Returning to work

There is increased awareness amongst the medical royal colleges of the challenges of returning to work after a long period away, and the need for this to be a structured, managed process.  The Faculty is developing its own Return to Work (RTW) guidance, which will be a synthesis of the guidance provided by its constituent colleges.

Aoibhin Hutchison, an ICM consultant at the RVI in Belfast and a member of the WICM group, is leading on this. I thought I would share my personal experience of a return to full time practice after a period of time off work, the challenges I faced, and how a structured, managed, supportive approach helped me.

The RTW document follows several principles…

“If possible, before you go, plan your leave”

I am very, very short sighted (we’re talking -27D). Because of this, I’ve had 2 retinal detachments in my left eye, and a cataract in my right. The vision in my left eye has never been fantastic since the detachments, and I’ve relied heavily on my right eye and am very right eye dominant. On Wednesday 4^th October 2017 at about 11am, I was talking to the man replacing the extractor fan in my bathroom, when his face was suddenly blotted out by a big black shadow.

I phoned the eye hospital. They saw me the next day and confirmed that I had developed myopic choroidal neovascularisation – a form of macular degeneration – in my right (good) eye, and one of the fragile new blood vessels encroaching on my macula had burst, covering its upper half in blood. They booked me in for the first of 3 intraocular anti vascular endothelial growth factor injections to try and arrest the neovascularisation. The damage from the bleed would not be improved by the injections – I just had to wait and see if things improved.

I’d gone from being completely fine, to being what the ophthalmologists called a ‘low vision’ patient, in the blink of an eye, with no warning at all.

“Absences from work are often unavoidable but they have an effect”

I had always managed to keep it together after my retinal detachments. I didn’t keep it together this time. I was in a real state, a crying-in -the-toilets-being-comforted-by-grannies having-their-cataracts-seen-to kind of state. Walking home from the Eye Pavilion, I phoned my professional lead and told him what had happened – I was unable to work for the foreseeable future, and at this point I wasn’t feeling optimistic I’d be able to work again, ever. My vision was poor enough that I couldn’t take the bus home as I couldn’t see the bus numbers, and just couldn’t bring myself to ask the other people at the bus stop to help me. My professional lead could not have been lovelier. I wasn’t to worry about work – everything would get covered and I should just focus on my treatment. My CD and AMD both phoned soon after to reassure me that work should be the least of my worries. My CD kept in touch over the next couple of months, just to check I was managing, but I was kept out of any emails referring to rota cover issues and was never made to feel like I should feel guilty for my colleagues having to cover me.

The reality of living life with low vision is one of constant unpleasant surprises of discovering new things you can’t do anymore. It’s really hard to get toothpaste onto your toothbrush if you can’t see it! You just have to put the toothpaste on your tongue instead. You try and chop vegetables, but chop your finger. You walk past people you know in the street as you can’t see their faces. The only possible positive was since I was unable to drive, my daughter had to learn to take the bus to and from school, which I doubt would have happened otherwise. My dog also lost a kilo, which she needed to lose, as we now walked everywhere.

“Assess the impact of the return to work”

About 3 months after the bleed, after I had completed my 3-injection course of anti-VEGF treatment, my vision began to improve. I could see bus numbers form about 15m away. I could read street signs from across the road. I had managed to go all the way to Liverpool on the train to talk about WICM at the ICS State of the Art meeting, without anyone noticing (I think) that I was struggling to see much (this in itself was a good lesson in not relying on presenter notes and keeping slides clear and simple).

The big black splodge in my central vision was gradually clearing, and it looked like I might be able to come back to some kind of clinical work. I had been seeing the organisation’s occupational health service – my OH doctor was so kind and really helpful – and by late January, my vision had improved sufficiently that I was able to come back to supernumerary clinical work. My vision issues fell under the Equalities Act, which means my employer is obliged to make ‘reasonable adjustments’ to accommodate me. I work in critical care and anaesthesia, and my clinical directors were more than willing to do whatever was needed to allow me to return to practice. I was told I could be doubled up in theatres with another consultant as long as I felt it was necessary. In the end I had 4 days doubled-up in theatre before returning to solo practice. In our ICU we have 2 consultants on during the day, so I was able to spend several months building up my clinical confidence doing daytime work, with a colleague on hand to help if needed. The main adjustment I made wasn’t that drastic – increasing the font size from 8 to 12 on our electronic patient record when viewing or adding notes (turns out most of my consultant colleagues do the same!). By April, 7 months after the bleed, I was able to return to on call and – and I would never even have dreamed this would be possible – my vision had improved enough that I was able to drive again.

“Time away from a high-performance specialty can have a significant effect on our ability to resume full clinical duties unless we acknowledge, anticipate, plan and support during this period of return to work”

I can’t pretend that the last 9 months have been easy. Developing a progressive, degenerative, incurable condition like myopic CNV, knowing that it will likely rob me of useful vision at some point in the future, is pretty miserable. Dealing with the anxiety of knowing that my vision could deteriorate again with zero warning requires active work to stop it becoming debilitating. As a single parent, knowing that if I cannot work I will not be able to support my daughter is potentially a big source of stress. I am lucky to have family nearby. They gave me lots of lifts to the supermarket when I couldn’t drive, as well as emotional support. My colleagues were fantastic, and I will never forget their kindness and understanding. There was only one occasion that struck a bum note, when a senior joked to me about whether I had looked into getting a guide dog and white stick. I laughed along, because that’s what you do in that kind of situation – but I didn’t find it funny at all. I think he was trying to cover up his awkwardness with the situation, rather than being intentionally cruel, but it was the one poor interaction out of the many, many brilliant ones I had with my colleagues. Humour can be a great tool in getting through tough times, but I think needs to be used sensitively. When a colleague of yours is staring down the barrel of never being able to work again, it’s maybe better to just stick to the usual bland platitudes rather than chancing it with edgy jokes.

Before my bleed, I had been stressing, like many of us do, about how I would work till 67 – now I think if I get to 55 with useable vision I will be pretty pleased (I’m 42 now). I’m also so happy I am back working in the ICU because I love working with my team – they are a great bunch and I am not ready to stop being an intensivist yet. I need to be vigilant for any deterioration in my sight, and may need more injections, but all in all I never would have hoped to get to this stage and be back to full time consultant work.

Having come close to losing the ability to be an intensivist has really made me grateful for the chance to keep doing the job I do.

My time off work, and my return to work, was managed brilliantly. We hope the FICM guidelines will help all departments manage their colleagues’ returns to work in a similarly structured, supported way.