Marcel Blignaut1
doi: http://dx.doi.org/10.5195/ijms.2021.990
Volume 9, Number 2: 176-177
Received 10 04 2021: Rev-request 26 04 2021: Rev-recd 27 04 2021: Accepted 13 05 2021
Three years ago, in the middle of my junior year of high school, my life was thrown into disarray when I started experiencing debilitating chronic pain and fatigue. In the midst of what was already an academically important year, the unrelenting constellation of symptoms I was experiencing was nothing more than an unsparing disruption. In only a few weeks, I had been subjected to what seemed to be a never-ending series of diagnostic workups. These included an MRI of the sacroiliac joints and an array of blood tests, including rheumatoid factor, erythrocyte sedimentation rate, anti-nuclear antibodies and human leukocyte antigen B27. In the end, all results pointed to a dead-end with common differential diagnoses such as spondyloarthropathies, lupus, and rheumatoid arthritis all being ruled out. On June 27th, 2018, my rheumatologist was finally able to tell me that I had fibromyalgia, a chronic pain condition involving widespread muscle pain, fatigue, problems with sleep, and cognitive issues.1 With fibromyalgia lacking specific diagnostic markers and the tender point criteria (which my rheumatologist had made use of) having limitations, the long-delayed final diagnosis was essentially one of exclusion.1 However, with my doctor's words came a sense of relief for not only did it validate the agonizing symptoms I experienced daily, but it opened the path to getting better. Despite knowing that fibromyalgia was a life-long condition, I did not know what the state of my health would be at any point during the three years that have passed since.
At the time of writing, I am a second-year medical student. Although I have lived with fibromyalgia for just under three years now, it has never been more relevant in its impact on my personal life as it is now. Like most of my peers, I stress over the desire to perform well academically and keep up with the tremendous workload. After my diagnosis in 2018, I successfully learned how to find balance between performing well academically and taking care of my health. My efforts were so successful that I remained almost entirely symptom-free for a year. Some of these efforts included getting at least eight hours of sleep each night, going for 30-minute walks five times a week, and minimizing my stress by taking breaks from studying and seeing a clinical psychologist. Unfortunately, my ability to find and execute this balance was sidetracked upon beginning medical school. I knew medical school would be challenging but what I had failed to anticipate was it becoming more onerous to find and maintain this balance. In my time as a second-year student, my fibromyalgia symptoms have been at their worst since my diagnosis. I have long been mindful of the strong correlation between stress and fibromyalgia flareups, something I picked up on as I was learning to control my symptoms. Ever since, I have made strong efforts to minimize my stress levels so as to avoid flareups.
Although the first year of medical school was stressful, I was able to keep most fibromyalgia symptoms under control. Unfortunately, the first seven weeks of second year were not as kind. Compared to first year, this year's workload has been twice as much and the work thrice as difficult. Needless to say, the stress has caught up with me. Although I have been successful in staying on top of the work, the fear of falling behind or performing poorly on assessments has proved to be enough to provoke my fibromyalgia. In staying on top of my work, I have also found myself neglecting taking time off from studying to take short walks or relax, thereby sacrificing some of the very measures which had kept me symptom-free in high school. From the first week, my body has harassed me with unrelenting muscle spasms and twitches, issues with short term memory, and severe fatigue. The muscle spasms have found opportunity in sitting at a desk all day due to remote online learning in response to the current COVID-19 pandemic, with the smallest deviation from correct posture triggering disabling pain. The severe fatigue has also taken advantage of a second-year sleep schedule. Despite always aiming for eight hours of sleep every night, I often find myself needing to settle for six hours in order to finish the day's work. Although those two hours may seem insignificant to the lay individual, it is enough to send my body into even more pain the next day. To make matters worse, the fatigue has me yearning for long naps which I often cannot afford as it risks me falling behind with work and causing myself further stress. Essentially, fibromyalgia and medical school join forces in creating a vicious cycle. Aside from the muscle spasms and fatigue, issues with short term memory have been one of the most distressing manifestations of my fibromyalgia flareups. With courses such as anatomy, physiology, and molecular medicine being taken this year, I have had to rely heavily on the ability to retain copious amounts of information. There are few things more frustrating than forgetting something I read over not even 30 seconds before. Not only does it result in taking twice as long to complete lectures, but it also adds significant stress to the studying process. The brachial plexus is an intimidating topic for many and requires continuous revision for it to become common knowledge. However, add the ability to forget what the superior trunk is seconds after reading about it, and the studying process becomes agonizing and tedious in return.
Living with fibromyalgia has not made medical school easy and the opposite holds true as well. As I am writing this, I am in the process of finding ways to restore balance between my academics and good health by planning my work to make space for at least eight hours of sleep and 30-minutes of exercise each day to minimize my pain levels and the stress associated with both my health and academics. I doubt it will be a simple undertaking and one that will likely need to be repeated in future years as I encounter new obstacles. However, I have come to appreciate my fibromyalgia as more than something holding me back. Fibromyalgia has significantly influenced my passion for medicine. Aside from admiring the human body since I was 12 years old when I started struggling with my health, the diagnostic challenge of fibromyalgia contributed significantly to this admiration as learning about the complexity and extensiveness of the body's pathologies only further strengthened my desire to study medicine. Most importantly however, I was put in the position to sympathize with the millions of others going through similar battles, which is the reason I aspire to be a rheumatologist and contribute to breakthroughs in the management of fibromyalgia. I also believe that my story will make me a better doctor by being able to connect with future patients. Although I have in this journey often felt alone, I find comfort in hearing of peers and other students in positions similar to mine.
I have found two stories like mine published in medical literature. The first details a fourth-year medical student's experience of living with diabetes in medical school, described as “both challenging and rewarding”.2 The second describes the experience of an anonymous doctor living with sarcoidosis since medical school in a very similar fashion to that of the first story.3 The doctor mentions both their struggle with accepting their diagnosis and learning to take care of their health as well as the hope of becoming a more empathetic doctor because of their illness.3 It is this very aspect of “both challenging and rewarding” that I think underlies the importance of these stories being told. Despite there being many more of these stories, they are seldom recognized or spoken about which these individuals feeling isolated, even though we are not. In fact, the author's anonymity in the second story above clearly demonstrates how we have been conditioned to keep our stories to ourselves for fear of shame, alienation, stigma, or pity. I wish to share three messages with those who are living stories similar to mine. The first would be to know that our circumstances and experiences are nothing short of a testament to our strength and resilience. The second is that we should take the time to find and appreciate the hidden blessings in our circumstances. Lastly, I encourage all fighting similar battles to find both a balance between their health and academics as well as a strong support system. I hope that in the future, more of these stories are shared proudly with the world for they deserve to be heard and commemorated.
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Conceptualization: MB. Writing – Original Draft Preparation: MB. Writing – Review & Editing: MB.
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1. Goldenberg DL. Diagnosis and Differential Diagnosis of Fibromyalgia. The American Journal of Medicine. 2009 Dec;122(12):S14–S21.
2. Segall P. The rewards of chronic illness. Western Journal of Medicine. 2001 Nov;175(5):347–8.
3. Working as a doctor with a chronic illness. BMJ. 2004 Aug 14;329(7462):s67.
Marcel Blignaut, 1 MBBCh, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
About the Author: Marcel Blignaut is currently a second-year medical student at the University of the Witwatersrand, Johannesburg, South Africa, of a 6-year MBBCh program. He has an eager interest in Rheumatology and Internal Medicine. He is also an invitee of the Golden Key International Honour Society and member of the Dean's Merit List.
Correspondence: Marcel Blignaut, Address: Med School, 7 York Rd, Parktown, Johannesburg, 2193, South Africa. Email: blignaut.marcel@gmail.com
Editor: Francisco J. Bonilla-Escobar Student Editors: Mohamed Fahmy Doheim Student Editors: Lourdes A Medina-Gaona Copyeditor: Nikoleta Tellios Proofreader: Ciara Egan Layout Editor: Judie Joo
Cite as: Blignaut M. Reflection of a Second Year Medical Student: Navigating Medical School with Chronic Illness. Int J Med Students. 2021 May-Jun;9(2):176-7.
Copyright © 2021 Marcel Blignaut
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 9, NUMBER 2, May-June 2021