Experience of a single “epileptic” fitBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7465.s98 (Published 04 September 2004) Cite this as: BMJ 2004;329:s98
- David Parkins, consultant in emergency medicine
There seem to be no hard and fast rules about what specialties doctors with epilepsy, or those who experience a single grand mal seizure, should go in for. Although David Parkins's experience was over 20 years ago, many doctors in a similar position are still dictated to about what they can and cannot do, with little evidence base to back up these decisions
As a senior house officer in anaesthetics I was enjoying life. I'd finally secured a post in my chosen field; I'd entered medical school after qualifying as a dentist, with the express aim of becoming an anaesthetist.
While having a couple of days off with vague flu-like symptoms of headache, fever, and photophobia I became aware that I was having difficulty understanding the newsreader on the television; it was almost like he'd switched into another language. I tried to move on the sofa and found this a bit difficult. My left side was definitely weaker than it ever had been before. I tried saying my name and address and that seemed okay. I managed to get to a nearby telephone and, after several misdials, got the hospital where my wife (also a doctor) worked and eventually spoke to her. She came straight home and managed to get me into the car and took me into the accident and emergency department. By this stage my weakness was improving, but I still had a terrible headache and photophobia.
Trips to the theatre
A computed tomography scan revealed a right temporal lobe cerebral abscess, with surrounding oedema and midline shift. I have vague recollections of my wife signing a consent form and my being wheeled into theatre for a right temporal burr hole, which was done under sedation and local anaesthetic.
The next two days are a blur, but I gradually returned to “normal” apart from a brief episode of steroid induced psychosis secondary to dexamethasone. The neurosurgeons then began the hunt for the cause and eventually, with the help of an oral surgeon, tracked the primary focus down to an asymptomatic dental abscess on an upper molar that had been crowned when I was a dental student. This necessitated a second trip to theatre to remove the offending tooth.
After three weeks in hospital on intravenous antibiotics I was discharged, and two months later I returned to work. The first week was like starting all over again as I was totally supervised. This was very reassuring and safe, both for the patients and me.
The next phase
One night when covering intensive care and accident and emergency, I became dizzy and couldn't talk. I went outside for a few seconds to “clear my head” and went back into the resuscitation room. My next recollection is of waking up on a trolley with my intensive care consultant telling me that I'd had a grand mal seizure, I'd had some diazepam, and I should be admitted.
Life changing edicts
At this stage it didn't really occur to me that this might influence my future career; this was probably a combination of naiveté and a postictal state. I had a couple of days off and then went back to work, driving myself. It was only when I went to see my general practitioner three days later that I found out that I must stop driving and inform the Driver and Vehicle Licensing Agency. At that time, this meant a two year ban on driving if the cause of the fit was known. I continued to get to work by train and bus. It was only about a month later that I was summoned to see the head of the anaesthetic senior house officer rotation to be told that I could no longer be employed as an anaesthetist.⇓
He said that he'd spoken to my neurologist, who agreed with this, and that it would be better for all concerned if I resigned with immediate effect. The mind numbing effect of this edict was profound and very depressing. Occupational health services were nonexistent at the time, and, having nowhere else to turn for advice, I meekly tendered my resignation. I started on regular phenytoin, which I had started taking after my operation, but the dosage was subtherapeutic and it made me drowsy when on-call, so I only took it when I remembered.
The next problem was to find a new career. The postgraduate dean was supportive and arranged interviews with the heads of those departments that he thought would be appropriate employment for an “epileptic” doctor, namely pathology and radiology. Neither was particularly helpful: the radiologist suggested that I could never do interventional radiology, and the pathologist intimated that if I had a fit whilst doing a postmortem I might injure myself.
Back to dentistry
My last port of call was the postgraduate dean of dentistry, who informed me that there was a rotational registrar post vacant. I applied and was appointed in the child dental health department. At the time it struck me as odd that some people couldn't see me even doing a post mortem, whereas others were happy for me to be wielding an airotor doing 650 000 rotations per minute in a child's mouth.
He said that he'd spoken to my neurologist, who agreed with this, and that it would be better for all concerned if I resigned with immediate effect
After my two year driving ban I was granted a licence and returned to driving, with a 25% increase in my insurance premium. My dental career was not what I had hoped for, and I therefore returned to clinical medicine. I know that you might find this bizarre, but I actually found the nine to five, Monday to Friday, no on-call, routine of dentistry slightly humdrum; it certainly lacked the spark and immediacy of acute medicine.
All in the past
All of this is now in the past, and I'm a consultant in accident and emergency medicine. I never did have another fit, and I've been off all anticonvulsants for many years. The only legacy of my cerebral abscess is a palpable hole in my right temporal bone, and higher car insurance premiums (still, after 20 years).
Career decisions and your health: some advice
Involve a consultant in occupational health at an early stage. Don't take the word of a senior who wants a service provision, including on-call. The occupational health consultant should be able to advise you; whether you can no longer follow your chosen career pathway, and what would be an appropriate career option given your unique problem(s)
Don't take any hasty decisions; then you won't have to repent at leisure
Follow medical advice and ensure that your follow up is not an ad hoc arrangement. Insist on appropriate, formal outpatient appointments, not chats in the corridor
Take your medication as directed. If it is having side effects see your clinician
If you think the safety of or care for patients is being put at risk by your illness you must stop and withdraw from treating all patients.
Next week David tells us the next instalment of his health difficulties: adjusting to a colostomy