University Accommodations?

[Libby]

So I'm thinking about going back to school. Medical school. Not just thinking about, I guess - I've applied and today I received an interview invite. Really exciting because now the pool of candidates that I'm competing against - at least for this school - drops from 5,000 to 600.

After the high finally wore off, I started to think a bit. I don't want to get too far ahead of myself, or jinx myself for that matter, but when I'm looking at these schools it's something I need to consider. What accommodations am I realistically going to need.

I would say my POTS is on the mild side of moderate right now. My vision goes black fairly often when I stand up, but I stay upright. If I'm standing in place for more than a few minutes, I start to get pre-syncopal, but I'm usually okay if I'm walking - as long as it's not too far and stairs aren't involved. I'm fatigued, but I can manage a full day at work - I'm sitting 90% of the time, though. Depending on the day, brain fog can be an issue. Finding words, making my point. But sometimes it's not so bad. My gastroparesis is minimal right now, but if it comes back (and it does, randomly) I'm going to be either stupid from hunger or stupid from nausea.

I made it through my masters without accommodations. I probably should have had them, based on my performance towards the end, but I was't diagnosed yet. So I'm not sure what's reasonable for my condition. I've been trying to compensate for this stupid disease for so long that I just don't know. If I can't finish a test on time, is that my fault or the POTS?

Asking for help has never been my strongest suit, and thinking other people view me as weak - or abusing the system - really, really rubs me the wrong way. But if I'm going to do this, I want to do it right, and I need to understand that just because I CAN do something now doesn't mean that I should if I'll pay for it later. Especially if I'm not going to have much free time in my budget to lie in bed. I don't want my pride to get in the way of me becoming the best doctor I can be.

The one thing that I know I would definitely need a chair for any anatomy labs or courses where I'm expected to be on my feet for long times. Gore doesn't freak me out, but me passing out because of pooling wouldn't be fun for anyone. But beyond that, I'm not sure (which is ridiculous, I realize LOL). Extra time on tests? I feel like I might not always need that - but I don't want to not have it for the times I do need it. For anyone who has had accommodations, or has any ideas on them, what else should I look into?

[Dyspatient]

Hi Libby,

I can take a swing at this. My background is 7 years as an inpatient unit clerk (surgery), 5 years working in college/university disability services, and additionally I'm someone with dysautonomia who has requested accommodations in a PhD program and at work for myself. Not always successfully I might add, but then the PhD was the worst and it was quite a while ago. Things have changed somewhat since I was in my PhD program, more students coming through post secondary ed with declared disabilities for starters (although the majority of those are learning disabilities, so that skews the experience of school staff toward that accommodation set, but the general influx still benefits all of us).

I think you're on the right track. You have to write up and request your accommodations as if for your "worst" days, not for days when you can maybe push through without accommodation. Remember that accommodation is about two factors: you and your environment. You may want to get some more information about the typical day to day for a med student at schools where you're considering going. Accommodations can be "tweaked" after the fact, added, modified once you have more info, but remember that they cannot be retroactive. If you miss a class or do poorly on an assignment because an accommodation should have been in place but wasn't, then there's no "do over".

So you have POTS and GP (me too). Anything else? Insomnia/other sleep disorder? Chronic pain? (I have Ehlers Danlos, and this combined with "brain fog" means I move badly often and hurt myself easily when I'm fatigued). I'm going to write below from what I know about POTS/syncope type stuff and GP.

• Access to any campus transportation for "handicapped" students and staff. Some campuses are tough to get around, some have vans that can be used. Have it listed, that way if there is a shuttle, you can use it. I know a lot of schools don't have this....I'm actually thinking back on my first husband (and ER doc) who destroyed a tendon in his foot while in med school and who was left to hobble his way around Boston in the Winter by public transit by the school. Yay med school. That was just after the ADA was passed into law though, and a LOT of schools were behind the times then. Transportation for temporary or permanent disability is a growing need at most universities so hopefully, wherever you end up will have this.
• Parking. On some campuses, you don't need a state permit to use the campus handicapped spots. At some point in your med school training, you will be off site though, and you may want to look into a state parking pass. I asked my doctor to avoid mentioning syncope in my request, we focused on the EDS/pain symptoms instead, I didn't want an over aggressive DMV person questioning my ability to drive.
• Priority registration. I don't know if this is even possible in med school, since so much of the curriculum is fixed and static, and it's not like classes are all over the schedule, but priority registration is something that is done for students who's health care needs (appointments, self care, medication) might necessitate avoiding certain times of day, or reducing how spread out the day is (or how congested).
• Access to a refrigerator/kitchen area. If your GP flares, you will need this. I sure do. Can't carry soup and pudding around with me all ****** day. Also, if you use cooling garments, you may need access to a freezer to store replacements ice/cold packs.
• Ability to use cooling/heating/compression garments. This may require a modification of dress code or classroom/lab policies.
• Ability to use elevator/escalators (some attendings/faculty like to do rounds via stairs. no. not on a bad day.)
• Ability to use a rolling bag and that space be made for it at med school events and classes.
• Seating/priority seating at all classes, labs, events, etc. Some talks can end up as standing room only. Not ok for you. Also not ok, clambering your way across laps to get to and from your seat if you ever end up developing some "lower end" effects of dysautonomia (e.g., I have polyuria now, and let me tell you, I sit at the END of the row every time whenever I have to sit in assembly seating).
• If things get bad in the later years when you have to do rounds, consider a "rollator" for rounding. You'd have your chair with you. I'm almost at the point where I need one, and if I had to do something like rounds, I would most certainly require one now.
• Ability to take breaks for snack, restroom during lectures, labs, practica, etc.
• Access to a break room with a couch or office with a yoga mat at least. There will be times when you need to lay down. You don't want to go through the trouble of finding a lounge where you can lay down if you need to only to get told med students aren't allowed in here or something like that. Consider it like this: nursing mothers now have to be provided with rooms to pump at work under provisions of the ACA. Shouldn't POTS-ies have access to a g. d. couch?! Heck yeah. I had one at my last job and it's a big part of why I was able to stay working full time.
• Extended time and reduced distraction environment for exams due to fatigue and cognitive issues from POTS.
• Electronic texts. Books are HEAVY.
• Use of laptop or mobile device in class, lecture, lab, practica, etc.
• Use of recording device such as a smart pen (amazing, super awesome device, especially for someone who might have trouble keeping up with notetaking and auditory processing due to cognitive burden of POTS/CFS type stuff).
• Discuss modification of attendance policies for tardiness (esp. if there is no campus/med center shuttle) and for medical care and appointments. They may reject this as "unreasonable" in med school, but it doesn't hurt to bring up with the disability office.
• Extended time on assignments.

Let's see...that's all I can think of for now. You wouldn't need to use all of these all the time, hopefully you'll have to use them only rarely during a flare. But having them there is so important.

A last note: The nature of the latter years of med school is such that someone from the school's Disability Office is going to have to coordinate with your work/clinical sites to make sure you have reasonable accommodations while you're at those places. Keep that in mind, and be as proactive as you can on it so things don't fall through the cracks. Document everything, oral discussions about your disability and accommodations are ok, but follow up with emails, e.g. "thank you for talking with me about....I just wanted to summarize our conversation on..." and save and archive those emails periodically. No one likes to sue, but sometimes you need to complain to get what you need.

Good luck!

[Libby]

Thank you so much!! That was a fantastic reply!

POTS and GP are my main issues, no EDS (you have my sympathies!) I have Hashimotos too, but that mainly contributes to fatigue.

This gave me a lot to go forward with. A few things you mentioned wouldn't have even crossed my mind - at least not until I was actually in the situation, and by then it would be too late. Rounds/clinic is something I can't believe I didn't consider - I shadowed a doctor over the summer and stood whenever I was in a patient's exam room (which was so stupid of me, but I didn't want to inconvenience the doctor). I didn't pass out, but it was a near thing a few times. And if I had been required to actually answer questions or learn in that situation, I would have failed miserably.

Thanks again! I'll keep all of this in mind while I'm looking at schools.

[Dyspatient]

You're welcome! Glad it was helpful. Don't be shy about researching schools online too, I just looked and found pages from Dartmouth and Brown's med schools specifically on med students with disabilities, there are dedicated coordinators for med students with disabilities at some schools, which is perfect because they will have thought of things I didn't. Meeting with them early on is a good idea.

Don't feel bad for not thinking of rounds/clinical rotations. Sometimes it's easier to see these things when you're an observer. I had 7 years of watching residents, interns, and med students do rounds on a surgical unit. Never saw anyone pass out, but I saw a few who looked like they were close to it .

[SarahA33]

Libby,

Don't really have any suggestions, other than to ask and accept the help as it offered to you. I think Type A should be put in the POTS symptoms list.

As for a fellow POTsie whom was only able to complete her Bachelor's and choose her Master's Program, I want to tell you that I think you are amazing. You will do great things in your life, especially with all that compassion that you seem to have that most doctors seem to lack. (see..you are already ahead of the game!)

Reach for the moon girl!

Sarah

[Libby]

Aw, thanks Sarah!