment. My relationship with my husband is strained by all this grief, both his and mine.

2. As you could read in my previous thread, http://forums.studentdoctor.net/showthread.php?t=800260&highlight=janedoedoctor, things were already not going swimmingly in my professional life. The atmosphere at work had improved a little since I wrote that post.
However, I had not yet told anyone that I was pregnant, because of the negative attitude towards women in general and pregnant women in particular. I was coming to a point where hiding my belly was becoming impossible, so I made an appointment with the PD to break the news to him. Unfortunately, I miscarried while rounding in the ICU, hours before that conversation was to take place. It created quite a scene. Everyone was very nice to me at that moment but I really don't know how they will react once I get back.

3. I have postponed working on several publications and research projects because of what happened. When i go back i'll have to catch up with everything. One big piece that I did manage to send in was rejected by the journal. I will probably get it published somewhere else but it's very demotivating and just adds to my gloomy mood.

So... would you guys take more time off if you were in my shoes, or do I need to go back and grit my teeth? I'm not sure I can manage that second option. I've always considered myself a very strong person who could keep het private and professional lives separated, but all this just might be too much.

jane, i posted in your other thread months back.

you sound really down right now. seriously, PM me your email or phone number ill talk with you. been in the same place as you before.

 

[PharmaTope]

Thanks for your kind words.
Perhaps I should have been more clear that my feeling bad at this time is not because of physical illness. I have made a slow but steady recovery in that department. From a strictly physical point of view there is no impediment to starting work on monday.
The length of my fellowship WILL be extended by too much medical leave. However, their definition of 'too much' is rather generous and at this time I'm not in danger of exceeding it.

I've been thinking about a leave of absence. I have no experience with the concept and I don't know anyone who's had one. How long are they typically?
How much impact would the gap in my CV have on future applications for subspecialty fellowships?

well i cannot say bc i dont have any involvement in fellowships. i can tell you, a leave of abscence can be explained by a medical situation (yours obviously occured). a leave can be explained by a switch to another job but that job fell through right as it began bc of funding cut etc etc.

i think your gap is explainable in my opinion. if you cannot explain it a friend can put you on as payroll at their company etc.

also if you do take a leave, MAKE SURE you fill out FMLA. this will protect you. an employer will have a VERY HARD TIME terminating you if you use FMLA bc then it opens the door to a MAJOR LAWSUIT for breaking the law regarding medical leave. send me a PM, let's talk and try to figure something out for you ok?

 

[Geri_Gal]

I am so sorry for your loss.

Take time off. Use your FMLA benefit. The grief that happens after a miscarriage is intense and private -- it is so difficult for others to know how emotionally devastating it is. It often becomes complicated by depression. I had a pregnancy loss in my last year of residency. I took some time off (~2 weeks) and wish I could have taken more. When I returned, people were much more understanding than I anticipated they would be. The sadness will resurface in unexpected ways -- I had a particularly difficult time dealing with the emotional intensity of the ICU. What you are feeling is normal.

 

[WFM18940]

So sorry to hear about your loss. Surround yourself with support and take the time you need to plan for the future. Do you think you could work out an arrangement to work part time? Job sharing could be another option.

 

[badasshairday]

Take care of yourself first and foremost. If that means taking time off, then do it.