Grin and Bear It

Heather Finlay-Morreale, MD
Department of Pediatrics
UMass Chan School of Medicine

As teachers, we might make unconscious assumptions about learners. About what they learned in prerequisites, about what life experiences they may have had, about what cultural or media exposures we may have both shared, but we really tread on thin ice when we make assumptions about what a learner's body and mind can and cannot do. Hear from an attending who grinned and bore it through medical school and residency with multiple disabilities before the era of accommodations. 

The Health Education Academy for Leadership and Learning (HEALL) would like to acknowledge More Voices PULSE publication for first publishing this reflection on their website in January 2025.  The author has since made some updates to the original story.

I was already in high school when the Americans with Disabilities Act passed. At the time, the occurrence of learning disabilities in bright and talkative girls was not recognized. My schooling through college graduation was all before accommodations were commonplace. It wasn't until medical school that I hit a wall, and was diagnosed with ADHD and dyscalculia, a math-related disability. I recall being the only student in my medical school class with academic accommodations. Some other students obtained ADHD medications by sketchy means and left no paper trail due to concerns about stigma and embarrassment. My pathology professors often shared to my face their negative views of my disability accommodations and tried everything possible to thwart them. I tried and failed to get accommodations for board exams, despite meeting all the rigorous and expensive requirements. After that rejection, I did not even dare to bother asking for accommodations for clinical rotations. Making it through medical clinical training, an ableist system, with disabilities, took all the grit I could summon.

 The summer before residency was when my neurological Sjögren's disease, at the time still undiagnosed, flared greatly.  From then onward, my feet raged in pain after minimal time standing due to severe neuropathy. When I finally had a biopsy, it noted "near total loss" of small fiber neurons. Constant assumptions about my able-ness, made residency rotations at times unbearable. It was a grin-and-bear-it 3-year period. Not only nerve pain but also fatigue from the untreated autoimmune fire was a major challenge. Work hours were grueling, and I slept nearly every minute I was not in the hospital. Going to medical appointments post-call in my "free time" was beyond challenging.

 My daily physical pain was tremendous and never abated. My foot neuropathy in particular was exacerbated by the demands of rotations. I was once documented as unprofessional for wearing cushioned shoes. So, from then on, I'd stack 3 inserts in my shoes to no avail. By 10AM, I'd be dying to sit, and rounds seemed endless. One outpatient rotation was in a somewhat small office, and only attendings were given chairs. Trainees were assumed to be able-bodied, and able to stand for the entire work day. All day I'd be sucking up tears from near-crippling foot pain. Beyond the demands of a typical day, at times heroics were expected. My fellow trainee was lauded for hiking miles in feet of snow to get to the hospital. Whereas I would try to muffle huffing and puffing after being dragged up flights of stairs on rounds.

Perceived weaknesses or differences in abilities were treated harshly. With my dyscalculia, a math learning disability, I can do complex math if using a calculator, but struggle to do math visually in my head. On NICU rounds, I was asked to calculate some cal/ml/kg/hr in my head. I could not do it, and the fellow seized on this weakness. Daily she would roast and belittle me on rounds. One attending joined in and the two took joy in bullying me. My program director was aware of what was occurring, but the merciless bullying was tolerated. On a rotation with long hours, where I rarely saw the scarce winter sun, this pushed my mental health to near its limit.

 Even harder than the physical challenges were the, at times, ableist and uncompassionate remarks made by colleagues about patients I shared similarities with. In particular, I heard callous and uncaring statements about patients with chronic illness and pain. These remarks, made by people who have never experienced unrelenting pain, hit me hard and personally.

The years spent in this environment took every ounce of grit that I had, but the cost was wounds to the body and spirit that remain. It shouldn't have been so hard. I'm thankful today's students are more able to obtain accommodations for academic and clinical months with less stigma. There's a long way to go towards acceptance of physical differences and neurodiversity but I am pleased to mentor the current generation of diverse future doctors that have significant lived experience as patients.